By Elon Glucklich

The Bulletin

Two Bend candidates for public office, each with different takes on Oregon’s changing health care system, shared their views on the state’s successes and failures in expanding medical access and lowering costs at a discussion panel Sunday.

Aelea Christofferson, a Democrat hoping to unseat U.S. Rep. Greg Walden, R-Hood River, and Knute Buehler, a Republican looking to claim State Rep. Jason Conger’s House seat, spoke to a crowd of about 40 at First Presbyterian Church of Bend. Kat Mastrangelo, executive director at Volunteers in Medicine Clinic of the Cascades, and Patrick O’Keefe, a partner at Cascade Insurance Center, also spoke.

The discussion ranged from the pros and cons of the Affordable Care Act and Cover Oregon to the role of coordinated care organizations (CCOs) and employers in providing health care coverage to Oregonians.

The two political candidates have seen health care reform unfold from unique positions. Christofferson sat on health care reform committees from 2007 until the announcement of her congressional campaign earlier this month.

Buehler is an orthopedic surgeon in Bend who sits on the board of directors for St. Charles Health System and the Ford Family Foundation.

Buehler said the Affordable Care Act is one in a long line of attempts by the government to lower insurance costs, improve quality of care and expand access to doctors. But many aspects of federal insurance reform are driving costs up instead, he said.

“The main cause of our poor health system is clumsy government intervention over the last 40 years. It was well-intentioned, but clumsy,” he said.

Enrollment in new health insurance plans by customers younger than 35 has lagged, which could cause premiums to rise and cripple the whole reform effort, he said.

One of the biggest fixes would be to expand the “catastrophic” coverage plans, which offer just a basic level of insured services at a lower cost.

“Right now, people are being forced to buy a level of insurance they don’t need,” Buehler said.

Christofferson said aspects of the Affordable Care Act, and especially the Cover Oregon enrollment program, have been rolled out poorly.

But “the (insurance) exchange is just one part of health care reform.” Christofferson noted that the federal expansion of Medicaid has helped thousands of Oregonians who couldn’t afford private insurance but made too much to qualify for Medicaid before.

CCOs, which are efforts to link physicians, patients and insurers in regions across the state, are also lowering medical costs by keeping patients in primary care offices and out of emergency rooms, she said.

Buehler agreed that CCOs are helping to lower costs but said they need to do more. He noted that nearly $2 billion in federal funds to set up 16 CCOs depends on the state lowering health care costs by two percentage points by the end of the year. So far the savings have been closer to one percent.

The state has spent about $300 million in federal funds and $10 million on ads for the Cover Oregon website, meanwhile, which has been crippled by technical problems and has the state lagging behind others in enrollments.

Mastrangelo, Volunteers in Medicine’s director, said the full effects of state and federal reform in Oregon won’t be fully known for a few more years. She said estimates are for the number of uninsured Deschutes County residents to drop from about 20,000 before the health care law took effect to 6,000 or 7,000 in 2017.

The increase in covered residents, coupled with more outreach from the CCOs, could reduce the number of uninsured patients coming to the emergency room – one of the main drivers of rising costs.

On the insurance side, O’Keefe said the last six months have brought unprecedented change to the industry. The Cover Oregon website, meanwhile, has been a major source of frustration for insurance companies and policy shoppers alike.

But “it is progressing, it’s moving forward,” O’Keefe said. A few months ago, no one could shop for plans or find out if they qualify for subsidies online. That’s still the case for customers, but insurers can now navigate the system with their client online, he said.

— Reporter: 541-617-7820,