Cover Oregon Advisory Council Report by Roberta Hall of MVHCA

Dec. 9:  CAC meeting, Cover Oregon, Friday Dec. 5, 2014  -- a virtual, by-phone regular meeting. Roberta Hall, MVHCA and CAC member, reporting.

Of course one report from this meeting was about enrollment which started mid-November and ends mid-December for those purchasing commercial products (Qualified Health Plan). As usual, the process has gone more slowly than is desirable. One problem is that if people wait until the last minute, there could be clogging of the website – not pleasant.

This week (of Dec.8-on) are the Legislative Days when continuing members of the Legislature meet. The Health care Committee of the house and the Senate’s Health and Human Services committee were meeting. Aaron Patnode, CEO of cover Oregon, told us he would speak to each of them, give an update, and discuss how the errors Cover Oregon (C0) made re: advance tax credits could be corrected, among other topics. On Wed. the Joint interim Committee on Health Care Transition is to meet for the first time, to consider the future of Cover Oregon. The Legislative Concept (the equivalent of a draft bill) LC 1203, now available on line, calls for abolishment of CO—it would also abolish the Board and our CAC – but of course the exchange would continue to exist and its functions would move to Consumer and Business Services, where the Insurance Division is.  Of course the bill could be altered, but in any case it sounds more like a symbolic act than anything that would bring a great deal of change from a user’s point of view; but of course I could be wrong.

Advertising is going on to try to motivate people to enroll in insurance plans through

Insurance companies, we were reminded, are commercial enterprises. They are supposed to remind people to enroll, but sometimes their notices imply that people need to enroll in their plans whereas of course people are free to explore others. There have been workshops to help people, as we noted in the recent MVHCA newsletter, but the one nearest to us is Dec. 10 in Eugene, at Lane Community College Downtown Center, 11 to 3, 101 W 10th st. room 107.

Judy Mohr-Peterson, Oregon’s Medicaid Director, provided useful information. People new to Medicaid can go to and see if they qualify to enroll, but they also may find helpful information on a new site called, before they go to  It provides screening questions on income and other factors that could help people learn about OHP and if they qualify.

People who qualify and are accepted receive OHP services dating from the date of their application. This is an important point often not stressed. People who were fast-tracked via the SNAP or food-stamp program do need to apply in order to continue to be part of OHP, and some other OHP members will simply be contacted and asked to affirm that their financial situation has not changed, in order to continue. My understanding – I hope it is correct – is that some OHP members will not be contacted but simply will continue on OHP. In any case, if a person is contacted and either does not see the letter, or fails to reply, he or she will be contacted at least twice again, with notices asking them to reply, before being dropped. This is a necessary process, as sometimes letters are lost in the mail, or mislaid. Of course, people with questions about making an OHP application can talk with our Health Dept. Navigators who can be reached at 541-766-2130 or by going to the department office at 27th and Tyler.

One quarter of our Oregon population is on OHP, giving an indication that a very large percentage of our population experiences some degree of poverty. We all have a lot to do to turn this around.

Elizabeth Hayes: The Uncovered

From Portland Business Journal:

In 2019, five years after the Affordable Care Act has kicked in and, presumably, Cover Oregon’s woes are a distant memory, many more Oregonians will have insurance than do today.

But not everyone.

An estimated 120,000 Oregonians who are subject to the “individual mandate” will still lack insurance, according to a new fact sheet by the Oregon Center for Public Policy. Here’s a breakdown:

• An estimated 71 percent — or 84,000 people — will be low income, earning below 200 percent of the federal poverty line.

• At least two thirds of them — or 56,000 people — will earn too much to qualify for the Oregon Health Plan.

• Another 11,000 would make too much for a tax subsidy through Cover Oregon to help offset the cost of their premium.

The subsidy is available for those earning under 400 percent of the federal poverty level. But even a subsidy wouldn’t place insurance within reach for many of these people, hence the tens of thousands of future uninsureds.

“The primary issue is affordability and the options available on Cover Oregon,” said Janet Bauer, health care policy analyst for the Center for Public Policy.

When other states offered coverage to those who made too much for Medicaid, here’s what happened: If the premium was at 1 percent of their income, 57 percent took the plans. When the premium rose to 4 percent, the “take up rate” dropped to 25 percent.

“Low income individuals are very price sensitive,” Bauer said.

In addition to the 120,000 estimated uninsured, another 99,000 undocumented immigrants will also lack insurance, as will another 69,000 who are deemed exempt from the mandate, including those who aren’t required to file federal taxes, tribal members and those experiencing hardship circumstances, the Center for Public Policy estimates.

Despite all this, the picture would look much bleaker without health reform. Under that scenario, there would be 680,000 uninsured in 2019, up from 600,000 in 2013.

“That, to our minds, is major progress,” Bauer said, “but we’re not there yet.”

One possible way to fill the gap in affordable coverage is for the state to offer what’s called a Basic Health Plan for people who make between 139 percent and 200 percent of the federal poverty level, too much for Medicaid. A bill to study the cost of such a program in Oregon will be considered by the Legislature in February.

More next week on how exactly it would work.

Low income, lower coverage

By 2019, a vast majority of the estimated 120,000 Oregonians still uninsured will be low income, defined as earning below 200 percent of the federal poverty line, according to research from the Oregon Center for Public Policy. All are subject to the “individual mandate” that requires individuals to obtain health insurance or pay a penalty.




Elizabeth Hayes covers health care for the Portland Business Journal.

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