Oregon Grapples With Republicans’ Federal Healthcare Proposal

Bill released Tuesday by Congressional Republicans would eliminate public health efforts, cut funding for state Medicaid programs, eliminate dollars for in-home care for intellectually and developmentally disabled

As Oregon’s healthcare leaders grapple with their first official look at the Affordable Care Act Republicans in Washington, D.C., have drafted, they are faced with a bill that could force drastic changes to the state’s ongoing efforts to provide insurance coverage to all Oregonians. The Oregon Health Policy Board received an initial briefing on the Congressional proposal Tuesday morning.

“We all know this is probably a long, long conversation, this is probably the first of many versions,” Leslie Clement, director of health policy and analytics for the Oregon Health Authority, told the board. “In fact, we looked at a leaked bill that came out and was publicly shared, we are looking at this, and we expect to look at other versions.”

But the version presented Monday night by Congressional Republicans would directly counter a number of major goals being sought by the state.

In recent visits to Washington, D.C., Oregon Health Authority leaders emphasized their priorities for a “repeal and replace” bill, Clement said.

“Changes to the ACA and Medicaid should maintain, not reverse, gains to enrollment,” she said.

“Oregon’s coordinated care system is a model for federal Medicaid reform. We believe that cost changes should be achieved by changing the delivery system,” she continued. “Federal changes to the ACA should stabilize, not disrupt, Oregon’s insurance market. … Funding should allow innovation and a focus on prevention, including funding for public health services.”

Instead, the proposed bill would remove all funding for public health prevention and wellness efforts, she said.

The proposed ACA replacement also removes funding for Oregon’s “K Plan,” a program that funds in-home healthcare support for intellectually and developmentally disabled children and adults. The American Health Care Act would also require officials collect documentation proving citizenship before enrolling new members.

“There is a new requirement that was not in the previous proposed bill that requires a redetermination every six months to validate eligibility” of people enrolled in Medicaid-funded plans,” Clement said. “And then there’s a phase-out of enhanced Medicaid funding. That’s of great significance to us.”

A new payment cap would also potentially limit dollars coming to Oregon from federal Medicaid funds.

“Massive changes seem to increase administrative burdens to everybody engaging in the process, as well as shifting financial responsibility to the state from the federal government,” Clement said.

Though passage of the American Health Care Act would upend Oregon’s years-in-the-making healthcare reform efforts, state leaders are continuing to move ahead with implementing the Affordable Care Act while it remains in effect.

Those ongoing efforts include a push to better coordinate applications for CCO coverage with the process of applying for food stamps and Temporary Assistance for Needy Families, known often as welfare.

In addition, a state-level push to provide health insurance for all children, regardless of immigration status, is moving forward in the state legislature, said BethAnne Darby, director of external relations at the Oregon Health Authority. The Cover All Kids legislation would be state funded, as federal Medicaid rules already prohibit undocumented immigrants from receiving Medicaid coverage.

“Shortly after the new president came into office, Governor Brown issued an executive order of nondiscrimination based on immigration status,” Darby said, noting the Cover All Kids legislation has strong backing from the governor.

After hearing from Oregon Health Authority officials, members of the Oregon Health Policy Board urged those leaders to continue working with the state’s congressional delegation, and to communicate the legislation’s effects with people in the state.

“I would imagine it takes a good bit of staff time to do the analysis of what’s coming out of Washington, DC,” said board chair Zeke Smith, who is chief impact officer of the United Way of the Columbia Willamette.

“It’s going to be very important for the public to access what this means,” said Karen Joplin, a member of the board, and board chair of the Columbia Gorge Health Council, the gorge’s regional CCO governance body.

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Reach Courtney Sherwood at sherwood@thelundreport.org.

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