Thousands will lose Oregon Health Plan coverage
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June 9, 2004
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Thousands will lose health plan coverage
By Tim Christie
The steady erosion of the Oregon Health Plan continued Tuesday when state health officials said they will slash enrollment in the Standard benefit package over the next year.
The Standard plan covers low-income adults who don't qualify for traditional Medicaid. The state will stop enrolling new members on July 1, and cut the number of enrollees by more than half - from about 51,000 to around 25,000 - by June 30, 2005. As recently as January 2003, the plan had 110,000 members.
"It's one more nail in the coffin for low-income people who have almost nowhere else to turn," said Tim Miller of the Oregon Health Action Campaign, a patient advocacy group.
It's not known how many of the 5,408 Lane County residents on the Standard plan would lose their coverage.
When the Oregon Health Plan was enacted a decade ago, the brainchild of then-Sen. John Kitzhaber, it represented a bold new approach to health care of the needy and working poor. The idea was to ration health care and thus be able to serve more people.
By prioritizing services that would be covered and spending more state money on health care, Oregon was able to extend coverage to uninsured workers, childless adults, and others who had gone without medical coverage in the past.
But runaway medical costs, a long-lived state budget crunch and the the federal government's refusal to let the plan work as designed have forced state officials to drastically rewrite the plan and curtail the number people getting coverage.
"We've got to have a plan that's affordable and sustainable and that meets critical need," said Cindy Becker, deputy director of the Department of Human Services.
There was some positive news for OHP Tuesday: Starting June 19, OHP Standard enrollees no longer will have to make co-payments for drugs, doctor visits and hospital stays, after a federal judge ruled the payments violated federal law.
And some of the benefits that were cut from the Standard plan last year will be restored, albeit at lower levels. Those include prescription drugs, emergency dental treatment, outpatient mental health and drug and alcohol treatment, and a limited hospital benefit.
The Standard plan is one of two benefit packages in the Oregon Health Plan. The other package, known as OHP Plus, covers about 300,000 Oregonians, who are entitled to coverage under Medicaid. They include the disabled, blind, the elderly, children and pregnant woman.
The state will cut enrollments in the Standard plan by imposing stricter income eligibility requirements when members reapply every six months. Anyone with income equal to 100 percent of the federal poverty level - about $748 per month for a single person, $1,041 for a family of two - qualifies for OHP Standard. The state will change the eligibility requirement to somewhere between 30 percent and 50 percent of the federal poverty level.
The result, say state officials and patient advocates, is that more people will rely on emergency rooms when they get sick, which is the most expensive way to provide health care. And that will mean the cost will be shifted to people who have private health insurance.
"One way or another society pays," Miller said. "It's just a matter of how we're going to go about doing it."
The move to cut enrollment in the Standard plan came as no surprise to social service providers such as HIV Alliance.
"We knew it was coming, but it doesn't change how severe it will be for our clients," said Renee Yandel, client services director for the Eugene-based organization.
It's not clear yet which agency clients will be cut from the plan, Yandel said, "but whoever it is, it's the difference between life and death."
When people with HIV - the virus that causes AIDS - go without their medicine, the virus can mutate, which means they no longer can take that drug regimen. It also means their viral load will go up, and that means they're more likely to infect someone else, and more likely to develop AIDS.
"We'll have to stop looking at quality of life issues for clients and start looking at end of life issues for those people," she said.
The decision to cut enrollment in the Standard plan is the latest in a series of major changes to the Oregon Health Plan, resulting in part from voter rejection of tax-raising measures the last two years.
After the defeat of Measure 28 in January 2003, lawmakers cut benefits for the Standard population, including dental, mental health and substance abuse treatment. After the defeat of Measure 30 last February, lawmakers decided to use no state general-fund dollars to support the Standard benefit package.
But the 2003 Legislature did approve two new taxes - one on Medicaid managed care plans and one on hospitals - to help pay for the Standard plan, both of which required federal approval. Federal officials have approved the managed care tax and approval of the hospital tax is pending.
Each dollar from the new taxes will be matched with $1.50 in federal Medicaid money to help fund the Standard plan. But these revenues are not enough to pay for the plan at its current level, and the provider tax is only supposed to last for four years.
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