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About Street roots. (Portland, OR) 1998-current | View Entire Issue (Feb. 3, 2017)
Street Roots • Feb. 3-9, 2017 HEALTH CARE, from page 4 News It’s stressful for all the providers.” Blackburn said Old Town providers the Affordable Care Act’s nebulous future. already struggle to make sure the patients He predicts that, if people are dropped from most in need remain enrolled in health insurance, they will return to the emergency insurance. Now they find themselves room for care and medical costs will explaining that patients will have insurance skyrocket at least for a year, if not longer, depending.on Regardless of whether his patient will be how quickly Congress acts. able to pay in'the future, he says he will “It’s a lot of work,” Blackburn said. continue to provide them with care T H The main reason, Blackburn and others show up everyday and said, that Oregon take care of my Health Plan patients patients,” Soans said. "We have m entally 01 people have reacted so “I really think that, strongly is because of who would net have health unfortunately, the the enormous role downstream effects of insurance because they h a w becoming insured has this are going to be had on their lives - a disability, We have people negative.” in the m iddle of cancer treat- something they “Unless they truly describe as life don’t care about taking ment. There are people with, changing. diabetes, wondering where health care from \ “We have mentally ill millions of people, they w ill get their insulin. people who would not some version of Their care Is integral to have health insurance Obamacare will them. Their lives are so much because they have a remain,” Scott Ekblad, disability,” Blackburn better because they^ve man the director of OHSU’s said. “We have people Office of Rural Health, aged their addictions &s their in the middle of cancer pain or their Illnesses." said. treatment. There are Ekblad said that is a people with diabetes, eo blac k bu r n , sentiment shared E X E C U T IV E D IR E C T O R , wondering where they C E N TR A L, C IT Y C O N C E R N among many rural will get their insulin. healthcare providers. Their care is integral to People who received them. Their lives are so health insurance due much better because they’ve managed their addictions or their to the Affordable Care Act and “who had a pain or their illnesses.” lot of delayed medical needs and are finally Lisa Greenfield, 25, became covered by seeing a provider...aren't going to stop ffe3ltjh_Pjan about a year, and a, seeing their providers,” h e s a i(t.“Jath.o.se.i.. small, close-knit communities, providers see people regardless of their ability to pay.” Ekblad said rural communities—which often have high unemployment rates, lower average income and, therefore, higher rates of people eligible for Medicaid—will be deeply affected by marked changes, or wholesale repeal, of the Affordable Care A ct “We stand a real risk of losing some of our smaller, low-volume rural hospitals,” Ekblad said. Many of those hospitals, especially along the coast and in eastern Oregon, remain open twenty-four hours a day, with medical staff available, even if there isn’t the patient volume to necessitate remaining open all hours of the day. Ekblad said the Affordable Care Act benefitted rural hospitals greatly due to the increase of the insured population, which ensured that hospitals could be reimbursed for services they provided. “There were many hospitals in the state that were operating in the red and it was simply the increase in the insured level of their patients that made them show a little bit of black again,” he said. “There’s no way I could afford that,” she said. “I will get sick. I will go through withdrawals. I’d be in a lot of pain. “Obamacare has helped me tremendously,” she said. “If that goes away, the whole foundation that I’ve built my life upon in the last year is- turned upside-down.” The belief expressed by Greenfield - that her life is in order because of health insurance - is one shared by many Oregon Health Plan patients, Meyer said. Becoming healthy “makes you feel like you have a bit of control in your life,” Meyer said. “By empowering people to seek preventive and primary care, you give them the hope that they can work tiieir way out of poverty, and work toward whatever their goal is in their life.” HealthShare provides health care to approximately 80,000 of the 350,000 Oregonians who make up the “expansion population,” the people now covered by the Oregon Health Plan because of the Affordable Care Act’s provision to expand Medicaid in states that accepted additional federal funding. The majority of that population, Meyer said, is under age 45. On average, she said, 300 people have a prescription filled each day. Half of the population have had their teeth cleaned since receiving coverage. “We think of teeth cleaning as this little luxury,” Meyer said. “Not really. It’s part of being employed. We know that people with j3^tl^-QraLhejalth.have.,_a. better chance of, „ -, halfl^oT sne^ppBeato> yo^tne^Iaii:tn re ^ OT retainingtheir employmenit.^ " times, in the past. Each time, she was denied If the federal government chose to cut because she did not m eet Oregon Health the parts of the Affordable Care Act that Plan’s restrictive eligibility criteria, put in extend health insurance to the Medicaid place during the recession. expansion population and other populations Greenfield, who grew up in Portland, now insured because of the law, it would be began using drugs when she was 19 and inhumane, she said. living with her mother. Her mother “got “To have been given access to health tired of me using” and kicked h er out. insurance and then so quickly have it taken Homeless, she continued to use drugs. away, it would he devastating,” she said. “It’s She tried to quit heroin cold turkey but said a horrible thing to contemplate. That is just she couldn’t make it “past day two of being a travesty.” sick.” She compared heroin withdrawal to the The state flu, but 100 times worse. “You’re vomiting, As the Oregon Legislature convenes for a you’re sweating, you have diarrhea,” she six-month session this month, the state said. “It’s excruciating.” faces a $1.7 billion deficit, approximately $1 So she kept using, until she entered drug billion of which is due to the federal treatm ent at Central City Concern. While government no longer paying for the costs there, she was enrolled in the Oregon of insuring Oregon’s Mecjjcaid expansion Health Plan, which had since added 350,000 population. Oregonians onto coverage with the ACA’s Gov. Kate Brown’s budget proposal, expansion of Medicaid. released in December, calls for continuing Greenfield now regularly takes Suboxone, to cover the Medicaid expansion population. which reduces her cravings and keeps her The budget plan also does not change the off heroin. She also takes medication for eligibility requirements to be covered by the bipolar disorder and participates in group Oregon Health Plan, nor does it change the therapy. She-doesn’t pay any out-of-pocket services the plan provides. costs. She goes to the doctor if she gets sick. The patients Whether Brown’s intentions come to pass She credits becoming insured for allowing is dependent upon the Legislature’s her to get her life back together. Ed Blackburn, the executive director of enacting new taxes to close the budget “I work. I’m going to go back to school. I Central City Concern, a social service deficit without affecting the Oregon Health agency that serves homeless and low-income pay my own rent. I pay my own phone bill,” Plan. Brown wants to raise the state’s she said. A year ago, she said, she could not Portlanders, said patients who go to the Old cigarette tax by 85 cents a pack, double the have done any of those tasks, which many Town Clinic have already assumed that they liquor tax, increase alcohol licensing fees, people take for granted. no longer have health insurance. and allow some tax credits to expire. The possible repeal of the Affordable “We’ve had doctors say, ‘Why are you Brown’s budget also calls for increasing Care Act frightens Greenfield, who worries canceling your appointments?’ and patients the hospital provider tax, which is sure to that she will start using drugs again. There’s are saying, ‘Because I won’t be covered become the most controversial of the no way that she could afford to pay for her anymore.’ They’re coming in the door and governor’s tax proposals. Suboxone prescription, which costs saying, ‘Will you still see me?’” Blackburn Oregon’s hospitals are exempt from thousands of dollars each month. said. “It’s very stressful for those people. Page 5 paying property taxes because hospitals provide charity care - essentially providing health care to people regardless of whether they can pay. That was important in a pre-ACA Oregon when the rate of people who were uninsured was higher than it is today. Because more people have insurance, hospitals provide less charity care but are reimbursed, through insurance, for care hospitals provide. So hospitals have made money. Providence Health & Services, the state’s largest hospital system, has $6 billion in cash reserves. The governor’s budget is an optimistic one; the budget developed by the co-chairs of the Legislature’s budget-writing Ways and Means committee is not. That budget assumes a state budget with no hew revenue, including no new taxes. The Oregon Health Authority’s budget would be c u t by 27.5 p e r c e n t. T h e co -ch air’s b u d g e t m a k e s it c le a r t h a t e v e ry p a r t o f th e s t a t e s . health system would be affected, including reducing dental services and addiction services provided by the Oregon Health Plan, with the exception of pregnant women. That budget also calls for cutting health insurance coverage to the 350,000 people now insured through Medicaid expansion. The other gaping question is how Medicaid will be funded at the federal level. The idea that has gotten the most attention is funding Medicaid through block grants, which Republican House Speaker Paul Ryan advocates. Block grants are lump sums of money provided to states or programs. It’s still unclear if states would be given a concrete amount of money for Medicaid, leaving it up to the states to decide how to fund their Medicaid programs. I t’s also unclear if the amount of the block grant would be based on enrollment numbers—as funding is currently calculated-or other demographic information. “I haven’t gotten my head wrapped around a CCO model works under block grant funding,” Meyer said. “I find it hard to believe that block grant funding can sustain the (Oregon Health Plan) as it is today in Oregon. The devil is in the details. That’s a whole new world, if that is in fact where we go as a nation.” Blackburn, like many others, believes the Affordable Care Act will not be entirely repealed; the political consequences of 30 million people becoming dropped from health care coverage are too g reat “People can die,” he said. “They’ll suffer needlessly. We would have a lot of sick people in the emergency room. We’ll have a lot more uncompensated care in community health clinics.”
