Breakthrough for affordable health care

February 16, 2016

[This commentary was first published in The Portland Tribune.]

by Janet Bauer and Martin Taylor

Industry leaders and consumer advocates often don’t see eye-to-eye. So when they come together on a solution to a vexing problem, you can be pretty sure that Oregonians stand to benefit.

That is the case with a new proposal for how to implement a Basic Health Program in Oregon, which promises to extend health insurance coverage to many low-income Oregonians who still have none. Health industry leaders and consumer advocates serving on a legislatively convened work group have issued recommendations for how to operate a Basic Health Program. The ball now is in the Legislature’s court to take the next step.

Basic Health would close a gaping hole in our system of health care. Many low-wage Oregonians earn too much to qualify for the Oregon Health Plan (the state’s Medicaid program), but too little to afford health insurance through Oregon’s health insurance marketplace. Even the generous subsidies available in the marketplace aren’t enough to lower costs sufficiently. That helps explain why low-income, working Oregonians are more than twice as likely to lack health insurance as workers with higher incomes.

Recognizing the problem, the 2015 Oregon Legislature directed a work group of health industry representatives and consumer advocates to craft a Basic Health Program, an option that states have under the Affordable Care Act. Under Basic Health, federal dollars that would otherwise go to marketplace subsidies for low-income individuals would go instead to the state to provide health insurance for this population.

The advantages of a Basic Health Program became clear. Low-income Oregonians could get more comprehensive health coverage at a much lower cost. And the federal government would pick up most of the tab, since the federal subsidies would largely cover the cost of the program.

But, rightly, lawmakers raised concerns about the impact of a Basic Health Program on Oregon’s health insurance marketplace. How to balance these apparently competing concerns fell to the work group, which met over the summer and fall.

To the surprise of many, the work group succeeded by coming up with a novel approach. The solution was to offer Basic Health insurance plans inside, rather than outside, the health insurance marketplace. Retaining those customers would protect the stability of marketplace operations, while providing low-income Oregonians (primarily those between 138 and 200 percent of the federal poverty line) quality, affordable health insurance.

This proposed solution has the additional benefit of building upon Oregon’s innovative coordinated care model, which has begun to show positive results in improving care at a lower cost. Under this model, insurers, doctors and other health care providers are accountable and rewarded for keeping people as healthy as possible. Coordinated Care Organizations, as well as commercial insurers, could choose to provide Basic Health insurance through the marketplace.

The bottom line is that the Basic Health proposal before the Legislature is the next step toward a win-win solution. Thousands of low-income Oregonians finally would be able to afford health insurance. Many more who are struggling to pay for their coverage would see a much lower health insurance bill — all at little cost to the state. Oregon’s health insurance marketplace would be protected and more of Oregon’s health system would have the benefit of recent innovations in health care delivery.

Industry representatives and consumer advocates have tackled the hardest task. Now, it is up to the Oregon Legislature to take the next step and approve HB 4017 to create a Basic Health program blueprint for consideration by the next Legislature.

Janet Bauer is a policy analyst with the Oregon Center for Public Policy ( Martin Taylor is director of public policy and community relations at CareOregon (