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.”