The national health-care overhaul has dramatically reduced the share of Oregonians without insurance coverage, but it also has posed new challenges.

State Insurance Commissioner Laura Cali and Peter Graven, a health economist at Oregon Health & Science University, discussed the wide-ranging effects of the Affordable Care Act at a Salem City Club luncheon Friday.

“What we have is a result of a lot of competing interests,” Cali says.

While Cali declined to speculate what changes in the 2010 law might occur in the future, “you learn things along the way as you implement it and you make adjustments.”

Graven says Congress isn’t likely to change it anytime soon. The original 2010 law squeezed by with a 60-39 vote in the Senate — 60 is the minimum required to avert a filibuster — and 219-212 in the House. Both votes took place when Democrats had majorities in both chambers.

Since 2011, Republicans who have controlled the House have taken 56 votes, most recently on Feb. 3, to repeal it. However, President Barack Obama says he will veto any repeal.

Graven says a single-payer system, under which the government pays all health care similar to what Canada does, is also unlikely.

More to the point, Graven says, is what states such as Oregon do to extend coverage through private insurance and state-supported care known as the Oregon Health Plan — and how to keep that coverage affordable, such as the 16 coordinated-care organizations that oversee care for almost 1 million low-income recipients under the plan.

“It’s good to keep an eye on Oregon,” he says.

State regulation

As part of the Department of Consumer and Business Services, the Insurance Division regulates all insurance sold in Oregon, including health insurance for individuals and small groups. Cali took over as insurance commissioner on July 15, 2013.

Under the federal law, plans must offer “essential benefits,” are rated based on how much of their cost is shared with beneficiaries, and coverage cannot be denied to people based on pre-existing medical conditions. The law also requires individuals to obtain coverage.

For the first year of the federal health-care overhaul in 2014, she says, insurers had virtually no reliable claims data on which to project rates — and it was not much better for this year, when rates were set based on part-year claims data for 2014. However, she says the average rates that insurers proposed for 2015 were lower than in the initial round in 2014.

This year, as the Insurance Division considers rates to be set for 2016, Cali says insurers and her staff will refine the process.

“Our goal as a regulator is not just to make sure that rates are affordable as possible,” Cali says. “They also have to be sustainable.”

If an insurer sets rates too low one year and finds it has to raise them a lot more the next year, “the consumer is not winning.”

How Oregon stands

Graven listed some Oregon results from the federal overhaul:

• The share of uninsured people has dropped from 14.5 percent to 5.6 percent. “We have not seen that kind of drop anywhere.”

• Most of the new people (362,000) have enrolled in the Oregon Health Plan, which expanded eligibility from 100 to 138 percent of the federal poverty level. “Medicaid is the big story,” and around 950,000 Oregonians are enrolled in the plan.

• Oregon’s health insurance exchange added 70,492, although the net increase is about 32,000, once a decrease in individual and small-group increase purchasers is accounted for. Although Cover Oregon has been dismantled as a public corporation — and the state relies on the federal website for enrollments — lawmakers transferred remaining functions of the exchange to Cali’s parent agency.

• While formerly uninsured people use up to 32 percent more care, the growth of health care prices has slowed, “and they have come down closer to inflation.” Graven says, however, that expiration of some drug patents may have contributed to that trend – and that pharmaceutical companies are finding ways to raise prices on other medications.

• Uncompensated care provided by hospitals also has decreased as the number of uninsured people has dwindled, and may help reduce insurance premiums.

• The additional workforce projected to meet rising demand for health care has materialized — and Graven says it has surged faster than expected.

• Competition among insurers in Oregon is greater than among hospitals, depending on market areas.