state legislature

355,000 Oregonians could lose health coverage

State budget cuts may include Medicaid expansion

By Tara Bannow, The Bulletin, @tarabannow

Public hearings

Oregon’s budget-writing joint Ways and Means Committee will host a series of public hearings in seven Oregon cities. Central Oregon’s event will take place from 1 to 3 p.m. Saturday at Madras High School’s Performing Arts Center, 390 SE 10th St. in Madras.

Kim Palin didn’t notice at the time how much caring for her elderly parents was affecting her own health. She just did what had to be done, even if it meant driving her dad from Prineville to Bend five days per week for cancer treatments.

He died around the same time her then-husband’s post-traumatic stress disorder got out of hand. She sold her business to care for him.

“I didn’t look at that as stressful,” said the 64-year-old Prineville resident. “I just looked at it as what you do.”

She got onto Oregon’s Medicaid program, the Oregon Health Plan, and saw a doctor who diagnosed her with sleep apnea and an irregular heartbeat, remnants of years of stress. She’s now on heart medication and uses a machine to keep her breathing while she sleeps.

“It’s good support,” she said of OHP. “I’m very, very thankful for it every day.”

President Trump and Republicans in Congress vow to repeal the Affordable Care Act, including its 2014 expansion of Medicaid to more people. It might surprise, though, that Oregon’s own legislators — known for their progressive stances on health care — may themselves eliminate Medicaid for the roughly 355,000 low-income Oregonians added to the program since the expansion in their effort to fill a $1.8 billion budget hole.

“I wouldn’t necessarily call it a worst-case scenario,” said Sen. Richard Devlin, a Tualatin Democrat and the Senate’s chief budget writer. “I would call it more a realistic scenario given what our resources are.”

Leaders from the Legislature’s budget-writing committee released a 2017-19 budget framework that delivers a nearly 28 percent cut to the Oregon Health Authority and proposes rolling back the 2014 Medicaid expansion under federal health care reform that opened the program to people with higher incomes than were previously covered.

As of fall 2016, 1 in 3 Oregonians on OHP — about 378,000 people — had joined the program under the expansion, according to an OHA report. That number has since declined to roughly 355,000.

In Central Oregon, that population included nearly 23,000 people as of fall 2016, according to the report. Another 34,500 had been on the program prior to the expansion.

Mosaic Medical, a community health center with clinics throughout Central Oregon, has about 5,000 patients who are on OHP as a result of the ACA expansion. Dr. Christine Pierson, Mosaic’s chief medical officer, said patients are in tears over the prospect of losing coverage. Many of them have just begun getting the medical care they needed for years, she said.

“There’s a lot of fear about what’s going to happen,” Pierson said. “We’ve finally gotten them on regimens of medication and things they need to sustain good health and now they fear, ‘What’s going to happen if that goes away? I cannot afford those things.’”

Medicaid in Oregon is administered largely through 16 regional coordinated care organizations, which are funded based on how many members they have. If approved, the changes would be a difficult blow for CCOs.

Leslie Neugebauer, director of Central Oregon CCO’s, PacificSource Community Solutions, declined to provide an opinion on the new budget proposal. She said it’s not clear how much revenue the CCO would lose or whether it would have to cut services.

“We haven’t had discussions internally about how it might affect operations because it’s not finalized yet,” she said.

Part of the idea behind a budget framework is to make it so “unpalatable” that legislators agree on new revenue measures to help fill the budget hole, said Ben Hoyne, executive director of CCO Oregon, a nonprofit member association that supports CCOs. Nonetheless, he said the cuts to Medicaid expansion would hurt CCOs.

“Honestly when you’re paid by the number of lives covered, cutting that in half would be a dramatic cut,” Hoyne said.

The state has only about a 6 percent increase in general fund dollars and other money to address its 2017-19 needs, said Devlin, an author of the budget framework and co-chair of the joint Ways and Means Committee. Most state functions, such as education and public safety, require 8 percent budget increases to continue operating at current levels, he said.

The OHA, by contrast, would need a 50 percent budget increase, Devlin said. That’s because much of the agency is funded by one-time funds or funds whose sources are changing. The federal government’s contribution to Oregon’s Medicaid program is declining across the board, and the CCOs did not receive any of the $1.25 billion the OHA had requested from the federal government over the next five years to continue its reform efforts.

The budget framework also proposes cutting some of the services Medicaid covers entirely. It would also reduce funding for dental and addiction services, school-based health centers, family planning services, tobacco cessation programs, county health departments and would close wards at the Junction City and Salem campuses of the Oregon State Hospital.

The cuts would affect people like 39-year-old Angela Bishop of Prineville. She joined OHP after losing the coverage she’d had through her husband’s employer, a local mill that closed in 2015.

Bishop has four kids and has been battling recurring cervical cancer since 1999. OHP has allowed her to continue her treatments. Her next surgery is scheduled for April.

“If I didn’t have the Oregon Health Plan, I wouldn’t have been able to be alive today,” Bishop said.

Palin is looking for a job and said she plans to get off of OHP once she finds one. But for now, the program pays for the machine and medications that keep her healthy. Losing it would be tough.

“It would be pretty traumatic for me,” she said.

— Reporter: 541-383-0304,

tbannow@bendbulletin.com

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