OKLAHOMA CITY — Oklahoma voters narrowly decided on Tuesday to expand Medicaid health insurance to tens of thousands low-income residents, becoming the first state to amend its Constitution to do so.

With 100% of precincts reporting unofficial results, State Question 802 passed by less than 1 percentage point. The question fared well in metropolitan areas, including Oklahoma City and Tulsa, but was overwhelmingly opposed in rural counties.

Idaho, Maine, Nebraska and Utah have all expanded Medicaid through ballot questions, but did so by amending state statutes, according to the nonpartisan Kaiser Family Foundation.

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Amending the Oklahoma Constitution will prevent the Republican-controlled Legislature, which has resisted Medicaid expansion for a decade, from tinkering with the program or rolling back coverage. Missouri voters also will decide on a constitutional amendment on Aug. 4.

State Question 802 will extend Medicaid health insurance to those earning up to 138% of the federal poverty level, which is about $17,200 for an individual or $35,500 for a family of four.

Oklahoma was one of 14 states, along with neighboring Texas and Kansas, that had not expanded Medicaid under the 2010 federal Affordable Care Act. Republican Gov. Kevin Stitt and his predecessor, Mary Fallin, have opposed expansion, citing uncertainty about future costs for the state.

Amber England, campaign manager, Yes on 802, addresses supporters via the internet Tuesday, June 30, 2020, in Oklahoma City, as due to Covid-19 concerns, a virtual watch party replaces the normal watch party, as they await results in a vote in which Oklahoma voters are deciding whether to amend the state Constitution to expand Medicaid health coverage to tens of thousands of low-income residents. (AP Photo/Sue Ogrocki)

“We have a billion-dollar shortfall next year," Stitt said recently at a forum hosted by Americans for Prosperity, a conservative political advocacy group that opposes the measure. The state would have to “either raise taxes or to cut services somewhere else like education, first responders, or roads and bridges” to cut additional Medicaid costs, he said.

After years of legislative inaction on health insurance proposals, supporters of Medicaid expansion launched an initiative petition last year to get the measure on the ballot, and collected a record number of signatures. The plan was endorsed by several politically powerful groups, including chambers of commerce, medical trade groups, the Oklahoma Education Association and the Oklahoma Conference of Churches.

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Some Republican opposition to Medicaid expansion has eroded in recent years, particularly in rural areas where hospitals have suffered financial problems or closed.

Kevin Penry, a Republican and retired pastor from Edmond, said that before going on Medicare last month he had to buy expensive insurance on the federal marketplace, which “really made me feel for folks who are in a difficult financial situation." He said he voted for the expansion.

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The Oklahoma Health Care Authority has projected that about 215,000 residents would qualify for a Medicaid expansion, for a total annual cost of about $1.3 billion. The estimated state share would be about $164 million. But those numbers could be considerably higher given the number of Oklahomans who have lost their jobs and work-related health insurance because of the economic shutdown amid the coronavirus pandemic.

To help fund the proposal, the Legislature is expected to increase a fee that hospitals pay from 2.5% to 4%, which would generate about $134 million annually. Stitt vetoed such a measure earlier this year.