Analysis Politics

Health-Care Access, Medicaid Expansion Among Key Issues in Oklahoma Gubernatorial Race

Teddy Wilson

On issues of reproductive rights, the candidates do not differ substantively; both incumbent Republican Gov. Mary Fallin and Democratic nominee Rep. Joe Dorman have staunchly anti-choice voting records.

On November 4, Oklahoma residents will make a choice for governor between incumbent Republican Gov. Mary Fallin and Democratic nominee Rep. Joe Dorman (Rush Springs).

Fallin has focused her campaign on her record as governor, including her legislative achievements and economic improvements in the state. (Since she took office, the unemployment rate in the state has fallen from 6.6 percent to 4.6 percent.)

Dorman’s campaign messaging has also centered on economic issues—in his case, issues such as rising income inequality in the state. According to a study by the Economic Policy Institute, from 2009 to 2011 the income of the top 1 percent of earners in the state grew by 13.8 percent, compared to 6.5 percent for the bottom 99 percent of earners. Dorman has also focused on state issues such as the lack of storm shelters at public schools. Gov. Fallin has opposed Dorman’s proposal to finance the construction of new storm shelters.

Dorman has framed his opponent as someone who after serving two terms in Congress brought Washington, D.C.’s partisan politics back to Oklahoma City.

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Dorman told Rewire that Fallin’s administration has placed more emphasis on the needs of corporations than on the needs of citizens in the state. Fallin’s record as governor includes signing a bill banning cities in the state from raising the minimum wage, implementing a “sun tax” on alternative energy, and a proposal to eliminate hundreds of millions of dollars in tax deductions. This year Fallin proposed cutting the state’s highest income tax rate by 0.25 percent and reducing state agencies’ budgets by 5 percent to pay for that tax cut.

“We see many Oklahomans struggling to make ends meet,” he said. “We need a governor that won’t forget people all across the state, and not just focus on those people who are writing the larger campaign donations.”

(Fallin did not respond to two interview requests from Rewire.)

The Affordable Care Act and Medicaid Expansion

Both candidates originally opposed the Affordable Care Act (ACA).

While representing Oklahoma in the U.S. House, Fallin voted against the health-care legislation. In 2011, after being elected Oklahoma’s governor, she released a statement on the ACA’s one-year anniversary saying that she supported efforts to “repeal and replace” the law.

Dorman has characterized the ACA as “a mess.” In 2010, he voted in favor of placing a state constitutional amendment on the ballot banning the implementation of the individual mandate provision of the ACA in Oklahoma. However, Dorman says that since the Supreme Court has ruled that the ACA is constitutional, lawmakers must work to implement the law. “We have to find a way to make sure that the law fits the needs of Oklahomans,” said Dorman.

Fallin was one of several Republican governors who’s refused federal funds to expand Medicaid as part of the ACA. According to a 2012 Oklahoma Health Care Authority report, the state could save $48 million a year by expanding Medicaid.

The state does have a system in place to provide health-care access to low-income residents. Implemented in 2005, Insure Oklahoma uses state and matching federal funds to provide employer-sponsored insurance to low-income residents who are employed. The number of low-income residents the program covers has decreased, from 30,033 in May 2013 to 18,776 in May 2014, largely due to the fact that residents making between 100 and 200 percent of the federal poverty level now qualify for subsidized insurance on the Affordable Care Act marketplace.

Insure Oklahoma was scheduled to expire at the end of this year but was recently extended through the end of 2015. The federal Centers for Medicare and Medicaid Services allowed the extension to negotiate a path to expand Medicaid that would include incorporating Insure Oklahoma into the expansion. According to the agency, there is no deadline for when a state must decide whether to expand Medicaid, and a number of states are continuing to consider their options.

In a press release following the announcement, Dorman said that the extension is a “Band-Aid” compared to expanding Medicaid in the state. “If we accepted Medicaid expansion, it would cover nearly eight times as many Oklahomans. It is ridiculous for Fallin to reject such a valuable program that would do everything Insure Oklahoma does and more.”

Dorman says that as governor he would keep the Insure Oklahoma program, and work to expand Medicaid benefits.

“We have so many working poor that are [in the coverage gap], that simply cannot afford insurance,” said Dorman. Last year 6,900 low-income residents who became ineligible for Insure Oklahoma were also unable to qualify for subsidized health insurance under the ACA. According to the Kaiser Family Foundation, there are a total of 144,480 low-income uninsured and non-elderly Oklahomans in the coverage gap.

We have to do what we can to provide insurance for them,” said Dorman.

Hospitals in Oklahoma have already been faced with a difficult financial situation; operators of the Mercy health system blame the lack of Medicaid expansion for having to lay off 300 workers.

Last week a White House report found that the failure of 24 states to expand Medicaid has had serious consequences for uninsured residents in those states. The report found that if Medicaid expansion was enacted in Oklahoma, an additional 123,000 low-income residents would receive health-care coverage.

Reproductive Rights

On issues of reproductive rights, the candidates do not differ substantively; both Fallin and Dorman have staunchly anti-choice voting records.

Similar to many states in the region with Republican-controlled state legislatures, during the 2013-14 Oklahoma legislative session several bills were introduced to restrict reproductive rights, and six eventually became law. As a result of this legislation, two of the state’s three abortion clinics will likely be forced to close. The staff of what will likely be the state’s lone abortion clinic worries it will be the target of even more anti-choice legislation, and reproductive rights advocates fear that this lack of access to safe, legal abortion care will lead to women seeking out illegal and possibly unsafe abortions or attempting to self-induce abortion.

Fallin’s campaign website promotes her record of signing anti-abortion legislation in the state, including legislation that banned abortion after 20 weeks’ gestation, banned private insurance coverage of abortion, and restricted the use of medication abortion.

Fallin also had a consistently anti-choice voting record while in Congress.

Dorman does not mention his position on reproductive rights anywhere on his campaign website, but in more than a decade in the state house, Dorman has consistently voted for anti-choice legislation. In an interview with the Spanish language newspaper La Semana, he said that his views on anti-abortion restrictions are in line with the values of his constituents.

Dorman told Rewire that he identifies as “pro-life” and is opposed to abortion. “But I do feel that we need to create better programs for Oklahomans that would allow for more adoptions, provide better prenatal care, and provide for more opportunities for the women to carry the child to birth,” he said.

“I think that the government of Oklahoma, and across the United States, has not done enough to take care of women’s health and provide opportunities to allow women to have the chance to carry their child. Many feel that they have no opportunities, no hope,” he said.

Dorman added that he does not think it is realistic to eliminate abortion. “Going back to the laws that we had pre-Roe v. Wade, it creates an unsafe condition for women,” he said. “We have to do better. We have to come up with policies that still allow women to have choices when it comes to health care.”

Dorman told Rewire that he does not see any inconsistency in supporting access to health care for low-income Oklahomans while at the same time supporting restricting access to reproductive health care. “Not at all,” he said.

Since Fallin was elected governor in 2010, Dorman has largely supported the anti-abortion bills she has signed into law. During that last legislative session alone, Fallin signed laws requiring abortion providers to obtain admitting privileges at a local hospital, restricting the use of medication abortion, and amending the state’s informed consent law to creating additional reporting requirements for providers.

News Abortion

Study: United States a ‘Stark Outlier’ in Countries With Legal Abortion, Thanks to Hyde Amendment

Nicole Knight Shine

The study's lead author said the United States' public-funding restriction makes it a "stark outlier among countries where abortion is legal—especially among high-income nations."

The vast majority of countries pay for abortion care, making the United States a global outlier and putting it on par with the former Soviet republic of Kyrgyzstan and a handful of Balkan States, a new study in the journal Contraception finds.

A team of researchers conducted two rounds of surveys between 2011 and 2014 in 80 countries where abortion care is legal. They found that 59 countries, or 74 percent of those surveyed, either fully or partially cover terminations using public funding. The United States was one of only ten countries that limits federal funding for abortion care to exceptional cases, such as rape, incest, or life endangerment.

Among the 40 “high-income” countries included in the survey, 31 provided full or partial funding for abortion care—something the United States does not do.

Dr. Daniel Grossman, lead author and director of Advancing New Standards in Reproductive Health (ANSIRH) at the University of California (UC) San Francisco, said in a statement announcing the findings that this country’s public-funding restriction makes it a “stark outlier among countries where abortion is legal—especially among high-income nations.”

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The researchers call on policymakers to make affordable health care a priority.

The federal Hyde Amendment (first passed in 1976 and reauthorized every year thereafter) bans the use of federal dollars for abortion care, except for cases of rape, incest, or life endangerment. Seventeen states, as the researchers note, bridge this gap by spending state money on terminations for low-income residents. Of the 14.1 million women enrolled in Medicaid, fewer than half, or 6.7 million, live in states that cover abortion services with state funds.

This funding gap delays abortion care for some people with limited means, who need time to raise money for the procedure, researchers note.

As Jamila Taylor and Yamani Hernandez wrote last year for Rewire, “We have heard first-person accounts of low-income women selling their belongings, going hungry for weeks as they save up their grocery money, or risking eviction by using their rent money to pay for an abortion, because of the Hyde Amendment.”

Public insurance coverage of abortion remains controversial in the United States despite “evidence that cost may create a barrier to access,” the authors observe.

“Women in the US, including those with low incomes, should have access to the highest quality of care, including the full range of reproductive health services,” Grossman said in the statement. “This research indicates there is a global consensus that abortion care should be covered like other health care.”

Earlier research indicated that U.S. women attempting to self-induce abortion cited high cost as a reason.

The team of ANSIRH researchers and Ibis Reproductive Health uncovered a bit of good news, finding that some countries are loosening abortion laws and paying for the procedures.

“Uruguay, as well as Mexico City,” as co-author Kate Grindlay from Ibis Reproductive Health noted in a press release, “legalized abortion in the first trimester in the past decade, and in both cases the service is available free of charge in public hospitals or covered by national insurance.”

Analysis Abortion

Legislators Have Introduced 445 Provisions to Restrict Abortion So Far This Year

Elizabeth Nash & Rachel Benson Gold

So far this year, legislators have introduced 1,256 provisions relating to sexual and reproductive health and rights. However, states have also enacted 22 measures this year designed to expand access to reproductive health services or protect reproductive rights.

So far this year, legislators have introduced 1,256 provisions relating to sexual and reproductive health and rights. Of these, 35 percent (445 provisions) sought to restrict access to abortion services. By midyear, 17 states had passed 46 new abortion restrictions.

Including these new restrictions, states have adopted 334 abortion restrictions since 2010, constituting 30 percent of all abortion restrictions enacted by states since the U.S. Supreme Court decision in Roe v. Wade in 1973. However, states have also enacted 22 measures this year designed to expand access to reproductive health services or protect reproductive rights.

Mid year state restrictions

 

Signs of Progress

The first half of the year ended on a high note, with the U.S. Supreme Court handing down the most significant abortion decision in a generation. The Court’s ruling in Whole Woman’s Health v. Hellerstedt struck down abortion restrictions in Texas requiring abortion facilities in the state to convert to the equivalent of ambulatory surgical centers and mandating that abortion providers have admitting privileges at a local hospital; these two restrictions had greatly diminished access to services throughout the state (see Lessons from Texas: Widespread Consequences of Assaults on Abortion Access). Five other states (Michigan, Missouri, Pennsylvania, Tennessee, and Virginia) have similar facility requirements, and the Texas decision makes it less likely that these laws would be able to withstand judicial scrutiny (see Targeted Regulation of Abortion Providers). Nineteen other states have abortion facility requirements that are less onerous than the ones in Texas; the fate of these laws in the wake of the Court’s decision remains unclear. 

Ten states in addition to Texas had adopted hospital admitting privileges requirements. The day after handing down the Texas decision, the Court declined to review lower court decisions that have kept such requirements in Mississippi and Wisconsin from going into effect, and Alabama Gov. Robert Bentley (R) announced that he would not enforce the state’s law. As a result of separate litigation, enforcement of admitting privileges requirements in Kansas, Louisiana, and Oklahoma is currently blocked. That leaves admitting privileges in effect in Missouri, North Dakota, Tennessee and Utah; as with facility requirements, the Texas decision will clearly make it harder for these laws to survive if challenged.

More broadly, the Court’s decision clarified the legal standard for evaluating abortion restrictions. In its 1992 decision in Planned Parenthood of Southeastern Pennsylvania v. Casey, the Court had said that abortion restrictions could not impose an undue burden on a woman seeking to terminate her pregnancy. In Whole Woman’s Health, the Court stressed the importance of using evidence to evaluate the extent to which an abortion restriction imposes a burden on women, and made clear that a restriction’s burdens cannot outweigh its benefits, an analysis that will give the Texas decision a reach well beyond the specific restrictions at issue in the case.

As important as the Whole Woman’s Health decision is and will be going forward, it is far from the only good news so far this year. Legislators in 19 states introduced a bevy of measures aimed at expanding insurance coverage for contraceptive services. In 13 of these states, the proposed measures seek to bolster the existing federal contraceptive coverage requirement by, for example, requiring coverage of all U.S. Food and Drug Administration approved methods and banning the use of techniques such as medical management and prior authorization, through which insurers may limit coverage. But some proposals go further and plow new ground by mandating coverage of sterilization (generally for both men and women), allowing a woman to obtain an extended supply of her contraceptive method (generally up to 12 months), and/or requiring that insurance cover over-the-counter contraceptive methods. By July 1, both Maryland and Vermont had enacted comprehensive measures, and similar legislation was pending before Illinois Gov. Bruce Rauner (R). And, in early July, Hawaii Gov. David Ige (D) signed a measure into law allowing women to obtain a year’s supply of their contraceptive method.

071midyearstatecoveragetable

But the Assault Continues

Even as these positive developments unfolded, the long-standing assault on sexual and reproductive health and rights continued apace. Much of this attention focused on the release a year ago of a string of deceptively edited videos designed to discredit Planned Parenthood. The campaign these videos spawned initially focused on defunding Planned Parenthood and has grown into an effort to defund family planning providers more broadly, especially those who have any connection to abortion services. Since last July, 24 states have moved to restrict eligibility for funding in several ways:

  • Seventeen states have moved to limit family planning providers’ eligibility for reimbursement under Medicaid, the program that accounts for about three-fourths of all public dollars spent on family planning. In some cases, states have tried to exclude Planned Parenthood entirely from such funding. These attacks have come via both administrative and legislative means. For instance, the Florida legislature included a defunding provision in an omnibus abortion bill passed in March. As the controversy grew, the Centers for Medicare and Medicaid Services, the federal agency that administers Medicaid, sent a letter to state officials reiterating that federal law prohibits them from discriminating against family planning providers because they either offer abortion services or are affiliated with an abortion provider (see CMS Provides New Clarity For Family Planning Under Medicaid). Most of these state attempts have been blocked through legal challenges. However, a funding ban went into effect in Mississippi on July 1, and similar measures are awaiting implementation in three other states.
  • Fourteen states have moved to restrict family planning funds controlled by the state, with laws enacted in four states. The law in Kansas limits funding to publicly run programs, while the law in Louisiana bars funding to providers who are associated with abortion services. A law enacted in Wisconsin directs the state to apply for federal Title X funding and specifies that if this funding is obtained, it may not be distributed to family planning providers affiliated with abortion services. (In 2015, New Hampshire moved to deny Title X funds to Planned Parenthood affiliates; the state reversed the decision in 2016.) Finally, the budget adopted in Michigan reenacts a provision that bars the allocation of family planning funds to organizations associated with abortion. Notably, however, Virginia Gov. Terry McAuliffe (D) vetoed a similar measure.
  • Ten states have attempted to bar family planning providers’ eligibility for related funding, including monies for sexually transmitted infection testing and treatment, prevention of interpersonal violence, and prevention of breast and cervical cancer. In three of these states, the bans are the result of legislative action; in Utah, the ban resulted from action by the governor. Such a ban is in effect in North Carolina; the Louisiana measure is set to go into effect in August. Implementation of bans in Ohio and Utah has been blocked as a result of legal action.

071midyearstateeligibilitytable

The first half of 2016 was also noteworthy for a raft of attempts to ban some or all abortions. These measures fell into four distinct categories:

  • By the end of June, four states enacted legislation to ban the most common method used to perform abortions during the second trimester. The Mississippi and West Virginia laws are in effect; the other two have been challenged in court. (Similar provisions enacted last year in Kansas and Oklahoma are also blocked pending legal action.)
  • South Carolina and North Dakota both enacted measures banning abortion at or beyond 20 weeks post-fertilization, which is equivalent to 22 weeks after the woman’s last menstrual period. This brings to 16 the number of states with these laws in effect (see State Policies on Later Abortions).
  • Indiana and Louisiana adopted provisions banning abortions under specific circumstances. The Louisiana law banned abortions at or after 20 weeks post-fertilization in cases of diagnosed genetic anomaly; the law is slated to go into effect on August 1. Indiana adopted a groundbreaking measure to ban abortion for purposes of race or sex selection, in cases of a genetic anomaly, or because of the fetus’ “color, national origin, or ancestry”; enforcement of the measure is blocked pending the outcome of a legal challenge.
  • Oklahoma Gov. Mary Fallin (R) vetoed a sweeping measure that would have banned all abortions except those necessary to protect the woman’s life.

071midyearstateabortionstable

In addition, 14 states (Alaska, Arizona, Florida, Georgia, Idaho, Indiana, Iowa, Kentucky, Louisiana, Maryland, South Carolina, South Dakota, Tennessee and Utah) enacted other types of abortion restrictions during the first half of the year, including measures to impose or extend waiting periods, restrict access to medication abortion, and establish regulations on abortion clinics.

Zohra Ansari-Thomas, Olivia Cappello, and Lizamarie Mohammed all contributed to this analysis.