Examining the impact of Measure 101

Graphic by Sheila Embers.

Assuming you’re registered to vote in Oregon, by now you should have received a ballot in the mail regarding the upcoming special election on Jan. 23. The special election has just one item to be voted on, Oregon Ballot Measure 101: “Healthcare Insurance Premiums Tax for Medicaid Referendum,” as Ballotpedia.com puts it.

How exciting! you’re no doubt whispering to yourself, spine a-tingle with anticipation… I just LOVE discussing premiums, health insurance and taxes in general. This shit is my bread and butter. I set my ringtone to “Physical” by Olivia Newton-John, only I pretend she’s saying “fiscal” instead – that’s how much I love number-crunching. I totally know who Olivia Newton-John is…

But for those of you who aren’t quite as enthused when it comes to policy discussion, we’ve broken the measure into bite-size, comprehensible nuggets of information that will hopefully give you a better grasp of what it is you’re voting about (assuming you’re one of the 30 percent of Americans who even bothers to vote in the first place).

Measure 101 is a referendum measure: a public up-or-down vote on a decision made by the Oregon Legislature, before it can officially take effect. The referendum is an important part of Oregon’s political scene, along with the more-popular voter initiatives (think legalized marijuana) that can bypass legislators altogether.

In a nutshell, Measure 101 is asking if most of us are willing to pay a little more on our premiums to ensure the poorest Oregonians keep their health care.

This measure has to do with House Bill 2391, a bill enacted last year by the Legislature and signed by the Governor. It’s a complicated affair, but in essence, the legislation tacks a 1.5 percent tax on the collection of healthcare insurance premiums paid by most Oregonians, whether through private (personal) or managed-care plans.

HB 2391 was passed in the House of Representatives, 36-23, and then the Senate, 20-10. In both cases, the ‘No’ votes were exclusively cast by Republican members of the Legislature.

So why are we even having a referendum about this, if it was passed by legislators and signed by Oregon Gov. Kate Brown? Credit goes to GOP Reps. Julie Parrish, Cedric Hayden and Sal Esquival, who filed a petition for the veto referendum – all three voted “No” on HB 2391 and are vocally outspoken about the ramifications of its passage.

House Bill 2391 in a Nutshell

HB 2391 affects the Oregon Health Plan, a state health care program for individuals who qualify for Medicaid, including low-income families, people with disabilities, the elderly, and pregnant women. The program’s costs are partially funded by the state, but primarily funded by the federal government.

Following passage of the Affordable Care Act under the Obama Administration, Oregon expanded those persons eligible for Medicaid, from people who earn 100 percent of the federal poverty income level, up to 138 percent. The Affordable Care Act matched federal money at a 3:1 ratio, but the share of funds the state has to provide, however, is growing. For 2015-2017, for every dollar that was spent on OHP, 21 cents came from state funds; for the 2017-2019 budget cycle, that burden has increased to 25 cents on the dollar. A four-cent increase may not sound like much, but when you’re talking about a $9 billion budget (counting both state and federal funds), it adds up.

Democrats who championed the passage of HB 2391 consider health care coverage for eligible Oregonians as a good thing; according to the Portland Tribune newspaper, an additional 366,000 people were eligible for OHP coverage in 2016 – many of whom live in rural areas (most of whom happen to be represented by Republicans opposed to the bill, oddly enough).

Weighing In

Opponents of HB 2391, and those pushing for a “No” vote on Measure 101, by extension, don’t think that OHP coverage is a bad thing, per se.

“This ballot measure isn’t about whether Medicaid is good or bad… It’s about whether we picked the right funding mechanism to pay for it,” says Parrish. She and other foes view the measure as a Band-aid, at best. Hayden said approval of Measure 101 would just push a $1.5 billion Medicaid funding crisis into the 2019-21 budget cycle. Stop Healthcare Taxes, a political action committee based in Wilsonville, describes the bill as “a sales tax on healthcare premiums,” and much of the “Vote No” rhetoric centers on the “unfairness” of the tax, from which many private and public workers would be exempt from paying.

So, if Measure 101 is passed, and HB 2391 proceeds as planned, what will that look like? Are Republican lawmakers right to worry over rising premiums?

The short answer is, yes. According to a document published by Oregon’s Department of Consumer and Business Services (http://dfr.oregon.gov/healthrates/Documents/2018-fnl-prpsd-rates.pdf), all the major providers of health care in Oregon for both Individual and Small Group markets will be seeing premium increases in 2018. This list includes Kaiser-Permanente, Moda, Providence; you name it. The rate increases range from 2.4 percent on the lower end, up to 10 percent or more. And these rates are after several rounds of negotiations; the initial rate request on the Individual market hovered around 12 percent. Like it or not, healthcare costs are increasing, and premiums are, of necessity, reflecting that.

HB 2391 recognizes that fact, however, and language is built into the bill limiting the amount that insurers may increase their premium rates by to 1.5 percent as a result of the assessments collected.

So, Republicans are right: If the people of Oregon vote “Yes” on Measure 101, they will likely see premium increases as a direct result of this. Democrats, however, defend the bill as a necessary fix to keep Medicaid recipients in Oregon safe from reductions in critical benefits or eligibility.

In a nutshell, Measure 101 is asking if most of us are willing to pay a little more on our premiums to ensure the poorest Oregonians keep their health care.

Whether you think the rabble deserve to go to the doctor or if you’re fine with them dying in the streets, ballots are due by 8 p.m. Tuesday, Jan. 23. It is too late to mail in your ballot, but you can find a ballot drop box near you on the Secretary of State’s website. (http://sos.oregon.gov/voting/Pages/drop-box-locator.aspx)

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