At the stroke of midnight, December 31, 2017, about 120,000 Oregonians will have to find all new healthcare providers within HealthShare if the inequity in funding FamilyCare is not addressed.
It Doesn’t Make Sense
This note is from the point of view of those of us on the ground, working with clients. We don’t know the complexities behind this situation, that are discussed in the board rooms of upper management in HealthShare, FamilyCare, the legislature, OHA or the Governor’s office.
But from our vista, the FamilyCare system works exceptionally well for clients. You’ll read more about that below.
As we understand the situation, the OHA offered to pay FamilyCare $377 per person per month in 2018 while paying HealthShare $409. Ironically, if all 120,000 members will have to switch to HealthShare, the OHA will have to pay $409 for their healthcare anyway.
Why not just pay FamilyCare what it will have to pay HealthShare in 2018 and not disrupt the lives, the health and mental well being of so many people. Why create such unnecessary misery and chaos for 120,000 people?
Avoid Disruption
The logical thing to do would be to pay FamilyCare the same as HealthShare and let 120,000 Oregonians keep their doctors, therapists, and medical care team.
Instead 120,000 FamilyCare members will have no access to health care, or mental health care for months and months, if not longer. Where will they go for treatment? The Emergency Department or Urgent Care, which typically costs 5 - 10 times more than primary care. FamilyCare reports they saved $65,000,000 in Emergency Department, Urgent Care, specialty referrals, surgical referrals with their philosophy of easy access to primary care and mental health services.
How will HealthShare providers manage 120,000 new members, when colleagues report that they already have wait lists and unmanageable client loads? How long will take HealthShare to simply enroll 120,000 new members, assign them case managers, let alone providers who can see them regularly?
There's a heroin epidemic in Portland and all those people in treatment under FamilyCare services will be left without treatment. According to the OHA as reported by Brent Weisberg KOIN 6 News Staff ”Oregon has one of the highest rates of prescription opioid misuse in the nation, according to OHA.” The down stream ripple effects of closing FamilyCare is increased crime, increased medical costs to local hospitals, and a strain on police departments.
The OHA cites three actuarial reviews which found the disparity in rates to be fair. However, the actuaries do not take into account the ripple effects of such a massive disruption of service to 120,000 members, nor the difficulty in doing a fair comparison when HealthShare costs are some what hidden within their subsidiaries.
And ironically, switching 120,000 people to HealthShare will still cost the extra $44 million they would pay FamilyCare that would keep them from going bankrupt.
What will the ripple effect cost?
- FamilyCare’s 250 employees will lose their jobs, which could result in $2.5 million in unemployment benefits [1]
- Another 1000 - 2000 jobs will be lost or reduced to part time as a result of the doctors, administrative personnel, therapists, etc who will no longer be treating 120,000 people. This might cost another $5 – 10 million in unemployment benefits.
- If 5% of those 120,000 people have even a single visit to the ER, 6000 uninsured people will be using charity care at local hospitals. At an average cost of $1223 [2] per visit, that totals a minimum $7,330,000 in charity care.
- Job loss not only results in increased unemployment benefits, but reduced spending in Oregon businesses, defaults on car payments and mortgages. The dollar cost of this ripple effect is incalculable.
Unspoken Messages and Beliefs
What would cause the OHA to persist in a course of action that will not only hurt 120,000 FamilyCare clients, but also the Oregon economy?
As the campaign to destroy FamilyCare by OHA former director Lynne Saxton came to light in August of 2017 [3], one can’t help but wonder what would motivate a public official to undermine the 32 year success FamilyCare has had in providing excellent service and saving money. Could it be the philosophy we’re seeing in national politics whose beliefs seem to rest on the assumption that the poorest and weakest deserve to suffer.[4]
Who are FamilyCare clients?
Meet one of our clients who we will call Mary.
Mary was unemployed, depressed and anxious after a series of life events beyond her control, left her with crippling PTSD.
As a single mom, she raised a special needs child and helped her successfully graduate from high school. In the first year of her treatment, Mary started recovering and started looking for work. Though very scared, she faced her fears of job interviews and applied. She landed a minimum wage job working in a small boutique business that she had loved for years. It turned out to be her dream job. Here’s what happened next.
As her confidence grew, she took over management of the website and product development at the boutique business. With her growing confidence and the skills learned in therapy, she spoke up to the owners about how they could make the company more profitable.
After her second year in therapy, she was hired full time and was able to switch to commercial health insurance and drop her FamilyCare coverage because she was making more money. Just recently, she was made part-owner of the company.
This same client experienced the fall out of Lynne Saxton’s plan to destroy FamilyCare. Early in her treatment in 2015, Mary’s mental health claims were denied because staff at the OHA had switched her care to HealthShare without her knowledge or consent. We discovered a number of other clients having the same problem. With FamilyCare’s help, we reinstated her services and she continued treatment.
Had she gone along with the arbitrary switch to HealthShare, she would have been subject to long wait lists for treatment, with therapists struggling with unmanageable case loads who would likely be unable to see her weekly.
Taking advantage of her FamilyCare coverage, she was able have weekly appointments, with a veteran therapist who specialized in PTSD, not someone just out of graduate school trying to manage a large case load.
Where would Mary be now, if she had lost her FamilyCare coverage? She might still be on HealthShare, struggling with PTSD, getting appointments when her new therapist could fit her in to an already full schedule. Instead of saving the Medicaid system the cost of her treatment, it would be prolonging it.
Mary is just one of many success stories.
Put Yourself in the Shoes of the Working Poor.
Imagine you have a spouse or a child with a serious chronic illness. And all of a sudden, all of your trusted providers, your doctors, your case manager, your therapists will no longer be available to you. You may have difficulty affording prescriptions, some of which may not be covered by HealthShare. You will have to start over with all new providers, who will likely place you at the end of a long wait list for treatment. If you have surgery scheduled, it will not be happening. Would you want this for your loved ones?
Yes it’s not fair. But more importantly, it is not cost effective.
When your child or spouse gets ill, the only place you can go for treatment is the Emergency Department or Urgent care. As their chronic health problem worsens, they will need more care, not less. And it will be more expensive care.
What We Urge the OHA, Governor Brown and the Oregon Legislature to do.
The only fair, logical and sane response is to keep FamilyCare open and pay the extra $32 dollars per client per month to stay with a system that is already working effectively rather than pay HealthShare the same amount and disrupt the lives of 120,000 Oregonians.
Yes this is social justice in action, which challenges the underlying bias that the poor and vulnerable deserve to suffer. But more importantly, it makes financial sense to provide quality healthcare so they can be part of the solution. We see our clients move in this direction every day.
Why pay HealthShare the same $32 a month to provide less service and cost Medicaid more through the ripple effect described above.
We urge the OHA and Governor Kate Brown to come to the table, to do not only what is right, but what will not only cost less in the short and long run.
We urge the Oregon legislature call a special session to agree to fund FamilyCare and help vulnerable Oregonians have the best chance of making a contribution to the quality of life and the community we love here in Oregon.
Sincerely,
Susan Wolfer, LCSW, SEP
Co-Owner of Counseling Services of Portland
7100 SW Hampton #129
Tigard OR 97223
Cell 503-816-2549
[1] Based on $1500 in benefits per month, for 6 months
