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, 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 12th 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 2015 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.
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.
How did Obamacare help 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 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.
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 mid-2015, Oregon’s percentage of uninsured fell to 8.8 percent, for an overall change of 10.6 percentage points.
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.
During 2015 open enrollment, a total of 112,024 Oregonians enrolled in coverage through the state’s exchange. By June 2015, that number had dropped to 102,912 after nearly 10,000 enrollees failed to make premium payments or canceled their coverage. Of those remaining, 75 percent had plans with advanced premium tax credits and 44 percent received cost-sharing reductions.
Oregon developed two Consumer Operated and Oriented Plans (CO-OPs) under the ACA. One of these, Health Republic Insurance, announced this year that it would not offer coverage for 2016. It is among nine Obamacare CO-OPs that have announced closure.
The Beaver State was the first to release final 2016 rates. Some of those filed were deemed too low by Oregon’s Insurance Commissioner, and regulators increased some rates beyond what carriers had requested. However, they reduced hikes proposed by PacificSource and LifeWise. Overall, rate increases in Oregon’s individual market range from 8.3 percent to 37.8 percent for 2016 coverage. Samples of approved 2016 rates based on age and region can be found at Oregon Health Rates.
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 July 2015, the average monthly enrollment in Oregon Medicaid grew 69 percent – the third-highest increase of all states after Kentucky and Nevada. The national average was 24 percent. 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.
Medicare enrollment in the state of Oregon
Oregon Medicare enrollment totaled 745,436 in 2015 – about 18.7 percent. Nationwide, about 17 percent of the population is enrolled in Medicare. Historically, 83 percent of Oregon Medicare recipients have qualified based on age alone and the remaining 17 percent due to a disability.
The state spends about $8,247 annually per enrollee and 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 2014, 43 percent of all Oregon Medicare recipients enrolled in a Medicare Advantage plan instead of Original Medicare – nationwide, this total is 30 percent. The state falls 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 43 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: