Oregon Legislature considers health care plan for low-income residents

Today, more than 96% of Oregonians have health insurance coverage, thanks to the innovations of state government and community-based leaders. However, this upward trajectory is threatened by a change to Medicaid that could eliminate coverage for 300,000 Oregonians in the short term and more in the long term. 

Over the next 14 months, the state will begin reexamining the eligibility for every person on the Oregon Health Plan, the state’s version of Medicaid. Coverage will continue only for people whose income level is at or below 138% of the federal poverty line: $20,120 a year for a single person or $41,400 a year for a family of four. 

A recently approved temporary waiver expands Medicaid in Oregon to cover people between 138-200% of the federal poverty level: $29,160 a year for one person and $60,000 a year for a family of four. But long-term coverage for this population still hangs in the balance. If certain investments are not made during this legislative session, many Oregonians eventually could lose their coverage and shoulder the costs of health care services alone.

Too many Oregonians are caught in an insurance gap; they make too much to qualify for Medicaid, but they cannot afford coverage available on the marketplace. One emergency room visit could send such a family into a financial crisis. 

There is one bright spot: After this redetermination cycle, children are protected from the future loss of coverage. Through an agreement with the federal government, Oregon is the first state providing continuous coverage for children from birth to age 5. This recognizes the reality of so many low-income working families: One extra shift can put you above the line, one unpaid sick day can put you below it. 

Oregon’s families cannot wait for an equitable path to health coverage for parents and older siblings, however. Fortunately, Oregon’s Legislature is working on the issue through the proposed Bridge Plan. The concept is like Medicaid – the Bridge Plan would allow people in the lowest income brackets (up to 200% of the federal poverty level: $29,160 for a single person and $60,000 a year for a family of four) to continue coverage, remain with their Medicaid insurer, a coordinated care organization, and maintain care with their established providers. 

This program is essential to continue addressing the damaging health disparities that come from lack of access to care for Black, Indigenous and people of color in our state.  In addition to its equity imperative, it is a smart investment. The Bridge Plan would have a limited financial impact on the state, thanks to a federal funding opportunity. For every $5 Oregon would invest into the program, the federal government puts in $95, bringing the total federal funding Oregon receives to approximately $866 million per year. 

By fully funding this program, Oregon could continue to reduce coverage disparities and ensure that all Oregonians have access to quality health care. 

Our organization, which represents community health centers serving over 436,000 of Oregon’s lowest income residents statewide, is poignantly aware of the positive impacts of fully funding this program and, conversely, the consequences of its absence. Many of our patients are those at highest risk of losing coverage during redetermination – many are experiencing houselessness, are best served in languages other than English, and may move frequently throughout the year. 

While they can access care at a community health center regardless of insurance status, uninsurance and lack of certainty about costs can deter patients from entering these clinics. Without the Bridge Plan, many will defer care until they are in crisis. This incurs higher costs to the health system and allows preventable diseases to evolve into chronic conditions.

To enact the Bridge Plan, however, the state would need to continue working with the Centers for Medicare and Medicaid Services to apply for a permanent waiver which would make low-cost health coverage available for working people in the insurance gap.

The Bridge Plan would ensure that in 2025 working people don’t fall so deep into the insurance gap that they cannot get out. The Bridge Plan is a smart investment to reduce health disparities, and move towards our guiding star of health equity for all by 2030, ensuring that all Oregonians have access to quality health care.