U.S. Rep. Greg Walden maintains that his plan to replace the Affordable Care Act won’t cause Oregonians to lose their Medicaid coverage.
“In Oregon, if you’re on Medicaid or expanded Medicaid, you stay on,” the Oregon Republican told The Bulletin shortly after his committee released its plan, “and the state gets reimbursed at the same rate.”
The latter — and possibly even the former — would no longer be the case in 2020, which is when the plan, if passed, would dramatically lower the amount the federal government pays to cover Medicaid enrollees who joined the program under the Affordable Care Act’s 2014 eligibility expansion. Not only that — the plan seeks to overhaul how the federal government pays states to cover their Medicaid populations, changes health policy experts say would result in less money for states.
Those changes would result in billions fewer federal dollars to Oregon’s budget, said Leslie Clements, director of health policy and analytics for the Oregon Health Authority. OHA officials are currently trying to determine exactly how much money Oregon would lose, and plan to release those findings next week.
So far, it doesn’t look good for Oregon.
“We’re trying to find the golden nugget here that gives us some hope that this is going to be good for the citizens of Oregon, and we’re really challenged to find that piece,” Clements said. “This just feels like a massive shift in terms of the cost to the states.”
Clements couldn’t say for certain whether any of the more than 1 million people currently enrolled in Oregon’s Medicaid program, known as the Oregon Health Plan, would lose coverage if Congress approves the plan. Two House committees approved the House Republicans’ proposal, called the American Health Care Act, on Thursday.
Cutting Medicaid expansion
The federal government currently pays for 95 percent of the health care costs for the more than 375,000 people covered under the 2014 expansion, which allowed people with higher incomes to join the program. The federal government pays about 60 percent of the costs of the rest of the people on the program.
The House Republicans’ plan would bring federal reimbursement for the expansion population down to the same level as the rest of the OHP population: roughly 60 percent.
“That is a significant impact,” Clements said. OHA officials haven’t yet calculated how much anticipated federal reimbursement Oregon would lose.
Nationally, an estimated 11 million adults became eligible for Medicaid under the Affordable Care Act in 2015, all of whom risk losing that coverage under the plan, according to the Kaiser Family Foundation.
Per capita payment
The American Health Care Act also seeks to change the overall structure of how the federal government pays states for Medicaid.
Currently, Oregon tells the federal government how much it costs to cover its Medicaid population, regardless of how many people are enrolled, and the federal government pays a percentage of that with no limits set ahead of time.
Under the plan, the federal government would pay the state based on the number of people enrolled in the program. That per capita payment would be adjusted for medical inflation. The state would get higher payments for populations that are more expensive to cover, like seniors and individuals with disabilities, and lower payments for less expensive populations, like children.
Such a format would reduce overall funding levels to states, likely causing them to restrict eligibility, benefits and payments to medical providers, according to the Kaiser Family Foundation.
Under the current system, federal payments for Medicaid are adjusted annually based on the state’s economic condition, Clements said. That would not happen under the proposal. The current system also allows for the federal government’s share of Medicaid spending to increase during recessions, when more people tend to join Medicaid programs. The new proposal also would not allow for that, she said.
“That would be a concern for us going forward under that methodology,” Clements said.
Clements said her agency is also concerned about a provision in the plan that would make people renew their Medicaid eligibility every six months rather than every year, as the program currently exists.
That would place a large administrative burden on states to process all of that paperwork and would likely cause many people to unintentionally lose coverage because they didn’t know they had to renew, Clements said.
“People fall off because you’re not able to connect with them,” she said. “That’s a big, significant concern of ours.”
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