Bills Look At Expanding Oregon’s Medicaid Model By Allowing Buy-Ins

Oregon lawmakers are taking several stabs this session at increasing health insurance coverage in the state.

Last month, Democrats in both chambers introduced a plan that would create a single-payer system with no premiums, deductibles or copays for consumers. Then last week, the House health care committee heard three bills that would allow Oregonians to buy into the Oregon Health Plan, the state’s version of Medicaid.

Besides Oregon, nine other states are considering buy-in Medicaid plans. New Mexico and Washington state have pushed bills out of legislative committees, but large insurers have voiced strong opposition to the concept. Last year Nevada’s mostly-Democrat Legislature passed a Medicaid buy-in bill, but then-Gov. Brian Sandoval, a Republican, vetoed it.

Buy-ins are largely a partisan issue, both in Oregon and elsewhere, with Democrats leading the charge. More than a dozen Democrats in the state Legislature have signed on to all three bills.

None of them has any Republican sponsors.

The party has not voiced much opposition either. That has come from insurers -- both commercial companies and coordinated care organizations that provide coverage under the Oregon Health Plan. Both warn that the bills could disrupt the marketplace. Instead of creating a Medicaid buy-in option, they said insurance coverage could be expanded through smaller, more incremental steps, like increasing subsidies to lower premiums for those with limited means.

There are currently more than 200,000 Oregonians without health insurance. House bills 2009, 2012 and 3185 are designed to expand care potentially to all of them through the Medicaid model.

House bills 2009 and 2012 came out of a committee last year led by Rep. Andrea Salinas, D-Lake Oswego, the current chair of the House health care committee. They would:

  • Apply to individuals who earn too much to qualify for a subsidy under the Affordable Care Act, provided they make no more than 400 percent of the federal poverty level, or about $16,910 a year for a household of two.
  • Allow residents whose employers require them to pay the full cost of insurance to earn up to 600 percent of the poverty level.
  • Have premiums ranging from about $400 to $600.

House Bill 2009 would levy a 9 percent fine on the income of consumers who forego coverage for more than nine months or who don’t have the minimum coverage established by the Affordable Care Act.

House Bill 3185, backed by Tiffiny Mitchell, D-Astoria, also spells out a Medicaid buy-in option but this bill is geared towards employees who would sign up through their job. Premiums would be based on a monthly average paid by the state per person to Medicaid insurers.

Several grassroots organizations have come out in support of the bills as has the Oregon Nurses Association, a large lobbying group.

“When we are able to provide the care that our residents need when they need it, the impact is both local and national,” Deborah Riddick, the association’s government relations director said last week during a health committee hearing.

A spokesman for Health Care for All Oregon, a coalition of more than 100 state organizations that support universal care, added in the hearing that having uninsured people amounts to “pervasive injustice.”

“Medicaid is such a system that provides comprehensive care with the opportunity to focus on prevention and early (care) for anyone,” said Tom Sincic, the coalition’s president and a retired nurse practitioner. “As a provider, I knew exactly how to care for people under this system, and patients have no need to delay care or fear the costs since there are traditionally no co-pays or deductibles.”

Opponents say the bills could prompt large numbers of healthy policyholders to switch plans, opting for the Medicaid buy-in coverage. That would leave some insurers with a higher proportion of sicker patients. To compensate, they would have to raise premiums which, in turn, would cause more policyholders to switch in what’s known in the insurance industry as a death spiral.

On the flip side, the plans could also attract a bigger pool of patients with more serious medical conditions, said Mike Becker, vice president of government relations for PacificSource Health Plans. He told The Lund Report that coordinated care organizations would have trouble ensuring their care and staying financially viable.

Instead of creating new insurance options, Becker said the state should analyze why uninsured Oregonians are opting out of health care coverage. A report last year by the Oregon Health Authority found that 6 percent of Oregonians lack health care coverage. Most cited cost as the biggest impediment.

Insurers, like Becker, say that rather than creating new options the state should identify new incentives and subsidies to encourage these people to receive coverage through existing channels.

The divide between the two sides is not likely to be bridged anytime soon. And the bills could die this session. But Mitchell said lawmakers need to come up with bold ideas to push health care policy forward.  

“We are really just trying to find a way to move the dial backward in terms of price and accessibility for consumers,” Mitchell said. “I really just want to have some discussion about these really big ideas.”

Have a tip about health care or the Legislature? You can reach Alex Visser at [email protected].

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