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THE DAILY ASTORIAN • TUESDAY, NOVEMBER 15, 2016
Trump could have big impacts on Oregon health care
Changes could
take a few years
to filter down
By NICK BUDNICK
Capital Bureau
Oregon has plenty to
lose when it comes to Pres-
ident-elect Donald Trump’s
vow to change the nation’s
health care system.
His surprise victory threat-
ens state officials’ hope of
plugging a looming budget
hole with $1.25 billion in fed-
eral health care reform pay-
ments, and his vow to imme-
diately repeal Obamacare
creates uncertainty for more
than 470,000 Oregonians who
received coverage or subsidies
under the law.
However, Trump already
has signaled a willingness to
reconsider aspects of the fed-
eral Affordable Care Act, and
observers believe nobody’s
coverage is in immediate dan-
ger. Any changes could take
until 2018 to filter down.
Here’s what Oregonians
should know as Trump pre-
pares to take office in January.
Oregon Health Plan
About 1 million Orego-
nians are enrolled in the state’s
version of Medicaid, the gov-
ernment low-income health
care program.
Of those, 378,607 adults
Pablo Martinez/The Associted Press.
President-elect Donald Trump speaks during his meeting
with President Barack Obama last week in White House.
Trump could have a big impact on Oregon health care.
qualified under Obamacare’s
expansion of Medicaid, which
in Oregon boosted the max-
imum income to qualify
from 100 percent of the fed-
eral poverty level to 133 per-
cent. Instead of having to earn
$20,160 or less to qualify, a
family of three could make a
little more than $26,800 under
the new cap.
But while Trump has
vowed to repeal and replace
Obamacare, it’s unclear how
that might affect Medicaid
expansion.
Jeff Heatherington, CEO of
Portland-based Family Care,
one of 16 organizations around
the state providing for Oregon
Health Plan members, echoes
other health care officials in
saying it’s unlikely Repub-
licans will strip millions of
Americans of their health care.
“I think it would be a crazy
disaster,” he says, “The hos-
pitals and the pharmaceuti-
cal companies would argue
against doing that because
they’re making too much
money.”
Robert Gootee, president
and CEO of Moda Health,
which operates the Eastern
Oregon Coordinated Care
Organization, also sounded a
note of optimism. “I remain
confident the uncertainties of
today will transition to oppor-
tunities for sustainable long-
term solutions, so that our
members throughout Eastern
Oregon can secure broader
choices, with lower costs,
and greater flexibility in their
access to health care,” he said.
Trump has proposed turn-
ing Medicaid into a program
that gives states block grants
rather than placing restrictions
on the spending. Republicans
in Congress, meanwhile, have
long sought to add conditions
to the program such as premi-
ums or work requirements.
Oregon could avoid any
major changes under an appli-
cation for a five-year waiver
from standard Medicaid rules.
President Barack Obama could
approve the plan before leav-
ing office.
Gov. Kate Brown’s office
released the following state-
ment: “There will be a lot of
speculation in the next cou-
ple of months, but we have to
work with the facts we have,
which is that Oregon has a suc-
cessful coordinated care model
that is improving the quality
of care while holding down
costs.”
State budget
Oregon faces a nearly $1.4
billion budget hole over the
next two years.
The state’s waiver appli-
cation includes a request for
$1.2 billion over the next five
years from the federal govern-
ment, which could do a lot to
help plug that hole. A similar
request by Gov. John Kitzhaber
in 2012 yielded $1.9 billion.
But even if the state’s
Medicaid waiver request is
approved by Obama, any fund-
ing that goes with it could be
cut off by the Trump admin-
istration at any time, officials
say. “I think that could be at
risk, said Health Share of Ore-
gon CEO Janet Meyer.
It’s too soon to say, but
the resulting budget pressures
could affect how the state
administers the Oregon Health
Plan.
Obamacare private
insurance
More than 220,000 Orego-
nians not covered by employ-
ers or Medicare buy their own
insurance policies in a market
that has undergone a radical
makeover under the Afford-
able Care Act.
Obamacare bans insurers
from discriminating against
people with pre-existing med-
ical conditions and levies a tax
penalty against many of those
who don’t have health cover-
age, while offering subsidies to
those with incomes of 400 per-
cent of federal poverty level or
less.
About 130,000 Oregonians
signed up through the fed-
eral website HealthCare.gov,
and of those 95,000 qualified
for tax credits to offset their
premiums, averaging $250 a
month.
Premiums for the 130,000
Oregonians who don’t receive
subsidies have skyrocketed,
however. On the national
level, such hikes have driven
the push to repeal Obamacare.
Since being elected, Trump
has said he favors preserv-
ing Obamacare’s guaran-
tee that sick people can’t be
denied coverage — triggering
speculation that the changes
to Obamacare may not be as
widespread as advocates of the
law feared.
What does the future hold?
“We can’t answer that right
now — it’s too early to tell
what changes may be made,”
said Lisa Morawski, a state
spokeswoman.
Morawski says people
should keep enrolling for
2017 private health insurance.
Those who do are guaranteed
no changes in terms for the
coming year.
Medicare
More than 750,000 Orego-
nians receive benefits under
Medicare, the health insur-
ance program for people 65
and older.
Trump has vowed to pre-
serve and modernize Medi-
care, but congressional Repub-
lican leaders want to turn it
over to private insurers.
Budnick is a reporter for
Pamplin Media Group’s Port-
land Tribune.
Enforcement of public benefits in Elliott sale still to be determined
als for responsiveness and pass
those that are deemed respon-
sive to the State Land Board for
ranking and a final decision.
The board is composed of
the governor, treasurer and sec-
retary of state.
The Department of State
Lands won’t have a further
role in the Elliott Forest prop-
erty once it is sold to another
entity, and so it can’t enforce
the requirements.
Several groups
interested in
buying forest
By CLAIRE
WITHYCOMBE
Capital Bureau
SALEM — The eventual
buyer of an 82,500-acre parcel
of state-owned coastal forest
will be required to provide 40
full-time jobs for a decade, pre-
serve some old growth stands,
maintain trees in riparian areas
and allow public access to half
the forest.
As the deadline to sub-
mit acquisition proposals
approaches, one key detail is
still unknown — how those
“public benefit” requirements
will be enforced.
A range of parties have
expressed interest in buying
the large swath of the Elliott
State Forest, including con-
servation groups such as the
Audubon Society of Portland
and timber companies such as
Roseburg-based Lone Rock
Resources.
The acquisition plans are
scheduled to be released pub-
licly next week, but the enforce-
ment provisions won’t be fully
hammered out until after a
buyer is selected.
Although prospective buy-
ers have been asked to include
Enforcement
enforcement provisions in their
acquisition plans, these could
differ among bidders.
So it remains to be seen who
will assess how well the even-
tual buyer meets the require-
ments, and who will step in to
require the entity to follow the
rules if the buyer is found to be
out of line.
“I know it’s kind of squishy,”
Department of State Lands
Spokeswoman Julie Curtis said
last week. “It’s just really hard
to say what the proponents are
going to say.”
Oregonians will know who
submitted plans Wednesday,
but will not know the sub-
stance of the plans, including
suggested enforcement mecha-
nisms, until they are released in
full Nov. 22.
The department will eval-
uate potential buyers’ propos-
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Alder and Maple Saw Logs & Standing Timber
The proposals have to iden-
tify a third party responsible
for enforcement — such as a
tribe or conservation group —
or give the public standing to
enforce those requirements.
The department has said
that ownership by a land trust
“in and of itself” is insuffi-
cient to meet the public benefit
requirements.
held by another party such as a
land trust.
The public benefits —
excluding the jobs require-
ment, which lasts for 10 years
— would have to continue in
perpetuity, according to the
department.
Public ownership
Environmental groups and
activists have supported keep-
ing the land in public owner-
ship, and several public enti-
ties such as the Bureau of Land
Management and the Oregon
Department of Forestry have
expressed interest in buying the
property.
As far as assessing whether
the buyer has met its obligations
down the line, it’s unlikely that
the secretary of state, the state’s
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top auditor, would audit the
eventual buyer due to the secre-
tary’s position on the land board.
Molly Woon, a spokes-
woman for the Secretary of
State’s Office, said that if the
secretary participates in the
acquisition decision, the office’s
current auditor would recom-
mend that an outside entity con-
duct an audit.
“We want to avoid auditing
anything related to the secre-
tary’s State Land Board respon-
sibilities,” Woon wrote in an
email Thursday.
The Department of State
Lands is charged with manag-
ing the Elliott for the benefit
of the Common School Fund,
which was designed to provide
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The prospective buyers’ sug-
gested enforcement provisions
may factor into the board’s final
decision.
“Differences
between
responsive plans on how to
address assurances of enforce-
ability may be a basis for their
prioritization and choice,” the
department said in response to
questions submitted by inter-
ested parties earlier this year.
Negotiations will continue
after the land board selects the
buyer as officials and the buyer
work out a purchase and sale
agreement.
Department of State Lands
Director Jim Paul said last week
that prospective buyers submit-
ting plans could choose a default
enforcement mechanism — a
conservation easement.
Conservation
easements
typically prohibit certain uses
of land by the owner and are
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