With the costs of Medicaid expansion exploding, and even greater increases potentially looming in the future, members of an Oklahoma Senate committee have voted overwhelmingly to place reform proposals before voters.

“Oklahomans have a kind heart as a whole, and we want to make sure we can take care of those people who have a difficult time taking care of themselves,” said Senate President Pro Tempore Lonnie Paxton, R-Tuttle. “There’s been quite a bit of pushback on just those who refuse to take care of themselves.”

In 2020, voters approved a ballot measure that added hundreds of thousands of able-bodied, working-age adults to the state’s Medicaid program. That measure passed by an extremely narrow margin, generated entirely by absentee votes.

The costs of that expansion have since exploded.

This year, the Oklahoma Health Care Authority, which administers Medicaid, requested nearly half a billion dollars in increased funding to cover Medicaid expansion’s runaway costs. This year’s budget agreement provides $250 million in additional Medicaid funding to cover part of that cost, and lawmakers had to draw down state savings to make that happen. Otherwise, the costs of Medicaid expansion would have prevented a teacher pay raise and funding for reading initiatives.

And the costs of Medicaid expansion could increase by an even greater amount in the near future.

Currently, the federal government pays 90 percent of the cost for expansion enrollees, and the state must cover 10 percent. But if the federal Medicaid match is changed to a 60-40 ratio, similar to what is provided for those in the traditional Medicaid population, lawmakers noted it would increase state government expenses by $1 billion annually. That would require either massive tax increases or massive cuts in medical provider payments.

Lawmakers are now poised to give voters the chance to reassess Medicaid expansion and provide policymakers with more financial flexibility.

House Bill 4440, by House Speaker Kyle Hilbert and Paxton, would allow Oklahoma voters to remove Medicaid expansion from the state constitution and instead place expansion in state law, allowing lawmakers to amend the law as financial conditions require in future years.

House Joint Resolution 1067, by state Rep. Ryan Eaves and state Sen. Julie Daniels, would allow Oklahoma voters to amend the state constitution to repeal Medicaid expansion if the federal match is cut below the current 90-10 federal-state split. Ten other states have similar trigger provisions in place.

HJR 1067 would not take effect or go before voters if HB 4440 is approved.

One Democratic lawmaker suggested lawmakers should address Medicaid’s cost overruns by draining state savings at a rapid clip. State Sen. Mary Boren, D-Norman, declared that the $1 billion increased cost of Medicaid expansion is “less than $4 billion,” a reference to the total amount of state savings now in reserve.

Boren also suggested lawmakers should increase taxes by eliminating various tax breaks.

Another Democrat objected to the idea that lawmakers might cut any able-bodied adults off Medicaid in the future, even if that prevented provider cuts that would harm health-care access for disabled individuals on Medicaid.

“The Legislature, in future years, in order to manage what could be a $1 billion increase on state dollars, plans to reduce either covered individuals or services provided,” said state Sen. Carri Hicks, D-Oklahoma City.

Hicks and Boren later issued a press release attacking both bills. Hicks declared the reforms “a quick-action power grab by the supermajority,” while Boren said the two pieces of legislation were “about seizing constitutional control from voters,” even though both bills require voter approval.

Supporters countered that state savings would be quickly wiped out if used to prop up Medicaid expansion.

“We have to operate on a balanced budget,” said state Sen. Casey Murdock, R-Felt. “And this billion dollars isn’t just one time. This is going to be year after year after year, if not growing.”

“When I came into this building, there was a budget shortfall. And as I recall, we had to cut or try to save ourselves from cutting a billion dollars from the recurring budget of the State of Oklahoma,” said state Sen. Julie Daniels, R-Bartlesville. “This is the same situation we will face if the federal government goes to a 60-40 match. And that would mean every year we would be looking for a billion dollars, and it won’t take even one year for that to start affecting all the other critical services that we provide to the people.”

“Under the current program, the 90-year-old who is blind and in a wheelchair receives the same benefits as the 25-year-old who just finds reasons not to go work and would rather go play video games in his grandma’s basement,” Paxton said. “This right here allows us to go in there and work on the eligibility a little bit.”

Without removing Medicaid expansion from the Oklahoma Constitution, he noted that lawmakers will be forced to cut provider rates, meaning that access to health-care treatment will be reduced for the man in the wheelchair as much as it is for the 25-year-old deadbeat.

“That is not right,” Paxton said.

HB 4400 passed the Senate Rules Committee on a 14-2 vote that broke along party lines, with Republicans in support and Democrats opposed.

HJR 1067 passed by an identical 14-2 vote.

Both bills now proceed to the floor of the Oklahoma Senate.