The successful Oklahoma vote on Medicaid expansion, State Question 802, may be a resounding success, but it was overestimated in how wide the margin would be between Yes and No. Pollsters predicted a 60-40 Yes vote, but it barely passed at 50-49. A few points, and how they apply to the Missouri Medicaid expansion vote on August 11:

• That those 7 counties in which Yes was the majority only sustained half of the total statewide Yes vote. 49% of the Yes vote came from all of the other 70 counties in the state, even the border counties. So that is another reminder that land doesn’t vote, and campaigning to the cities in a state where the urban population at the last census was 66% is not a good idea.
• That the vote largely reflected income patterns across the state, a bit more so than urban-rural setting. Research is showing that the richest 200 precincts in the state voted in the minority for SQ802, while the poorest 200 precincts voted in the majority for the same, even as both groups of precincts are largely split between urban and rural precincts.
• That voter suppression played a role in the final vote. Besides the antagonism of Governor Kevin Stitt, Oklahoma Republicans and Americans for Prosperity against the initiative, this primary was impacted by the Oklahoma Legislature passing new requirements for notarizations on absentee ballots, even after the State Supreme Court threw out the requirement as unconstitutional. There’s also the fact that 200k less Oklahomans turned out for this primary than the 2018 primary, when Oklahomans voted 60-40 in favor of medical marijuana.

Also, a crucial minority of Republicans voted for Medicaid expansion, pushing #SQ802 over the top in a state where Trump won 60-30 and Stitt won by more than 10 points. This result shows that the support for these ballot initiatives has swingier, more elastic votes among both party bases than how they vote in elections.

So this brings me to Missouri, which will vote on Medicaid expansion on the August 4 gubernatorial primary ballot. Missouri has a higher urban-to-rural population ratio than Oklahoma, the same as Idaho (which also passed Medicaid expansion 60-40 in 2018), and has had a similar tendency to vote for progressive measures such as nonpartisan redistricting and medical marijuana. But Oklahoma’s razor-thin margin shows that advocates for Medicaid expansion must work for this vote this month. Also, Missouri has the same requirements about absentee voting as does Oklahoma, and the same Republican legislative opposition against Medicaid expansion.

I have family in the St. Louis area, and their health would stand to gain from a Yes vote.