For thousands of people who have struggled to find affordable health insurance because of the failures of Cover Oregon, a distant hope may be on the horizon — a so-called “Basic Health Plan,” in which the state would offer a health plan to low-income people who don’t qualify for the Oregon Health Plan.
Oregon wouldn’t be able to offer such an option until Jan. 1, 2016, but support is building among advocates, and Rep. Mitch Greenlick, D-Portland, is putting forward legislation for February that would ask the Oregon Health Authority to study the provision of the Affordable Care Act for Oregon.
The Basic Health Plan would apply to legal residents below 200 percent of the poverty level who can’t get Medicaid. It would include legal non-citizens who are barred from receiving the Oregon Health Plan until they have been in this country five years, even if they live far below the poverty level.
The Basic Health Plan would cover a family of four with an adjusted gross income up to $47,000 or a single person up to $23,000.
The Oregon Law Center’s John Mullin, who advocates for low-income Oregonians, said the federal government might supply the state with enough money to run a program with all the essential health benefits where premiums, deductibles and copayments would either be very low or at no cost to the consumer.
“It would use the subsidy money in the exchange,” Greenlick told The Lund Report.
A comprehensive study is needed because the Basic Health Plan could take several forms, from one mirroring the Oregon Health Plan to a contract with a private insurer like the Healthy KidsConnect Program, which was administered by PacificSource. A study would also provide the state with cost and design elements.
While Oregon has at this point ended up with the nation’s worst health insurance exchange, it has been a national leader in reforming the delivery of its state Medicaid program for the poor, the Oregon Health Plan.
Greenlick said it could potentially fit in as a neat expansion of the coordinated care organizations. “I was basically assuming that it will be [managed by] the CCOs, but that may not be true,” he told The Lund Report.
Mullin said the Basic Health Plan was inserted into the Affordable Care Act by U.S. Sen. Maria Cantwell, D-Wash. The idea is based on a program in that state that has been largely defunded, he said.
But if Oregon or other states choose to implement the ACA’s Basic Health Plan, instead of relying on state revenues, it would be funded with the federal subsidies that now go to private health insurance companies to offset the cost of insuring this population though Cover Oregon.
In doing so, it would siphon away customers from Cover Oregon, which is already on the rocks. The state insurance exchange gets a small commission on every plan it sells. But Mullin said this population might decide it cannot afford even heavily subsidized private insurance through Cover Oregon regardless.
National organizations like the Urban Institute have already studied how the plan could be implemented, so there would be no need to reinvent the wheel.
“We need to be best prepared to see if this is right for Oregon,” Mullin said.
One large question mark is whether the Oregon Health Authority is interested in going along with the concept. Greenlick said the agency could decide the Basic Health Plan is a direction it would want to go anyway, and have the money entirely within its budget. Or it could ask for another $250,000 to do the study.
“That would end the conversation,” Greenlick said.
Mullin said he estimated the study would cost $180,000 at the high end, and probably much lower.
An authority spokeswoman, Christine Stone, refused to comment or tip off the agency’s hand on the Basic Health Plan before the February session, even to detail work the agency has already done investigating the possibility.
The Oregon Health Authority discussed the matter with legislators such as Greenlick and Rep. Alissa Keny-Guyer, D-Portland, in August, and the authority submitted comments to the federal Centers for Medicare & Medicaid in November.
A request for comment from Kitzhaber spokeswoman Amy Wojcicki was ignored.
Still, Mullin is optimistic that the authority will allow a study to go forward, once the current crisis ebbs. Conducting a study is no guarantee it will either be adopted or determined to be right for Oregon.
“We’d like to have the study to be done to have information ready for the 2015 session,” he said.
