Oregon is poised to make significant progress toward universal health coverage this year. Recent data put the uninsured rate in Oregon at 6%, about a 2/3 reduction in the percentage of people who lacked coverage before the Affordable Care Act (ACA). Despite this progress, gaps remain and not all who have coverage can afford to use it. Building on the 2023 expansion of Medicaid to all low-income immigrants, Oregon will start a new health plan in July that should further reduce the number of un- and underinsured.
The ACA had two major parts: the expansion of Medicaid to people up to 138% of the Federal Poverty Line (FPL) and the provision of subsidies for health insurance for people earning up to 400% of the FPL. Medicaid expansion succeeded in Oregon, allowing the state to piggyback programs like healthcare for migrant workers and dental care for veterans onto it.
However, the second half of the program is less successful. Tax subsidies gave many people in the 138% to 250% FPL range “free” bronze plans on the exchanges. However, these plans had high deductibles and cost sharing. Even free insurance doesn’t go far with a deductible in the thousands of dollars for someone making $25,000 a year.
In 2022, Oregon voters passed Measure 111, giving all Oregonians a state constitutional right to affordable, clinically appropriate, and cost-effective health care. The new basic health plan will implement Measure 111 by taking the federal money that was used for tax credits and use it to expand Medicaid up to 200% of the FPL. The program will be administered through the Oregon Health Plan (Oregon’s Medicaid program). This minimizes Medicaid “churn”, which happens when families’ varying income causes them to go on and off the Medicaid rolls frequently. It comes at just the right time for many, as the pandemic area requirement not to drop people off Medicaid comes to an end.
It is not all sunshine and roses, unfortunately. Medicaid only pays providers about 80% of the cost of providing care. Conversely, Medicare pays 100-102% of the cost. Effectively, this means that providers will have to charge private insurers more to cover the deficit, meaning that provider reimbursements from private health insurance generally range from 120%-200% of the cost of delivery. It is for this reason that most single payer proposals rely on Medicare as their foundation, not Medicaid. Expanding OHP up to 200% of the FPL is expected to drive costs up and will hit those in the 200-250% FPL range particularly hard.
We are see Oregon’s over-reliance on Medicaid not just in high private insurance premiums, but also in limited access to primary care. To put it bluntly, we have expanded health insurance coverage at the cost of making it very difficult for providers to offer primary care. This is especially true in pediatrics. When the federal government passed the Children’s Health Insurance Plan(CHIP) in the 1990s, Oregon piggybacked pediatric care on Medicaid up to 300% of the FPL, similar to what will happen under the basic health plan. Almost half of babies are born on Medicaid or CHIP in Oregon and Oregon’s uninsured rate for children is half that for adults. However, because provider reimbursements for care are far below the cost of delivering healthcare services, access to pediatric care has become more and more difficult, with access to children’s mental health care being especially poor. Access to primary care has become so difficult that Oregon’s most recent Medicaid plan had to include specific provisions ensuring that payments to primary care providers did not drop below 80% of the cost of delivery.
Despite the drawbacks, the Basic Health Plan represents a big step forward. About 100,000 Oregonians, roughly 2.5% of the population, are expected to benefit from it. While not all of these would have been uninsured, a substantial portion were and others had health insurance that was too expensive to use. While it’s no quantum leap forward, the Basic Health Plan represents significant progress toward universal health coverage.
Dehumanization as an Obstacle to Peace
Dehumanization of the enemy is a major threat to any resolution of any armed conflict. Prisoner exchanges are one measure of dehumanization. When we see hugely disproportionate ratios, it’s a sign that there’s a fundamental unwillingness to see the other side as fully human. We see this in the Israel/Gaza conflict - Hamas demands multiples of their own people released for every hostage they release. Conversely, in the Russia/Ukraine conflict, the exchanges are in rough parity. While both conflicts have a long road to resolution, this is at least one indicator that there is still hope for a long-term peace between Ukraine and Russia, however difficult it will be to get to a just place to end hostilities. It is also perhaps one reason why recent polling shows Israelis as doubtful of their security in the future.
Recommendations
Oregon Politics. If you just can’t get enough, The Oregon Way over at theoregonway.substack.com will give you great information weekly.
There’s a related podcast with Ben Bowman, Reagan Knopp and others at -
https://oregonbridgepodcast.podbean.com/
Health Policy. Fellow health policy nerds, you will find no better podcast on the topic than What the Health from kff.org. https://kffhealthnews.org/news/tag/what-the-health/
Spanish. If, like me, you’re learning Spanish the long way, Simple Stories in Spanish is a great podcast to help you progress.
https://smalltownspanishteacher.com/category/simple-stories-spanish/
The 4th Most Populous and Largest Islamic Country on Earth. Ok, this is admittedly a niche interest, but I love Jeff and Kevin’s podcast about Indonesian Politics -
https://reformasi.buzzsprout.com/
Got a suggestion you’d like me to highlight? Shoot me an e-mail at wildefororegon@gmail.com and I’ll check it out.
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From your post... this sentence was a slap in the face:
"When we see hugely disproportionate ratios, it’s a sign that there’s a fundamental unwillingness to see the other side as fully human. ...Hamas demands multiples of their own people released for every hostage they release."
...Perhaps you are unaware of the degree to which the Israeli gov't does not see Palestinans as humans. They are seen as animals... men, women and children alike... "Never again" means never againfor ANYone. Perhaps you will believe Human Rights Watch?
I grieve for the people of Gaza, but I also grieve for the people of Israel. The crimes that their gov't is committing, with our gov't's assistance, will no doubt come back to haunt them, and likely us, too. Enough already, of the violence perpetrated around the world by our military industrial complex.
https://www.hrw.org/news/2023/11/29/why-does-israel-have-so-many-palestinians-detention-and-available-swap