Page 4
News
Street Roots •
Feb. 3-9, 2017
Vital signs
Uncertainty about the fate of the Affordable
Care Act spells confusion for Oregon Health
Plan patients and providers, and leaves the
state facing tough budget decisions
BY AMANDA WALDROUPE
STAFF W R IT E R
he Oregon Health Plan is reputed to be one
of the most innovative and ambitious
Medicaid programs in the nation. *
The program provides health care for 1 million
people, or nearly 25 percent of Oregon’s
population - anyone who makes below roughly *
$16,000 a year or is disabled or elderly.
Oregon Health Plan patients receive their care
through coordinated care organizations, or GGOs,
which were created in 2012 to coordinate the
physical, mental and dental health care of Oregon
Health Plan patients. If a patient goes to the
doctor and shows signs of anxiety, the doctor can
connect the patient w ith mental health care in the
■
sam e building. Electronic h ealth records ensure
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Through emphasis on preventive and prim ary
health care, medical staff helps patients stay
healthy and out of the emergency room.
Oregon has received billions of dollars from the
federal government to help fund the state’s 16
CCOs, partially because the coordinated-care
model is expected to cut health care costs while
improving people’s health.
According to the state, that is already
happening: Since 2012, Oregon’s CCOs have
already saved $1.4 billion in health care costs.
Emergency room use has been cut by a third, and
preventive health care - such as doctor’s visits,
immunizations and teeth cleanings - have all
increased dramatically.
. That progress now hangs in the balance with
the likely repeal of the Affordable Care Act.
Repealing the ACA became the biggest
campaign promise made by President Donald
Trump and the Republican caucus, and a vote is
expected fairly quickly The ramifications of a
repeal are still unknown.
The structure of Oregon’s CCOs is not
threatened. A new federal waiver allowing them to
continue operating was approved in mid-January
and is in effect until January 2022.
What is at stake is how much federal funding
will be available to fund the Oregon Health Plan,
whether the plan will continue to provide health
care for its one million members - including
350,000 Oregonians now on the plan due to the
expansion of Medicaid - and how destabilizing any
change to the Affordable Care Act will be for
provider networks and health care programs.
With the Affordable Care Act’s fate unknown,
Oregon is preparing to take on more of the
responsibility of providing health care for the
state’s most vulnerable residents through
legislation and tax proposals.
One of the biggest challenges state
government - including the Oregon Health
Authority, which oversees the Oregon
Health Plan - and health care providers
face is uncertainty.
The providers
What it means to repeal the ACA is
unclear, said Janet Meyer, the executive
(MB
director of HealthShare of Oregon, a CCO wBB
that serves the Portland metropolitan area.
“It’s a very complicated set of policies and
regulations and programs. There’s a lot of
confusion.”
It’s not clear if the entire health care law will be
repealed or if popular parts of it - including
allowing children to rem ain on th e ir parents’ plan
to age 26 and th e prohibition on denying health
insurance to people who have a pre-existing health
condition - will be kept in p la c e /
It’s also not clear what will replace the law.
Despite the fact that the Republican-controlled
House of Representatives has voted dozens of
times in recent years to repeal or change the ACA,
leaders in the Republican Party have not released
draft legislation to replace i t
The uncertainty prompted Oregon Health &
Science University President Joe Robertson to
announce in mid-January that OHSU would
significantly reduce hiring, almost tantamount to a
hiring freeze, until it became clearer what the
state’s budget and federal binding for Medicaid
and other health programs would be.
Rob Soans is a physician assistant who has
practiced primary care for 20 years at Manzanita
Urgent, Primary and Specialty Care, a clinic in
Nehalem, Oregoh.
One can tell from the clinic’s name that Soans,
on any given day, sees the gamut of health
conditions in the rural, impoverished community.
On a recent Saturday, Soans performed 11
house calls in 14 hours. One elderly woman had
lost her glasses, so she could not see the numbers
on the syringes she uses to give herself insulin.
Soans gave her a pair of reading glasses, he had
bought at Costco.
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I
He told another woman, a 29-year-old who
brought her 2-year-old child with her to the clinic,
that she has cancer. He got phone calls and texts
throughout the day from patients,
In addition to children immunizatioB/routine
checkups, and helping people manage chronic
conditions, people suffering from heart problems,
burns, broken limbs, the flu and other ^urgent
ailments walk through the door, ;
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“I serve everybody who walks in the,,door,”
Soans said.
Like other medical providers, ;h ^ :i^ S frg te d by
See HEALTH CÀRE, page 5
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