The ins and outs of Measure 101
This month Oregon voters will have a chance to weigh in on Measure 101, helping decide how the state pays for its Medicaid program.
The measure, which deals with insurance premiums, managed care organizations and federally regulated hospital taxes, is not an easy read. Here are the basics:
Ballots will be mailed to voters this week, and must be received by elections officials by 8 p.m. Jan. 23.
Last summer, Democrats in the Oregon Legislature pushed through a bill providing temporary funding for the state's Medicaid system — the government healthcare coverage program for the poor and other qualifying groups. In Oregon, the Medicaid program is known as the Oregon Health Plan and covers about 1 million people, including 400,000 kids.
Three Republican lawmakers — State Reps. Julie Parrish of West Linn, Cedric Hayden of Roseburg and Sal Esquivel of Medford — decided they wanted to refer parts of the law to voters. They led a petition campaign to gather signatures and are now urging voters to vote "no" on the measure, which would repeal those parts of the state's Medicaid law.
Both the state and the federal government pay for Medicaid with public funds. Hospitals, insurers and coordinated care organizations all pay taxes — described in the measure as "assessments" — to the state. Oregon uses that money to get matching funding from the federal government.
Hospitals pay a 5.3 percent assessment on net revenues, which, once matched by the feds, is returned to them as a group and redistributed. Under the state law passed earlier this year, they also pay a 0.7 percent assessment on net revenues that is not returned to them, but put into a state fund for healthcare.
A "yes" vote would allow the state to impose and keep the nonrefundable 0.7 percent assessment on hospitals, as well as assessments on insurers, the Public Employees Benefits Board and coordinated care organizations — regional networks of OHP providers.
Supporters of the measure say the plan is necessary to help pay for people on the Oregon Health Plan.
Hundreds of thousands of Oregonians gained Medicaid coverage under the Affordable Care Act, which allowed states to provide coverage to people making up to 138 percent of the federal poverty level. As of November 2016, about 366,000 people were eligible for OHP under the Affordable Care Act.
Previously only those making up to 100 percent of the federal poverty level were considered eligible. But that group, earning between 100 percent and 138 percent of the federal poverty level isn't legally required by the federal government to be covered by states.
Supporters of Measure 101 say that if it fails, the Legislature could decide to cut those people from the health plan to save the money that the state government won't be able to collect. Proponents note that faced with funding gaps in the past, lawmakers have knocked people off the Oregon Health Plan.
"If you are a Medicaid recipient, this is about whether you have access to your health care," said Jessica Adamson, a lobbyist for Providence Health & Services, which is backing Measure 101. "This is about whether or not the funding is there to fully fund this program. Anything else besides Measure 101 is a gamble. There is no Plan B."
Opponents counter that state legislators can find that money elsewhere in the budget to cover those people.
"This ballot measure isn't about whether Medicaid is good or bad," said Parrish, the lawmaker urging a "no" vote. "It's about whether we picked the right funding mechanism to pay for it."
Oregon's Medicaid program costs $9.3 billion in state and federal funds per year, according to the Oregon Secretary of State's office.
If the measure is overturned, legislators would face an $840 million to $1.3 billion hole in the Medicaid budget, a figure that includes both state and federal matching funds.
Supporters of Measure 101 say that expanded Medicaid coverage reduces demands on costly emergency care. It also funds a program called reinsurance designed to hold down rate increases in premiums for people who buy their own insurance.
It essentially acts as insurance for insurers, providing a pool of money to reimburse insurers part of the cost of very expensive procedures. In 2018, the program is holding rates in Oregon's individual health insurance market, on average, 6 percent lower than they would be without reinsurance, according to the Department of Consumer and Business Services. That's about $300 less per year, according to the "Yes on 101" campaign.