QuickTake:

Oregon’s Medicaid system provides health care to 1.4 million low-income people. Under a GOP-backed proposal in Congress, more than 100,000 Oregonians, including thousands in Lane County, would lose health benefits. 

Oregon health care providers warned Tuesday that proposed cuts to Medicaid in a GOP-backed bill in Congress would devastate hospitals and force thousands of Oregonians who rely on the safety-net program to either delay health care for treatable conditions or, at worst, leave the program entirely. 

The stakes are high: About 1.4 million Oregonians are enrolled in the Oregon Health Plan, which provides Medicaid coverage to low-income residents in the state. That’s about 1 in 3 Oregonians overall. An analysis by the nonpartisan Congressional Budget Office estimates nearly 130,000 Oregonians statewide would lose Medicaid coverage under the bill. 

In Lane County, nearly 131,000 people rely on Medicaid for health care coverage. 

Oregon hospital executives and legislators in Salem are worried as they watch the bill. With GOP support, the bill passed the U.S. House, but faces scrutiny in the Senate. 

Opponents, including U.S. Rep. Val Hoyle and U.S. Sen. Ron Wyden, both Oregon Democrats, have repeatedly criticized the bill, saying it could harm Oregonians. 

In Salem on Tuesday, state legislators monitoring the issue in Washington, D.C., heard from health care providers and patients in a hearing before the Legislature’s Senate Committee on Health. 

Its chair, Sen. Deb Patterson, D-Salem, said this issue is the one she loses the most sleep over. 

“This is a very difficult situation to face,” she said before testimony started. 

Emma Sandoe, Medicaid director for the Oregon Health Authority, outlined a number of proposed changes in the bill that would impact providers and Oregonians. Oregon’s Medicaid enrollment is currently at an all-time high, Sandoe said.

Sandoe said Oregon historically has expanded its Medicaid program. 

“It has been used as an example for the rest of the country to expand health care access,” she said.

That work, though, now faces potential threats.

The proposed changes include work requirements for many Oregonians in the program, including up to 462,000 who already have jobs and would face more red tape to keep their coverage. 

Other proposed changes would require people to fill out paperwork every six months, proving they meet requirements. The complex proposal has exceptions, such as for caretakers, students and people engaged in drug addiction treatment. 

The proposed changes also include eligibility checks every six months for participants. Currently, adults who qualify receive at least two years of coverage, and children enrolled in the Oregon Health Plan are automatically covered from birth to age 6.

People who overlook the new requirements and extra paperwork could lose coverage — even if they’re eligible for benefits.

Witnesses at Tuesday’s hearing pointed to another problem: mandatory co-pays proposed for Medicaid that would require patients to pay for doctor visits. Oregon has not required Medicaid recipients to pay anything since 2017. Co-pays would discourage people from accessing care, providers said, meaning they would put off treatment for conditions that worsen, like diabetes or infections. 

That can mean more trips to the emergency rooms in Oregon hospitals, which would cost more and delay care for chronic and preventable problems.

“Hospitals are buckling under the pressure of rising expenses and payments that don’t cover the cost of care,” Becky Hultberg, president and CEO of the Hospital Association of Oregon, told lawmakers. “Last year, nearly half of Oregon hospitals operated at a loss, forcing them to cut more than 800 jobs to reduce or eliminate services.”

Hospitals in Oregon and across the nation were hammered during the COVID-19 pandemic with labor shortages. Hospitals continue to face financial pressures, including PeaceHealth, which recently laid off 1% of its workforce at Sacred Heart Medical Center at Riverbend in Springfield.

“Like other hospitals and health systems in Oregon, PeaceHealth is struggling to meet the needs of our community as we navigate the challenging environment,” Alicia Beymer, chief administrative officer of PeaceHealth Sacred Heart RiverBend, said in the presentation.

Beymer said the layoffs were a “very difficult decision and painful one,” but necessary because of the bleak financial picture. 

At the same time, PeaceHealth has turned its attention to expansion, including a 42-bed inpatient rehabilitation hospital in Springfield, which is under construction. PeaceHealth also has plans for a 96-bed inpatient psychiatric hospital that will “revolutionize behavioral health care in Lane County,” Beymer said.

If Medicaid reimbursements drop further, it will only increase hospitals’ difficulty in planning similar expansions. 

That work and those expansions, Beymer said, are “now being threatened by declining reimbursement rates due to cuts to Medicare and Medicaid. That keeps me up at night.”

Other providers from across the state testified, from Portland-based Central City Concern to Wallowa Memorial Hospital in northeastern Oregon.

“It’s going to take all of us working together to help families navigate the potential policy changes coming out of Washington, D.C.,” Beymer said.

Ben Botkin covers politics and policy in Lane County. He has worked as a journalist since 2003, most recently at the Oregon Capital Chronicle, where he covered justice, health and human services and documented regional efforts to combat fentanyl addiction. Botkin has worked in statehouses in Idaho, Nevada, Oklahoma and, of course, Oregon. When he's not working, you'll find him road tripping across the West, hiking or surfing along the Oregon Coast.