State legislature kicks 40,000 off Oregon Health Plan
Article in today's Eugene Register-Guard and my letter to the editor in response.
Thank you for your Oct. 26 article on the decline of the Oregon
Health Plan. The comfortable, self-righteous, middle-class state
legislators have no understanding of what it means to be poor. Never
mind mental illness or drug addiction - often caused BY poverty -
just being poor is enough to create constant instability in our
lives. The problem is unemployment, low-wage jobs, part-time and temp
work, insufficient Social Security and disability payments.
The state legislature has kept OHP in an uproar with constant
changes. They split it into two programs, Plus and Standard, and cut
benefits from Standard - mental health, addiction, dental,
prescriptions. People died. They pushed us into HMOs, supposedly to
save money, even though this just adds an extra layer of
administrative cost, and set up premiums and copays people can't
Now they're proposing to reinstate some of the benefits they cut,
but will reduce the list of illnesses that are covered and cut
hospitalization so your life has to be threatened to use it.
Worst of all, the legislators have twice tried to "save" OHP
with tax increases they know the voters will turn down. Instead, they
should have used money already available to fully fund OHP, and dedicated
any tax increases to schools and public safety. Survival comes first.
October 26, 2003
40,000 poor lose coverage: Since requiring premiums, state has cut a
third of one program's users
By David Steves
Nearly 40,000 poor people have been banished from the Oregon Health
Plan this year, the result of their own failure to make monthly
The departure of more than one-third of the 88,000 poor people from
the state-subsidized Oregon Health Plan Standard program has far
exceeded most officials' expectations. The consequences of
participants' failure to pay as little as $6 a month have been
strict: Once kicked off the plan, they're not allowed back for six
As tens of thousands of Oregonians began losing their OHP coverage,
officials came to realize that not only were the premiums beyond the
financial means of many of the state's poorest residents, but the
government may have overestimated their capacity to comply with the
monthly task of making those payments to the state.
"It's an enormous barrier," said Ellen Pinney, director of the Oregon
Health Action Committee. "Let alone the $6, there is the whole issue
of writing a check or getting a money order, putting it in an
envelope with a stamp and putting it in the mail to this place in
Portland that must receive it by the due date."
Next month, the first wave of people barred from OHP Standard will be
eligible to return to the plan.
Groups such as Pinney's are urging the state to consider reforms,
such as reducing the disenrollment period and reducing or eliminating
patient fees such as the premiums and co-payments for prescriptions
and hospital and doctor visits. They also want to make the process
easier by allowing participants to pay cash in person at state social-
services offices and allowing medical providers or charities to pay
OHP patients' costs on their behalf.
Oregon Health Plan Standard is a slimmed down version of the state's
health insurance program for low-income residents. About 15 percent
to 20 percent of the Health Plan's participants are in the standard
program, which covers adults who aren't blind, disabled, elderly or
pregnant and who are below the poverty line, which is $748 a month
for an individual and $1,010 for a couple.
State data show that more than half of OHP Standard enrollees are
about 40 percent below the poverty level and tend to be jobless,
often homeless and have a high prevalence of mental illness and drug
or alcohol abuse.
"That's why they're living so far below poverty," said Dr. Bruce
Goldberg, administrator of the Office of Oregon Health Policy and
Research. "They have illnesses and life circumstances that put them
Springfield woman kicked off
Helen Jenkins, an unemployed Springfield woman, is one such person,
who until September had medical coverage through OHP Standard.
Even though her income was just $124 a month in back-payments of
child support, Jenkins said, she and her husband, Ron, had managed to
come up with their monthly premiums of $9 apiece. But getting the
money wasn't her only challenge; mailing it off each month proved to
be her stumbling block. In July, Jenkins said she had the check
mailed to a Salem address they'd located on an envelope from the
health plan. It was the wrong address, Jenkins later discovered. Now
she's been barred from the plan and can't return until March.
A mother of five children aged 16 through 26, Jenkins had been a stay-
at-home mom, a classroom aide, and worked as an office manager. For
most of her life, she had health insurance.
Thanks to the Oregon Health Plan, medical coverage continued even
after Jenkins divorced, met the man who would become her current
husband, started using drugs and became homeless and jobless, living
in illegal camps or crashing for a week or two at a time at the homes
or apartments of different relatives.
Last week, Jenkins was temporarily sleeping on a blow-up mattress on
the kitchen floor of a Springfield apartment shared by three of her
children and a grandchild.
She used OHP coverage to pay for prescription drugs, mental health
treatment, and doctor's care for migraine headaches, arthritis in her
hip, and hepatitis C, which Jenkins thinks she contracted by using
dirty needles to inject herself with methamphetamine, a drug she said
she stopped using in February.
Since she was kicked off the health plan, Jenkins has been relying on
free samples of the prescription drugs she uses. She used the $20 she
earned by baby-sitting one of her grandchildren to make a down
payment on a $75 visit to a medical clinic to find out why her
breathing has been difficult and her throat and neck so sore. And
without money to see a dentist, she's begun to brush and floss
religiously to prevent a cavity in a front tooth from worsening.
What if one of Jenkins' medical problems deteriorates to the point
that she has to go to a hospital emergency room?
"I'm worried about that all the time," she said.
Emergency rooms feeling impact
Dr. Goldberg, the health policy expert, said that should be a concern
for policy-makers and taxpayers, too. Uninsured people such as
Jenkins tend to postpone treatment until a health problem gets so
painful or debilitating that they go to the emergency room.
Such care is more costly because it's often delivered when a
patient's condition has reached a chronic stage, Goldberg said. In
addition, hospitals pass the cost of such uncompensated care on to
insurance companies, which in turn increase premiums for consumers.
"Individuals don't choose whether or not they get ill. And when they
do, that cost is borne by somebody," he said. "So the issue is, how
to provide that care in the most timely, cost-effective way."
And that more costly care appears already to be making its way from
the emergency rooms to the consumers. Three months after the Oregon
Health Plan started charging monthly premiums, emergency-room care
for the uninsured had risen by 17 percent at Oregon Health & Science
University in Portland.
It's far from certain that the monthly premiums - and the stiff
penalty of disenrollment for those who don't pay them - has triggered
this jump in emergency-room visits by the uninsured, Goldberg said.
His office and OHSU are starting to research the issue, contacting
banned, ex-OHP enrollees to determine why they left the plan.
Jim Edge, a state administrator for Oregon's Medical Assistance
Programs, said all of those departed OHP Standard enrollees left for
nonpayment of premiums.
"But we don't know for sure if that's because they couldn't pay the
premium, or if that's because the benefits got cut and they chose to
not stay in the program because of the loss of mental health and
chemical dependency and dental services," he said. The types of care
Edge cited have been eliminated because of state budget problems, but
are expected to be reinstated if the federal government approves a
set of changes in how the health plan works.
A get-tough approach
Many state health care officials and advocates of universal medical
coverage said they were taken aback by the sharp decline in OHP
Standard enrollment. However, Rep. Jeff Kruse, a Sutherlin Republican
who helped design and supported the premium and co-payment schedules
for OHP enrollees, said he hasn't been been surprised by the 42
percent drop in OHP Standard enrollment since the new premium
requirements took effect.
"It wasn't something we were trying to do, but it's something we knew
would happen," said Kruse, whose House district includes eastern Lane
Kruse said OHP enrollees who have lost coverage because they didn't
pay their premiums are being forced to change the way they view the
program. In the past, people signed up for coverage when they were
sick or hurt. Paying premiums was always viewed as optional, since
people who were kicked off could sign up again any time a need for
medical care arose, Kruse said.
"It's not that I wish people anything bad, but there needs to be
consequences for not living up to the responsibility that we've put
into it. And that's why we have the six-month disenrollment," he
said. "It's going to take some time for people to fully understand
that there are consequences and we mean it."
Pinney, the activist for medical coverage for the poor, said that
approach is just not realistic for people who are struggling with
poverty and in many cases, drug-related problems, mental illness and
"All these hoops can apply to those of us who have homes with desks,
and stamps and pens and checkbooks," she said. "But these folks are
people whose lives are in chaos."
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