The number of Oregonians without health insurance has decreased dramatically since the Affordable Care Act took effect. HHS records show the state’s uninsured rate dropped 59 percent since the healthcare reform law took effect in 2010.
An estimated 256,000 Oregon residents are uninsured under the ACA; an estimated 731,000 would be uninsured if the ACA were to be repealed in full. House Republicans passed the American Health Care Act (AHCA) in May 2017, repealing or changing several significant aspects of the ACA (but it is not a full repeal). The Senate is likely to craft a different bill, however, and the two versions would have to be reconciled before being sent to President Trump.
For the time being, the ACA remains in effect as do its penalties and subsidies. Oregonians who purchase coverage through Oregon’s exchange may qualify for premium tax credits and cost-sharing reductions.
2018 coverage: same 8 insurers will offer coverage, including 6 on-exchange
Open enrollment for 2018 coverage will begin November 1, 2017, and end December 15, 2017 (this is a shorter schedule than prior years have used). The same eight insurers that offer individual market plans in Oregon in 2017 have filed rates and plans for 2018 coverage; six offer plans both on and off-exchange, and two (Regence and Health Net) only offer plans outside the exchange.
The six insurers that plan to offer coverage in the exchange are the same six insurers that offer exchange plans in 2017, although some are adjusting their coverage area for 2018:
- Atrio (Atrio offers plans in six counties in 2017, but will only offer coverage in Douglas and Deschutes counties in 2018, per their actuarial memorandum).
- BridgeSpan (plans are available statewide, on and off-exchange in 2017, but the coverage area will be sharply reduced for 2018: BridgeSpan plans will only be available on-exchange in three counties: Clackamas, Multnomah, and Washington. Off-exchange plans will be available in rating area 6, which includes 15 counties).
- Kaiser Permanente (available in ten counties).
- Moda (Moda was available state-wide in 2016, but is not available in Benton, Crook, Deschutes, Douglas, Jefferson, Kalamath, Lane, Lincoln, Linn, or Tillamook counties in 2017; For 2018, they will offer plans in 30 counties, and will once again have plans available in Kalamath, Jefferson, Crook, and Deschutes counties, per their filing description).
- PacificSource (was available state-wide in 2016, but coverage area was drastically reduced for 2017, and plans are currently only available in six counties: Clackamas, Crook, Deschutes, Jefferson, Multnomah, and Washington).
- Providence Health Plan: 20.7 percent increase (available state-wide; Providence had 104,747 members in March 2017, but expects their 2018 membership to decline to 59,397).
Oregon started with two CO-OPs under the ACA. The state has none following the July 2016 closure of Oregon Health CO-OP and the 2015 closure of its other CO-OP, Health Republic Insurance. Furthermore, Oregon exchange carrier LifeWise Health Plan of Oregon announced this year that it would exit the state’s individual and group market at the end of 2016.
Furthermore, LifeWise Health Plan of Oregon, Trillium, and Zoom+ Performance Health Plan all exited the exchange at the end of 2016, and are no longer selling individual market plans in Oregon.
Oregon health ratings
When it comes to overall health, The Commonwealth Fund’s Scorecard on State Health System Performance for 2017 ranked Oregon 22nd out of the 50 states. The number of people without health insurance has been halved since 2013, thanks to the ACA, and Oregon ranks 3rd in the country on the metric of avoidable hospital use/cost. But Oregon lags behind — in 35th place — on the far-reaching metric of “prevention and treatment.”
The 2016 edition of America’s Health Rankings placed Oregon 21st. Low public health funding and childhood immunization rates negatively impacted the state’s ranking while it performed better in measures related to lack of health insurance and number of primary care physicians.
Trust for America’s Health published Key Health Data About Oregon in 2016 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.
Has Obamacare helped Oregon residents?
In 2013, about 14.7 percent of Oregon residents did not have health insurance – a little higher than the national average. Despite the troubles its exchange experienced before switching to the HealthCare.gov enrollment platform, 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.
Following ACA implementation, the state’s uninsured was more than halved, reaching 7 percent by 2015.
114,074 enrollees in Oregon’s exchange are receiving premium subsidies to offset the cost of private plans in the individual market in 2017. And 60,287 of them are receiving cost-sharing subsidies to reduce their out-of-pocket expenses when they need health care. Enrollment in Oregon’s Medicaid program has increased by 52 percent since 2013, due in large part to expansion of Medicaid under the ACA.
Oregon enrollment in qualified health plans
A Kaiser Family Foundation study near the end of 2013 estimated that the potential market for Oregon’s exchange 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 selections for qualified health plans in the Oregon exchange.
That number has increased substantially throughout the years. During 2015 open enrollment, a total of 112,024 Oregonians enrolled in coverage through the state’s exchange. In 2016, the number of people enrolled in private plans through Oregon’s federally-supported state-based exchange was 147,109. Of them, 45 percent were new to the exchange for 2016. And for 2017, enrollment grew again, reaching 155,430 people by the end of open enrollment.
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. Walden is supportive of the AHCA, which passed the House in early May 2017, and would repeal or change various aspects of the ACA.
Under the leadership of former Gov. John Kitzhaber, a former physician who made healthcare and healthcare reform priorities throughout his years in public service, Oregon opted to expand Medicaid and run its own exchange, known as Cover Oregon. Kitzhaber resigned from office on Feb. 13, 2015, and was replaced by Gov. Kate Brown.
Medicaid expansion was a success in Oregon, but unfortunately, the state’s exchange rollout did not go well. The online enrollment system was inoperable for months, and the exchange had to process thousands of paper applications. In late April 2014, the exchange board voted to use HealthCare.gov instead of continuing to try to fix the broken website, and Oregon residents started using HealthCare.gov during 2015 open enrollment. They have continued to do so ever since, although the state has considered the possibility of eventually switching back to a state-run exchange platform.
Oregon’s exchange type is now considered to be a federally supported state-based marketplace. The Cover Oregon website is no longer operational. Consumers can use OregonHealthcare.gov to learn about the state’s exchange-based health plans and eligibility; when they are ready to apply and enroll, they are taken to the federal marketplace website.
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 2014, there were 207,329 people enrolled in Medicaid or CHIP through the Oregon exchange – more than three times as many as had enrolled in private plans through Cover Oregon.
Oregon has seen some of the nation’s most dramatic jumps in Medicaid enrollment under the ACA. From 2013 to February 2017, the average monthly enrollment in Oregon Medicaid grew 52 percent – the tenth-highest increase of all states. The national average was 29 percent. Eligible applicants can enroll in Medicaid at any time during the year, so that number continues to change, 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.
Medicare enrollment in the state of Oregon
As of 2013, Oregon Medicare eligibility was distributed as follows: 85 percent of recipients qualified based on age alone and the remaining 15 percent due to disability. At $6,631 per enrollee, the state has below-average annual spending and, as of 2009, ranks 30th in overall Medicare spending with $5 billion per year.
Oregon ranks third in the nation when it comes to Medicare Advantage enrollment. In 2016, a total of 44 percent of all Oregon Medicare recipients enrolled in a Medicare Advantage plan instead of Original Medicare – nationwide, this total is 31 percent. The state has lower Medicare Part D enrollment than the national percentage, however. About 33 percent of Oregon Medicare beneficiaries have selected stand-alone prescription drug plans, compared with 45 percent across the United States.
State-based health reform legislation
Oregon has had some interesting healthcare legislation in recent years, 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:
Gov. Brown signed OR SB1 into law March 6, 2015, which resulted in the dissolution of Cover Oregon and its board of directors. The remaining responsibilities were transferred to the Oregon Department of Consumer and Business Services. Though the act was effective immediately, the full transfer was not complete until June 2015.
Oregon HB2342 passed the House Rules Committee on May 12, by a 7-2 vote. HB2342 would grant the state the authority to take a variety of actions to stabilize the individual market, if and when federal changes are made to the ACA.
Other state-level health reform bills: