Medical emergency

Fighting for health justice in Oklahoma

Kelly Smalley had her first grand mal seizure in 2008. It’s what you think of when you think of the word seizure: unconsciousness, muscle contractions, foaming at the mouth. She was a single mom caring for her disabled, nine-year-old son. Then she developed epilepsy. Last year, she was diagnosed with multiple sclerosis—right around the time her son turned 19, aging out of the Medicaid (SoonerCare) benefits they both desperately needed.

Smalley is now one of more than 600,000 Oklahomans without health insurance, caught on the wrong side of the razor’s edge between poverty and a bad diagnosis. In a state with one of the highest uninsured rates in the country, her story is tragic but familiar, drawn into dire relief by images of shuttered rural hospitals and crowdsourced social media fundraisers for life-saving medical treatments.

A deep and diverse coalition is looking to change this bleak reality. The Coalition to Expand Coverage is made up of a broad network of organizations from the Oklahoma Policy Institute, Together Oklahoma, and the ACLU Oklahoma, to groups like the Oklahoma State Medical Association, Fellowship Congregational Church (United Church of Christ), Mental Health Association Oklahoma, and dozens more.

“We gathered different groups from all over the state—healthcare, child advocacy, civic organizations, and religious organizations—just anybody who wants to come on board behind this campaign to bring federal tax dollars back to Oklahoma to cover more than 100,000 uninsured Oklahomans,” said Gene Perry of the Oklahoma Policy Institute.

“It’s a great deal for the state,” he added. “It would help our economy and our health.”

Legal challenges to the Affordable Care Act gave states the ability to reject federal money that would fund the expansion of state Medicaid programs like SoonerCare. Oklahoma did just that under the governorship of Mary Fallin, turning down an estimated $3.6 billion in federal funding across a seven-year period, according to The Oklahoman. As a result, Oklahoma’s uninsured rate has fallen far less than the national average since 2010.

For the crowd gathered at the Oklahoma State Capitol during the Rally to Expand Coverage on the morning of April 24, these numbers are a matter of life and death. “People’s lives are in jeopardy,” said former state Sen. Angela Monson. “We cannot wait for this change to happen. We need it now.”

Many rally speakers touted the economic advantages of healthcare expansion, but the morality of the issue was a common throughline. “We have laid before us the unprecedented opportunity to make a difference in the lives of hundreds of thousands of Oklahomans,” Rev. Joe Alsay told the crowd. “And indeed we have the moral obligation to stand up and to speak out in solidarity with those in our community whose voices have not been heard—or have been squashed.”

Inside the Capitol, rally-goers met with representatives to make their case. A line of advocates snaked around the end table in a hallway waiting area, where that morning’s issue of The Oklahoman announced: Stitt would fight Medicaid expansion. The governor had just gone on record, saying he would “absolutely” oppose the state ballot initiative filed on April 19 by representatives of Kelly Smalley and fellow advocate Erin Taylor, designed to close Oklahoma’s coverage gap by accepting federal money to bring more people into the federal-state health insurance program.

Similar questions have recently been put before voters in reliably conservative states like Nebraska, Utah and Idaho. All three Medicaid expansion ballot measures passed with a sizeable majority, but the states’ Republican-controlled legislatures have undercut those initiatives by capping enrollment, delaying implementation, and adding burdensome work requirements not included in the original ballot language.

Gov. Stitt said his administration would offer voters a “Plan B” to traditional Medicaid expansion, but provided no details about what that alternative would look like.

Gene Perry disagrees with the governor’s decision, but hopes his administration will support legislation that offers real relief to the state’s most vulnerable residents. “We would be concerned if whatever came through the legislature included all sorts of red tape and restrictions and expenses for patients,” he said. “There are ways you could do it that we’d be concerned about, but you can come up with an Oklahoma plan in lots of ways …  that would still bring affordable coverage to Oklahomans in a way that works.”

There is currently a $9-to-$1 match on traditional Medicaid expansion, meaning the federal government would pay the lion’s share of funding on every dollar spent to provide essential care to people like Michele Eccleson, a cancer survivor who suffers from scoliosis and a heart condition. This is what advocates mean when they talk about “bringing money home” on a federal pay-in, but Michele’s story also reveals the human shade of the crisis.

 “I know what it’s like because I did go without insurance, and my family lost everything because of it,” Michele said. She and her husband, a war veteran, were forced to move across the country to live with his parents in New York. Michele is worried about those who don’t have the same option.

“I’m lucky enough to have [coverage] now,” she said. “But I don’t want to see any other family go through what mine went through.”

For more information on the Campaign to Expand Coverage, visit coverok.org.