Oregon Medicaid needs reforms and oversight, not a new tax
By Knute Buehler
As a physician, I believe assuring access to quality health care for all is a value Oregonians share. However, Oregon now faces a health care problem: how to best pay for the care provided to thousands of Oregon families through the Affordable Care Act.
While many politicians in Washington, D.C. are debating the best way to cut funding for health care, elected officials in both political parties here in Oregon are debating ways to save health care. There is no disagreement that making health care more accessible to more Oregonians is the right policy. Our disagreements are over the details of funding, management and accountability.
Oregon’s experience with the Affordable Care Act is mixed. The good news is that Medicaid expansion under the ACA is now providing more than 400,000 Oregonians with health security for the first time. The bad news is that state government’s management of key aspects of the ACA, including the infamous Cover Oregon website, has been a fiasco. In addition, health insurance premiums for thousands of Oregonians in the individual market continue to rise with no end in sight.
Unfortunately, rather than learning from these expensive mistakes and making careful adjustments to the management of precious federal and state Medicaid tax dollars, the governor and Democrat leaders in the legislature have chosen to double-down on a failed approach (link). And in doing so, they are missing the chance to repair and reform how the state funds and spends government health care dollars.
This failure of leadership was on display last Thursday in Salem when the House of Representatives led by Rep. Dan Rayfield (D-Corvallis), a personal injury lawyer, voted to approve the governor’s plan to maintain the failed status quo and to create a new tax on health insurance premiums. Rather than working to reduce the cost of health insurance, the governor’s plan will make it more expensive for most Oregonians. Those hardest hit by the governor’s new health insurance tax are college students, K-12 schools and small businesses, while excluding self-insured unions and big corporations. Rather than reforming a worthwhile but failing individual insurance market, this new tax is simply a bailout.
It didn’t have to be this way. I joined with several lawmakers to create a plan to fully fund Oregon Medicaid for the next year. Not a single current recipient of health care would be cut. And during this next year, our plan would require state health care managers to clean up the agency by doing simple things like ensuring that everyone who should be enrolled is properly qualified and finishing long-suffering IT projects (link). (A recent state audit suggests there could be up to 85,000 people enrolled in Medicaid that shouldn’t be). Rather than creating a new tax on health insurance, our plan relies on increasing existing hospital fee assessments, along with a small increase in tobacco taxes, to fully fund the program.
At the end of the first year, armed with up-to-date and accurate information about enrollment numbers, the governor and Oregon lawmakers could implement the second year of the Medicaid budget. And in the process, make needed reforms and more carefully manage precious health care dollars to ensure they are spent on helping the sick rather than troubled IT projects.
Unfortunately, the hunger for new taxes and Democrats’ resistance to accountability prevailed once again in Salem. It was a missed opportunity for more thoughtful, creative and bipartisan lawmaking that would have protected health care for hundreds of thousands of Oregonians while making government work better and smarter in the process.