A legislative task force has announced its initial recommendations for how to design a new health insurance program to cover poor Oregonians who still make too much to qualify for the Oregon Health Plan.
In a meeting on Oct. 18 at 8:30 a.m., the public will learn more about how the plan might look in real life, and what effects it might have on the health care system.
Proponents of the plan say it will improve health outcomes for people throughout the state, particularly those who cycle on and off the Medicaid-funded OHP or can't afford insurance through the state's existing health insurance marketplace. That’s the website where people who don’t receive government or employer-based coverage can obtain premium-reducing tax credits and purchase their own policies.
The Bridge Health Program, as it is called, would be available to individuals making under 200% of the federal poverty level — or $55,500 per year for a family of four — but more than 138% of the poverty level, which is the state Medicaid cutoff. The lower end of the range translates to $38,295 per year for a family of four.
Those above 200% of poverty will still be eligible for coverage on the health insurance marketplace.
Around 94% of Oregonians currently have health insurance.
The preliminary program design was released Aug. 31.
“The bridge plan is certainly a solution for folks who qualify for it,” said Maribeth Guarino, OSPRIG high value health care advocate. "Most people can agree that we need to do something about health care costs … the people between 138% and 200% are the most vulnerable at this point.”
Introduced by outgoing Rep. Rachel Prusak on behalf of the House Health Care Committee, House Bill 4035 last year initiated the task force. One of the key goals for the program is to leverage available federal funding to the greatest extent possible.
The path the task force decided to take — with input from the Centers for Medicare and Medicaid Services — was to create a basic health plan utilizing a federal program known as the 1331 waiver. It's named for the section of the 2010 Affordable Care Act that authorized it.
Members of the task force intend for the benefits within the health plan to be substantively similar to what the state already provides through OHP, and it is being designed to avoid the need for cost-sharing reductions (premiums, deductibles, co-insurance, co-pays) for individuals, relying instead on federal dollars.
The state will at least have to allocate funds for administrative costs, which will be discussed during the upcoming 2023 session of the Oregon Legislature.
However, a number of actuarial analyses are not yet completed, so uncertainty still exists around the program's financial ripple effects and overall costs.
The task force will learn at its Oct. 18 meeting the results of simulations that tested how much this program might impact the marketplace with respect to premiums, enrollment, morbidity, composition and tax credits.
This analysis could lead to changes for the design of the plan if costs are higher than currently anticipated, members of the taskforce said at their Oct. 4 meeting.
“Under no circumstances do we want to see the marketplace destabilized … because then we have perpetuated the exact problem we’re trying to solve, which is helping people access health insurance,” said Marty Carty, director of government affairs for the Oregon Primary Care Association.
Plan Could Help 55,000 People Next Year
The program's biggest target, at least initially, is individuals who have remained on OHP during the coronavirus pandemic despite no longer qualifying.
Throughout the pandemic, due to a new federal policy, the state of Oregon has not removed anyone from OHP, opting instead to allow enrollees to maintain their health insurance coverage.
However, the public health emergency declaration that has allowed this "continuous eligibility" is expected to end in the coming months, perhaps as early as January. The state will then have one year to check the eligibility for all members of the plan. Without a health plan in place for poor individuals, thousands of Oregonians could lose their insurance if they're unable to pay for marketplace plans.
The Oregon Health Authority estimates as many as 300,000 Oregonians could lose OHP insurance after the public health emergency ends.
Of that number, state officials estimate the bridge program could enroll an estimated 55,000 people in 2023. In 2024 and beyond, as people move into BHP from marketplace plans and from uninsurement, that population could double, according to an analysis presented to the task force.
At a minimum, the plan will cover the same 10 “essential health benefits” as any plan offered on the health insurance marketplace. However, the taskforce supports providing more benefits, including up to the service level provided by OHP, if possible.
One of the big issues not resolved is adult dental care coverage, which is included in OHP but is not among those services considered essential health benefits. Lawmakers in HB 4035 noted explicitly they wanted the bridge plan to include dental coverage options "to the extent practicable" because they view it as a critical health care need.
Some proponents note that creating identical public health insurance options is simply a more fair option.
“We don’t want a two-tiered health insurance program where the state offers a set of benefits to one group of people and a different set of benefits to another group,” Carty said.
Care under the basic health plan would be provided by the same regional insurers, called “coordinated care organizations,” that contract with the state to serve members of the Oregon Health Plan. It would allow individuals to retain their health care providers whether on OHP or the basic health plan.
This, along with making the new program's benefits identical to OHP as some proponents want, will allow a more seamless transition between OHP and BHP for the "churn" population — people who often qualify for OHP, but some months earn more income and bring them to above 138% of the federal poverty level.
Research has found these individuals — who include seasonal farmworkers — will often go without insurance during the periods they don't qualify for OHP instead of going through the hassle of finding new insurance and health care providers.
"That kind of churn is really bad for people's well-being because you lose continuity of care, you lose access to care and it's expensive," said Sen. Elizabeth Steiner Hayward, D-Beaverton. “When people aren't getting the right care, then they don't take their medication properly, they end up in the emergency department more, they don't control chronic illnesses well and we have the administrative costs of getting people back on OHP."
The basic health plan process could, as some advocates support, lead to the state extending optional government coverage to people who make up to 400% of the federal poverty limit using a different kind of federal waiver. But conversations for that possibility are not likely to begin until 2025, if the basic health plan is successfully launched
Throughout the fall the task force will review its design for the bridge program; a final report is due by Dec. 31.
You can reach Connor Radnovich at [email protected] or via Twitter @CDRadnovich.