The 2020 election cycle is shaping up to be especially interesting in Oklahoma, and not just because it is a presidential election year.

Though it is possible a special election could be called, it is more likely one of the regularly scheduled elections in March, June, August, or November will be when Oklahomans are asked to decided whether to expand SoonerCare, the state's program for providing health care to low-income individuals. Of course, this all depends on whether enough signatures are gathered on the petitions now circulating in support of the expansion. There is a deadline of Oct. 28 to collect the approximately 178,000 signatures needed to put the issue before the voters.

Oklahoma has the second-highest rate of uninsured people in the country. When estimates from both proponents and opponents are considered, it is said the expansion could insure anywhere from 160,000 to 628,000 additional Oklahomans. No matter which number you believe most accurate - and the actual number would almost certainly lie somewhere in between, probably closer to a quarter-million people - arithmetic tells us the proportion of people who have no coverage would be reduced. Even if we quibble about the method used to create it, few people who would argue that a reduction in the number of people who don't have access to health care is a bad thing.

Appropriately, opponents have questioned the cost-effectiveness of the expansion. Fears of a rollback of the 90 percent federal reimbursement have been raised, but the examples of previous payment reductions are apple-to-oranges comparisons. Even with that fear eliminated, opponents point to a projected cost to the state of $850 million over a 10-year period. What is often left out of the discussion are the projections of the net savings to the state budget when all factors are considered. Those savings have been estimated at $464 million over that same 10-year period. To be clear, that means that there could be an overall monetary benefit to Oklahoma that approaches a half-billion dollars.

Then there are the considerations for physical access to health care for rural Oklahomans. Hospitals outside urban areas are struggling. One of the many challenges they face is the cost of providing care to the uninsured. People who work hard, but in jobs that don't provide health insurance for them or their family members, often find themselves having to seek care through the most expensive methods possible, usually emergency rooms. The inefficiencies of providing care in this manner create additional strain on hospitals that are already struggling financially.

The solution most often pursued by hospitals, whether they are struggling or not, is to pass that cost along to their insured patients, with the ultimate result being higher premiums. If even that solution fails, hospitals are forced to close. Those closures often happen in rural areas where they have a disproportionate impact, causing Oklahomans to have to travel great distances for basic medical care. The consequences of the lack of availability of emergency care in those communities are even more obvious and evident.

Though it is, admittedly, an imperfect solution, the expansion of the SoonerCare program would accomplish the goals of expanding coverage for a great many hard-working Oklahomans who are in need and help protect against increases in insurance premiums and rural hospital closures, all while providing an overall benefit to the state's budget. Since our Legislature has been so unwilling to act, sign the petition to get SQ 802 on a ballot in 2020 and let voters decide for themselves if those benefits outweigh any perceived consequences.

Jason Nichols is District 2 Democratic Party chair, a political science instructor at NSU, and a former city mayor and city councilor.

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