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The health care financing package enacted by the 2017 Legislature was a smart move. A 'yes' vote on Ballot Measure 101 will protect health care for hundreds of thousands of working- and middle-class Oregonians.

Many more Oregonians are now able to see a doctor when they need to, compared to the situation just a few years back. Health insurance coverage is at an all-time high. Hundreds of thousands of working- and middle-class Oregonians have gained coverage, thanks to our state's work to make health insurance available to everyone. 

Unfortunately, there is a political effort afoot in Oregon that would unravel this progress. The threat to the health coverage of middle-class and working Oregonians is the defeat of Ballot Measure 101, to come before voters in January.

The campaign to defeat Ballot Measure 101 aims to torpedo one of the most important pieces of legislation to come out of the 2017 legislative session — the enactment of a financing package to protect Oregonians' health care. A "no vote" in January would overturn the package. That would leave the state's Medicaid program in shambles and raise costs for people who purchase their own health insurance. 

The Oregon Health Plan (OHP), Oregon's Medicaid program, covers about a million people, including low-income children, seniors and people with disabilities. Since 2014 under the Affordable Care Act, Oregon also has covered adults who don't get insurance through their job. 

Medicaid is a state-federal financing partnership, which offers a very good deal for Oregon. For every dollar Oregon puts in, many more federal dollars flow into the state. 

For the first few years that OHP covered the new group of adults, the federal government paid for the full cost. Now, the federal government is paying 94 percent of the cost. With the feds still footing most of the bill, the challenge for the 2017 Legislature was to come up with the balance. 

The Legislature worked with stakeholders on a funding package that increased assessments on hospitals and health insurance companies. Hospitals, insurers, nurses, doctors and consumer groups all supported the financing package. 

These kinds of assessments are used in 49 states to fund health care. In Oregon, the approach has a proven track record. For years, Oregon hospitals have helped pay for OHP, because doing so helps people pay their hospital bills. Prior to 2014, an assessment on insurers funded Oregon's Healthy Kids Program, which dramatically reduced the number of children going without health insurance. The assessment was allowed to expire.

Upending the health care solution would blow a hole in Oregon's budget as large as $320 million, putting everyone relying on OHP at risk of inadequate coverage or losing it altogether. At particular risk are the 350,000 newly added adults, since covering them under Medicaid is optional. 

Why would the lost funds put coverage for so many Oregon adults in jeopardy? The reason is that for every dollar Oregon puts in to cover working Oregonians, the state receives a particularly handsome match of $16 in federal funds. A "no" vote on Ballot Measure 101 risks the loss of up to $5 billion in federal funds — dollars needed for their coverage.

Also at risk are essential cost protections for middle-class Oregonians. 

The financing solution approved by the Legislature protects middle-class Oregonians from spikes in health insurance premiums. The cost of premiums were rising fast for the 210,000 Oregonians buying insurance on their own. Some were at risk of becoming uninsured. Others lacked coverage altogether, being unable to afford it. In response, lawmakers and stakeholders agreed that some of the insurance company assessment would go toward lowering their premiums. 

Those funds bring matching federal dollars into Oregon and become a backstop in the individual market for insurers with extraordinarily large claims. This "reinsurance" protection allows insurers to lower premiums by about 6 percent, even accounting for the cost of the assessment. 

Without the funds to pay for it, the reinsurance protection will go away. That means higher premiums for middle-class households. 

Oregon businesses also will be harmed. Experience shows that when more people lack health insurance, premiums for businesses rise. More uninsured relying on emergency rooms means more unpaid hospital bills. Those unreimbursed costs are passed on in the form of higher premiums for everyone purchasing health insurance, including businesses.

The health care financing package enacted by the 2017 Legislature was a smart move. A "yes" vote on Ballot Measure 101 will protect health care for hundreds of thousands of working- and middle-class Oregonians.

Janet Bauer is a policy analyst with the Oregon Center for Public Policy (ocpp.org).

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