Supreme Court Ruling Met With Relief in Oregon

Oregon’s reforms will continue without disruption or loss of necessary funding

June 28, 2012—Today’s Supreme Court ruling largely upholding President Barack Obama’s Patient Protection and Affordable Care Act and its provisions means it’s full steam ahead for the state’s health insurance exchange, creation of coordinated care organizations, and other reforms being implemented in the state.

A flurry of press releases and statements from elected officials, health providers and consumer organizations celebrated the Court’s ruling, emphasizing that the law’s provisions—including allowing young adults up to age 26 to be on their parent’s health plan, prohibiting insurance
companies from not covering people with pre-existing conditions, and doing away with life time caps—will continue and thus help people access healthcare more easily.

Rocky King, the exchange’s executive director, said he and other exchange staff celebrated the ruling for about 10 minutes. Then they got back to work.

“There was a great feeling of relief that we don’t have to spend a lot of time finding solutions to what could have been a very difficult six months,” King said. “I don’t think there’s any change based on the ruling coming out of the Supreme Court this morning. We’re moving forward.”

Rep. Val Hoyle (D-Eugene), co-chair of the Ways and Means Human Services Subcommittee, said she “was not hopeful” the Court would uphold the law, and that she and other legislative leaders had already begun crafting a “plan B” in case the Court had ruled differently.

“We would have moved forward,” she said. “It would have been more difficult.”

Oregon is getting local and national media attention for being ahead of many other states in health reform. The state’s coordinated care organizations (or CCOs), which will integrate and coordinate the physical, mental and dental care of Oregon Health Plan members starting in August, are one example of Oregon anticipating many of the provisions of the Affordable Care Act (in the case of coordinated care organizations, expanding a coordinated medical home model of care).

Hoyle attributes much of Oregon's success the collaboration among numerous interest groups, including businesses and consumer advocacy groups, as well as bipartisanship on the part of lawmakers. “It [wasn’t] hyper partisan,” she said. “We were able to approach it by working together.” You’re not seeing that elsewhere.”

The exchange, created by the Legislature in 2011 and which will begin offering insurance coverage to individuals and small businesses in January 2014, stood the most to lose if the Supreme Court had ruled differently.

The law’s individual mandate, which requires people to purchase health insurance or pay a fine, quickly became the law's most controversial piece, with opponents arguing it violated the Constitution’s commerce clause.

If the individual mandate had been struck down, it would have seriously impacted the exchange’s ability to attract people to purchase insurance and meant there might not have been a sufficient pool of people in the exchange to keep the premium rates low. Also, federal subsidies expected to help people purchase insurance through the exchange, if they earned below 400 percent of the federal poverty level, would not have been available.

Additionally, federal grant funding helping exchanges become operational would have dried up. Oregon’s exchange has been the recipient, thus far, of $64 million in grant funding. King said the federal government would have honored any financial commitments that had already been made, but future funding would have been unlikely.

King said it would not have been as simple as going to the Legislature and asking lawmakers for money. “It would have been a very, very tough debate to move forward without federal dollars,” he said.

The Supreme Court ruled that the individual mandate can be enforced as a tax, rather than as a way of regulating commerce. King doesn’t expect that to impact the exchange’s efforts to attract people to purchase coverage.

“I think a lot of people are going to buy insurance,” he said. “Will everybody buy insurance? Of course not. Look at auto insurance now. People take those risks. But if you’re paying $90 a month [as a fine], you’re getting nothing. If you’re paying $150 a month, at least you’re getting coverage.”

Image by Matt Wade (CC BY-SA 3.0) via Wikimedia Commons.

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"...if you’re paying $90 a month [as a fine], you’re getting nothing. If you’re paying $150 a month, at least you’re getting coverage.” I object to this argument. As a house painter and recent graduate from university, with more than $40k in student debt, married to an adjunct English professor with $100k+ in student debt, even $90 is a lot of money to commit every month. This is the problem with mandated insurance. It assumes that everyone has a little extra to spend, or that we can divert our less-productive medical expenditures to this new monthly bill. The people organizing these solutions aren't in touch with the needs of working class people. We are currently spending $0 on healthcare - not because we don't need it, but because we don't have extra money to spend. -Joe

Dear Joe. I hear this same complaint over and over. BUT... why should you prioritize your student loan debt over your inevitably huge healthcare costs? You and your family members will not avoid expensive healthcare problems forever -- It's not "if" but "when" that you will have some health calamity, say a broken neck or arm, from falling off a ladder when you are painting a house, or your wife falls down the stairs when going to teach a class. You will be taken to an ER and your bills will be too much for you to afford on your own. Since you don't have any health insurance, the rest of us will pay your healthcare costs because you do not have any coverage. This is why my healthcare costs are going up in double digits every year -- too many like you are shifting your costs to the rest of us because you prefer to budget $0 for healthcare. Why is it that you feel ok about not paying for your healthcare but you willingly pay for your student debt, car insurance, home/rental insurance, cell phone, rent, food, etc., etc.? I don't get it. You can only spin the roulette wheel so many times until your number comes up and you have healthcare bills that you cannot possibly pay out of pocket. The time has come for people in your position to rethink how you are prioritizing your family budget and stop relying on the rest of us to pay it for you, your wife and your children. Truth is that the real cost of healthcare for working class people has a real number attached to it... and it is not $0. What would you be willing to pay to get healthcare for you and your family when you need it? And how much of that do you think that I should pay for you?

Sassy, you've got it right. HippyJoe - you are responsible for the cost of your healthcare, and those costs are inevitable and unpredictable. You carry auto insurance don't you? Yet collisions are less likely than healthcare. So what makes it OK for you to neglect this in your budget? When you chose to borrow for your student loans, you didn't factor in healthcare? There are millions of other Americans like you, and I am paying for it along with my own premiums, and I don;t like it. How about taking your share?