Where President Trump plans cuts, Oregon plans to fill in the gaps, with $1.8 million in support for the 2018 health insurance open enrollment period, which starts in less than two weeks on Nov. 1, and runs through Dec. 15.
“Oregon is in a better position than other states that use healthcare.gov,” state marketplace spokeswoman Elizabeth Cronen said of the federal online insurance portal. “We run our own navigator program and our own advertising and marketing.”
When the state’s attempt at running its own health insurance exchange, Cover Oregon, failed, state officials switched to healthcare.gov, but they retained a handful of responsibilities -- including advertising and outreach -- and housed them in the Department of Consumer & Business Services.
That decision is paying dividends this year, as a presidential administration hostile to the Affordable Care Act has moved to sabotage the law.
Besides killing the subsidies to health insurance companies for cost-sharing reductions, Trump cut the funding for non-profit navigators nearly in half, from $63 million to $36 million, while taking advertising down 90 percent from -- $100 million to just $10 million.
If Obamacare has to continue, Trump appears to hope that nobody knows they can still get insurance through the Affordable Care Act.
Offsetting these cuts, the Oregon Health Insurance Marketplace plans to start TV ads in Portland, Eugene and Bend on Nov. 1, as well as radio ads throughout the state. It also plans to maintain its core strategy of billboard and web-based microtargeted ads through Facebook, Google and other Internet platforms.
The broadcast media buy runs to $528,000, while the marketplace plans to spend $700,000 on digital advertising. The ad buy is the first time that the marketplace has planned TV ads since Cover Oregon collapsed, although federal authorities previously ran their own broadcast ads. The digital ad purchase is down from $815,000 last year, when the open enrollment period ran twice as long -- till Jan. 31, 2017.
“Once we heard [of the federal cuts], we retooled our budget,” Cronen said.
In addition to the advertising spending, the Oregon Health Insurance Marketplace has released grants of $645,000 to nonprofit groups and health insurance brokers to facilitate their outreach efforts to consumers.
The marketplace gave six grants of $370,000 to nonprofit groups across the state, including Cascade AIDS Project and Project Access Now in Portland. Thirty-one brokers also received grants of $5,000 to $12,500 for a total of $275,000, in lieu of a commission.
Cascade AIDS Project focuses on people at risk of HIV or living with the disease, as well as the broader LGBTQ+ population. "We work in all three of these groups to make sure they have access to the insurance they need," said spokesman Peter Parisot.
Oregon’s marketplace still has limitations that a successful Cover Oregon would not have -- Washington residents looking for insurance on Washington Healthplanfinder will have till Jan. 15, 2018, to sign up, while Covered California will keep open enrollment going until Jan. 31.
The cost-sharing subsidies helped insurers keep premium costs down, but cutting them does not mean low-income consumers will have to pay more -- the insurers are required to still give people below 250 percent of poverty a discount on coinsurance and deductibles when they use the insurance.
“Coverage options and help paying is still available until the deadline on December 15,” Cronen said. “Those plans don’t change for the consumer at all.”
To help keep insurers solvent and prevent them from fleeing the market, the Department of Consumer & Business Services responded to Trump’s sabotage by raising silver-level individual health plans 7.1 percent from previously approved rates. Silver plans are mid-level plans, and the only plans which people can use to get help with cost sharing.
A bipartisan proposal has emerged in Congress from Sen. Patty Murray, D-Wash., and Sen. Lamar Alexander, R-Tenn., that would fund those cost-sharing reductions through 2019 at $10 billion a year, plus $104 million during the upcoming open enrollment, restoring promotional funding.
To make the deal more palatable to Republicans, the deal loosens restrictions on federal waivers to the ACA, and makes catastrophic “copper plans” available to everyone, not just adults under 30. Copper plans have an actuarial value of 50 percent, meaning the premium pays only half the average cost of care.
Additionally, the deal would save about $38 billion in the next two years in reduced premium subsidies, according the Congressional Budget office.
The deal has the support of 12 Republicans, a mix of conservatives and moderates, as well as the Senate Democrats. But the president has waffled on support and the House of Representatives may not play ball, with hardliners pushing House Speaker Paul Ryan, R-Wis., to oppose, despite recent support from mainstream conservatives like Rep. Greg Walden, R-Ore., to fund the cost-sharing reductions.
Reach Chris Gray at [email protected].