A bill that keeps the hopes of immigrant- and low-income advocates alive for a Basic Health Plan passed the Senate by a 22-7 vote, leaving just Gov. Kate Brown’s signature before House Bill 2934 becomes law.
The legislation is dialed back from its original version, which would have ordered the Oregon Health Authority to draft and submit a blueprint to the Centers for Medicare and Medicaid Services on the state’s plans to implement the program for immigrants and working-class Oregonians.
Instead, HB 2934 will direct the health authority to convene a stakeholder group to work with the state and the federal government to craft an Oregon-specific program, one that will likely use the health plan structure of the coordinated care organizations.
The delay is not expected to hold back the implementation from the advocates’ desired date of Jan. 1, 2017, which the Legislature would have to approve in next year’s short legislative session.
Four Republicans each in the House and the Senate supported the measure, including Rep. Vic Gilliam of Silverton, who has been an advocate for his district’s large migrant farm worker population; Senate Minority Leader Ted Ferrioli of John Day and Sen. Jackie Winters of Salem, who for years has been a key Republican player in getting the numbers to add up for Oregon’s health and human services programs.
Interestingly, none of the Republicans on the health policy committees supported the bill on the floor; Sen. Jeff Kruse of Roseburg, Rep. Cedric Hayden of Cottage Grove and Rep. Bill Kennemer of Oregon City supported the bill in committee but ultimately switched their votes. All the Democrats backed the bill.
The Basic Health Plan would apply to working-class adult Oregonians between 138 and 200 percent of the federal poverty line, as well as legal immigrant residents with lower incomes who are now barred by federal rules from the state Medicaid program.
A study from Wakely Consulting showed the state could offer a more robust health plan that covers more people with the money now given to private health insurers. That study showed that the state would need to complement a modest $25 million to run the program for 87,000 people, although Janet Bauer of the Oregon Center for Public Policy has argued that the state share will be offset by a reduction in spending on programs for pregnant women. A modest premium for qualified people above 138 percent of poverty is also a possibility.
Opposition to the bill has been led by the Oregon Association of Health Underwriters, whose insurance agent members would lose the commissions they earn by helping these people choose health plans off the exchange.
Advocates will also need to show that the CCOs are capable of taking on this population and handling the increased caseloads. FamilyCare CEO Jeff Heatherington has told The Lund Report that his organization could absorb the new customers, but others, such as Trillium Community Health Plan in Lane County, have failed to keep up with the 2014 Medicaid expansion.
Trillium has sponsored legislation that would force doctors to accept their patients as a way to deal with a primary care crisis that has left 12,500 Trillium members without a general practitioner.
“There has been some questions about how it will be operationalized,” conceded Joseph Santos-Lyons of the Asian-Pacific American Network of Oregon. “We’ve worked closely with CareOregon, and they’ve taken good leadership to work with other CCOs.”
CareOregon public policy director Martin Taylor said his organization supported HB 2934 but was waiting to see what kind of health program the stakeholder group devises before CareOregon could support its implementation. He said the federal rules governing basic health plans did not call for a straight expansion of Medicaid, and counties with CCO monopolies would have to allow for an open bidding process before health plans could receive the new members.
Santos-Lyons’ organization is especially interested in a Basic Health Plan as a means to help a Pacific Islander population of about 8,000 people from islands known as the Compact of Free Association states, who are legal residents of the United States, but not technically immigrants and have been barred from all medical assistance since 1996.
About one-quarter of this group would be eligible for the Basic Health Plan, as well as 5,000 adult legal immigrants, who must reside in America for five years before they can be eligible for Medicaid.
“It begins to address some of the cultural barriers facing our community,” said Alberto Moreno, the chairman of the state’s Commission on Hispanic Affairs. “It removes barriers for legal residents. We think it’s the right to time to do this in Oregon.”
Santos-Lyons said Oregon could help immigrants in other states get health coverage. “We will be a model for other states that don’t currently cover these populations.”
