Increased benefits helped a record number of people enroll in private health insurance around the country this year, but gains in Oregon have lagged behind dozens of other states — potentially because so many in the state already had coverage.
Oregon’s Health Insurance Marketplace last week reported enrollment of 146,602 for 2022, a growth of about 3.8% over 2021.
A state-issued statement attributed the gains to a federal enrollment period extension from 45 to 76 days, as well as increased tax credits available to income-qualified enrollees, which Congress approved last year in the American Rescue Plan Act.
“I am elated to see more Oregonians taking advantage of the tremendous savings available on health coverage through the Oregon Health Insurance Marketplace,” said the state marketplace’s Administrator, Chiqui Flowers, in the statement. “We are encouraged to see the benefits the American Rescue Plan Act and extended open enrollment period will have on the ability for people to seek the care they need.”
The 2010 Affordable Care Act set up a federal online marketplace called Healthcare.gov to help people who are not on Medicare to shop for health insurance and enroll while tapping premium tax credits, or discounts, if they meet federal income limits.
Oregon was one of many states to set up its own state-based marketplace, only to have the technology project implode, causing Oregon to use the federal marketplace instead.
The state’s previous enrollment record was 145,264 people in 2020.
Oregon’s enrollment gains this year were far less than those seen in other states.
States that, like Oregon, had previously expanded Medicaid eligibility, saw average gains of 11.5% as of Jan. 15, according to ACAsignups.net, a prominent blog authored by Charles Gaba that tracks Affordable Care Act enrollment.
Oregon’s gains ranked 33rd out of 38 states that had expanded Medicaid.
Meanwhile, states without expanded Medicaid saw average gains of 31.5%.
The reasons for the difference are unclear, but the state may simply not have much room for further gains, according to a marketplace spokesperson in Oregon.
“We’ve always had a pretty low uninsurance rate,” said Amy Coven, a communications strategist for the Oregon Health Insurance Marketplace unit of the Oregon Health Authority.
According to data posted by the Kaiser Family Foundation from the Community Population Survey of the U.S. Census, Oregon ranked 10th among states in the lowest overall insurance rate in 2020.Coven also noted Oregon’s enrollment gains in the Medicaid-funded Oregon Health Plan. Since the pandemic started and the federal officials prohibited states from kicking people off the free low-income health program, Oregon’s Medicaid enrollment has grown from about 1.1 million to nearly 1.4 million.
Jeremy Vandehey, director of health policy and analytics for the state, said there is a connection. He said many of the people who were kicked off the Oregon Health Plan in the past often didn’t go to the online marketplace simply due to cost. Before the federal government halted the churn of disenrollment and reenrollment, research showed there were “a lot of folks who are uninsured who are going on and off of the Oregon Health Plan pretty quickly over the course of a couple of years,” he said.
The expanded marketplace subsidies approved by the 2021 federal legislation would be extended under the Build Back Better Act promoted by President Joe Biden. However, the bill stalled in the U.S. Senate.
You can reach Nick Budnick at [email protected] or via Twitter at @NickBudnick.
Audrey, great question. But I'm not sure I would say the portion of the population "is" moving away; to say it "was" doing so pre-pandemic feels more accurate. According to the fine print on that KFF tool, the 2020 estimate is based on the March CPS. So very early in the pandemic. Also, while I know the CPS is well-regarded, I don't know enough to say how comparable estimates are over time. That said, you pinpointed a pretty large drop.
When looking at the KFF historical enrollment percentages you referred to, it looks like Oregon went from 22.1% Medicaid in 2016, to 17.4% (2020). It seems like this portion of the population is moving away (~5% decrease) from Medicaid even with the lack of movement during the pandemic. What are your thoughts?