More people could be coming into Oregon’s healthcare transformation, but low-income advocates are opting for a step-by-step approach to a Basic Health Plan, a possible expansion of the coordinated care system that provides care to the state’s Medicaid population.
“We do think Basic Health is right for the state of Oregon,” said John Mullin, who’s helped lead a coalition of low-income advocates in support of the concept. “But we are interested in being deliberate and taking this one step at a time.”
House Bill 2934 directs the Oregon Health Authority to draft a framework for how the program will work to the Centers for Medicare & Medicaid Services and explain how the state plans to operate a Basic Health Plan for legal residents and citizens who earn up to 200 percent of the poverty level and did not qualify for the 2014 expansion of the Oregon Health Plan.
The Basic Health Plan would cover people who have low incomes, but who make too much money to qualify for the state’s Medicaid program, the Oregon Health Plan. Last year, the advocates helped pass House Bill 4109, which commissioned a favorable high-level study of the concept. That bill attracted some bipartisan support, with three Republicans in each chamber joining all the Democrats.
The discussion between the state and feds would give the Oregon Legislature the chance to vote on implementing the plan in the 2016 short session, Mullin told The Lund Report.
A likely vision for the Basic Health Plan in Oregon would be to expand the service population of the coordinated care organizations. Since the CCOs provide healthcare for children up to 300 percent of the poverty level, expanding the CCO service level up to 200 percent of poverty would provide free or low-cost care for their parents.
As described in the Affordable Care Act, the Basic Health Plan concept takes the money currently given to private insurance companies and redirects those dollars to the state for a program much like the Oregon Health Plan. The state could provide better care for less money than what it costs the federal government to help buy private insurance, not including the money consumers themselves must shell out of pocket for the remaining premiums and coinsurance for subsidized plans.
The Basic Health Plan was modeled after a defunded program in Washington state and the transfer of subsidies for a state program concept is currently used in Minnesota.
The cost to Oregon would not likely be zero -- last year, a study from the Wakely Consulting Group and the Urban Institute indicated that the cost for one likely option would be about $25 million -- still very low in terms of the state budget. Rep. Mitch Greenlick, D-Portland, said HB 2934 -- the blueprint -- would likely not require additional funding, since he had been told that the Oregon Health Authority could do such a plan within its existing budget.
Program Could Have Premiums
Janet Bauer of the Oregon Center for Public Policy testified that the cost to the state could potentially be lower since the Wakely study did not discount for pregnant women who currently receive assistance but who wouldn't otherwise qualify for the Oregon Health Plan.
The state could also elect to make people on the Basic Health Plan, especially at the upper end of the income group, pay a small monthly premium to support their health coverage, a policy the study did not assume in its numbers.
Mullin said many of these fine details would be worked out by the Oregon Health Authority in its discussions with the federal government.
The majority of the population covered by Basic Health, about 60,000 people, are working-class citizens, who make too much money for Medicaid and are instead getting by with private insurance bought on the federal exchange.
Oregon also has 6,000 legal immigrants whose incomes would qualify them for Medicaid if the program did not have a five-year bar on immigrants. There is no such barrier for the Basic Health Plan or the federal insurance exchange.
Alberto Moreno, the director of the Oregon Latino Health Coalition, said that farm workers add $5.3 billion to the Oregon economy, but a typical laborer earning $10,000 a year is not eligible for any of the existing Obamacare programs.
Of the immigrants, about 1,000 are Pacific Islanders whose homelands have been adversely affected by U.S. military involvement, including atomic bombing. Treaties allow for their immigration and they were once eligible for Medicaid, but these people lost coverage during the 1996 federal welfare reform act, according to Joseph Santos-Lyons of the Asian Pacific American Network of Oregon.
CCO System Not Working for All on Medicaid
HB 2934 is opposed by the Oregon Association of Health Underwriters, the lobbying group for the state’s insurance brokers. The group’s lobbyist, Doug Barber, noted that the Basic Health Plan would take away the consumer choice that patients have with private health plans.
Barber said that a separate state study from the Medicaid Advisory Committee advised against the basic health plan. But that in-house study assumed the state would operate Basic Health as a separate program and not integrate care within the CCO framework. A separate program would cause disruption in care both when a resident’s income goes down -- and they qualify for Medicaid -- and when their income goes up -- and they’re put back on subsidized private insurance.
“Integration and coordination would have benefits,” Mullin told The Lund Report.
Whether all the CCOs are actually up for the job is suspect, and none of them testified on the blueprint legislation. Barber pointed out that at least one CCO -- Trillium Health Plan in Lane County -- has had troubles doing the job it’s already been given -- providing for the healthcare needs of the state’s Medicaid population.
Many doctors refuse to take Medicaid because of low reimbursement rates, and Barber said Trillium had been unable to serve as many as 13,000 Medicaid-eligible adults in its coverage area over the past year, putting them back onto the Oregon Health Authority, where an “open-card” program gives them little access outside hospital emergency rooms. This comes despite a reportedly lucrative potential sale of Trillium to the Centene Corporation, a Fortune 500 company out of St. Louis.
By January, Trillium had reduced the 13,000 to a few hundred people, and as of Feb. 1, Trillium spokeswoman Debi Farr said the health authority had allowed Trillium to take responsiblity for the remaining people, although 6,300 remain without a primary care practitioner, which Farr blamed on an across-the-board provider shortage in the Eugene area.
Barber said that Lane County, which includes Eugene, has about one-tenth of the state’s population, presumably meaning the Basic Health Plan would put Trillium in charge of healthcare for another 6,000 to 7,000 lives. The Cascade Health Alliance in Klamath Falls has also had troubles over the past year and needed to temporarily turn away new members.
Barber didn’t mention one critical point -- insurance agents have a dog in this fight. They receive a commission on every individual healthcare policy they help consumers purchase on the subsidized insurance exchange, but they would receive no such money if the CCOs provided the health coverage.
Trillium and Cascade were the only CCOs that had been unable to handle the increased caseload that came with the Medicaid expansion. The other 14 CCOs took those new members in stride, and FamilyCare CEO Jeff Heatherington told The Lund Report late last year that his CCO would likely be able to accept new members from the Basic Health Plan without any problems.
Editor's Note: The original article incorrectly stated that Trillium was still not accepting new members. The Lane County CCO has been able to take all the eligible Oregon Health Plan members in its coverage area since Feb. 1. The revised article also clarified Trillium's inability to serve those members. We regret the error.
