The measures demonstrate a broad understanding that the Biden administration is unlikely to be able to deliver on its promise to expand healthcare. And they come amid growing concerns that the looming end to the Covid-19 public health crisis could result in millions of people being kicked out of Medicaid and fear that the Obamacare subsidy that helped millions of people buy coverage will expire in the end of 2022.
In Oregon, Democrats adopted a bill in March to establish a basic health program, the details of which will be improved by a task force that began meeting this week. In Kentucky, Republicans approved $ 4.5 million in state funds in the spring to set up a basic health program, which was signed into law by the state Democratic governor. It is estimated that 85,000 Oregonians and at least 37,000 Kentuckians will be eligible to sign up for the plans as soon as next year.
“Because the federal government has failed in so many ways to provide access to health care to Americans, Oregon is stepping in,” said Jonathan Frochtzwajg, public policy and grant director at the Cascade AIDS Project and one of the members of the Oregon Task Force. “Congress, and especially the Senate, is broken, and states have to compensate for that.”
A basic health care program offers low-cost insurance for people who make up to twice the federal poverty level – about $ 55,000 for a family of four – and do not qualify for Medicaid. New York and Minnesota offer plans with few or no prizes, co-pays or deductions, an important selling point for followers.
“Co-pays and premiums are a big reason people don’t get access to care,” the Oregon Rep. Rachel Prusak, a nurse who oversaw the basic health program through the Legislative Assembly as chair of the House Health Care Committee. “From a clinician’s perspective, if we do not do this, then what?”
Unlike other provisions of the Affordable Care Act, which have been the subject of intense partisan shocks, the basic health program is finding masters even among some Republicans who see it as a way for low-wage workers to make more money or work extra hours. without fear of losing their insurance because they no longer qualify Medicaid.
“Kentucky is not known for our good health measurements, and we do our best to really address some of the gaps and barriers in the system,” the Kentucky Rep said. Kim Moser, a Republican who chairs the House Health and Family Services Committee and is a trained nurse. “We know this is the group of people signing in and out of health coverage.”
When the Centers for Medicare & Medicaid Services released a rule in the spring of 2014 about creating the basic health program, Minnesota and New York jumped on it. Both had state-run programs that covered people who did not qualify for Medicaid, so the new policy provided a huge federal subsidy for plans they already had in place.
“We were a little surprised if you go back to the early days of the Affordable Care Act that only one other state created a basic health plan right from the beginning,” said Chuck Johnson, deputy commissioner for the Minnesota Department of Human Services. “For us, it was a kind of no-brainer.”
A handful of states, including Oregon, were interested in the program but did not go ahead because health authorities assumed people would sign up for subsidized marketplace plans when they earned too much to qualify for Medicaid. They did not expect that so many would find that coverage unaffordable.
For example, a 40-year-old earning about $ 26,000 a year would have had to pay about $ 140 in monthly premiums for the second-lowest price silver plan before Congress increased marketplace subsidies last year, according to the Kaiser Family Foundation.
“There was a nascent realization that the coverage just wasn’t as affordable as it should be,” said Jennifer Tolbert, the foundation’s director of state health care reform. “It’s a good option, but there were a lot of people who simply could not afford the coverage.”
Earlier this year, Oregon health officials found that more than a third of Oregonians who were uninsured pre-pandemic said losing their Medicaid coverage was a major reason they did not have health coverage, even though they should have been eligible for grants on the stock exchange.
“We’re talking about people whose income fluctuates between Medicaid and the marketplace, but they do not actually go between Medicaid and the marketplace. They go between Medicaid and being uninsured,” said Jeremy Vandehey, director of the Oregon Health Authority’s Department of Health Policy and Analysis.
At the beginning of the pandemic, Congress banned states from removing people from the Medicaid rolls, even though their incomes increased. Oregon’s uninsured rate fell from 6 percent in 2019 to a record low of 4.6 percent in 2021. The uninsured rate for black Oregonians fell from 8 percent to 5 percent.
Proponents see the basic health plan – which evolved from the state’s talks on creating a public health insurance option – as a way to preserve these coverage gains and maintain health improvements as the end of the public health emergency approaches.
“When we think about who benefited from not losing insurance, it was colored people,” said Adrienne Daniels, interim director of Integrated Clinical Services at the Multnomah County Health Department and a member of the Task Force that develops Oregon’s core health program. “I do not want Oregon to return.”
Out of the 300,000 people enrolled in Medicaid but who are no longer expected to be eligible when the public health emergency ends, Oregon health officials estimate that about 55,000 will be eligible for the basic health program. An additional 30,000 people enrolled in exchange plans are also expected to qualify.
In Kentucky, advocates have been pushing for a basic health plan for years, but work accelerated last year as lawmakers adopted a bill to explore the establishment of a bridge health insurance plan. A task force, which met last summer, concluded in its final report that a basic health program would “allow individuals who would otherwise lose their health coverage through Medicaid to be able to accept work and wage increases and remove the incentive to accept increased pay” or work. “
A feasibility study conducted for the state by health consulting firm Milliman found that 40 percent of the people in the basic health program membership, which it estimated at about 37,000, had previously been uninsured.
“It’s clear to see where the gaps lie and what populations technically have coverage options, but not coverage options that work for them,” said Emily Beauregard, executive director of the Kentucky Voices for Health advocacy group.
Critics, however, believe that states could instead focus on making exchange coverage more affordable instead of creating a new basic health program. Connecticut, for example, plans to join a handful of states that use state dollars to subsidize marketplace plans for low-income residents.
In a letter to the CMS earlier this month, Kaiser Permanente called the basic health program an “illegitimate and potentially market-undermining program.” Hospitals have also expressed concern about reimbursement rates under the basic health program, arguing that it should be a temporary solution.
A spokesman for the CMS declined to comment on any talks with states, but said in an email that the agency “urges all states to explore the creation of a BHP if they feel it would be beneficial to provide a more affordable comprehensive coverage for its entrants. ” The spokesman added that the Biden administration believes that so-called state innovation exemptions “represent an exciting opportunity for states and the departments are ready to help states pursue exemptions.”
Oregon plans to submit its application for a basic health program to the CMS later this year with enrollment scheduled to begin toward the middle of next year.
A spokesman for the Kentucky Cabinet for Health and Family Services said the goal is to enroll people in the fall for coverage starting in January.
And West Virginia could be next.
A Republican House delegate who is a former Medicaid recipient is working with health advocates to build support around his bill to create a basic health program during interim legislative meetings this summer, and West Virginia’s majority leader in the Senate has done so sponsored the companion bill in the Senate.
“It just seems so simple to me,” said Delegate Evan Worrell. “It’s about taking care of people. I do not think it’s about politics. “