5A
THE DAILY ASTORIAN • FRIDAY, JANUARY 5, 2018
MEASURE 101
AGAINST
FOR
Measure is an unfair tax on health care Hospitals, medical
professionals back
O
ballot measure
n Jan. 23, voters across
Oregon will consider
a very simple question
about one of the most complex
and expensive services the
state provides its citizens.
The question isn’t whether
we should fund Medicaid,
Oregon’s low-income health
care system. As lawmakers
we have proven vote records
supporting Medicaid. Both
personally and professionally,
we believe the Oregon Health
Plan is a critical part of the
social safety net, providing
needed services to low-income
seniors, children, and disabled
patients.
No, the real question for
voters is whether you believe
legislators crafted a fair,
equitable, and sustainable way
to fund Medicaid. Lawmakers
taxed some people’s health
care, but left wealthy corpo-
rations, unions, and insurance
companies who can all afford
to self-insure, exempt from
chipping in for Medicaid.
Nearly 90,000 Oregonians
disagreed with the Legislature
and signed a petition so you
could vote on whether Oregon
should tax other people’s
health care premiums and
hospital services.
Know this: A “no” vote on
Measure 101 will not upend
the health care of 350,000
Oregonians. Financially, the
scare tactic numbers you’re
hearing from pro-tax special
interests who are pumping
millions of dollars into the
“yes” campaign just don’t
add up. Serving 350,000
Oregonians with Medicaid at
an average of $430 per patient
per month paid to Oregon’s 16
coordinated care organizations
costs taxpayers an estimated
$3.61 billion of state and fed-
eral resources. Measure 101’s
Julie
Parrish
Cedric
Hayden
repeal doesn’t even come
close to that amount.
Measure 101 repeals only
$330 million of a $13.69
billion budget. Uncle Sam
only matches state Medicaid
costs based on real case-
loads. Oregonians recently
learned about nearly 90,000
people who were ineligible
or improperly coded into
Medicaid, costing taxpayers
hundreds of millions of
wasted health care dollars. As
eligibility continues to decline
due to a growing economy
and a higher minimum wage,
it means we’ll need less state
revenue to fund Medicaid.
Measure 101 unfairly
balances $330 million of the
Medicaid budget on the backs
of individuals and organiza-
tions that can least likely pay
the new 1.5 percent health
care sales tax — individuals,
small businesses, nonprofits,
college students and even our
public schools.
In fact, $25 million of
these new taxes are going to
come right from Oregon’s
classrooms because our
public schools buy taxable
insurance plans in the large
group market. The Beaverton
school superintendent said
in a Dec. 20, 2017 email to
his staff that the tax would
impact the Beaverton School
District budget by $540,000
per year. That’s the equivalent
of funding six teachers. Can
your community afford to
lose educators at a time when
Oregon’s graduation rates are
low, our class sizes are high,
and our absenteeism is the
worst in the nation? We don’t
think that’s a responsible way
to fund Medicaid.
Proponents tout a “rein-
surance” program that brings
down rates as a reason to vote
“yes.” Their rationale: tax
everyone’s insurance and then
give a windfall to insurance
companies to bring down the
cost for only some individuals.
Yet individual markets saw
rate increases go up as high
as 21 percent before the tax.
However, even that windfall
didn’t prevent Regence from
leaving 15 counties in Oregon
and creating counties where
one insurer has an entire
insurance monopoly. Small
businesses, nonprofits and our
schools will see no benefit of
a reinsurance program, but
they’ll shoulder the cost.
If we need to raise money
for Medicaid, shouldn’t every-
one have skin in the game? Yet
groups with lobbyists, making
campaign contributions, found
a way to be exempted. What
makes this whole thing even
more egregious is how insur-
ance companies successfully
lobbied for their own sweet-
heart deal. If Measure 101
passes, insurance companies
will have statutory authority
to pass health care taxes to
consumers.
Moreover, taxing net rev-
enues of our hospitals means
higher hospital costs overall
for patients. A senior who has
hospital expenses not paid for
by Medicare will see higher
copays as the hospitals will be
forced to pass an untenable tax
along to you.
Don’t be fooled by propo-
nents who claim Oregonians
will lose health coverage if
you vote “no” on Measure
101. As petitioners, we didn’t
refer all of House Bill 2391,
meaning hundreds of millions
of dollars for Medicaid are
operable now. Moreover, the
economic impact of serving
350,000 Oregonians with
expanded Medicaid actually
generates over a half billion
dollars in state and local tax
dollars from the 38,000 health-
care jobs it creates.
An alternative bill is
drafted and ready for 2018,
just as alternatives were
offered during the 2017
session. We weren’t saying
“no” to taxes, merely pointing
out that taxing other people’s
health care won’t make health
care cheaper.
For too many families,
health care costs more than
their rent or mortgage. Small
businesses can’t handle
another tax or mandate from
the Legislature, especially
when their larger competitors
who can afford to self-insure
won’t pay a dime to shoulder
the cost of Medicaid under
Measure 101. That kind of
unfair competitive advantage
favoring the large corporate
coffee shop may just put your
local one out of business.
Oregonians expect tax
fairness, and they want good
health care. We can have both,
but not if pro-tax special inter-
ests win the day. Vote “no” on
Measure 101, and demand the
Legislature pass an equitable
Medicaid funding plan.
Rep. Dr. Cedric Hayden is
a Medicaid dental practitioner,
and vice chair of the Oregon
House Healthcare Committee
serving House District 7. Rep.
Julie Parrish serves District
37 in the Oregon House, and
served a term on the House
Healthcare Committee.
I
t’s a critical moment
were forced to rely on the
in Oregon for ensuring
Emergency Department for
their basic health care needs.
that we all have access
Today that doesn’t happen
to affordable health care.
Voting YES on Measure 101 as much, because so many
on Jan. 23 is one of the most more people have insurance
and access to
significant things
the primary care
you can do to keep
providers they
affordable health
need. Fewer trips
care accessible —
to the Emergency
especially for kids,
Department also
seniors and people
means lower
with disabilities.
costs for all of us,
Well over 10 per-
Erik
cent of our region’s
because people get
Thorsen
population depends
the care they need
on Medicaid for health
from the doctor’s office or
care. These are our friends,
urgent care center, instead
families and neighbors who
of the high-cost Emergency
would otherwise go without Department.
needed care.
A YES vote on Measure
During the past legisla-
101 protects health care
tive session, state lawmak-
coverage for one in four
ers crafted a balanced law
Oregonians, including
to fund these vital insurance 400,000 kids, and holds
programs. The law had the
down costs for all of us. It
support of the entire health
creates a fee on insurance
care community — doc-
companies, hospitals, and
tors, nurses, hospitals and
managed care organizations
beyond. Now voters are
to make basic health care
being asked to weigh in on
affordable and accessible
the package on Jan. 23, and
to every Oregonian. No
those same doctors, nurses
one in Oregon should have
and hospitals are asking for
to wait to go in for needed
a YES vote on Measure 101. health care or have their
For the past 15 years,
only access point be an
I’ve had the opportunity to
Emergency Department.
work with our health care
With this law, more hard-
working Oregonians will
professionals at Columbia
be able to afford the health
Memorial Hospital. Like
insurance they need.
all the doctors, nurses and
Please join me, and
caregivers at the hospital,
thousands of health care pro-
I know firsthand how
fessionals across the state, in
important accessible and
voting YES on Measure 101.
affordable health care is to
Erik Thorsen is CEO
our local community.
of Columbia Memorial
Just a few years ago,
Hospital.
people without insurance
VOTER PRIMER ON BALLOT MEASURE 101
By CLAIRE WITHYCOMBE
Capital Bureau
On Jan. 23 Oregon voters will have a
chance to weigh in on Measure 101, help-
ing decide how the state pays for its Medic-
aid program.
President Trump noted earlier this year
that “nobody knew that health care could
be so complicated” and this measure, which
deals with insurance premiums, managed care
organizations and federally regulated hospital
taxes, is not an easy read. Here are the basics:
• When do I need to understand this?
Ballots will be mailed to voters between Jan.
3 and Jan. 9, according to the Secretary of
State’s Office. Ballots must be received by
elections officials by 8 p.m. Jan. 23.
• Why is this on the ballot? This summer,
Democrats in the Oregon Legislature pushed
through a bill providing temporary funding
for the state’s Medicaid system. Three Repub-
lican lawmakers — State Reps. Julie Parrish
of West Linn, Cedric Hayden of Roseburg
and Sal Esquivel of Medford — decided they
wanted to refer parts of the law to voters. They
led a petition campaign to gather signatures
and are now urging voters to vote “no” on the
measure, which would repeal those parts of
the state’s Medicaid law.
• Remind me. What’s Medicaid? Medic-
aid is a government health care coverage pro-
gram for the poor and other qualifying groups.
Oregonians earning up to 138 percent of the
federal poverty level ($16,100 for an individ-
ual; $32,900 for a family of four) are eligi-
ble for the program. In Oregon, the Medicaid
program is known as the Oregon Health Plan
and covers about 1 million people, including
400,000 kids.
• How is the Oregon Health Plan
financed? Both the state and the federal gov-
ernment pay for it with public funds, but the
federal government picks up most of the tab.
Plus, hospitals, insurers and coordinated care
organizations all pay taxes — described in the
measure as “assessments” — to the state. Ore-
gon uses that money to get matching funding
from the federal government.
• How much do hospitals pay? Hospitals
pay a 5.3 percent assessment on net revenues,
which, once matched by the feds, is returned
to them as a group and redistributed. Under
the state law passed earlier this year, they also
pay a .7 percent assessment on net revenues
that is not returned to them, but put into a state
fund for health care.
• What does a “yes” vote mean? A “yes”
vote means you want the state to impose and
keep the nonrefundable .7 percent assessment
on hospitals, as well as assessments on insur-
ers, the Public Employees Benefits Board and
coordinated care organizations — regional
networks of OHP providers.
• What does a “no” vote mean? A “no”
vote means you wish to repeal the nonrefund-
able .7 percent assessment, and the assess-
ments on insurers, the Public Employees Ben-
Joshua Bessex/The Daily Astorian
The Columbia Memorial Hospital emergency room in 2014. Fewer patients without
health care insurance are relying on the emergency room when they fall ill, according
to CEO Erik Thorsen.
efits Board and coordinated care organizations.
• How does this ballot measure affect
people on the Oregon Health Plan? Hun-
dreds of thousands of Oregonians gained
Medicaid coverage under the Affordable Care
Act, which allowed states to provide cover-
age to people making up to 138 percent of the
federal poverty level. As of November 2016,
about 366,000 people were eligible for OHP
under the Affordable Care Act.
Previously only those making up to 100
percent of the federal poverty level were
considered eligible. But that group, earning
between 100 percent and 138 percent of the
federal poverty level, isn’t legally required
by the federal government to be covered by
states.
Supporters of Measure 101 say that if it
fails, the Legislature could decide to cut those
people from the health plan to save the money
that the state government won’t be able to
collect.
• If the measure fails, would lawmakers
have to cut the health plan budget? No, but
proponents note that faced with funding gaps
in the past, lawmakers have knocked peo-
ple off the Oregon Health Plan. “If you are a
Medicaid recipient, this is about whether you
have access to your health care,” said Jessica
Adamson, a lobbyist for Providence Health
& Services, which is backing Measure 101.
“This is about whether or not the funding is
there to fully fund this program. Anything else
besides Measure 101 is a gamble. There is no
Plan B.”
Opponents counter that state legislators
can find that money elsewhere in the budget
to cover those people. “This ballot measure
isn’t about whether Medicaid is good or bad,”
said Parrish, the lawmaker urging a “no” vote.
“It’s about whether we picked the right fund-
ing mechanism to pay for it.”
• I buy my own insurance. Does this
affect how much I pay? Yes. Under the law,
insurers will be assessed a 1.5 percent of gross
premiums earned.
Premiums on the individual market could
increase by 1.5 percent because the legisla-
tion allows insurers to increase premiums by
up to that amount to offset the tax that they’ll
be paying, opponents say.
• So if the tax fails, my rates won’t go
up? Not necessarily. Supporters of Measure
101 say that expanded Medicaid coverage
reduces demands on costly emergency care. It
also funds a program called reinsurance that is
designed to hold down rate increases in premi-
ums for people who buy their own insurance.
It essentially acts as insurance for insurers,
providing a pool of money to reimburse insur-
ers part of the cost of very expensive proce-
dures. In 2018, the program is holding rates in
Oregon’s individual health insurance market,
on average, 6 percent lower than they would
be without reinsurance, according to the
Department of Consumer and Business Ser-
vices. That’s about $300 less per year, accord-
ing to the “Yes on 101” campaign.
• I get insurance through my employer.
Does this affect how much I’ll pay? If you
work for a business with 50 employees or
fewer, neither outcome of the measure likely
will affect your rates in 2018, but likely would
in 2019.
Since 2018 rates have already been
approved by the Oregon Department of Con-
sumer and Business Services, the Legislature
would have to take action to change those
rates.
Insurers in the small group market would
pay the 1.5 percent tax on gross premiums
earned.
• What about big employers? For Orego-
nians who are covered through an employer
with more than 50 employees, insurance costs
will likely not immediately change due to
either outcome of the measure, either. The state
doesn’t regulate rates for large employers.
Some large employers go out and buy
plans from insurers. The state doesn’t regu-
late rates for those types of plans, but it does
regulate benefits, the way policy contracts are
written and the financial solvency of compa-
nies offering plans. Those insurers who pro-
vide plans in the large group market will pay
the 1.5 percent assessment as well if Measure
101 passes.
• My company is self-insured. What can
I expect? Some companies — usually big-
ger ones — self-insure and get plans through
what’s called a third party administrator.
About 790,000 Oregonians are enrolled in a
plan through a self-insured employer, accord-
ing to the Oregon Department of Consumer
and Business Services.
The state doesn’t regulate any part of those
plans due to federal law. Self-insured employ-
ers are exempt from paying the state tax on the
premiums specified on the ballot.
• How much does all of this cost? Ore-
gon’s Medicaid program costs $9.3 billion in
state and federal funds per year, according to
the Oregon Secretary of State’s office.
If the measure is overturned, legislators
would face an $840 million to $1.3 billion hole
in the Medicaid budget, a figure that includes
both state and federal matching funds.
• How does this election affect people
on Medicare? Measure 101 will not have
an effect on Medicare coverage. Medicare,
the health care coverage program for people
age 65 and older, is funded solely by the fed-
eral government and would not be affected by
changes in state policy.
• What about Tricare? Tricare, the health
insurance program for military members, will
not be affected by the insurance tax.
• Will the outcome of the vote settle this
issue? No. If Ballot Measure 101 fails in Jan-
uary, legislators will have to re-balance the
budget during the February special session.
But even if the measure passes, the funding
provisions expire, meaning lawmakers would
be debating this again in 2019.