06 Jan

Healthcare community riding together on 101

Measure 101, the subject of the ballots that dropped into Oregon mailboxes last week, stands almost alone among the vast bushels of Oregon tax measures.

For this one, some of the folks who would pay it are its strongest supporters.
It’s like homeowners demanding to pay more property taxes.

Measure 101 puts a small tax on health care providers, and yet just about everybody in the Oregon health care community – doctors, nurses, hospitals, insurance providers, disease advocates, mothers who want their children to be doctors – supports it. In the medical community’s thinking on Measure 101, it’s not easy to find a second opinion.

The money raised by the tax would bring in a much larger amount from the federal government, protecting the health insurance of hundreds of thousands of Oregonians recently added to Medicaid. The strategy has already worked for Oregon and its health care community, and for some other states and their health care communities – which may be why so many providers are in such unusual agreement on a tax, even if they’re paying it.

“It’s very important that the majority of healthcare in Oregon is working behind 101,” agrees Kevin Ewanchyna, a Corvallis family physician and Oregon Medical Association board member. “My colleagues and I all have stories about lives saved because people came in for primary care when they had coverage.”

Over two years, the tax would collect between $210 million and $320 million from the Oregon healthcare community. But as matching funds, it would bring in $630 million to $960 million from the federal government, covering the 350,000 Oregonians added to Medicaid by the Affordable Care Act, and supporting the reforms Oregon has made to its healthcare system in recent years.

Folks in healthcare aren’t always in total agreement; doctors complain about insurance providers, hospitals complain about doctors. There are always conflicts, admits Jessica Adamson, director of government affairs for Oregon at Providence Health and Services, “But on this one we agree. We believe it’s important to stand together to defend this package.”

Oregon – as well as other states – has done this before. In 2009, the legislature adopted a similar strategy to maximize the state’s use of the Children’s Health Insurance Program. That tax has lapsed now, after helping cut the proportion of uninsured Oregon children from 12 percent to 2 percent.

Everybody in Oregon healthcare also agrees that doing that was a good idea.

On the other hand, risking the federal support for insuring 350,000 Oregonians is a problem for everybody. Uninsured people endanger their own health, hurting themselves and the economy. But as we learned over decades, lack of insurance, preventing primary care, causes expensive emergency room appearances and late-stage treatment, costs landing on the entire system.

“When people lack access to affordable care,” points out Janet Bauer of the Oregon Center for Public Policy, “everybody else’s costs go up.”

This would be especially true of defeating Measure 101, which includes a reinsurance plan protecting insurers against extreme individual expenses, otherwise spread over everyone’s premiums – raising them by an estimated $300 a year.

The Voting Pamphlet arguments against Measure 101, mostly from individuals, argue against any taxes, against providing health coverage for undocumented children, against abortion, against state college tuition levels and against Nike (it’s a long story). They also object to the cost and quality of health care in Oregon, although it’s not clear how risking billions in federal money helps that.

But, state Rep. Cedric Hayden insists, “There’s NO RISK 350,000 low-income Oregonians will lose healthcare if you vote NO on 101! Income tax revenue created by Oregon’s $5 BILLION DOLLAR healthcare industry exceeds the revenue we need to fund Medicaid patients.”

The state’s just spending its money wrong, he explains, so all the legislature would have to do in its short session next month is redesign the state budget.

People in Oregon healthcare are less confident. Measure 101 “is the only guarantee we’ll be able to qualify for the Medicaid benefit,” says Adamson of Providence, currently the only statewide individual insurance provider. “Anything else is a gamble.

“There is no Plan B.”

Never a comforting medical opinion.

It took six months – and multiple trips through the number-crunching Legislative Fiscal Office – for the legislature to put together the program and the budget behind Measure 101, and to gather the overwhelming support of Oregon healthcare behind it.

“That’s why,” explains Kevin Ewanchyna, “the physicians of Oregon have to support the expansion of the Medicaid program, and Measure 101. From my perspective, it’s either Measure 101 or it’s not happening.”

To the people who provide health care in Oregon – who treat the patients and keep the facilities working – Measure 101 isn’t just a proposal.

It’s a prescription.

NOTE: This column appeared in The Sunday Oregonian, 1/7/18.