A state task force has come up with a plan to help pay for new health insurance for low-income Oregonians not covered by existing government programs. , which is a concern for some health care providers.
A 21-member committee, including representatives of legislators, state officials and medical professionals, is finalizing the details of what is called the Bridge Health Program. The new program is intended to serve people who earn too much to qualify for Oregon’s Medicaid-funded health plan, prompting the federal government to take urgent action against the pandemic. As it lifts, some people are expected to lose coverage.
Once finalized, state officials will submit the plan to the federal government for approval under the Affordable Care Act provisions that allow states to establish additional health care options for low-income individuals. Funding for the new plan will be based on amounts that would otherwise use the federal health insurance market to subsidize low-income participants.
An estimated 102,100 Oregonians enrolled in federal funding to fund the program’s annual surplus of $142.52 million, according to an analysis provided to the task force in November by consulting firms Manatt Health and Oliver Wyman. It turns out that the Its surplus will be used to build a trust fund to ensure the sustainability of the programme.
“This is a logical next step in Oregon’s more than 30-year history of innovation in health policy and access to healthcare,” said Sen. Elizabeth Steiner-Hayward of the Portland Democratic Party, co-chair of the task force. told the Lund Report. She said the program will provide stability to Oregonians who find themselves in low-paying jobs and no longer covered by Oregon Health Insurance after returning to work for a few more hours.
Analysis shows that the new plan is financially viable, but could lead to higher premiums in individual markets and strains on safety net medical services. , have expressed concern that they will not be able to pay enough.
shift coverage
The Bridge Health Program is available to Oregonians who are above the poverty level of 138% or earn $38,295 annually for a family of four. This is the cutoff point for health plans in Oregon. However, a recipient of the new plan must be below her 200% of the federal poverty level to qualify.
Proponents believe the plan will provide stable coverage for people who cycle on and off the program due to changes in income, family circumstances, or administrative hurdles—a dynamic known as “churn.” said to improve health.
They also say it will provide a soft landing when federal officials resume income eligibility checks for Medicaid recipients.
According to a draft task force report, health insurance coverage in Oregon will grow from about 1 million in 2019 to 1.3 million by 2021. Even among households with poverty levels of 138-200%, coverage increased by nearly 10%, the report said.
The federal government has not given a firm date for when the state should begin checking the income of Medicaid recipients. I had estimated that there was.
Consultant analysis predicts that 55,000 people will transition to the Bridge program after the program is set up in 2025, with unenrolled Oregon Health Plan beneficiaries being the largest group transitioning to the Bridge program. . In addition, he is expected to reach 11,300 uninsured Oregonians and approximately 36,000 currently insured through the federally subsidized private market. .
When those people join Oregon’s new plan, it leaves a slightly healthier, younger consumer segment in the private market, with 19% of those aged 45 to 54, according to the Task Force’s draft report. from 18%. Market consumers are also getting richer, with 54% of his market consumers earning more than his 400% of the federal poverty level.
A healthier consumer base “will initially lead to slightly lower premiums across individual markets, but these impacts will vary by age and rating region,” the report said.
But consumers will also see a decline in the purchasing power of federal market tax credits used to purchase coverage, according to the report. As a result, the premium for the lowest-cost Bronze level plan on the market rises from $39 to $50 for 21-year-olds. At age 64, this is an increase of $116 to $151.
Steiner Heyward said switching the federal subsidy benchmark from the Silver plan to the Gold plan would minimize disruption.
“It’s not only a matter of reducing the impact on the consumers who are using the market, but it’s also a matter of maximizing the amount of money the federal government is giving us, and that’s all part of the bargaining process. It is,” she said.
Consultants warned the task force that it was unclear how Oregon’s healthcare market would react to plans for the new bridge, Steiner Hayward said. but encourages similar programs in Minnesota and New York to be financially viable.
New program, same price
The Bridge Plan is structured similarly to the Oregon Health Plan. This is a concern for some healthcare providers.
Oregonians enrolled in the new program will receive coverage similar to the Oregon Health Plan, with recipients being billed or sharing the cost out of concern that low-income households will skip coverage. It is not. Regulating health institutions contracted by the state to serve people in Oregon health plans are also responsible for serving Oregonians in bridge plans.
The task force had previously called for reimbursement rates for the new plans to be higher than those of the Oregon Health Plan. It is recommended that you stack
Shawn Colmer, senior vice president of policy and strategy for the Oregon Hospital and Health Systems Association, told the task force in a Nov. 28 letter that hospitals were already struggling financially.
“In developing recommendations for the allocation of federal BHP (Bridge Health Program) funding, including surpluses beyond program costs, we ask the Task Force to provide hospital reimbursement to cover the costs of providing care to the BHP population. We request that you give priority to ,” said Kolmer. “Current experience shows that anything close to OHP reimbursement levels will not support access in the community.”
The Oregon Primary Care Association has also expressed concern about how another low-reimbursement health care program could affect Oregon’s 34 federally accredited medical centers. Safety Net Clinic receives cost-based payments to serve and ensure financial stability for Oregon Health Plan beneficiaries.
The health center serves Oregonians in a bridge program but does not receive cost-based payments, which the association fears will disrupt finances.
“This is not a treasure trove for provider organizations,” says Marty Carty, director of government relations for the Oregon Primary Care Association. “This is based on the cost of providing care to the patient population at all his FQHC, and is true and transparent.”
Carty said diverting revenue away from safety-net clinics by reducing payments could impact the programs and services available to the entire patient population.
Steiner Hayward has admitted that the Oregon Health Plan’s reimbursement rate is “lower than we would like.” She also said federally accredited health centers should be closely monitored for potential effects.
You can contact Jake [email protected] or via Twitter @jakethomas2009.
