Power

Medicaid Expansion Under Attack—This Time by Democrats in Oregon (Updated)

Health advocates in Oregon fear the looming Medicaid rollbacks are an omen of what’s to come if congressional Republicans gut Obamacare.

To close the budget deficit, state lawmakers have suggested cuts to schools, universities, and health and welfare programs. Gov. Kate Brown (D) recently approved a two-month state hiring freeze. Scott Olson/Getty Images

UPDATE, January 25, 9:14 a.m.: Oregon voters on Tuesday approved a measure to fund the state’s Medicaid program through a tax on health insurance plans and hospitals. The measure could also reduce premiums for those with private health insurance, Splinter reports

Farm jobs raising sweet potatoes, grains, and grass seeds, some of the main crops in rural Jefferson County, Oregon, offer no guarantee of health insurance.

Instead, 36.2 percent of the 23,080 residents of Jefferson County are covered by Medicaid, the highest percentage in the state. When Oregon expanded Medicaid coverage under the Affordable Care Act (ACA), the state enrolled more than 378,000 people. One in three Medicaid recipients in Oregon gained health coverage through Medicaid expansion.

Even as some Republican-led states have sought to undermine the ACA, health policy advocates have hailed Oregon as a success story. A state report released in January indicates 98 percent of children and 95 percent of adults in the state now have health coverage.

But to help close a two-year $1.6 billion state budget shortfall, top Democrats on the Oregon Joint Committee on Ways and Means last week issued a laundry list of proposed cuts, including ending Medicaid expansion. The proposal would save the state $256 million by dropping 350,000 people from the Oregon Health Plan, the state Medicaid program.

Rep. John Huffman (R-The Dalles), whose district includes Jefferson County, said it’s too soon to say if state legislators can save Medicaid expansion. “I honestly don’t know if we will be able to continue coverage for the entire expansion population, but I know we will try our best,” he told Rewire in an email.

Health advocates in Oregon fear the looming cuts are an omen of what’s to come if the Republican-held U.S. Congress guts the ACA, also known as Obamacare. Similar questions are arising in statehouses around the country. Oregon was one of 31 states, along with the District of Columbia, that expanded Medicaid coverage to people with low incomes under Obamacare.

In ultra-blue Oregon, where Democrats hold both legislative chambers and the governor’s office, progressive lawmakers now find themselves weighing whether to strip their constituents of health benefits. Medicaid-expansion enrollees, one of the targets of the GOP’s failed plan to repeal and replace Obamacare, are now in the crosshairs of Oregon Democrats.

Oregonians with low incomes and communities of color will be hardest hit if the state ends Medicaid expansion. Latinos, for example, make up 11.4 percent of the state population, but are 14.6 percent of Medicaid enrollees. In Multnomah County, where Portland is located, some 82,245 Oregonians would lose Medicaid.

To close the budget deficit, state lawmakers have suggested cuts to schools, universities, and health and welfare programs. Gov. Kate Brown (D) recently approved a two-month state hiring freeze. She has said she’s “absolutely unwilling” to support a budget that makes it difficult for people with low incomes to gain or keep health insurance.

Obamacare fully funded Medicaid expansion through 2016, after which the states are expected to pick up a rising share of the cost. Oregon is expected to contribute 6 percent, or $290 million in 2017-19, according to the Oregon Health Authority.

Huffman told Rewire in an email that lawmakers expected a corporate tax hike called Measure 97 to pass in November 2016, which would have helped fill the state’s coffers. The measure’s failure has left lawmakers searching for new revenue sources. Until an updated budget forecast comes out next month, Huffman said it’s too early to map out specific solutions, but he’s hopeful.

“Before the end of the session I do believe that we will come together around a plan to continue Medicaid coverage for as many Oregonians as possible,” Huffman said.

An Oregon policy center has suggested raising taxes on health-care providers, like hospitals, to pay for the state’s share of Medicaid. State Sen. Elizabeth Steiner Hayward (D-Portland), chair of the human services budget subcommittee, said lawmakers were “getting close to an agreement” on raising taxes on insurers, hospitals, and other health-care entities, according to Oregon Public Broadcasting.

Hannah Rosenau, program director with Oregon Foundation for Reproductive Health, which advocated against Obamacare’s repeal, said the state mounted a vigorous outreach and enrollment campaign for Medicaid expansion. Its success means the state would be “hardest hit” by a possible federal repeal of Obamacare, along with the threatened state rollbacks.

A state report issued last month estimated 375,000 Medicaid-expansion enrollees in Oregon would have lost health coverage under congressional Republicans’ failed Obamacare repeal bill. The figure is nearly identical to the 350,000 who might lose health-care benefits under Oregon’s Democratic-led proposal.

Rosenau believes the budget crisis offers Oregon officials the chance to safeguard Medicaid expansion and protect essential health benefits, such as birth control and maternity care. State Medicaid also covers abortion care.

“We don’t just want people to have the ability [to get coverage], we want the coverage to meet their needs,” she said.

If state leaders prioritize health care even in times of crisis, “we will be an example,” Rosenau said. “It’s actually a chance for our state to show our values and show what’s important.”