The Legislature has passed a bill intended to preserve coverage for some people facing disenrollment from the Oregon Health Plan through the creation of a hybrid health care plan that would cover tens of thousands of Oregonians.
The House passed the bill on Wednesday with a a 40-19 vote. The Senate passed House Bill 4035 18-8 on Thursday, sending it to Gov. Kate Brown, who supports it. Both votes were primarily along party lines.
"Every Oregonian deserves access to quality health care," Brown said in a statement after the Senate vote. "Throughout the pandemic, we worked to ensure Oregonians did not lose their health coverage––and we must ensure they stay covered. The disparities in our health systems mean that Black, Indigenous, Latino, Latina, Latinx, Asian, Pacific Islander, Tribal, and people of color are disproportionately impacted by inequitable health care coverage. We must develop a process to ensure everyone has access to quality health care coverage."
The bill has two major goals. The first is to guide the state’s post-pandemic eligibility checks for the 1.4 million low-income people on the Oregon Health Plan. That step is needed because the pandemic prompted a federal ban on kicking people off Medicaid when their incomes grow beyond the limits set for the program.
State officials estimate that 300,000 Oregonians could be disenrolled when the state evaluates who is eligible for the Oregon Health Plan. Enrollment in the Oregon Health Plan during the pandemic grew from about 1.1 million to 1.4 million.
That federal ban is set to expire on April 15 when the federal public health emergency expires. That date could get pushed back, but regardless, it will require states, including Oregon, to determine who qualifies to remain enrolled and who does not because their income has grown.
The bill also intends to preserve health care coverage for some of the people disenrolled – an estimated 55,000 – by launching a so-called Basic Health Plan. Also called a “bridge plan,” it would add another layer of coverage beyond the Oregon Health Plan and cover people with incomes just beyond the threshold to qualify for Medicaid.
“On any day our lives can be flipped upside down by a diagnosis or an accident,” said Rep. Rachel Prusak, D-Tualatin/West Linn and chair of the House Health Care Committee on the House floor.
The threshold for the proposed new program is 138% to 200% of the federal poverty level. For one person, that’s an annual income of $18,754 to $27,180. For a family of four, that range is $38,295 to $55,500.
Those with an income of up to 138% of the federal poverty level qualify will continue to qualify for the Oregon Health Plan, as they always have.
State officials want to maintain Oregon’s robust rate of health coverage, which has increased for people of color and minority groups during the pandemic, much of it due to the ban on removing people off Medicaid.
So the state won’t rush the eligibility checks for members on the Oregon Health Plan.Oregon plans to use the full 12 months allowed.
As that work proceeds, a task force will work on designing the Basic Health Plan and submit it to the federal government.
Other negotiations with the federal government will be required. The state will seek permission to keep people temporarily enrolled in the Oregon Health Plan longer if they would qualify for the Basic Health Plan that will roll out in 2023. For example, if an eligibility check found someone with an income too high to qualify for the Oregon Health Plan but low enough to be in the Basic Health Plan, that extension would allow a person to remain enrolled until the state sets up the program.
Upfront costs for the bill include $120 million in state general funding to cover staffing, marketing and outreach to Oregon Health Plan participants and continue to cover people enrolled in the plan. Separately, the Oregon Department of Human Services projects it will need $37 million for 96 employees who work in the call center, handle redeterminations and do other tasks. But the Legislature will handle that through a different budget rebalance request separate from this bill.
Those estimated costs, especially for coverage, could change based on factors like the number of participants and how quickly people enroll in the new program.
When factoring in federal matching funding, the program is estimated to cost about $589 million for the rest of the 2021-2023 biennium, according to the bill’s fiscal impact statement.
Some were concerned about the bill.
Rep. Kim Wallan, R-Medford, who voted against the bill, said she supports more coverage but wants to see it happen through the private market. Private market plans pay better reimbursement rates while costs continue to rise for the Oregon Health Plan, Wallan said.
“This doesn’t seem to be the way to get there because the price keeps going up,” she said, adding that the state needs to look at expanding people’s enrollment in the private market because “that’s who’s paying the freight on this.”
Rep. Cedric Hayden, R-Roseburg, though, said the step is needed. A dentist, he successfully pushed to get an amendment to the bill that encourages the state to include dental care in the new plan to the extent possible.
“The concern is that we want to make sure through this task force that we figure out how people won’t be losing their health coverage,” Hayden said. “This churn is something that affects all our communities.”
Providers praise state efforts to Oregonians enrolled in coverage. But they also warned that setting up a complicated program in a tight time frame carries risks.
Executives with Providence, Oregon’s largest provider, said they support a “true, short-term bridge program” to cover people who are bumped out of the Oregon Health Plan until they can transition to subsidized marketplace coverage. But they said the plan envisioned in the bill risked hurting people making incomes higher than the Basic Health Program is intended for, and urged the task force to study it.
“Rushing a permanent program through the short session, that has only been conceived of in the last few weeks, will have unintended consequences,” warned William Olson, CEO of Providence Health & Services—Oregon and Don Antonucci, CEO of Providence Health Plan, in written testimony.
You can reach Ben Botkin at [email protected] or via Twitter @BenBotkin1.