An ongoing series on efforts in Oklahoma to extend health coverage to thousands of uninsured people through Medicaid expansion or other approaches. The coverage is enabled by a grant from The Anne & Henry Zarrow Foundation.

For just the third time this decade, more Oklahomans went without health coverage in the most recent year compared with the year before.

New numbers released Tuesday by the U.S. Census Bureau show that 548,000 Oklahoma residents lacked insurance in 2018 – an increase of 3,000 since 2017.

The amount was not enough to increase Oklahoma’s uninsured rate from last year’s 14.2% or change the state’s ranking as second highest in uninsured rates – next only to Texas, which posted a 17.7% uninsured rate in 2018.

But it marks the second straight year that Oklahoma’s uninsured population increased. This comes after the state saw increases each year between 2010 and 2016 in getting residents signed up for coverage.

Oklahoma wasn’t alone in seeing the percentage stall or go backward.

The national uninsured rate also ticked up in 2018 for the first time since 2009 and since the Affordable Care Act was passed into law.

According to the Census Bureau, the number of Americans without health coverage increased by about 2 million in 2018, as the national uninsured rate climbed from 7.9% to 8.5%.

The bureau’s report showed that private health insurance continues to be the most popular form of coverage, covering slightly more than two-thirds of the nation, while public coverage, including Medicaid and Medicare, makes up the remaining third.

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But the report notes that a decrease in public insurance, specifically Medicaid, was one of the drivers in the increased uninsured population nationwide.

It also revealed a wide discrepancy in uninsured rates between the 36 states that have expanded their Medicaid programs and the remaining states, including Oklahoma, that have not. Expansion provides coverage for more low-income adults.

In 2018, the uninsured rate for states that accepted the expansion was 6.6%, while the rate for non-expansion states was 12.4%.

Discussions of whether Oklahoma should join the expansion states figures to be one of the state’s major political issues in the coming months.

A bipartisan legislative committee ,charged with deciding whether to endorse Medicaid expansion or other policy moves, kicked off its work last month and is expected to unveil recommendations before next year’s session.

Meanwhile, a signature-collecting drive is underway to put a state question on a 2020 ballot to accept expansion.

A 2016 analysis from the Oklahoma Hospital Association projected that with expansion, 550,000 Oklahomans would be newly eligible for Medicaid and 275,000, including 215,000 uninsured residents, would gain coverage.

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