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.

71% - BELOW 200% OF FEDERAL POVERTY LINE

20% - BETWEEN 200% - 400% OF FEDERAL POVERTY LINE

9% - OVER 400% OF FEDERAL POVERTY LINE

Elizabeth Hayes covers health care for the Portland Business Journal.

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