The Oregon Legislature launched a panel 10 months ago to develop a roadmap for affordable statewide universal health care. The task was ambitious. Similar efforts in other states have gotten nowhere, and there is scant support at the federal level for expanding Medicaid.
The group is closing in on its first report, due later this month. But it won't come close to being a guide for achieving universal affordable care.
Completing that task would be “like trying to find world peace,” said the panel’s chair, Rep. Andrea Salinas, D-Lake Oswego.
Besides differing opinions, there’s a lot of money at stake.
The Universal Access to Health Care Work Group, composed of lawmakers and health experts, has sketched out options for how to expand coverage under the Oregon Health Plan beyond the 1 million Oregonians already covered.
It's far from nailing down a funding concept, a price tag, or even a hard number for how many more people would gain coverage.
One of the problems is that any expansion of the Oregon Health Plan would be costly to taxpayers. Right now, the state’s Medicaid programs are budgeted to cost $13.8 billion in the current two-year period, which ends June 2019, with $10.3 billion from the federal government and $3.5 billion from the state, according to the Oregon Health Authority. The state’s share is proposed to rise 20 percent, to $4.2 billion, for the biennium starting July 2019, in part to cover a greater share of expanded coverage the state carried out under the federal Affordable Care Act.
To date, the panel, created by Rep. Mitch Greenlick, chairman of the House health committee, has zeroed in on the preliminary step of further expanding the health plan to cover even more people, mainly those whose incomes are above the current cut-off for qualifying for Medicaid, but who find it too costly to buy private health insurance, either on the state-overseen exchange or through work.
This is called the Medicaid buy-in option.
A number of other states – Minnesota, Massachusetts, New Mexico and Nevada – have looked at this option but none has adopted it, according to reports filed with the committee. The concept has gained little traction in Congress, and President Donald Trump has tried to dismantle the Affordable Care Act.
Finding the money to pay for any expansion “is the difficult part,” Salinas said.
A Medicaid Buy-In Option
The options developed by the workgroup center around creating a health/dental/mental health insurance package that would be offered to people above the current income cutoff for Medicaid of $16,100 a year for a single person and $32,900 a year for a family of four.
The panel has talked of expanding coverage to those earning up to 400 percent of the federal poverty level -- $48,500 for a single person or $100,400 for a family of four. The higher the range, the greater the number of people who would be included in the expansion.
Coordinated care organizations, the groups that act as insurers under the Oregon Health Plan, could either open up their rolls to those people, or create a separate insurance plan and offer it through the state health insurance exchange, according to the concepts developed by the workgroup.
A grant-funded May 2018 study by Manatt Health, a Los Angeles-based consulting firm, warned that expanding Medicaid and providing “less expensive or more generous” government-funded plans “could destabilize the marketplace” where private insurance is offered.
What such an expansion would cost in Oregon and who would pay for it remain unclear. Someone would have to pay premiums to the coordinated care organizations -- either the government, the added residents or both.
“Hopefully there would be a federal and state contribution,” said Dr. John Santa, a panel member who’s also on the Oregon Health Policy Board, which oversees the Oregon Health Authority. Many Oregonians need health insurance for a limited time – for example, a worker who loses insurance at age 63 and isn’t eligible for Medicare until 65, he said.
“Hopefully these folks would be worthy of support for a period of time before they got to a more stable place,” Santa said.
Health insurance offered by the private sector via the state health-care exchange might be too expensive for many consumers, Santa said. Even with federal tax credits available for many people who buy insurance via the exchange, it can be a struggle for consumers to pay premiums, deductibles and co-pays for private insurance, Santa said. In comparison, the Oregon Health Plan is almost entirely free to those who qualify.
Most Oregonians Already Covered
The vast majority of Oregon’s four million-plus residents have health insurance, according to the latest Oregon Health Authority data, for 2017. The Oregon Health Plan covers 1 million or one in four Oregonians. Group plans for public and private-sector employees and dependents cover 1.9 million. Medicare covers 600,000. Some 200,000 people are covered by insurance they buy privately, often via the exchange. Less than 245,000 are uninsured.
A study released this year by the state found that many of those uninsured in 2017 were eligible for coverage under the health plan or could get subsidies by buying insurance on the health insurance exchange. If all those people got insurance, only about 34,000 Oregonians would be uninsured, the study found.
But Salinas said under Oregon’s current system, too many people are paying too much for their health insurance, relative to their income. A “single payer” system in which the state buys and oversees all health insurance, could reduce costs, she said.
Advocates have found that creating what they call a “glide path” to such as system is hard.
As part of its concept of expanding coverage under the Oregon Health Plan, the workgroup talked about offering coverage to higher-income residents in return for securing from the federal government the premium assistance payments those residents would be due. The premium assistance payments could help cover the cost of the expanded coverage, Salinas said. But that would likely require federal approval, and no state has secured that, she said.
The average Oregonian buying insurance through the exchange averaged just over $4,000 in federal premium assistance last year, according to the Department of Consumer and Business Services, which runs the marketplace. But that amount would not cover the cost of adding those individuals to Oregon Health Plan, Salinas acknowledged. The current fiscal year’s Oregon Medicaid budget works out to about $7,000 per covered member.
The work group’s pending report to the Legislature “does not have to be the end of the discussion. This is the start of the discussion,” Salinas said.
For more information, visit this webpage. Photo by Bryan Brenneman/CC BY 2.0
You can reach Christian Wihtol at [email protected].