A state task force said it had found a way to pay for a new health plan for low-income Oregonians not covered by existing government programs. But the new program is expected to have ripple effects on Oregon’s health care system that have some providers worried.
The 21-member panel — which includes lawmakers, state officials and representatives of health care interests — is finalizing the details of what’s being called a Bridge Health program. The new program is intended to serve people who earn too much to qualify for Oregon’s Medicaid-funded health plan, some of whom are expected to lose coverage as the federal government rolls back emergency pandemic measures.
Once finalized, state officials will submit the plan to the federal government for approval under a provision of the Affordable Care Act that allows states to implement an additional health care option for residents at low income. Funding for the new plan will be based on the amount of money that would otherwise have subsidized low-income enrollees using the federal health insurance market.
An analysis by consulting firms Manatt Health and Oliver Wyman presented to the task force in November found that federal funds would cover program costs for the estimated 102,100 Oregonians who enroll and generate an additional annual surplus of $142.52 million. of dollars. This surplus would be used to establish a trust fund to ensure the sustainability of the programme.
“This is a rational next step in Oregon’s more than 30-year history of innovation in health policy and health care access,” said Senator Elizabeth Steiner Hayward. , a Portland Democrat who co-chairs the task force, to the Lund report. She said the program will provide stability for Oregonians in low-paying jobs who lose Oregon health plan coverage after racking up a few extra hours of work.
Although the analysis indicates that the new plan is financially feasible, it could lead to increased premiums in the individual market as well as a burden on safety net health services. Healthcare providers, meanwhile, have raised concerns that he will not pay enough.
The Bridge Health program would be available to Oregonians earning more than 138% of the poverty level, or $38,295 per year for a family of four, which is the threshold for Oregon’s health plan. But beneficiaries of the new plan would have to earn less than 200% of the federal poverty level to be eligible.
Proponents say the plan will provide stable coverage and improve the health of people who enter and leave the program due to changes in income, family circumstances or administrative barriers – a dynamic known as “churn”.
They also say it will provide a soft landing when federal authorities restore income eligibility checks for Medicaid recipients, which states were allowed to suspend earlier in the pandemic.
The number of people enrolled in Oregon’s health plan rose from about 1 million in 2019 to 1.3 million by 2021 as the state stopped checking eligibility, the group’s draft report notes. of work. Households falling into the 138 to 200 percent poverty bracket also saw their coverage rate increase by nearly 10 percent, the report said.
The federal government has not given a specific date for when states will have to start verifying the income of Medicaid recipients. But state officials earlier estimated that up to 300,000 Oregonians could be evicted.
According to the consultants’ analysis, beneficiaries who transitioned out of Oregon’s health plan are expected to be the largest group to transition to the bridging program, with 55,000 people transitioning after the program was introduced in 2025. expects another 11,300 uninsured Oregonians to enroll, along with about 36,000 who are currently insured through the federally subsidized individual market.
The draft task force report indicates that as these people join Oregon’s new plan, the individual market will end up with a slightly healthier and younger consumer base, the percentage of people aged 45 to 54 years going from 19% to 18%. Market consumers are also reportedly better off, with 54% of those in the market earning more than 400% of the federal poverty level.
A healthier consumer base “would initially lead to a slight reduction in premiums in the individual market, although these effects vary by age and pricing region,” the report says.
But consumers will also see the purchasing power of their federal market tax credits used to buy coverage decline, the report said. As a result, the cheapest bronze level plan premium on the market would increase from $39 to $50 for a 21-year-old. For someone age 64, that’s an increase of $116 to $151.
Steiner Hayward said the disruption could be minimized by moving the benchmark for federal grants from a silver plan to a gold plan.
“It’s about mitigating the impact on consumers using the marketplace, but also maximizing what the feds are giving us, so that’s part of the negotiation process as well,” she said.
The consultants warned the task force that it is uncertain how the Oregon health care market will react to the new bridge plan. Steiner Hayward said the Oregon bridge program will require close monitoring, but is encouraged that similar programs in Minnesota and New York have been financially viable.
New program, same prices
The bridge plan will be structured similarly to the Oregon health plan. This worries some health care providers.
Oregonians who enroll in the new program would receive coverage similar to Oregon’s health plan, and beneficiaries would not be charged premiums or cost-sharing for fear that low-income households income are covered. Managed care organizations that the state contracts with to serve people on the Oregon health plan would also be responsible for serving Oregonians on the bridge plan.
The task force has previously called for reimbursement rates for the new plan to be higher than those for Oregon’s health plan, which providers have long complained are too low. But the task force now recommends that the bridging program offer the same reimbursement rates as Oregon’s health plan to help build its reserves.
Sean Kolmer, senior vice president of policy and strategy for the Oregon Association of Hospitals and Health Systems, told the task force in a Nov. 28 letter that hospitals were already struggling financially. .
“In developing recommendations on the allocation of federal BHP (Bridge Health Program) funding, including any excess over program costs, we urge the task force to prioritize hospital reimbursement that covers the cost of providing care to the BHP population,” Kolmer said in the letter. “We know from our current experience that anything approaching OHP reimbursement levels does not support access in a community.”
The Oregon Primary Care Association also expressed concerns about how another health program with low reimbursement rates would affect Oregon’s 34 federally licensed health centers. Safety Net Clinics serve Oregon Health Plan beneficiaries and receive cost-based payments to ensure financial stability.
The health centers would serve Oregonians under the bridge program, but would not receive the cost-based payments, which the association says will upend their finances.
“It’s not a gold mine for a provider organization,” Marty Carty, director of government affairs for the Oregon Primary Care Association. “This is truthfully and transparently based on the cost of providing care to the patient population at each FQHC.”
Carty said shifting income from safety net clinics through lower payments could impact the programs and services available to all of their patient populations.
Steiner Hayward acknowledged that Oregon’s health plan reimbursement rates “are lower than we would like them to be.” She also said qualified federal health centers will need to be closely monitored for any potential impact.
You can reach Jake at [email protected] or through Twitter @jakethomas2009.
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