Oregon has found itself in the news a lot since the 2014 Obamacare open enrollment began. The state took an all-hands-on-deck approach to implementing the ACA, but the technological problems that plagued the state’s exchange made national headlines for months.
When it comes to healthcare, however, there’s a lot more to Oregon than the computer system the state used for its exchange. Here’s a summary of public health, access to affordable health insurance, and leadership’s approach to healthcare reform in Oregon.
Oregon health ratings
When it comes to overall health, The Commonwealth Fund’s Scorecard on State Health System Performance ranked Oregon 24th out of the 50 states in 2014 – the same position it held in 2009. Oregon’s Scorecard provides details to show how the rankings are determined.
But America’s Health Rankings places Oregon quite a bit higher, rating the state 13th in the nation. Factors that reduced Oregon’s ranking include low rates of immunization, low high school graduation rates, and more per capita days of poor mental and physical health than most states.
But in this ranking system, Oregon’s strengths in healthcare outweigh their challenges. Oregon has the lowest rate of physical inactivity in the US, and also enjoys a low incidence of preventable hospitalizations. Low birthweight and infant mortality are also less common in Oregon than they are in other parts of the US.
Trust for America’s Health published Key Health Data About Oregon in 2014 that includes state ratings for a wide range of illnesses and health outcome predictors. And this interactive map created by the Robert Wood Johnson Foundation lets you compare health factors and outcomes on a county-by-county basis in Oregon, so you can see that the northwest section of the state tends to rank highest on most metrics.
Oregon and the Affordable Care Act
In 2010, both of Oregon’s U.S. Senators – Jeff Merkley and Ron Wyden – voted yes on the Affordable Care Act. In the U.S. House, four of the five Oregon Representatives were Democrats and voted in favor of the law; Greg Walden, a Republican, cast the only no vote, and he is still the only Republican in Oregon’s U.S. congressional delegation.
Governor John Kitzhaber is a former physician and has made healthcare and healthcare reform priorities throughout his years in public service. He is supportive of the ACA, and under his leadership, Oregon opted to expand Medicaid and run its own exchange, known as Cover Oregon.
Medicaid expansion was a success in Oregon, but unfortunately, their exchange roll out did not go well. Their online enrollment system was inoperable for months, and the exchange had to process thousands of paper applications. In late April, the exchange board voted to use Healthcare.gov instead of continuing to try to fix the broken website, and Oregon residents will be enrolling through the federally facilitated marketplace during the 2015 open enrollment that starts in November.
Congress, HHS, and the FBI are all investigating the Cover Oregon debacle. In May, Governor Kitzhaber asked his Attorney General to consider a lawsuit against Oracle (the primary technology contractor in charge of building the exchange website). But in early August, Oracle struck first, officially filing their own breach of contract lawsuit against the state. The legal, political, and financial ramifications of the failed Cover Oregon project are likely to reverberate for some time.
The Cover Oregon website is still operational, and includes a section where consumers can get all the details about the technology transition that will allow the state to use Healthcare.gov for private plan enrollments going forward.
How did the ACA help Oregon Residents?
In 2012, about 19.4 percent of Oregon residents did not have health insurance – a little higher than the national average. Following ACA implementation, the state’s uninsured rate had dropped to 14 percent by the middle of 2014, for a decrease of 5.4 percentage points.
Despite the troubles that the exchange has had, the state’s supportive approach to the ACA – including expanding Medicaid – resulted in a significant decrease in the percentage of residents who have no health insurance coverage.
Oregon enrollment in QHPs
A Kaiser Family Foundation study near the end of 2013 estimated that the potential market for the exchange in Oregon was 337,000 residents, and that 187,000 of them would be eligible for premium subsidies to lower the cost of their coverage. By the end of the first open enrollment period, 68,308 people had finalized their plan selections in the Oregon exchange.
Eleven carriers are participating in Cover Oregon, and unlike a lot of states, every county in Oregon has at least five exchange carriers from which enrollees can choose.
Oregon Medicaid/CHIP enrollment
Utilizing federal funds to expand Medicaid eligibility to 138 percent of poverty has played a significant role reducing the uninsured rate in Oregon. As of mid-April, 207,329 people had enrolled in Medicaid or CHIP through the Oregon exchange – more than three times as many as had enrolled in private plans through Cover Oregon.
Eligible applicants can enroll in Medicaid at any time during the year, so that number is continuing to increase, further reducing the state’s uninsured rate.
What is Oregon’s health insurance history?
Before the ACA was implemented, individual health insurance was medically underwritten in Oregon, as it was in nearly all states. Because medical history was a factor in eligibility for coverage, people with serious pre-existing conditions were often unable to purchase a policy in the private market, or if they received an offer of coverage, it often included a substantial rate increase or a pre-existing condition exclusion rider.
In order to address this issue, the state created the Oregon Medical Insurance Pool (OMIP) in 1990 to provide an alternative for people who were unable to get private individual health insurance.
Now that medical underwriting is no longer used in the individual market – thanks to the ACA – there is no longer a need for state-run high risk pools. Oregon had intended to shutter OMIP at the end of 2013, but the technical problems with the exchange made it difficult for OMIP members to transition to a new plan. So Oregon created a temporary pool that provided coverage for OMIP members for the first three months of 2014.
That coverage ended on March 31, 2014, but the state worked closely with the pool’s members in early 2014 to make sure that anyone who wanted to transition to an exchange plan was able to do so by the time the temporary pool ceased operations.
State-based health reform legislation
Oregon has had some interesting healthcare legislation recently, including the passage of a bill that requires the state to request approval from HHS to provide premium subsidies and cost-sharing subsidies to people who purchase their qualified health plans directly from carriers rather than going through the exchange.
There was also an unsuccessful bipartisan effort to require all exchange executives and state elected officials who get state-sponsored health insurance to obtain it via the exchange (reminiscent of Senator Grassley’s amendment in the ACA). Here’s a summary of recent Oregon bills: