Measure 101, on which we will be asked to vote this month, is both complicated and simple. The history is complicated; the consequences of voting yes or no are simple.
First the history. Why does Oregon need to raise more money for health care? Remember the Affordable Care Act? States could — and Oregon did — expand the population of people eligible for Medicaid (called here the Oregon Health Plan) to include those not quite poor enough to qualify before. At first the federal government covered all the costs of the expansion, but as of this year, it covers only 95 percent. And if states don’t provide money to pick up that 5 percent, they lose a much larger part of the federal contribution.
Last year, Oregon legislators, along with key stakeholders such as hospitals, other health care providers and health insurers, worked out a solution. If Measure 101 passes (that is, if the majority votes “yes”) that solution will go into effect. It will ensure that all Oregon children, and 95 percent of all Oregonians will have access to health care coverage (including significant numbers of persons with disabilities and seniors, since Medicaid picks up costs not covered in Medicare, like nursing home coverage.
The money comes from an assessment (or fee or tax: the language really doesn’t matter) on hospitals, some other providers, and health insurers. Note: whatever this is, it isn’t a tax on you unless you are a hospital or a health insurer, and the trade associations for those groups agreed to the deal. It is true that insurers are permitted to pass through this cost to policyholders, but no more than a 1.5 percent increase.
So what happens if the vote is no? In theory, the Legislature could go back and find an alternative source for the funds that are needed. But it would be very difficult to redo the complex negotiations and find some alternative source. Is there some potential fraud or mismanagement in programs? Sure, in any entity. But there’s no indication that we could wave a magic wand, make all that disappear and come up with enough money to ensure that Oregon doesn’t suffer a devastating cutback in the federal money supporting the Oregon Health Plan. And Oregon doesn’t have a military whose budget could be trimmed to support health care costs!
Without the money that passage of Measure 101 would ensure, what would happen? The state could roll back the Medicaid expansion and leave thousands of Oregonians, including children, without coverage. Or it could cut back what it covers under Medicaid, leaving all poor Oregonians without coverage of drugs or other needed services.
One way or another, some of our neediest citizens would lack access to health care coverage. Some would not get care, or not get it soon enough before medical problems become worse. Some might leave infectious diseases untreated, putting public health at risk. And some would use emergency rooms (where hospitals are required to provide care for all) as their basic entry to the health care system, straining emergency room staffs and hospital budgets (since someone without funds isn’t going to be able to pay whatever bill the hospital sends them for that emergency room care).
Thus, a no vote puts a strain on the finances of health care providers, which in turn flows back into the charges they negotiate with health insurers. The parties that agreed to these assessments recognized that in the long run they were better off with the assessments than without them.
Not surprisingly, organizations representing the interests of hospitals, physicians, nurses, health insurers, children, seniors and people with disabilities, and general “good government,” like the League of Women Voters and the AAUW, have all urged a yes vote on 101. Is it perfect? No. But politics is the art of the possible, of finding the best solution for complex problems. “Go back and do better” isn’t an answer. "Yes” is.
— Mary Coombs lives in Ashland.