Eastern Oregon Counties Receive Outsize Benefit from Obamacare

About two-thirds of consumers in Democratic counties, particularly Hood River and the Portland metro, received subsidies for insurance, while far more received subsidies in rural, Republican Oregon.

Consumers in Eastern Oregon were overwhelmingly helped with Obamacare subsidies for the 2018 plan year, disproportionately receiving premium assistance compared to their fellow Oregonians in the rainy part of the state.

In at least 13 counties on the dry side, 80 percent of consumers or more received financial help that reduced the costs of their premiums and/or coinsurance, compared to just six counties in Western Oregon, according to data released this week by the Centers for Medicare and Medicaid Systems.

In Western Oregon, Curry, Josephine and Coos counties received the most assistance.

The four counties nearest to Idaho received the most help, with Union County and Malheur County each showing 91 percent of consumers paying below-market costs, followed by Baker County at 90 percent and Wallowa County at 89 percent.

John Fleming, an insurance broker in La Grande, the seat of Union County, said people were more likely to receive help because incomes were lower. Fleming said many of his clients were either retirees too young to receive Medicare or students at Eastern Oregon University, including COFA Pacific Islanders, who are eligible for a special program through the Oregon Health Insurance Marketplace.

Fleming said Eastern Oregon communities had developed a collaborative approach to maximize the benefit for residents through the Affordable Care Act.

He worked out a creative solution with the local Grand Ronde Hospital, which is providing charity care for out-of-pocket costs for people with incomes below 300 percent of poverty. At the same time that he assists people in this group with their healthcare.gov signup, they file a form with the hospital that waives or reduces their out-of-pocket costs.

“The good [silver or gold] plan is unaffordable,” Fleming said. “I marry you with a bronze plan to give you full coverage.”

Rather than having uninsured people show up at the emergency room for care, the arrangement allows Grand Ronde to direct care to insured patients in its outpatient clinics, and still receive some reimbursement through insurers, even as the nonprofit hospital system waives the copayments and coinsurance for these working-class consumers.

Grand Ronde also offers a sliding scale, so consumers above 300 percent of the poverty line can still receive reduced copayment costs. This differs from the Affordable Care Act premium subsidies, which leave consumers up the creek if they earn a penny over 400 percent of poverty.

Additionally, since the insurer is still billed, medical costs rung up at the local hospital and clinics count toward the deductible in case the consumer needs costlier medical care in Portland or Boise.

Statewide, because of a fluke in the calculation of cost-sharing reductions which the Trump administration refused to pay for, average healthcare.gov premiums were actually lower for 2018 than 2017 -- dropping from $147 a month to $138 a month.

Cost-sharing reductions reduce or eliminate out-of-pocket costs for consumers with midrange silver plans who have incomes below 250 percent of poverty.

Seventy-four percent of marketplace enrollees received financial help, or 116,000 of the 156,000 Oregon enrollees on healthcare.gov. An additional 70,000 people signed up for individual health insurance directly through an insurance company, making them ineligible for assistance.

“These numbers underscore just how important it is to check if you are eligible for financial assistance when you shop for coverage at healthcare.gov. The savings can be significant,” said Chiqui Flowers, the administrator of the Oregon Health Insurance Marketplace.

Open enrollment for 2018 ran from Nov. 1 to Dec. 15 and is now closed for consumers, unless they have a special life event such as a move, a marriage or a new child. Enrollment for 2019 will be over the same dates next autumn.

Republicans Benefit the Most from ACA

Ironically, it was the state’s most Democratic counties where people received the least financial assistance. In Hood River County, just 67 percent of marketplace purchasers received a subsidy, followed by 69 percent in Multnomah and Clackamas counties, 70 percent in Washington County and 71 percent in Benton County.

These figures reflect shifting political coalitions, where, within the white majority, Democrats increasingly represent the state’s wealthy and prosperous areas and Republicans represent struggling and downscale counties.

So while the Democrats fought tooth-and-nail for the law and the Republicans fought hard against it, it is the Republicans’ constituents who most benefit.

The Republican counties with lowest percentage of enrollees receiving reduced premiums are Polk and Yamhill, with 75 percent. Lane County had the highest percentage among Democratic counties at 80 percent, along with Jackson County at 82 percent, a swing county that went for Barack Obama in 2008 and Donald Trump in 2016.

Reach Chris Gray at [email protected].

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