More firms want to provide health care to low-income Oregonians
More companies soon could be competing to provide health care insurance to 1 million low-income Oregonians.
Two dozen firms have submitted pre-application letters to serve the Oregon Health Plan in various regions of the state, as compared to 15 such firms that do so now.
The prize? A share of the biggest procurement in state history. An estimated $5 billion is expected to be spent on the program in 2020, and similar or growing amounts through 2024.
The competition looks to be most heated in Clackamas, Multnomah and Washington counties, where six firms have applied for five-year contracts to serve 300,000 Oregonians.
Currently, only one such firm, Health Share of Oregon, contracts with the state to serve the health plan in the tri-county region.
The new pre-applications, called letters of intent, are significant for several reasons:
•The number of firms applying shows there is no decline of interest in serving low-income people in Oregon, despite assertions by the companies serving the health plan that they aren't paid enough.
•Some observers have felt there already were more care organizations than necessary, leading to inefficiencies. Now there could be more companies.
•The Oregon footprint of out-of-state, publicly traded firms serving the health plan will not expand as some had feared.
•The number of firms applying to serve Clackamas, Multnomah and Washington counties may foreshadow the breakup of the tri-county organization that already does so, Health Share of Oregon.
First contracting since 2012
Based on reforms approved in 2012, the Oregon Health Plan uses what are called coordinated care organizations, essentially insurance companies, to manage care for the state health plan.
To qualify for the program's free care, individual members must earn no more than $1,396 per month, or $2,887 for a family of four.
For more than a year, the state has prepared to issue a new round of contracts in the program while instituting further reforms to address concerns about financial transparency and escalating costs. State expenditures have exceeded the growth cap included in the state's agreement with the federal government for two years in a row.
The new round of reforms, in many cases, echoes previous goals — but the new contracts are intended to allow for more oversight, state officials say.
In recent months, speculation has mounted in health care circles of whether Health Share of Oregon, once the poster child of the 2012 reforms, would continue serving the health plan, or break up.
Under its current contract with the state to serve the health plan, Health Share essentially functions like a nonprofit umbrella company composed of local hospital systems, as well as the nonprofit CareOregon.
Health Share submitted a letter of intent to continue serving the health plan in the tri-county region. But so did several Health Share partners: Care Oregon, Providence Health and Kaiser Foundation Health Plan of the Northwest. PacificSource, a subsidiary of another Health Share partner, also applied.
A Health Share press release last week said Health Share's partners' "first preference" is to for the care organization to continue, but "some of Health Share's partners may submit letters of intent as a precautionary measure."
The only non-Health Share company to apply to serve the entire tri-county region is Moda Health. Moda already sells private insurance to people who don't qualify for the Oregon Health Plan.