Expanded health coverage is safe — for now

Oregon voters on Tuesday overwhelmingly supported the Legislature's funding mechanism for the state's expanded Medicaid program, preserving coverage for hundreds of thousands of people for two more years. Now lawmakers must look for a more permanent way to maintain one of the nation's lowest rates of uninsured people.

Measure 101 made the ballot after the Legislature passed a package of taxes on health care providers, insurance premiums and health maintenance organizations to continue funding the state's Medicaid expansion for two years. Hospitals will pay 0.7 percent on gross receipts and insurers will pay 1.5 percent on premiums.

A small group of lawmakers — including Rep. Sal Esquivel, R-Medford, who voted for the plan in the House — then launched a referendum campaign to repeal portions of it. The opponents argued that the burden unfairly fell on individual Oregonians who buy insurance policies on the federal exchange, and said claims that people would lose coverage were exaggerated. In the end, voters reaffirmed their support for continued health care funding, but the election cost taxpayers $3.32 million.

Backers of the plan mobilized health care professionals and others to campaign in support. They argued that insurance premiums on the individual market already had dropped 7.5 percent for 2018 on the strength of the cost reductions from expanded coverage, so even if policyholders had to pay the entire 1.5 percent cost increase, that still left a net savings of 6 percent.

Supporters also predicted up to 350,000 Oregonians could lose coverage if Measure 101 failed, forcing them to use emergency rooms for care, driving up costs for everyone. Hospitals are required by law to treat everyone regardless of ability to pay, and they pass on those costs to the population at large by increasing the rates they charge paying patients and insurance companies.

That's the principle behind the so-called individual mandate in the Affordable Care Act: When more people have insurance coverage, it drives the cost down for everyone, so it makes sense to require everyone to participate. Congress did away with the penalty for failing to purchase insurance as part of the tax bill passed late last year, but that doesn't take effect until 2019. When that happens, it could increase the number of uninsured Americans.

Federal policy — and Congress' willingness to continue matching state expenditures for Medicaid — are factors beyond the control of state lawmakers. But the Legislature does have to come up with the state's share of Medicaid funding. Voters have said loud and clear that the state should live up to that responsibility. Legislators should listen — and start now to secure long-term funding when the two-year plan voters just affirmed runs out.

 

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