A legislative task force has released initial recommendations on how to design a new health insurance program to cover poor Oregonians who still earn too much to qualify for the Oregon Health Plan.
at a meeting of Oct 18 8:30am The public will learn more about what the plan looks like in practice and how it could affect the healthcare system.
Proponents of the plan say it will improve the health of people across the state, especially those who turn on and off Medicaid-funded OHPs or who cannot afford insurance through the state’s existing health insurance marketplace. I’m here.that is website People without government or employer-based coverage can obtain tax credits that reduce insurance premiums and purchase their own insurance.
Called the Bridge Health Program, the program is available to individuals (state Medicaid) who are below 200% of the federal poverty level ($55,500 annually for a family of four) but above 138% of the poverty level . cut off. The lower end of the range equates to $38,295 per year for a family of four.
People with poverty rates above 200% continue to be eligible for coverage in the health insurance market.
About 94% of Oregonians now have health insurance.
of Preliminary design of the program It was released on August 31st.
Maribeth Guarino, High Value Healthcare Advocate at OSPRIG, said: “Most people can agree that we need to do something about health care costs. Right now, 138% to 200% of people are most vulnerable.”
Introduced by former Congressman Rachel Prusak on behalf of the House Medical Committee, House Bill 4035 Last year, we launched a task force. One of the primary goals of this program is to maximize the use of available federal funding.
The path the task force decided to take, with input from the Centers for Medicare and Medicaid Services, was to: 1331 ExemptionIt is named after the section of the Affordable Care Act of 2010 that authorized it.
Task force members intend benefits within the health care plan substantially similar to what the state already provides through OHP, with reduced cost sharing (premiums, deductibles, coinsurance, coinsurance). ) is designed to avoid the need for -pays) for individuals relies on federal dollars instead.
The state must at least allocate funds for administrative expenses, which will be discussed at the next 2023 session of the Oregon Legislature.
However, many actuarial analyzes have not yet been completed, and uncertainty remains regarding the financial ramifications and overall costs of the programme.
At the October 18 meeting, the task force will learn the results of simulations testing how the program will affect the market in terms of premiums, enrollment, prevalence, composition and tax credits.
Task force members said at the Oct. 4 meeting that the analysis could lead to changes to the design of the plan if costs were higher than current expectations.
“We don’t want the market to become volatile under any circumstances because it perpetuates the very problem we are trying to solve: getting people to have access to health insurance. Because it will be put away.” Association.
The plan could help 55,000 people next year
The program’s biggest targets, at least initially, are individuals who continued to use OHPs despite being disqualified during the coronavirus pandemic.
Due to new federal policy during the pandemic, Oregon chose not to exclude anyone from OHP, instead allowing subscribers to maintain health insurance coverage.
However, the public health emergency declaration that allowed this “continued eligibility” will end in the coming months, possibly as early as January. The state then gives him one year to verify the eligibility of all members of the plan. Without health insurance plans for poor individuals, thousands of Oregonians could lose their insurance if they were unable to pay for market plans.
The Oregon Department of Health estimates that as many as 300,000 Oregonians could lose their OHP insurance after the public health emergency ends.
According to analysis presented to the Task Force, after 2024, that population could double as people move from market plans and uninsured to BHP. .
At a minimum, this plan will cover the same 10 “essential health insurance” plans offered in the health insurance market. However, the Task Force will support providing more benefits, including up to the service levels offered by OHPs, where possible.
One of the big unresolved issues is adult dental insurance, which is included in OHPs but not in services considered essential health benefits. HB 4035 legislators have explicitly said they want the bridge plan to include dental insurance options “to the extent practicable.”
Some advocates point out that creating identical public health insurance options is simply the fairer option.
“We don’t want a two-tiered health insurance program where the state provides one set of benefits to one group of people and another set of benefits to another group,” Carty said. says.
Care under the Basic Health Plan is provided by the same local insurers, called “Coordinated Care Organizations,” which have contracts with the state to provide services to Oregon Health Plan members. This allows individuals to retain their healthcare provider whether they have OHP or basic health insurance.
This would make the benefits of the new program the same as OHP, as some proponents hoped, as well as the “churn” population (who often qualify for OHP but earn more in some months). , the people who bring them) to a more seamless transition between OHP and BHP. It exceeds the federal poverty level of 138%.
Studies show that these individuals (including seasonal farm workers) often live without insurance during the period when they are not eligible for OHP, instead of going through the hassle of finding new insurance or health care providers. I know
Beaverton Democratic Senator Elizabeth Steiner-Hayward said: “If people don’t get the right treatment, they don’t take their medicines properly, they end up in the emergency department more often, because they don’t have a good control over their chronic illness, and they return people to her OHP. management fee will be incurred.”
The basic health planning process, supported by some proponents, allows states to extend optional government coverage to those who make up up to 400% of the federal poverty limit, using another type of federal exemption. may lead to But the debate about that possibility may not start until 2025, if basic health plans are successfully launched.
Throughout the fall, the Task Force will review the design of the Bridge Program. The final report is due December 31st.
Contact Connor Radnovich at: [email protected] or via Twitter @CD Radnovich.
