Health insurance in Oregon
- Oregon’s has a state-run health insurance exchange but enrollment is through HealthCare.gov.
- Open enrollment for 2021 health plans begins November 1, 2020. Before that, residents with qualifying events can enroll or make changes to their coverage for 2020.
- Short-term health plans in Oregon cannot have terms that exceed three months.
- Five carriers are offering 2020 coverage through the Oregon exchange.
- For 2020, the weighted average premium increase in Oregon was 1.5 percent for individual market plans.
- A record number of Oregonians enrolled in 2018 coverage through the Oregon exchange, but enrollment dropped in 2019 and again in 2020.
- Oregon immediately implemented the ACA’s Medicaid expansion.
- Oregon has strong consumer protections related to Medigap plans
Oregon’s health insurance marketplace
Oregon has a state-run exchange that uses the Healthcare.gov enrollment platform. Open enrollment for 2021 health plans will begin November 1, 2020. Before that, residents with qualifying events (including loss of employer-sponsored coverage) can enroll or make changes to their coverage for 2020.
Five insurers are offering coverage for 2020 through the exchange, and two — BridgeSpan and PacifiCare — expanded their coverage areas for 2020. Two carriers, HealthNet and Regence, offer plans only outside the exchange.
Individual health insurance rates for 2020 are an average of 1.5 percent higher than 2019 rates. That applies to full-price premiums; rate changes for people who receive premium subsidies can be quite different, depending on fluctuations in the price of the benchmark plan in each area.
Enrollment in private plans for 2020 through Oregon’s exchange reached 145,264 people during the open enrollment window. That was the second year in a row with declining enrollment, although enrollment has likely increased during the COVID-19 pandemic as people transition from employer-sponsored coverage to plans in the exchange.
Medicaid expansion in Oregon
Utilizing federal funds to expand Medicaid eligibility to 138 percent of poverty has played a significant role reducing the uninsured rate in Oregon.
Oregon has seen some of the nation’s most dramatic jumps in Medicaid enrollment under the ACA. From 2013 to January 2020, the average monthly enrollment in Oregon Medicaid grew 59 percent – the seventh-highest increase of all states. As of January 2020, 992,863 Oregonians were covered by Medicaid/CHIP.
Oregon’s “Cover All Kids” law took effect in January 2018, ensuring that all children under age 19 with household income up to 305 percent of the poverty level have access to Oregon Health Plan coverage, regardless of immigration status.
Read more about Medicaid expansion in Oregon.
Short-term health insurance in Oregon
New federal regulations expanded access to short-term and association health plans in 2018, but the effects of those regulations were muted in Oregon. Oregon limits short-term health plans to three months in duration, so the federal rules do not apply.
Read more about short-term health insurance in Oregon.
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. By 2018, the uninsured rate stood at 7.1 percent — less than half of what it had been pre-ACA
In 2017, the state launched a website, 95percentoregon.com, to highlight how the ACA is helping Oregon and its residents.
Oregon started with two CO-OPs under the ACA but currently has no CO-OPs following the July 2016 closure of Oregon Health CO-OP and the 2015 closure of Health Republic Insurance.
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 is still the only Republican in Oregon’s congressional delegation.
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.
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 is considering 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 at HealthCare.gov.
Does Oregon have a high-risk pool?
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
Oregon has significant protections for Medigap enrollees, including an annual “birthday rule” enrollment period, during which a Medigap enrollee can switch to any Medigap plan with equal or lesser benefits, without medical underwriting. The state also guarantees access to Medigap plans for Medicare enrollees who are under age 65 (federal law only guarantees access when enrollees are 65).
State-based health reform legislation
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 was signed into law in August 2017, granting 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.
SB558 was also signed into law by Gov. Brown in August 2017, ensuring access to Oregon Health Plan (Medicaid) coverage for all children with household income up to 305 percent of the poverty level, regardless of immigration status.
SB250, enacted in 2019, codifies various ACA consumer protections into state law.
Scroll to the bottom of the page for a summary of other state-level health reform bills.
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.