- COVID/American Rescue Plan enrollment window continues through August 15, 2021 (residents do not need a qualifying event to use this window).
- Insurers have proposed an overall average rate increase of 1.8% for 2022; PacificSource is expanding statewide (all residents will be able to choose from 4+ insurers for 2022)
- Short-term health plans are available in Oregon with total plan duration of up to three months
- Oregon is considering a switch back to a state-based enrollment platform, but it won’t happen anytime soon.
- Insurer participation in Oregon’s exchange: 2014 through 2022.
- Oregon enacted legislation in 2019 to codify some of the ACA’s protections into state law.
- This follows several other laws that Oregon has enacted in the last few years to protect consumers, including reproductive health coverage, restrictions on short-term plans, AHPs, and surprise billing.
Oregon exchange overview
Oregon has a state-run exchange that uses the HealthCare.gov enrollment platform. 141,089 people enrolled in private individual/family plans through the Oregon exchange during the open enrollment period for 2021 coverage, and more than 10,000 additional enrollees had selected coverage during the first 2.5 months of the COVID/American Rescue Plan special enrollment period that continues through August 15, 2021.
Oregon was the second state in the nation (after Alaska) to obtain federal approval for a reinsurance program that receives federal “pass-through” funding: The reinsurance program keeps rates lower than they’d otherwise be (an average of 6 percent lower in 2021), which results in smaller premium subsidies. The federal government passes the subsidy savings on to the state, which uses the funding, in addition to state funds, to run the reinsurance program.
Oregon’s exchange has six insurers offering 2021 plans, with the addition of Regence. The overall average rate increase for 2021 was a little over 2% in Oregon’s individual/family market. For 2022 coverage, the six insurers have proposed an overall average rate increase of 1.8%; the rate proposals are being reviewed by the state’s insurance regulators.
Oregon offers a Compact of Free Association (COFA) Premium Assistance Program for low-income citizens of the Republic of Marshall Islands, the Federated State of Micronesia, and the Republic of Palau who reside in Oregon under COFA. When eligible enrollees choose a Silver plan through Oregon’s exchange, the program pays their share of the premiums (after federal premium subsidies are applied) and the enrollees are also not responsible for any cost-sharing for covered, in-network services.
Opportunities to enroll in coverage through Oregon’s marketplace
Open enrollment for 2021 health plans ran from November 1 through December 15, 2020, for coverage effective January 1, 2021. Outside of open enrollment, residents normally need a qualifying event in order to enroll or make changes to their coverage. But there’s a one-time COVID-related enrollment window in 2021 (February 15 to August 15) during which people can enroll or switch to a different plan, regardless of whether they have a qualifying event.
The COVID-related enrollment period is available to people who need to newly-enroll in coverage, as well as those who already have a plan and would like to choose a different one. This window gives new and existing enrollees an opportunity to take advantage of the additional premium subsidies created by the American Rescue Plan. Plan selections made during this window will take effect the first of the following month.
2022 rates and plans: Insurers propose 1.8% average rate increase; PacificSource expanding statewide
Open enrollment for 2022 coverage will begin on November 1, 2021, for coverage effective January 1, 2022.
Oregon’s six exchange insurers will all continue to offer coverage in 2022, and PacificSource plans to expand its coverage area to offer plans statewide, joining the three other insurers that already offer plans statewide. So residents in every county will be able to select from at least four insurers for 2022 coverage, and most residents will be able to select from among five or six insurers.
For the state’s individual market insurers, the weighted average proposed rate change for 2022 is a 1.8% increase. The insurers have proposed the following average rate changes:
- BridgeSpan: 4.8% increase
- Kaiser: 2.9% increase
- Moda: 2.6% increase
- PacificSource: 1.3% increase
- Providence: 0.1% decrease
- Regence: 4.9% increase
State regulators noted that the state’s reinsurance program is continuing to play a significant role in keeping premiums lower than they would otherwise be, for the fourth year in a row.
In the small group market, the average proposed rate increase is similarly modest, at just 1.5%. And Cigna plans to join the state’s small group market for 2022.
For perspective, here’s a look at how rates in Oregon’s individual/family health insurance market have changed over the years:
- 2015: Average decrease of 2.5%. PricewaterhouseCooper LLC tracked 2015 rates throughout the fall of 2014, and comparing them with 2014 rates. In Oregon, the weighted average across all 13 carriers (on and off-exchange) was a rate decrease of 2.5 percent. And the Commonwealth Fund conducted an analysis of rates for a 40-year-old non-smoker, and found an average rate decrease of 5 percent in Oregon. But for the cheapest Silver plans from 2014, most areas of the state saw a rate hike of around 10 percent for 2015.
- 2016: Average increase of 24.2%. Carriers requested a weighted average rate increase of about 23 percent. But Oregon’s Insurance Commissioner determined that some of the rates filed – from Health Net (off-exchange), Kaiser, Health CO-OP, and Providence – were too low, and wouldn’t be adequate to meet projected claims costs. To mitigate the problem, the state needed to require higher rates than some of the carriers had proposed. On July 1, 2015, Oregon became the first state to release final rates for 2016, and Oregon regulators did indeed increase rates beyond what several carriers had requested. But they also ended up reducing the proposed rate hikes for two carriers – PacificSource and LifeWise. Ultimately, the weighted average rate increase in Oregon’s individual market came in at 24.24 percent for 2016.
- 2017: Average increase of 26.5%. Oregon regulators initially gave tentative approval for 2017 rate changes. But when four carriers (Atrio, BridgeSpan, Providence, and — off-exchange — Regence) later agreed to cover a broader service area than they had originally intended for 2017, state regulators also allowed them to further increase their premiums, due to the increased risk they would be shouldering. Final approved average rate increases for Oregon’s exchange carriers ranged from an average increase of 14.5 percent for Kaiser Permanente, to an average increase of 29.6 percent for Providence Health Plan, with an overall weighted average increase of 26.5 percent. Ethan Baldwin, an Oregon’s Department of Consumer and Business Services rate review analyst, noted that state regulators “do have the authority to reject rate increases, but that doesn’t happen. I can’t remember the last time that’s happened.”
- 2018: Average increase of 15.7%, plus an additional 7.1% increase on silver plans to account for the loss of CSR funding. There was considerable uncertainty and instability in the individual insurance markets nationwide, despite the market stabilization rule that CMS finalized in April 2017. There was ongoing uncertainty around funding for the ACA’s cost-sharing reductions (CSR), and insurers generally expected enforcement of the individual mandate to be less robust in 2018. The 2018 rates that were finalized in August 2017 were, in most cases, lower than the insurers had proposed. Oregon regulators noted in their final rate decision announcement that the state’s new reinsurance program shaved six percentage points off the average individual market rate increases for 2018, although it added 1.5 percentage points to the small group rate increases (the reinsurance program took effect in January 2018).For the five on-exchange insurers in Oregon, average approved rate changes for 2018 initially ranged from a 1.6 percent decrease for BridgeSpan to a 14.8 percent increase for Kaiser Foundation Health Plan of the Northwest. Those average rates increases, however, were approved before the Trump Administration eliminated funding for cost-sharing reductions (CSR). On October 12, the Trump Administration announced that CSR funding would end immediately. As a result, the Oregon Division of Financial Regulation ordered individual market insurers to increase premiums for their Silver-level plans by an additional 7.1 percent, on top of the rate changes that had already been approved for 2018. Notably, this increase applied both on and off the exchange, including Silver plans offered only off-exchange by Regence and Health Net. This chart shows the impact of the additional premium increase on Silver plans.
- 2019: Average increase of 7.3%. In addition to normal health care inflation, most of the carriers cited the elimination of the mandate penalty and the fact that the exchange fee increased from 2 percent of premiums to 3 percent of premiums as factors driving the rates higher for 2019 (as described above, Oregon has its own exchange, but uses the HealthCare.gov enrollment platform; the fee for using the enrollment platform was 1.5 percent of premiums in 2017, increased to 2 percent in 2018, and increased to 3 percent in 2019, although it’s dropping to 2.5 percent for 2020). The cost of cost-sharing reductions (CSR) continued to be added to Silver plan rates in 2019, just as it was in 2018. In July 2018, the Oregon Division of Financial Regulation finalized the approved rate changes. At ACA Signups, Charles Gaba calculated a weighted average rate increase of 7.3 percent in Oregon’s individual market for 2019, but noted that it would have been significantly smaller if the individual mandate penalty hadn’t been eliminated at the end of 2018.
- 2020: Average increase of 1.5%. In July 2019, the Oregon Division of Financial Regulation published the approved rate changes for 2020 health plans in the individual and small group markets. They also published a list of counties where each insurer is offering plans for 2020, including service area expansion by BridgeSpan and PacificSource in the exchange, and Regence outside the exchange.Average premiums in the individual market increased by 1.5 percent in 2020 (down from the 3.3 percent average increase that insurers had initially proposed). Regulators noted that average premiums for 2020 were about 6 percent lower than they would have been without Oregon’s reinsurance program, which has been stabilizing the state’s insurance market since 2018.Regence (5.5 percent average rate increase) and Health Net (8.9 percent average rate increase) continued to offer plans only outside the exchange for 2020. Their rate increases were among the most significant in the state’s market (on a percentage basis), leaving the on-exchange insurers with a slightly smaller overall weighted average increase.
- 2021: Average rate increase of 2.1%. Six insurers offer coverage in Oregon’s exchange for 2021, up from five in 2020. And three of them — BridgeSpan, Providence, and Regence – offer coverage state-wide. The average rate changes for Oregon’s exchange in 2021 varied from a 3.5% decrease to an 11% increase.
Oregon has an SBE-FP, but is considering switching back to a fully state-run exchange
Oregon has a state-run exchange, run by the Oregon Department of Consumer and Business Services (DCBS), but they’ve been using Healthcare.gov’s enrollment platform since the second open enrollment period, after the state’s own exchange platform (Cover Oregon) failed to perform adequately in the first year. So the exchange is considered an SBE-FP (State-Based Exchange on the Federal Platform).
The federal government charged SBE-FPs a fee equal to 1.5 percent of premiums for use of Healthcare.gov in 2017. They had proposed increasing the fee to 3 percent starting in 2018, but settled on 2 percent instead, with the increase to 3 percent delayed until 2019. And it’s dropping down to 2.5 percent in 2020. Oregon has considered the possibility of switching back to having a fully-state-run exchange, and after reviewing bids from three technology vendors, DCBS put out a report in May 2016 detailing the pros and cons (and costs) of both options.
At that point, Oregon decided to continue to use Healthcare.gov, with plans to revisit this decision within three to five years. They noted that the decision was a toss-up, as it would have been a little more expensive to run their own exchange platform, but would have enabled the state to have a more finely-tuned enrollment platform, specific to Oregon’s needs. But they felt that they couldn’t go ahead with another significant change without it being clearly advantageous all-around.
Two years later, however, Oregon was once again considering running its own enrollment platform. The fees to use HealthCare.gov and the lack of flexibility in the platform are concerns for the state, and the state is looking into whether they can establish a more efficient, lower-cost platform and transition away from HealthCare.gov. That would give the state more flexibility in terms of things like open enrollment dates and special enrollment periods (for example, for 2018 and 2019 coverage, 10 of the 12 fully state-run exchanges extended their open enrollment periods, but states that use HealthCare.gov didn’t have that option).
But the discussion is very much ongoing in Oregon, and if any changes are made, they will not be hasty. The minutes of a June 2018 Oregon Marketplace Advisory Committee meeting made it clear that all options were on the table, including the possibility of switching to a fully federally-run exchange. But members of the committee also expressed dissatisfaction with the HealthCare.gov call center’s lack of knowledge pertaining to Oregon’s regulations and health plans.
In another meeting in late November 2018, the Oregon Marketplace Advisory Committee talked by phone with leaders from other state-run exchanges, including Nevada and New Mexico, both of which were in the process of transitioning to their own enrollment platforms (Nevada completed the transition in the fall of 2019, New Mexico will transition in the fall of 2020). The committee was gathering information about what other states have experienced, so that Oregon could determine what approach will be most beneficial in the state.
In April 2019, the Oregon Department of Consumer and Business Services put out a request for information, seeking proposals from vendors interested in creating a state-run exchange platform and customer service center. They received responses from 10 vendors, and the information in the proposals is being used by state officials to determine the financial feasibility of transitioning to a fully state-run exchange. But Oregon’s current contract with HealthCare.gov runs through the end of 2022, so the state has plenty of time to determine whether they want to break away from HealthCare.gov and run their own exchange again.
141,089 people enrolled in coverage through Oregon’s exchange during the open enrollment period for 2021 coverage. This was down from 145,264 people the year before, and was the third year in a row with declining enrollment; sign-ups had peaked in 2018, when more than 156,000 people enrolled. In most states that use HealthCare.gov, enrollment peaked in 2016 and has declined since then.
Oregon’s increasing enrollment in 2017 and 2018 (a time when most states using HealthCare.gov were seeing enrollment declines) could be due in part to the fact that Oregon handles their own marketing and outreach for the exchange, so the state was able to step up to fill in the gaps when the Trump Administration drastically cut funding for the federally-run exchange’s navigators and marketing. And although enrollment had been dropping in 2019 and 2020, the exchange noted that the enrollment drop in 2021 was expected, given how many people had transitioned to Medicaid during the COVID pandemic (Medicaid enrollment is up, while exchange enrollment is down).
Here’s a look at enrollment numbers over the years in Oregon’s exchange:
- 2014: 68,308 people enrolled. Oregon’s exchange platform did not function well at all during the first open enrollment period, which resulted in much lower than expected enrollment.
- 2015: 112,024 people enrolled. All of them had to re-enroll, even if they had exchange coverage in 2014, because Oregon transitioned from using the Cover Oregon platform to HealthCare.gov.
- 2016: 147,109 people enrolled.
- 2017: 155,430 people enrolled.
- 2018: 156,105 people enrolled.
- 2019: 148,180 people enrolled
- 2020: 145,264 people enrolled
- 2021: 141,089 people enrolled (the exchange noted that enrollment was down due to migration to Medicaid during the pandemic, and the federal rule that prevents states from transitioning people off Medicaid during the pandemic, unless the member requests it or moves out of state).
Insurer participation in Oregon’s exchange: 2014 through 2022
As is the case in most states, insurer participation in Oregon’s exchange has varied over the years. Oregon started out with a very robust exchange, with 11 insurers offering plans for 2014. And for 2015 and 2016, there were still 10 insurers offering plans. But several of those insurers were losing money during those years, and insurer participation dropped sharply for 2017, when only six insurers continued to offer plans in the Oregon exchange.
In mid-October 2015, Health Republic Insurance – one of two ACA-created CO-OPs in Oregon – became the eighth CO-OP to fail, and the fourth as a result of the risk corridor shortfall that was announced on October 1. In all, 10 CO-OPs closed their doors on December 31, 2015, and another – Health Republic in New York – closed at the end of November.
In April 2016, LifeWise Health Plan of Oregon (which offered plans statewide in 2016) announced that they would exit the state at the end of 2016, including both the individual and group market. Enrollees were able to keep their coverage through December 31, but had to pick a different plan for 2017.
Trillium (which primarily provides Medicaid managed care) offered on-exchange plans in 2016, but only in Lane county. In June 2016, the state approved the sale of Trillium to Missouri-based Centene, and Trillium did not file rates to sell plans in any Oregon county for 2017.
Zoom notified DCBS in August 2016 that they would exit the Oregon exchange at the end of 2016. Zoom had been the only exchange carrier that had planned to increase its coverage area for 2017 (they already offered plans in Clackamas and Multnomah counties in 2016, but had planned to add Washington county to their coverage area in 2017). Instead, they only offered off-exchange plans in those three counties in 2017. But Zoom ended up closing entirely at the end of 2017. All Zoom Health members who had off-exchange coverage in 2017 needed new plans for 2018, as the insurer shut down completely at the end of 2017.
On July 8, 2016 the Oregon Department of Consumer and Business Services announced that Oregon Health CO-OP would cease operations as of July 31. Oregon started out with two CO-OPs in 2014, but Health Republic had already failed at the end of 2015. There had been numerous insurer exits from the exchanges and CO-OP failures across the country over the last couple of years, but nearly all of them had been timed to coincide with the end of a calendar year. So Oregon Health CO-OP’s mid-year closure was unusual. Having to switch plans mid-year is challenging for people who have already paid money towards their deductible, since they generally have to start over with a new deductible for the new plan. But the Oregon Department of Consumer and Business Services worked with the other insurers in the state to ensure that CO-OP members’ already-accrued out-of-pocket expenses would count towards their new plans that took effect August 1.
For a while in early 2016, it looked like Moda Health Plan Inc. would also be leaving the exchange at the end of 2016, but they ended up staying, and have continued to offer plans in the Oregon exchange ever since. In January 2018, the Oregon Division of Financial Regulation placed Moda under supervision, and ordered the carrier to cease issuing or renewing individual plans, or enrolling new groups. That same day, Moda said that they would exit the individual market in both Oregon and Alaska in an effort to stem the losses they were incurring. On February 8, regulators in Alaska and Oregon reached an agreement with Moda that allowed the carrier to resume selling and renewing coverage in the individual markets in both states. Part of the agreement was a commitment from Moda to continue to service individual market policy-holders until at least the end of 2016. Ultimately, Moda opted to exit Alaska’s individual market at the end of 2016, but remain in Oregon (Moda had already exited the markets in Washington and California in late 2015, in order to focus on Oregon and Alaska).
In addition to the carriers that did not return to the exchange for 2017 (Oregon Health CO-OP, LifeWise, Zoom, and Trillium), many counties outside the I-5 corridor were facing the possibility of only having one carrier offering plans, as several remaining carriers had planned to reduce their coverage area. But regulators worked with carriers to address the problem, and by August 2016, BridgeSpan and Providence Health Plan (in addition to Regence BCBS outside the exchange) had agreed to continue to offer plans statewide in 2017, but with higher premiums. So every county in Oregon continued to have at least two carriers offering plans in the exchange for 2017, and most had at least three.
All six exchange insurers initially planned to continue to offer coverage in 2018, although Atrio had planned to reduce their coverage area for 2018. But they ultimately opted to withdraw their individual and small group plans in order to focus instead on their Medicare products. That left seven individual market insurers, five of which offered plans in the exchange for 2018 (BridgeSpan, Kaiser, Moda, PacificSource, and Providence). BridgeSpan significantly reduced its coverage area, however, leaving Providence as the only insurer offering coverage statewide in the exchange in 2018. But some insurers expanded their coverage areas, giving residents in some counties more options in 2018 and 2019. The 2018 coverage area chart is available here, and the coverage area chart for 2019 is here (on the second page, below the rate filings).
For 2020, the five remaining insurers continued to offer coverage in the exchange, with Providence still the only insurer offering state-wide coverage. Regence and Health Net continued to offer coverage outside the exchange. Regence joined the exchange for 2021, however, and BridgeSpan, Regence, and Providence all offer plans statewide in the exchange.
For 2022, all six insurers will continue to offer plans, and PacificSource will expand to offer coverage statewide. Residents in all areas of the state will be able to choose from at least four insurers during the open enrollment period for 2022 coverage. And residents in most areas of the state will be able to choose from five or six insurers.
Oregon enacts legislation to codify ACA consumer protections into state law
Oregon regulations mitigate the impact of the Trump Administration’s new rules for short-term plans and AHPs
In 2018, the Trump Administration finalized regulations to expand access to short-term and association health plans (which are expected to contribute to increased morbidity in the individual markets in many states, as healthy people can choose to enroll in less-regulated plans), but the effects of those regulations are muted in Oregon.
The state limits short-term health plans to three months in duration, so the new federal rules do not apply in Oregon. And the state is also taking a more stringent approach to association health plans: The AHP must be in effect for at least a year in order to offer coverage, and must be formed for a primary purpose other than providing health insurance. In addition, in most circumstances, Oregon uses the “look through” approach to determining whether an association is offering small group (ie, more heavily regulated) or large group (less regulated) insurance, so an association comprised of numerous small business will likely have to offer fully ACA-compliant small group coverage in Oregon.
Oregon enacts legislation to protect reproductive health coverage
In August 2017, Oregon enacted H.B.3391, which includes mandated coverage of comprehensive reproductive health care (most of its provisions didn’t take effect until January 2019). New York also adopted a measure in 2017 to protect access to contraceptive coverage.
H.B.3391 applies to any plans regulated by the state, which includes the individual market, Oregon Medicaid (Oregon Health Plan, overseen by Oregon Health Authority), and fully-insured group plans. But self-insured group plans are not subject to state regulations; instead, they’re regulated under federal law via the Employee Retirement Income Security Act (ERISA). And the majority of very large employers self-insure their workforce, as opposed to purchasing fully-insured group plans. In Oregon, 27.7 percent of the state’s population is covered under state-regulated plans, while 21.6 percent are covered under federally-regulated self-insured plans (the rest are on Medicare, Medicaid, TRICARE, and other federal health programs).
H.B.3391 requires health plans regulated by the state to cover a wide range of reproductive health care — including the full range of FDA-approved contraceptives at no cost to the insured. The ACA also requires that, but only for female contraceptives. Vasectomies are not required to be covered under the ACA, although female sterilization is. Oregon’s measure, however, includes coverage for voluntary sterilization for both men and women.
H.B.3391 also requires abortions to be available to Oregon residents with no cost-sharing (ie, no copay or deductible), so the cost is built into health insurance premiums. The bill’s protection of access to abortion applies without regard to immigration status: For undocumented immigrants without health insurance, the state of Oregon will pick up the tab for abortions, estimated at about $300,000 a year. The abortion coverage requirement has an exemption for religious employers to allow them to opt out of contraceptive and abortion coverage (not only does the ACA not require coverage for abortions, it also requires each state’s exchange to include at least one plan that doesn’t cover abortions).
Oregon’s new law also prevents health plans from discriminating based on gender or gender identity (Section 1557 of the ACA currently prohibits discrimination),
Oregon was already at the forefront of ensuring access to contraception: In 2016, the state began requiring pharmacies to provide on-demand birth control pills and patches, and also began requiring health insurers to cover a 12-month supply of contraception at one time, rather than requiring refills throughout the year (although the Oregon Insurance Division reported in late 2017 that they get a significant number of complaints about pharmacies not dispensing 12 months of birth control at a time). But H.B.3391 puts Oregon clearly in the lead in terms of protecting access to reproductive care, including contraceptive and abortion.
Other state laws and regulations that protect consumers: Surprise balance billing and general market stabilization
As of March 2018, Oregon prohibits out-of-network providers at in-network facilities from sending balance bills to patients, unless the patient has been informed that the provider is out-of-network and opts to receive services from that provider anyway. There is no federal protection from surprise balance billing, so it’s up to states to enact their own laws.
Also related to health insurance consumer protections, H.B.2342 was passed by Oregon lawmakers in July 2017, and signed into law in August. It grants the state the ability to take a variety of actions that may become necessary to stabilize the individual market, if and when federal changes are made to the ACA.
Specifically, the law authorizes the Department of Consumer and Business Services (DCBS) to promulgate rules (valid for up to six months) that aren’t in compliance with Oregon Insurance Code, if the federal government were to make changes that the Oregon DCBS believes “will cause imminent destabilization of insurance market and risk life or health of state residents.”
Standardized plans in Oregon
HealthCare.gov debuted optional “Simple Choice” standardized plans for 2017, although the Trump Administration is no longer designing or highlighting standardized plans as of the 2019 plan year. But some of the state-run exchanges — including Oregon’s — had implemented standardized health plans in previous years. In 2013, the Commonwealth Fund reported that Cover Oregon (a fully state-run exchange at that point) was allowing health insurers to offer, at each metal level, one standardized plan, two non-standardized plans, and two “innovative” plan designs.
Oregon’s state-run exchange now uses the HealthCare.gov enrollment platform, but the state still oversees the design of the standardized plan options. Coverage provided by Gold, Silver, and Bronze standardized plans in Oregon in 2020 is detailed here.
As noted above, Oregon SB 250, enacted in 2019, allows state regulators to require more than one standardized plan at the bronze and silver level, in order to ensure access to coverage and the availability of HSA-qualified plans.
Grandmothered plans terminated at the end of 2015
Transitional (grandmothered) plans that were purchased after the ACA was singed into law but before the end of 2013 were allowed to remain in force (at carrier discretion) in Oregon until the end of 2015. That means anyone in Oregon who still had a non-ACA-compliant, non-grandfathered plan, had to select new coverage for 2016.
Oregon is one of two states – the other is Colorado – where grandmothered plans were allowed to remain in force in 2015, but had to be replaced by ACA-compliant coverage for 2016.
State-run exchange platform was dissolved in 2015
Oregon was one of the states that initially opted to run its own exchange, but the state-based enrollment system never worked properly. Following months of efforts to fix the troubled website, Cover Oregon’s board voted on April 25, 2014 to switch to using Healthcare.gov rather than continue to try to repair the existing site. Since then, Oregon has continued to have a state-run exchange but uses the federal enrollment platform.
On March 6, 2015, Oregon Governor Kate Brown signed Senate Bill 1 into law. The legislation dissolved Cover Oregon and its board of directors, and transferred remaining responsibilities to the Oregon Department of Consumer and Business Services (the agency that oversees the Oregon Insurance Division).
The Cover Oregon website also ceased to exist at the end of June. Instead, the URL now redirects visitors to OregonHealthcare.gov. From that site, residents can enroll in Medicaid if eligible, or will be redirected to Healthcare.gov to enroll in a private plan.
As of 2020, the decision is still up in the air as far as whether Oregon will move forward with a new state-based exchange website/enrollment platform or to continue to use Healthcare.gov.
Cover Oregon’s troubled start: Uncovering what went wrong
The FBI and federal prosecutors launched investigations into the failed exchange – which cost $300 million in tax dollars and was never able to enroll applicants entirely online. In early June 2014, Governor John Kitzhaber asked Oregon Attorney General Ellen Rosenblum to take legal action against Oracle – the creator of the Cover Oregon website – in order to recover funds spent on the site. But Oracle fought back, saying that officials at Cover Oregon and Oregon Health Authority were to blame for the debacle. Both sides sued each other, and the issue was highly contentious.
On February 18, 2014 four and a half months after open enrollment began, Cover Oregon’s website was finally functional enough for insurance agents and navigators to be able to process enrollments start to finish online. Although the site was never fully functional for the general public to complete the entire enrollment process online, the availability of some electronic enrollment was a huge improvement after months of relying solely on paper applications.
Despite the fact that Cover Oregon was the only exchange relying solely on paper applications for the first four months of open enrollment, its total enrollment numbers for 2014 were around the middle of the road when compared with enrollment in other states – all of which were using much more efficient online applications for months.
Oregon exchange history
The Oregon legislature authorized a state-run health insurance exchange in 2011, and the exchange developed a formal business plan, which the Legislature approved in February 2012 as a final go-ahead for the exchange. The U.S. Department of Health and Human Services (HHS) gave conditional approval to Cover Oregon in December 2012. The exchange had a 2014 budget of $105.7 million, which was covered with federal grant money, and $62.4 million budget in 2015 according to a Cover Oregon spokesperson.
Before its dissolution, Cover Oregon acted as an “active purchaser,” meaning it actively negotiated with insurers in terms of the plans that were offered in the exchange. Participating insurers were required to offer a bronze, Silver and gold plan and had the option to offer additional plans.
The Oregon Medical Insurance Pool – a state-run high-risk pool – closed at the end of December 2013, but the state implemented a temporary medical insurance program that automatically covered risk pool members who were not able to enroll in an exchange plan with a January 1 effective date. The temporary plan remained in force until March 31, 2014 but ceased operation at that point.
Contact the Oregon exchange
Healthcare.gov (call center: 1-800-318-2596)
More Oregon health insurance exchange links
State Exchange Profile: Oregon
The Henry J. Kaiser Family Foundation overview of Oregon’s progress toward creating a state health insurance exchange.
Louise Norris is an individual health insurance broker who has been writing about health insurance and health reform since 2006. She has written dozens of opinions and educational pieces about the Affordable Care Act for healthinsurance.org. Her state health exchange updates are regularly cited by media who cover health reform and by other health insurance experts.