Oregon to establish basic health program for lower income adults

Oregon is asking CMS to approve a basic health program for lower-income individuals who make too much to qualify for Medicaid, a move that could raise premiums prices on the state's individual insurance market. 

According to a Sept. 12 press release from the Oregon Health Authority, coverage will be similar to that provided through Oregon Health Plan, the state's Medicaid program, for individuals with incomes between 138% and 200% of the federal poverty level. 

"People in Oregon within these income brackets have historically gone without health coverage at higher rates — more than any other income group in the state," Dave Baden, interim director at Oregon Health Authority, said in the release. "The Basic Health Program will mean that coverage, and subsequently care, is within reach to more adults and families in our state."

The program will also prevent people from cycling on and off Medicaid coverage as their incomes fluctuate, the state said. 

Insurers in the state have objected to the proposal, according to a July 10 report from Oregon Public Broadcasting. The basic health program will drive up premium costs on the state's ACA exchange, insurers say, by shifting thousands of people, and federal subsidies, out of the market. 

An analysis commissioned by the Oregon Health Authority, obtained by Oregon Public Broadcasting, estimated if premiums increase in the ACA marketplace 1,800 people will become uninsured and 5,100 people will downgrade their coverage. 

In its news release, the state said most marketplace consumers will see a premium increase of $25 per month or less if the state does not take any further action. 

"[Oregon Health Authority] is working with carriers to explore state-funded or other 'stopgap' solutions to prevent premium increases, until Oregon moves to a State-Based Marketplace for plan year 2027," the agency said in its news release. 

If approved by CMS, Oregon would be the third state to implement a basic health program, after Minnesota and New York. 

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