Sedentary lifestyles, poverty, lack of insurance and poor access to medical and mental health care plague Oklahomans, ranking the state among the nation’s unhealthiest. Gov. Kevin Stitt promised to use his business acumen to make Oklahoma top-10 in public health.
Four years later, and days from an election to determine whether he serves a second term, Stitt said his vision was only aspirational.
Our State Under Stitt
One in a series of stories looking at Gov. Kevin Stitt’s record as he runs for a second term. Other stories:
“You’re never going to get there on everything,” Stitt said in an interview with Oklahoma Watch. “But having a goal written down and getting people rallied around, here’s what we’re pushing, that gets everybody aligned.”
Stitt kept promises to sign abortion restrictions, provide mental healthcare to first responders and expand telehealth. In other areas, he fell short.
Oklahomans’ health declined during Stitt’s term, in part due to the biggest public health crisis in a century, testing his priorities.
In his first State of the State speech, Stitt said healthcare depends on personal responsibility. That became his tagline throughout the pandemic.
He chastised city leaders who implemented mask mandates and business closures. He fought federal vaccine mandates for healthcare workers in the name of “protecting and preserving individual freedoms,” the first line on the Governor’s page of the state’s website.
Three nights after COVID-19 emerged in Oklahoma, the governor posted a photo with his kids from a packed Oklahoma City restaurant contradicting advice from the nation’s top health expert, Dr. Anthony Fauci, who urged Americans to avoid spreading and contracting the virus by staying home.
Two days after that, Stitt declared a state of emergency.
He increased the state’s stockpile of gloves, masks, gowns and other protective equipment needed to test and care for patients. Many of those supplies remained in a warehouse until an Oklahoma Watch investigation revealed that long-term care facilities were unable to procure supplies needed to care for the state’s most vulnerable population.
He became the nation’s first governor to contract COVID-19 weeks after attending a June 20 rally for former President Donald Trump in Tulsa. Masks were optional at one of the nation’s first large public events as COVID-19 restrictions were lifted. At least two Secret Service agents who were there tested positive. And former presidential candidate Herman Cain tested positive for the virus within days of attending and died from COVID-19 on July 30.
COVID-19: A ‘Pro-Freedom, Pro-Business’ Response
Stitt and his Democratic opponent for governor, State Superintendent of Public Instruction Joy Hofmeister, pushed for schools to return to in-person learning. Virtual learning caused many students to fall behind. Stitt pushed against mask requirements for students returning to class and virtual learning triggered by community infections, while Hofmeister supported mandates.
The 2020 holiday season fueled a more contagious surge of the virus. While Fauci and other health experts pleaded with Americans to stay home, Stitt extended an “open invitation” to visitors in a commercial promoted by the state tourism department.
Stitt’s approach to the pandemic was praised by parents who wanted their children back in school, workers idled by restrictions, employers facing financial ruin and Americans who called the virus a hoax.
He was admonished by healthcare workers who watched as nearly 15,000 Oklahomans died from COVID-19 and tens of thousands more suffered; teachers forced to return to classrooms without mandated precautions; and caretakers who feared for the lives of at-risk loved ones.
Oklahoma has the nation’s 13th highest rate of COVID-19 deaths, according to the latest data collected by the New York Times.
Stitt blames poor pre-pandemic health, which increased Oklahomans’ risk for severe COVID-19 symptoms, and what considers bogus data for the state’s performance, accusing hospitals and doctors of lying about the cause of death to boost their COVID relief funding.
The health department was under fire during the pandemic over lack of testing, withholding data, unreliable reporting and conflicting direction from state leaders. From March 2020 to April 2021, the role of the state’s epidemiologist was held by four people.
The Senate shot down the governor’s first pick for health commissioner in May of 2020 because he did not meet statutory requirements. And the position of the state’s top public health official, which is appointed by the Governor, turned over twice more during the pandemic. Stitt appointed Dr. Lance Frye in October of 2020 and promoted Deputy Commissioner Keith Reed to the position after Frye resigned following criticism of the agency by Stitt after it settled a federal lawsuit to allow a non-binary gender designation on state-issued birth certificates.
The health department received local and national praise for its vaccine rollout, including an effort to speed up vaccinations for nursing home residents and workers when the federal program lagged.
Stitt received a COVID-19 vaccination and later refused to get a booster even though Reed, a Stitt appointee, encouraged all eligible Oklahomans to get one to reduce the risk of another surge.
In an interview this month, Stitt called criticism of his pandemic response “extremely unfair” and doubled down on his strategy of personal responsibility saying Oklahoma is “reaping the benefit.”
“We’re number 11 in the country of people moving into Oklahoma because of some of those pro-freedom, pro-business policies,” Stitt said, referencing U.S. Census data for July 1, 2020 to July 1, 2021. “And the way that we, in my opinion, did not overreact and shut everything down, I’m very proud about how we handled that.”
America’s Health Rankings, Oklahoma’s Shortcomings
Stitt criticizes Oklahoma’s undesirable spot in America’s Health Rankings — a database that uses information from the U.S. Census Bureau, the CDC and others to compare the health of residents in all 50 states.
As Stitt campaigned on improving health across the state, Oklahoma was ranked 43rd on the list. A strategic plan referenced the goal to be “top 30 in health outcomes,” which conflicted with his campaign promises. Neither goal was met.
Four years later, Oklahoma has dropped three spots to 46 — the highest position the state has held during Stitt’s tenure.
Oklahomans are more likely than other Americans to give birth in their teens, smoke, use illegal drugs, face food insecurity and die at a younger age, fueling the state’s low ranking, according to the latest report.
Stitt called the data “skewed” claiming that the federal government made Oklahoma look bad because the state hadn’t adopted Medicaid expansion.
Battling Abortion Rights
On the day that the Supreme Court overturned a 50-year-old constitutional right to abortion, Stitt reminded Oklahomans that he promised to “sign every piece pro-life legislation that hit my desk.”
He signed nine bills restricting abortion, according to his office. Five became law in Oklahoma, which now bans abortions beginning at conception. Confusion remains over the conflicting bills, including whether the state allows exemptions for victims of rape, incest or to save the life of the mother and what that means.
The New York City-based Center for Reproductive Rights sued the state, claiming access to abortion is a right guaranteed by the state constitution. That case is pending before the state Supreme Court.
In July, Stitt launched a task force of Christian non-profits, public health officials and healthcare aimed at supporting pregnant women. Stitt’s order requires a report detailing the group’s findings and recommendations.
One of the group’s directives is to bolster controversial crisis pregnancy centers, which counsel against abortion. In May, a state health department audit found that millions of state dollars allocated to these centers through the Oklahoma Pregnancy Care Network were misspent.
The task force expanded Medicaid benefits for pregnant Oklahomans by reducing the income threshold and extending postpartum benefits from two to 12 months. The move aligns with a federal initiative from President Joe Biden’s administration.
Mental Health Initiatives Focus on First Responders, Hope
In February, while encouraging Oklahoma leaders not to cut funding for law enforcement amid a national reckoning following the murder of George Floyd by Minneapolis police, Stitt said he would create a mental health program for first responders.
This spring, he signed Senate Bill 1613 creating a mental wellness division under the Department of Public Safety, but statewide suicides continue to increase.
In 2020, suicides in Oklahoma reached their highest point since 2006, prompted in part by the pandemic an Oklahoma Watch investigation found. The state’s suicide rate, which remains among the nation’s worst, according to the CDC, is one of two mental health measures included on the Governor’s dashboard.
Lawmakers allocated $125 million in federal ARPA funds to the mental health department in September to add 150 new hospital beds for mental health patients in Tulsa and Norman.
Stitt called for a statewide ban on youth hormone therapy and other gender-affirming care for minors this month after the legislature withheld federal funding for mental healthcare from OU Health until it agreed to halt some care for transgendered youth. Hospital officials conceded and lawmakers awarded the system more than $108 million to expand behavioral healthcare for kids, support cancer patients impacted by the pandemic, provide mobile dental care and update its records system.
The governor has supported legislation that opponents say attacks LGBTQ youth, who are already at greater risk for depression and suicide. Bills backed by Stitt, ban transgender girls and women from playing on female school sports teams and require students to use only bathrooms aligned with the sex they were assigned at birth.
As Superintendent of Public Instruction, Hofmeister, Stitt’s opponent for governor, championed mental health programming in schools, even before the pandemic.
More than $26 million in federal grants expanded counselors and trained educators to teach students how to identify and cope with their emotions in nine districts located in “mental health deserts.”
Progress was derailed by the pandemic and has been slowed by teacher and staff shortages.
The U.S. Department of Education touted a program Hofmeister launched using American Rescue Plan funds to hire more counselors in schools across the state. The Counselor Corps initiative was lauded as one of six “amazing examples” of states addressing student needs by Secretary of Education Miguel Cardona on Twitter last year.
Some rural school superintendents said they needed more than funding to attract mental health professionals to their communities. More than 300 school counselors and mental health workers were added to 176 districts through the program, according to an announcement from the Oklahoma State Department of Education in September.
Stitt leans on his wife’s experience growing up with parents who suffered from mental illness when he is asked about mental health.
During his State of the State this year, he credited her with an initiative to train “every state employee how to apply the science of hope to their agencies.” So far, 20 agency directors and 358 supervisors have received six hours of training “to visualize hope” in their agencies and “think strategically about opportunities for internal and external use of hope,” according to an email from Brett Hayes, the program’s director at the state Department of Human Services, and the governor’s spokeswoman Carly Atchison. The training was made available to all of the state’s 30,000 employees in July.
From Medicaid Expansion Opposition to Managed Care Maneuvers
More than 1 million low-income Oklahomans rely on the state’s Medicaid program for health insurance following an expansion of the program approved by voters in 2020. Another 200,000 Oklahomans qualified under a federal health emergency designation set to expire in January.
Stitt opposed the ballot measure and proposed his own Medicaid expansion plan that utilized a block-grant program with caps on spending, added work requirements and included premiums for new enrollees. When State Question 802 passed, Stitt’s priority shifted to the management of care.
He tried privatizing care by shifting oversight to private insurance companies. Lawmakers pushed back when they didn’t get a say and the Supreme Court ruled that the move required legislative approval. Contracts were void and lawmakers, hospitals and other stakeholders began developing a bill that would eventually move most Medicaid enrollees into the program called managed care.
Stitt said the program limits the state’s cost and the coordinated care approach has the ability to approve non-medical purchases that might improve health.
“If this person continually is going back into the hospital for the same thing, for heat exhaustion, a managed care organization could say, ‘well, let’s get ’em an air conditioner at their house,’” Stitt said. “So they can think outside the box.”
Physicians opposed the plan, fearing managed care companies’ quest for profits could reduce payment to doctors who work outside of hospitals, endangering rural practices.
Hospitals initially opposed the plan but later supported the measure in the 2022 legislative session after another bill that would boost federal funding for hospitals was made contingent on the passage of managed care.
Most state Medicaid patients will be moved to the program, which is expected to launch in October 2023. Native Americans on Medicaid can opt in and some Oklahomans with disabilities are exempt. It remains unclear how the change will impact treatment for low-income Oklahomans.
Rural Healthcare Expansion Barriers Remain
Stitt touted virtual care as a way to improve access in rural parts of the state that lack physicians and hospitals. Oklahomans without transportation or insurance or who can’t afford to take time off of work for appointments often put off preventative care until symptoms intensify leading to costly ambulance rides and emergency room treatments.
In fiscal year 2018, the last full year before Stitt took office, 2% of rural Oklahomans insured through Medicaid participated in at least one telemedicine appointment, the data shows. With COVID-19 surges in fiscal year 2021, that number jumped to 16%.
Despite the telemedicine push, barriers to care remain for some Oklahomans.
Copays apply to most online visits and prescribed medications. Unreliable, unavailable and expensive internet remains a barrier in some communities. The cost and learning curve that accompanies technology presents hurdles, especially for aging residents.
When asked how he would reach those Oklahomans, Stitt again invoked personal responsibility.
“Eventually, you know, people have to have personal responsibility. They’re gonna have to figure out a way,” Stitt said. “We’re not creating a system where, you know, the government’s going to necessarily take you to the hospital.”
Whitney Bryen is an investigative reporter at Oklahoma Watch covering vulnerable populations. Her recent investigations focus on mental health and substance abuse, domestic violence, nonprofits and nursing homes. Contact her at (405) 201-6057 or firstname.lastname@example.org. Follow her on Twitter @SoonerReporter.