Voters will decide on Jan. 23 whether to approve funding to preserve Oregon's expansion of health insurance coverage.
The Rogue Valley chapter of the League of Women Voters hosted a forum Thursday at the Medford library to urge voters to approve Measure 101. While the league doesn't take a position on political candidates, it occasionally takes a position on issues that come before voters.
Statewide, almost 100 groups have come out in favor of the measure, including health care organizations, unions and the Oregon branch of AARP.
Measure 101 would preserve a plan hammered out by the Oregon Legislature that raises revenue by taxing hospitals and insurance plans. Insurance companies could raise premiums by up to 1.5 percent to help cover the taxes.
Fueled in part by federal Affordable Care Act subsidies, the state expanded Oregon Health Plan coverage so that it now covers 1 in 4 Oregonians. The Affordable Care Act is also known as Obamacare.
Oregon has achieved almost universal health care coverage, with nearly 94 percent of residents now covered by some form of insurance, according to a report released this month by the Oregon Health Authority.
In Jackson County, 30 percent of residents have OHP coverage. The number rises to 36 percent in neighboring Josephine County, which has more low-income residents, according to figures presented at the forum.
Measure 101 was put before voters by Republican members of the Oregon House who oppose the new fees on the health care industry and insurance providers.
However, state Sen. Alan DeBoer, a Republican, joined two Democrats — former state Rep. Peter Buckley and Dr. David Gilmour, a former Jackson County commissioner — to speak in favor of Measure 101 at the Thursday forum. They were joined on a panel by pediatric nurse practitioner Lisa Callahan.
Although it seems counterintuitive, DeBoer said the fees on hospitals and insurance companies could actually help rein in rising health care costs for everyone.
The owner of a car dealership, DeBoer said his company is facing a 14 percent health insurance premium hike. He asked whether a voter rejection of the insurance tax would cause that rate to go down, but was told the answer was 'no.'
If voters reject Measure 101, about 200,000 to 300,000 people would lose health care coverage, DeBoer said.
Some proponents estimate up to 350,000 people could lose coverage.
DeBoer said Oregon would return to the days when uninsured people flooded hospital emergency rooms — one of the most expensive settings for care — rather than visiting health care providers in less expensive settings.
Hospitals would then shift the cost of uncompensated care for people who can't pay onto other patients, DeBoer said.
He said preventive care for all, and especially for babies and children, is the most cost-effective approach.
"It will save us money in the long run," DeBoer said.
Buckley said voter support of Measure 101 will help dampen rate increases on commercial insurance and will help hold down hospital costs.
He said opponents of the funding measure are likely counting on Oregonians' historical distaste for new taxes to help defeat the measure.
During the legislative session, Oregon faced a $900 million budget shortfall because of its health coverage expansion and declining federal subsidies for care.
Hospitals came forward with an offer to tax themselves $500 million to cover part of that shortfall. The tax on insurance companies was added to close the rest of the budget gap.
Hospitals will benefit by getting federal matching dollars for the money the state spends.
Measure 101 will generate an estimated $210 million to $320 million. That revenue will attract an additional $630 million to $960 million in federal Medicaid dollars, proponents said.
Callahan, the pediatric nurse practitioner, said Oregon is a "donor" state — paying more in federal taxes than it gets back in per-capita federal spending. Passing Measure 101 is a way to get more federal dollars returned to the state, she said.
However, opponents of the measure said the financial forecasts are speculative and Oregon has no guarantee the federal government will continue to provide subsidies, especially with Republicans in control of Congress and the White House.
Money matters aside, Callahan said she is most concerned about human impacts.
"I'm here to tell you what it looks like at the ground level," she said.
Before the Oregon expansion of health care coverage, a mom she cared for was covered by OHP while she was pregnant. She developed gestational diabetes and her insulin was covered.
After the woman gave birth, she was no longer covered by OHP, which at the time focused on kids and very low-income adults. The woman still had diabetes and could not afford insulin. Her husband had a job, but it didn't offer insurance, Callahan said.
After the OHP expansion, the woman gained health insurance coverage. She is now healthier and better able to care for her family, Callahan said.
The panelists acknowledged problems still abound for Oregon and the nation as a whole.
Republicans in Congress hope to eliminate an Obamacare mandate that all people have health insurance.
If that happens, more young, healthy people would decide to go without insurance. With sicker, older people left in the insurance pool, insurance costs would rise for everyone else who still has insurance, Gilmour said.
Rising costs would then drive even more people out of the insurance pool, he said.
Some audience members said they are reluctant to vote for Measure 101 because of reports of mismanagement and waste by the Oregon Health Authority, which oversees OHP.
An audit found the Oregon Health Authority misspent millions of dollars by providing benefits to people who were not eligible.
DeBoer said he hopes a new director for the troubled agency will provide better management.
Without Measure 101, DeBoer said, the state will not have a balanced budget and legislators will have to close the gap by dropping coverage for people, cutting costs elsewhere or imposing different taxes.
Audience members said not enough is being done to address the fundamental problem of health care, insurance and medication costing too much.
Gilmour said America definitely has a problem with out-of-control medication costs. He noted many brands of insulin have shot up in price from $50 a vial to $150 to $200 a vial.
He said when the price of one drug goes up, the cost of all the other drugs in that category also spikes.
"If that's not price-fixing, what is?" Gilmour asked.
Audience members also criticized a federal law that bans Medicare, the federal insurance program for senior citizens, from bargaining over drug prices.
Buckley said other industrialized countries allow negotiations with drug companies over prices.
America also bars consumers from buying drugs from other countries, creating a virtual monopoly for pharmaceutical companies.
DeBoer said Measure 101 will not solve the state's funding problems long-term.
Under Obamacare, the federal government will provide lower and lower subsidies to states over time.
Additionally, although Republicans in Congress were unable to overturn Obamacare, they continue to chip away at health insurance coverage, panelists said.
The loss of federal funding for health care would be particularly harmful to the Rogue Valley, which has a sizable health care industry. Cuts would impact health care workers as well as the overall community, Buckley said.
A March analysis by the Mail Tribune revealed Obamacare medical spending contributes almost $219 million a year to the Jackson County economy — a significant contribution to the Medford area's $1 billion health care sector.
Unlike Oregon, the federal government is not required to balance its budget and can engage in deficit spending.