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Oregon health insurance

Five insurers are offering 2019 plans through Oregon exchange; short-term coverage is now available with plan terms up to three months.

Health insurance in Oregon

Oregon’s health insurance marketplace

Oregon has a state-run exchange that uses the Healthcare.gov enrollment platform. Open enrollment for 2019 coverage ended on December 15, but enrollment is still possible for Oregonians who have qualifying events.

Five insurers that offered exchange plans for 2018 coverage are offering coverage for 2019 through the exchange, and two — Kaiser and PacifiCare — have expanded their coverage areas for 2019. Two carriers, HealthNet and Regence, offer plans only outside the exchange.

Individual health insurance rates for 2019 were calculated to be 7.3 percent higher than 2018 rates. Those rate increases would be significantly lower if the individual mandate wasn’t being eliminated.

Enrollment in private plans for 2018 through Oregon’s exchange was over 156,000. That was more than the number of people who had enrolled for 2017, and well in excess of the number who had enrolled for 2016 coverage. It was also nearly 50 percent higher than enrollment in 2014 (when Oregon’s exchange wasn’t functioning properly) and significantly more than 2015’s enrollment, when Oregon first started using HealthCare.gov.

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. 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. As of July 2018, 963,773 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 income.

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 will be 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 2017, more than 95 percent of Oregonians – and 98 percent of children – had health care coverage. Official census data pegs the 2017 uninsured rate a little higher than Oregon’s report, with 6.8 percent of the population uninsured and 93.2 percent insured — still a significant improvement since 2013, and well under the national average uninsured rate.

In 2017, the state launched a website, 95percentoregon.com, to highlight how the ACA is helping Oregon and its residents.

Oregon’s CO-OP

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.

Democrat Kate Brown, who has been Oregon’s governor since 2015 and we re-elected in 2018, is supportive of the ACA and has worked throughout her time in office to expand access to health coverage and health care.

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 835,111 people as of September 2018. That’s 19.9 percent of its total population, compared with about 18 percent of the United States population enrolled in Medicare.

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).

As of 2015, individuals who qualified for Medicare by virtue of their age alone made up 86 percent of Oregon Medicare recipients. The other 14 percent were on Medicare as the result of a disability.

At $6,956 per enrollee, the state has below-average annual Medicare costs. As of 2014, Oregon ranked 23rd in overall Medicare spending with $6.5 billion in total Medicare costs.

About 45 percent of Oregon’s Medicare beneficiaries are enrolled in Medicare Advantage plans, versus a national average of 36 percent. And about 265,000 Oregon Medicare beneficiaries have stand-alone Medicare Part D plans.

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 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.

Other state-level health reform bills: