The estimated cost of a Medicaid-expansion proposal narrowly approved by Oklahoma voters in June is soaring and threatens to force cuts to other parts of government, according to the state Senate’s chief budget writer.

“In the best-case scenario with Medicaid expansion we’re looking at a $164 million expenditure,” said Senate Appropriations Committee Chairman Roger Thompson, R-Okemah. “I’ve been in contact, even this morning, with the Health Care Authority. Our numbers keep going up, and so we could be looking at $246 million as the top number—and that’s just, again, an educated guess at this particular point. That being the case, we’re going to have to be able to come up with enough funds to be able to fund that this next year in the budget without cutting other services.”

The expansion of Medicaid, which will take effect in July 2021, adds hundreds of thousands of able-bodied adults to the medical welfare program.

A previous study commissioned by the Oklahoma Health Care Authority, which administers Medicaid, predicted up to 628,000 Oklahomans would become Medicaid-eligible under expansion. Based on current Medicaid expenses, that translates into a state cost of up to $374 million annually.

Supporters of expansion have argued associated costs will be much less, saying the overwhelming majority of Oklahomans eligible for “free” government health care under Medicaid expansion will choose to forgo it.

However, the experience of other states suggests low-ball cost estimates should not be trusted. In 2018, the Foundation for Government Accountability found states that expanded Medicaid signed up more than twice as many able-bodied adults as predicted and experienced cost overruns of 157 percent.

Paying for Medicaid expansion will occur in the 2021 legislative session even as lawmakers are also expected to face a shortfall of as much as $1 billion due to the COVID-19 recession and continuing low oil prices.

Thompson discussed the growing cost of Oklahoma’s Medicaid expansion during a Thursday meeting of the Oversight Committee for the Legislative Office of Fiscal Transparency (LOFT). LOFT was created in the 2019 session, and its mission is to audit state agency budgets and evaluate the effectiveness of state programs and services. The agency will issue reports of resulting conclusions, which will be made public.

The oversight committee approved a work plan for LOFT that outlines what agencies and boards will be among the first reviewed, and amended the plan to include a review that could include potential absentee voting irregularities in the June 30 vote that approved State Question 802, the Medicaid-expansion initiative.

SQ 802 was rejected in 70 of Oklahoma 77 counties. Nearly 55 percent of the 545,473 Oklahomans who voted in person on election day opposed SQ 802. However, 80 percent of absentee/mail-in ballots in the election were cast in favor of SQ 802.

Those absentee ballots offset the in-person voting enough that SQ 802 passed with 50.49 percent of the total vote, a margin of only 6,553 votes out of 674,591 total.

Rep. Meloyde Blancett, D-Tulsa, made the motion to add review of absentee voting to LOFT’s workload. Democrats have generally supported efforts to expand mail-in voting this year.

“Is there actually a problem with absentee voting and the legitimacy of absentee voting?” Blancett said. “It’s been suggested that absentee voting is fraught with fraud and there’s a lot of speculation around the efficacy of mail-in voting, and so I think that the scope of the project would be to determine the actual level of fraud in absentee voting, and is there a problem?”

The oversight committee voted 11-3 to add a review of absentee voting to LOFT’s portfolio. The opponents were Rep. Kyle Hilbert, R-Bristow; Rep. Jeff Boatman, R-Tulsa; and Sen. Frank Simpson, R-Ardmore.