About the only thing both sides in a Jan. 23 special election can agree on is this: If Measure 101 fails, Oregon lawmakers will have to go back and figure out how to pay for extending health care to 350,000 low-income people.
But an advocate and an opponent disagreed during a Washington County Public Affairs Forum on Jan. 8 about how easily lawmakers could do it during their upcoming 35-day session, which starts Feb. 5.
A "yes" vote on Measure 101 upholds the Legislature's 2017 decision to increase an existing assessment on hospitals by .7 percent, and impose a 1.5 percent tax on some health insurance plans. The $300 million generated by those sources recoups almost $1 billion in federal funds for the Oregon Health Plan.
A "no" vote would do away with the new sources and opens a $1.3 billion hole in budgeted spending.
The money offsets a declining federal share for states' expansion of Medicaid — including the Oregon Health Plan — under which Oregon has boosted coverage from 84 to 95 percent of its population. The federal share started at 100 percent in 2014, but dropped to 95 percent in 2017, and will decline to 90 percent by 2020.
Thirty-two states have chosen to expand Medicaid coverage under the 2010 Affordable Care Act.
"There is no magic pot of money. If Measure 101 does not pass and we have to come back and figure out how to rebudget in February, we will have to make cuts," state Rep. Andrea Salinas, D-Lake Oswego, said on behalf of the 165-member coalition supporting it.
"The ideas that have come up so far (from opponents) do not add up to $1.3 billion. They cannot show you anything on their web page that adds up. We are going to need to make up the difference."
About 1 million Oregonians, one in four, are enrolled in the Oregon Health Plan. The plan covers about 20 percent of Washington County's 600,000 people.
The money also reduces some individual premiums by $300 annually because it funds a state reinsurance plan for people with high medical costs.
The funding plan in House Bill 2391 passed largely along party lines. Only one Republican in the House and three Republicans in the Senate joined all Democrats to clear it with the required 60 percent majorities.
GOP Rep. Sal Esquivel of Medford, who voted for passage, later joined GOP Reps. Julie Parrish of West Linn — her district includes Tualatin — and Cedric Hayden of Fall Creek to sponsor successful petitions that forced a statewide election on the measure.
"It's an egregious way of funding the expansion of Medicaid," said Lindsay Berschauer, a political consultant from Newberg who spoke for the opposition Stop Health Care Taxes.
"This is not about folks falling off the care they need. This is about a more fair and equitable way to get it done. What we are arguing is that you don't need to go out and tax certain Oregonians on their health care, making it more expensive and less accessible for them in order to pay for Medicaid expansion when we have the money to do so."
Berschauer said Oregon could tap some of its projected windfall to state coffers from the recent congressional overhaul of the federal tax code, which limits deductions of state income taxes on federal returns.
But Salinas said that unlike provider taxes, the alternative sources suggested by Measure 101 opponents would force health care to compete with state aid to public schools and other state services in the general-fund budget that relies mainly on income taxes.
"Trusting them is a gamble we cannot make," she said of the opponents.
Oregon is already seven months into the current two-year budget cycle.
Oregon has had some form of hospital assessment since 2003, when it was devised by a budget subcommittee led by Sen. Jackie Winters of Salem, now the Republican leader in the Oregon Senate. All but one state (Alaska) levy some form of "provider tax" to recoup federal funds.
Measure 101 does not affect a separate 5.3 percent assessment on net patient revenues of hospitals, which also goes to match federal funds and which lawmakers passed with only three dissenting votes in 2015. That agreement expires Sept. 30, 2019, as does the additional money raised by Measure 101.
Berschauer offered harsh words for the Oregon Health Authority — the agency that runs the Oregon Health Plan, the target of a critical audit by Secretary of State Dennis Richardson, and where Gov. Kate Brown replaced the director about six months ago.
"We are getting things back on track" with the new director, Patrick Allen, Salinas said.
Berschauer also singled out large corporations that offer self-insured plans — such as Intel and Nike, Washington County's largest employers — that under federal law are not subject to the state tax. She argued that state lawmakers could have taxed them, but a 2016 U.S. Supreme Court decision appears to side with self-insured plans in their lawsuit against a tax by Michigan.
She also criticized some of the members of the supporting coalition, such as the Oregon Association of Hospitals and Health Systems, Oregon Medical Association and Oregon Nurses Association.
"Either they won't pay the tax themselves or they profit off it. You can pretty much split it right down the middle," Berschauer said.
"This is not about people for them. This is not about maintaining health care.
"This is about profit. It's always about money. Follow the money, and you will figure out why they are pushing this so hard."
Measure 101 supporters had raised about $2.5 million by early January, compared with $120,000 for opponents.
Berschauer even criticized former clients of Salinas, who in a previous job lobbied for Oregon's two largest public employee unions, Local 503 of Service Employees International Union and Council 75 of the American Federation of State, County and Municipal Employees.
Salinas left her lobbying job with Strategies 360, a Portland firm, to accept appointment to the District 38 seat vacated after the 2017 session. Salinas did not take part in the 2017 legislative votes.
Salinas said Berschauer is attempting to tap public unhappiness on a range of state issues, but many of them have nothing to do with Measure 101.
"I think they are unhappy with the way we deliver our health care system and the entire system," she said. "But that is not what this is about. This is about the Medicaid expansion budget.
"Our goal is to cover everybody so that everybody has preventive care and seeks treatment early, when it's cheaper, and not later, when it's more expensive or from the emergency room."
Link to Measure 101 supporters:
Link to Measure 101 opponents:
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