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Oregon health insurance

OR regulators work to prevent 2017 coverage-area shrinkage

  • By
  • healthinsurance.org Contributor
  • September 18, 2016

Oregon has frequented the news since Obamacare’s first open enrollment period. The state took an all-hands-on-deck approach to implementing the ACA in 2014, including Medicaid expansion, but the technological problems that plagued its state-based exchange made national headlines for months. Oregon later transitioned to a federally-facilitated state-based exchange and saw improvements.

When it comes to healthcare, however, there’s a lot more to The Beaver State. 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 for 2015 ranked Oregon 15th out of the 50 states – a dramatic jump from its 24th ranking in 2014. The state performed 31 percent better from one year to the next, seeing improvements in all five categories: Access & Affordability, Prevention & Treatment, Avoidable Hospital Use & Cost, Equity, and Health Lives. Were the state to see 208,313 more adults obtain health insurance, it would improve to the level of the best-performing state for that indicator. Its ranking for percentage of uninsured adults ages 18 to 64 was 23rd.

Oregon’s scorecard provides additional details to show how the rankings are determined.

The 20145edition of America’s Health Rankings placed Oregon 20th. 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 2012, about 19.4 percent of Oregon residents did not have health insurance – a little higher than the national average. Despite the troubles its exchange has experienced, 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 rate dropped 7.7 percentage points to 11.7 percent in 2014 – the third highest drop in the nation. By late-2015, Oregon’s percentage of uninsured fell to 7.3 percent, for an overall change of 12.1 percentage points.

Open enrollment rates, 2017 plans for OR

2017 open enrollment is little more than a month away, and Oregon is among the states that have experienced a reduction in on-exchange carrier options.

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.

When 2017 open enrollment begins, Oregonians can expect to see seven carriers offering exchange-based health plans – there were 10 in 2016. Oregon exchange carriers for 2017 will include:

  • Atrio Health Plans
  • Bridge Span
  • Kaiser Permanente
  • Moda
  • PacificSource
  • Providence Health Plan
  • Zoom + Performance Health Plan

Several of these carriers are reducing their coverage area, but regulators are working with them to see if this can be reversed prior to open enrollment.

Oregon regulators tentatively approved carriers’ requested 2017 rate changes. For the individual market, the weighted average increase will be about 24 percent, which is about the same increase the state experienced in 2016.

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.

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.

Under the leadership of 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.

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 June 2016, the average monthly enrollment in Oregon Medicaid grew 65 percent – the fifth-highest increase of all states after Kentucky, Nevada, Colorado and New Mexico. The national average was 27 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

Oregon Medicare enrollment totaled 754,402 in 2015 – about 19 percent of its state population. Nationwide, about 17 percent of the population is enrolled in Medicare.

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 2015, 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.

Other state-level health reform bills:

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