OPINION -- Oregon needs nearly $500 million in additional Medicaid funding in its next budget. How did we get here? How do we get out?
This shortfall is no surprise. The Affordable Care Act kindly promised to pay 100 percent of the extra bill to states that expanded Medicaid. Oregon accepted and promptly enrolled 386,000 new patients, all paid for by the federal government.
But that federal subsidy drops to 94 percent in 2017 and to 90 percent in 2020. Oregon’s new share represents an extra $369 million annually, which we don’t have. In five years, that share is $500 million, and we don’t have that either.
How will Oregon fund an extra $500 million — each year — to pay our Medicaid bill?
We have six options. None is easy.
The first five are the usual suspects, tried during previous Medicaid crunches and all leaving Oregon in terrible shape. In contrast, the untried option would leave Oregon in better shape — that option is universal care.
But first, the usual suspects, none of them pretty.
#1: raise taxes. Never attractive.
#2: slash other state programs. Fewer police, crumbling schools, less help for our elderly … been there and done that.
#3: reduce Medicaid eligibility. This immediately reduces state spending — until these desperately ill Medicaid-rejects stagger into emergency rooms. Then, unhappily, we spend more on their emergency care than we would have on their primary care. This option merely postpones increased spending.
#4: cut benefits. This option is no longer available, as Coordinated Care Organizations take responsibility for total care of Medicaid patients, not just individual services. Oregon can no longer pay just for specific procedures.
#5: pay CCOs less. Considering the precarious financial state of our CCOs with our current meager reimbursements, Oregon may end up with no CCOs and no physicians willing to accept Medicaid patients.
These are the familiar options. All addressed previous Medicaid shortfalls, but only temporarily and with severe compromises to Oregon’s quality of life.
Universal care is the untried option. This combines Medicaid with all other health care spending, including insurance premiums and out of pocket expenses. The subsequent single fund then provides comprehensive benefits to everyone, both Medicaid and everyone else.
With one program, one set of comprehensive benefits, and one network of all providers, administrative costs plummet. Experience with universal care confirms that net savings exceed the costs of increased coverage.
More than 20 states (including Oregon) are considering universal care. The appeal is obvious. Universal care provides better care to more people for less money in every population in which it is used. In Oregon, money recovered from unneeded administration exceeds the $500 million added Medicaid bill. Can any other option offer that?
Political obstacles are considerable. When Oregon changes how it pays for health care, special interest groups will object. But if access increases and costs decrease, patients and taxpayers will not.
Winston Churchill said, “You can always count on Americans to do the right thing — after they’ve tried everything else.” Oregonians have tried everything else. Now it’s time to do the right thing.
Dr. Sam Metz is a Portland anesthesiologist who has assisted in several pieces of health care legislation.
