By Tara Bannow

The Bulletin

Up to 465,000 Oregonians would lose health coverage by 2023 under the Republican plan to replace the Affordable Care Act, according to a new state report. Of those, 80,000 would lose coverage next year.

The American Health Care Act, unveiled by members of Congress last week, would mean $2.6 billion less in federal funding to Oregon in that time, a cut that would force the state to downsize its Medicaid program if it’s unable to fill the hole with state funding. The state already faces a significant budget deficit, however, including a shortfall in its Medicaid budget.

The report comes from the Oregon Health Authority and the state’s Department of Consumer and Business Services. Gov. Kate Brown directed the agencies to analyze what effects the American Health Care Act, if passed, would have in Oregon.

“This bill will pull the rug out from under Oregonians — from families, to doctors, to hospitals,” Brown said at a news conference Thursday in Salem.

The AHCA would triple the number of uninsured Oregonians, bringing the state’s uninsured rate to more than 15 percent by 2023, according to the report. Under the Affordable Care Act, the state’s uninsured rate went from 17 percent down to the current 5 percent.

The nonpartisan Congressional Budget Office estimates 24 million Americans would lose coverage by 2026 under the AHCA.

Medicaid changes

The biggest coverage losses are projected to take place in the state’s Medicaid program, known as the Oregon Health Plan. Up to 375,000 of the roughly 1 million people currently on the program could lose coverage by 2023, according to the report. That’s both because the state is no longer able to cover them and because of new administrative rules under the AHCA that would make it more difficult to stay on the program.

The AHCA would reduce funding for Medicaid in a number of ways.

Most importantly, it would bring the federal government’s share of costs for those who gained coverage under the Affordable Care Act from 90 percent down to about 60 percent by 2020. In 2020 alone, the report estimates 183,000 people would lose Medicaid coverage.

The proposal also seeks to change the overall structure of how the federal government pays states for Medicaid, moving from being based on the amount the state says it needs — without limits — to a per-capita payment adjusted for medical inflation.

Private insurance market

The report predicts 60,000 fewer Oregonians currently covered under individual health insurance policies, those people who buy for themselves or their families, would have coverage next year under the AHCA. That’s both because they could choose not to buy insurance or because it could become unaffordable.

The first big change the AHCA would make is to remove the requirement that people have insurance, replacing the mandate with a provision that lets insurers charge people 30 percent more if they had a lapse in coverage. Patrick Allen, director of DCBS, which regulates insurance in Oregon, told reporters Thursday he fears that would make it difficult for health insurers to predict who will buy coverage in 2018. To compensate for the uncertainty, he said they’ll likely propose higher rates.

The overarching concern, Allen said, is that young, healthy people would choose not to buy insurance under the proposal, resulting in a higher proportion of sick people on the market and driving up the cost of insurance.

Under the AHCA, people would receive tax credits based on their age. Currently, tax credits are based on income. The proposal would also allow insurers to charge older adults five times more than young people, up from three times more currently, which Allen said is also a concern.

“We think those who are likely to come out ahead are more likely to be younger and of relatively higher incomes,” he said, “and particularly those who are older and of lower incomes we think will do quite a bit worse in this system.”

Brown echoed that sentiment.

“This bill is not about improving health care,” she said. “This bill is about giving tax breaks to the wealthy.”

The report also predicts another 20,000 people currently covered under group policies through employers would lose coverage next year under the AHCA. That’s because the AHCA would remove the requirement that employers provide insurance for their employees, Allen said.

Other effects include:

• The loss of more than 23,300 health care jobs created in Oregon following the Affordable Care Act. Brown said the AHCA would also cut about 19,000 jobs that support the health care industry.

• The loss of more than $500 million in direct health spending in Oregon.

• The plan would cut $150 million per year in federal funding for programs that support the elderly and people with disabilities, including in-home and community services.

• Would prevent Medicaid and other federal programs from covering services, including contraception, STD counseling and cancer screenings, delivered at Planned Parenthood. As a result, more than 51,000 Oregon women would have to find new providers.

• Would deny federal tax credits to people who buy individual health insurance policies that cover abortion.

• Would cut a public health fund focused on prevention. Oregon received $10.4 million in 2016 from the federal fund for things like immunization programs, teen suicide prevention and chronic disease management.

— Reporter: 541-383-0304,