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Beyond Cover Oregon: The problem of uninsured and affordability will continue

Portland Business Journal
February 14, 2014By Janet Bauer

A few years from now, long after Cover Oregon’s website woes are but a distant memory, tens of thousands of low-income Oregonians will likely still lack health insurance.

At that point, faulty technology won’t be what stands in the way of these Oregonians purchasing health coverage. Cost will be the obstacle.

To avoid such an outcome, our state needs to find a way to make health coverage affordable for those who will still be uninsured after the health insurance marketplace is operating smoothly. Solving that challenge will be key in Oregon’s quest to extend health coverage to all.

For sure, Cover Oregon — the state’s health insurance marketplace — will make it possible for many Oregonians to obtain health care coverage. Cover Oregon sells quality health insurance plans that are more affordable than what existed prior to the exchange. Federal tax subsidies help make sure the marketplace works by lowering the cost of the plans.

Despite the great progress that Cover Oregon will ultimately represent, the marketplace won’t go far enough. State officials project that even with the generous federal subsidies, health coverage will remain out of reach for tens of thousands of Oregonians.

Take for example, Sally, a single working mom raising one child. Sally earns well above the minimum wage, making $25,000 a year, and her job comes with no health coverage. Her child qualifies for the Oregon Health Plan, the state’s Medicaid program, but Sally herself does not, due to more restrictive income limits applicable to adults.

Sally’s best option is to shop for a plan in Cover Oregon. After factoring in federal tax subsidies, premiums for one of the least expensive plans in the third rung “silver” tier would cost Sally $1,129 annually.

That might not seem like a lot of money for health coverage, especially given what existed before Cover Oregon. But for a family who is already living paycheck to paycheck, buying health insurance for Sally might mean not having enough money to pay the rent, heat the apartment, put food on the table or afford other basic necessities.

And the reality is that there will be many families in the same boat as Sally — low-income families who make too much to qualify for the Oregon Health Plan, yet still struggle to pay the bills.

Low-income Oregonians are expected to make up the bulk of the state’s population who still won’t have health insurance despite the Affordable Care Act’s requirement that they do so.

By 2019, an estimated 120,000 Oregonians subject to the “individual mandate” will remain uninsured. Of this group, 84,000 will be low-income, with earnings below 200 percent of the federal poverty line. And of those, 56,000 will have income too high for the Oregon Health Plan.

These figures only reflect the population subject to the individual mandate. They do not include 99,000 uninsured, undocumented Oregonians excluded from the benefits and requirements of the Affordable Care Act.

Nor do they include an estimated 69,000 uninsured who are exempt from the mandate, such as those who aren’t required to file federal income taxes, tribal members and people experiencing hardship circumstances.

The job won’t be done until all Oregonians have access to affordable, quality health care. A good next step in getting us there is figuring out how to make coverage affordable for the tens of thousands of low-income Oregonians who are required to have health coverage but can’t afford it.

Janet Bauer is a policy analyst for the Oregon Center for Public Policy

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