How will Oregon pay for Medicaid expansion in 3 years?

Jeff Kruse

Sen. Jeff Kruse (R-Roseburg)

Over the last two Sessions we did a lot of work in the creation of Coordinated Care Organizations (CCO).  It is the intent of the Senate Health and Human Services Committee, of which I am the vice chair, to do nothing this year relative to their structure.  Because it was our intention to allow these organizations the ability to develop locally, and because none of them are even a year old, it would be inappropriate for us to be doing so.  Keep in mind I am just speaking for the Senate and would not assume to know what the House might be considering.  The one area I have suggested we dig into are the metrics; not only those newly created by the Oregon Health Authority, but also those required by the federal government.  Metrics are the data points and statistics required for different levels of accountability, and I want to make sure we are measuring the right things and not over complicating the system.

Another major issue will be the insurance exchange, which now goes by the name Cover Oregon.  At this point it may be possible this issue will only be dealt with in the Ways and Means Committee, which I find unfortunate.  I supported the concept two years ago, hoping we would basically be creating just a market place.  One of the issues still to be resolved is whether the IT platform will actually work.  But the more important issue is the development of the business plan.  What I am hearing unofficially is the matrix currently on the table is going to significantly increase insurance rates.  If the goal of this is to force everyone into a government program, this would go a long way towards accomplishing this, and there are many who have that as their objective.  If at the end of the day the outcome of what is being proposed will do little more than create more government jobs and kill private sector insurance coverage we need to do everything we can to stop it.

Keep in mind as a member of the minority party we can’t stop anything without some help from the other side.  For example, I am certain we are going to do the Medicaid expansion referenced in the federal act.  We will do this with the promise from the feds that they will pay 100% of the cost from the first two years.  My real issue, besides the expansion of an entitlement program our nation is having to borrow money to pay for, is the impact this will have on our state budget year three and beyond.  We are currently able to keep our state Medicaid budget in place because of the “gift” of the additional federal dollars we are receiving above standard rates and this money as well will run out in time.  Politically speaking it becomes very hard to take away an entitlement once it has been implemented.  This would leave us three or four years from now with the potential choice of cutting funding to education or public safety, or looking at a massive tax increase.  None of those choices are good, but I believe this is the scenario we will be setting up.

We have already had a couple of “Health Care for All” rallies here and some of my constituents have visited me on the issue. What everyone needs to understand is the fact health care will always be rationed, as it is in every system anywhere in the world.  What we are doing at the very least is changing the decision point as to where the rationing happens.  I would still like to find a way to have these issues dealt with at the patent/provider level, but we are not there.  So far in health care transformation all we have done is rearrange the seats at the table for the Medicaid program.  It is too early to tell if this experiment will work for the public sector let alone trying to expand it to the private sector.

I am already hearing stories about some businesses having to cut back on their employee’s health care coverage and we need to do everything we can to prevent this from happening.  My personal take away from the President’s State of the Union address was that government was the answer to all of our problems.  My fear is our Governor may be of the same mind.  Time will tell how far down this road we end up going.

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Posted by at 05:00 | Posted in Health Care Reform, OR 77th Legislative Session, Oregon Senate | 9 Comments |Email This Post Email This Post |Print This Post Print This Post
  • Tom Joad

    Funny that a couple of Republican legislators warned of exactly the problems you outline in your article. With a tie in the House, the Republicans should have stood firm and refused to cooperate with Obamacare. Instead, the Republicans are largely responsible for the Obamacare-on-steroids model we have now. Thanks a lot.

    • voterid

      How do you justify that the Republicans are responsible for Obamacare? Not one Republican voted for Obamacare in the Senate and Harry Reid had to change the rules to just 51 votes to pass the law instead of the 60 votes it should have needed. Remember NOT ONE REPUBLICAN voted for Obamacare…and both the House of Representatives and the Senate Chamber along with the presidency was all governed by Democrates…that seems like it would be impossible to have stood firm and refused to cooperate with the law….they did and they lost…please get your fact straight.

      • DavidAppell

        The individual mandate was a conservative idea.

  • Damascusdean

    Saying the exchange is going to increase insurance rates is like saying that a car costs more than a bicycle. So what? Insurance offered under the exchange will be far better than some of the minimalist policies that one can buy today. And many if not most people in the exchange will get help to buy these new policies.

    • John Fairplay

      Help from whom?

      • valley person

        The government.

  • DavidAppell

    The author wrote:
    “I am already hearing stories about some businesses having to cut back on their employee’s health care coverage.”

    Of course, employers have been cutting back on employee health care for years, requiring employees to pay for a higher share of premiums, high co-pays and deductibles, or dropping coverage all together:

    Acting like it’s Obamacare that’s suddenly the cause of all this is disingenuous (at best).

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