A top House Republican told activists attending a Wednesday rally that Republican leaders have been working on a plan to expand Medicaid for more than a year, a goal that has long been a top agenda item for Democrats.

Speaking to a gathering of activists at the Oklahoma Capitol, Rep. Marcus McEntire, who chairs the House Appropriation and Budget Subcommittee on Health, said Republican legislative leaders have been seeking to expand Medicaid since before the 2018 legislative session.

“The House and the Senate have been working on a plan for about a year-and-a-half now,” said McEntire, R-Duncan. “It’s in process. Most of the details right now are embargoed until we get the support we need. But we have been working and we’ve been working hard. I’ve put a lot of blood, sweat, and tears into the plan that hopefully we’ll be able to unveil.”

Reached for comment on McEntire’s claim of longstanding negotiations, a spokesman for Senate President Pro Tempore Greg Treat said, “To my knowledge, no member of Senate leadership is involved in such planning.”

A similar request for comment was sent to House leadership, but no response had been received when this story was posted.

Under the traditional Medicaid program, states receive roughly 60 cents in federal money for every 40 cents provided in state funding to give government health coverage to very low-income and disabled individuals. But under the federal Affordable Care Act, better known as Obamacare, states receive a 90-10 match to cover able-bodied adults who earn too much to qualify for the current program. So far, Oklahoma lawmakers have declined to expand the program due to concerns regarding its cost and effectiveness.

McEntire said embracing Obamacare’s Medicaid expansion is “a hard thing to do” for Republicans because it is opposed by many Oklahoma voters, saying, “It comes down to your voting base and not getting re-elected.”

But he said the Legislature “has changed tremendously” and that “political expediency” may cause Republicans to vote for Medicaid expansion now that an initiative petition has been filed to place it before voters, likely in 2020.

Republicans have debated approving a modified version of Medicaid expansion. Rather than simply add citizens to the traditional program, the proposed legislation would use Medicaid-expansion funds to purchase private-insurance policies for the expansion population. That idea, based on an Arkansas program, would require a federal waiver that would have to be reauthorized annually.

It is estimated Medicaid expansion, whatever form it takes, could add 628,000 able-bodied adults to state welfare rolls and could cost Oklahoma taxpayers up to $374 million annually. However, if lawmakers pass an Arkansas-style version of Medicaid expansion, costs could be even higher. A 2014 report from the U.S. Government Accountability Office found the three-year cost of Arkansas’ Medicaid expansion was $778 million more than what would have been spent if the state had simply expanded its traditional Medicaid program.

Gov. Kevin Stitt has voiced concern about the state cost of Medicaid expansion and has said he will veto any bill that simply expands traditional Medicaid, but Stitt has said he is reviewing the Arkansas model.

Supporters of the Arkansas model argue it could include reforms that allow lawmakers to target assistance to the truly needy, and not merely those who are unemployed by choice. Advocates also suggest an Arkansas-style program can be tailored to require larger co-pays from recipients than what is allowed under traditional Medicaid, and that the state could require recipients to demonstrate they are seeking employment as a condition of eligibility for assistance.

But David Blatt, executive director of the Oklahoma Policy Institute, laid out a set of demands that appeared to rule out any alternative form of Medicaid expansion that includes such reforms or differs in any meaningful way from traditional Medicaid expansion.

“We’re open to discussing whether this should involve a straight Medicaid expansion or a plan that allows people to enroll in commercial insurance,” Blatt said at Wednesday’s rally. “But if lawmakers do come up with an alternative to Medicaid, it must work for the benefit of the expansion population. Any plan must ensure comprehensive health coverage with minimal out-of-pocket costs and no danger of being locked out of coverage.”