I know someone who used to say “I made a mistake once. I thought I had made a mistake, but I hadn’t.”
Oregon’s not so egotistical. Oregon did something stupid, studied what we did, and recently admitted to the world that we made a mistake.
Oregon’s once-landmark Oregon Health Plan in its heyday extended health insurance to over 130,000 poor and low-income Oregonians. Starting a little over a year after it was implemented, the Legislature and the Governor started whittling away at its scope. Today it serves only about 30,000 people who otherwise would not have insurance but for the OHP Medicaid expansion.
One way Oregon policymakers slashed workers and families from the OHP was by instituting, and then increasing, premiums and co-pays. “Cost sharing” is the 1984-ish, sounds-good, policy term legislators and government officials use to describe charging premiums and co-pays to the poor and low-income families who rely on Medicaid for their health insurance.
To its credit, Oregon decided to study the impacts of the increased premiums and co-pays. The result: disaster.
The results of Oregon’s study were recently published in Health Affairs. Six months after the changes were implemented, a survey showed that almost half (44 percent) of the people enrolled in the OHP lost Medicaid coverage. During that same time period, the total number of people enrolled in the OHP declined by 50,000 (46 percent).
Why did people lose OHP coverage? About half (44 percent) said they lost insurance because of difficulties paying the increased premiums and/or co-payments. Not surprisingly, those who had those problems were poorer than those who left for other reasons. As noted by the authors in the Health Affairs article, “Increased cost sharing disproportionately affected the most economical vulnerable OHP members.”
What happened to those who lost coverage? More than 80 percent of those who lost coverage due to the increases in premiums and/or co-pays had not found alternative forms of insurance, and remained uninsured, six months after the premiums and co-pay changes took effect.
The lesson from Oregon is clear: increasing premiums and co-pays for the families and individuals who rely on Medicaid is unhealthy public policy.
Will Oregon’s U.S. Senators Gordon Smith and Ron Wyden protect against further efforts (such as those promoted by the National Governors Association) to shift more of the cost of Medicaid onto the low-income families and individuals the program serves?
Time will tell whether Senators Smith and Wyden and their colleagues will heed the lesson from Oregon.