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Voters in four of the state’s most populous counties plus three others carried State Question 802 to a narrow victory, according to unofficial voting.

Subject to the official vote certification on Friday, Oklahoma will become the 37th state to pass Medicaid expansion, by a narrow 50.5% majority of votes cast.

The question was carried overwhelmingly by voters who submitted absentee ballots by mail, as well as those who voted early at county election boards, according to unofficial results posted on the state election board website.

Voters in 70 of the state’s 77 counties voted against the state question, which will enshrine the state’s expansion program in an amendment to the state’s constitution, which can’t be reversed or altered without another vote of the people.

However, the counties where voters approved the measure included four of the five most populous – Oklahoma, Tulsa, Cleveland and Comanche – garnering enough votes to pass the measure 339,799 to 333,111.

Pontotoc, Cherokee and Payne county voters also approved the measure, while the majority of voters in the remainder of the counties voted no.

In the case of Kingfisher County, the “no” was resounding – 76 percent of the voters cast ballots against the measure – one of the highest margins of any county in the state.

Statewide results show that mail-in absentee ballots and early voting also contributed to the state question’s passage.

Absentee voters approved the state question by a margin greater than 3-to-1, with 76,093 voting yes to 18,251 no votes.

Early voters approved the measure by a somewhat smaller margin (18,959 to 15,528), while Election Day in-person voters actually voted it down, 299,712 no to 245,227 yes votes.

Kingfisher Cou nty Results

Voters by mail in Kingfisher County also approved the measure, with 86 yes votes to 60 no votes, but early voters gave it a more than 2-to-1 thumbs down and Tuesday’s in-person voters voted it down nearly 3-to1.

In the final tally, no county precinct voted to approve the measure.

VOTING BY PRECINCT

101 – 147 yes; 454 no.

102 – 28 yes; 112 no.

103 – 37 yes; 158 no.

105 – 79 yes; 194 no.

106 – 9 yes; 42 no.

201 – 112 yes; 373 no.

203 – 19 yes; 47 no.

204 – 29 yes; 119 no.

301 – 169 yes; 439 no.

302 - 79 yes; 207 no.

303 – 10 yes; 58 no.

304 – 15 yes; 80 no.

305 – 14 yes; 97 no.

Details of the Expansion

The effect of State Question 802 is to amend the state constitution to expand federal health insurance coverage (Medicaid) by July 2021 to about 200,000 more qualifying Oklahoma adults whose income is at or below 133% of the federal poverty line.

Under the amendment, the state is prohibited from creating additional requirements for coverage, such as working, attending school or completing community service.

The amendment also requires the state to fund whatever portion of the program is not funded by the federal government, but does not include a revenue mechanism to provide that funding.

Currently, the federal government is picking up 90% of the cost, but even the 10% burden will be a challenge for Oklahoma lawmakers already dealing with a growing financial crisis in the wake of the pandemic and steep oil revenue declines.

The situation is compounded by the real possibility that the federal government will decrease its funding share as it battles its own coronavirus-induced fiscal woes.

Gov. Kevin Stitt and the State Legislature sought to forestall adoption of S.Q. 802 by adopting a more fiscally palatable version of Medicaid expansion which Stitt dubbed “SoonerCare 2.0.”

However, disagreements about the details of that alternative plan led to a veto by Stitt, which ended that option.

Some Local Thoughts

Three local lawmakers – one future, one current and one soon-to-be-former – offered their thoughts on the question’s passage.

“I wish something had been done prior (to the state question vote) and the Governor’s veto of SoonerCare 2.0 is a little perplexing to me,” House District 59 Representative-Elect Mike Dobrinski (R-Okeene) said. “But now that the people have spoken and it’s passed, it will be up to the Legislature, including myself, to figure out how to manage that.

“It certainly appears to be a challenge with the budget shortfalls that are expected, but hopefully the virus can be managed and we can continue getting people back to work as soon as possible to get them productive again and stop the bleeding.”

Current House Majority Leader Mike Sanders, the man whose shoes Dobrinski was elected to fill, said he finds passage of the constitutional amendment “troubling and alarming.”

“The TV ads were full of half-truths and were misleading,” he said. “The facts are that 12 states that have passed this plan have had to raise taxes or fees.

“This will cost the state over $300 million every year and that’s only if the federal government delivers on the $1 billion (the current federal share of the cost).

“Trust me, that’s not sustainable and the feds will pull back, leaving Oklahoma taxpayers on the hook to pay for this.”

Sanders said although he will no longer be a part of the Legislature that has to figure out how to finance the expansion, he believes cuts to core services like “education, public safety, transportation and county government” could be inevitable.

He added that the fact that only seven of the state’s 77 counties were able to pass the measure was further evidence of the growing urban-rural divide.

“The Tulsa, Oklahoma City, Lawton and Norman areas passed this against the wishes of the rest of the state’s voters,” he said. “When a few get to decide for the many, that’s problematic in so many ways.”

State Sen. Darcy Jech pointed out that the COVID-19 crisis has compounded the economic impact of Medicaid expansion in two significant ways.

“Not only are state revenues – potential funding sources – significantly down, but with higher unemployment, more individuals will qualify under this expanded Medicaid program,” he said.

“My main concern now that it’s passed is where will the funding come from to pay the state’s share.”

Jech said the task of answering that question will be up to the Legislature.

“This Medicaid expansion will allow for a certain population to have health insurance, but nowhere in the ballot initiative is a funding source identified,” he said.

“If, as the advocates claim, this new law actually does improve health outcomes, is somewhat self-supportive and helps to keep rural hospitals open, then it will have been a good thing.

“Only time will tell.”