Not having health insurance was making Tamica Kent sick. Stress caused flare-ups of her systemic lupus erythematosus during the 18 months after she moved with her family to Oregon in 2009 when she was unemployed and two applications to the Oregon Health Plan lottery -- put in place because of lack of funded openings -- didn't succeed.
Charitable physicians and a low-income pharmaceuticals program helped, but the mother of seven sometimes waited months for an appointment. Her lupus-related kidney disease is life-threatening, and three or four times she was forced to seek treatment in hospital emergency rooms.
Late last year Kent, 40, finally was accepted by Oregon's low-income insurance plan, and the timely access to doctors has been a huge relief.
"Each time you get sick, you're wondering," she says, "Am I going to be too sick to care for my children? Will I get better?"
The waiting period for people like Kent could end if Gov. John Kitzhaber gets his way on a proposal to add at least 160,000 people to the Oregon Health Plan -- but his budget has to get through the Legislature first.
Earlier this year, the U.S. Supreme Court ruled on the federal Affordable Care Act, saying it's up to each state whether they use the new law to expand Medicaid -- which includes the Oregon Health Plan. Under the law, eligible incomes would jump from 100 percent of federal poverty level to 133 percent, or $30,656 for a family of four.
In other states, the question has been a political football due to cost and ideology. Eight Republican governors have said they won't expand Medicaid, and in Colorado even Democratic leaders have expressed concern over potential costs.
Under the law, the federal government picks up 100 percent of health care costs at first, leaving Oregon to pay only for administration. By 2020, the federal government's share ratchets down to 90 percent. A recent report by the Urban Institute for the Kaiser Family Foundation pegged Oregon's expansion costs at $506 million over 10 years, but said it could also reduce government costs of providing other free care by $280 million. Oregon officials are working on another estimate, expected to be released in a few weeks.
One question is whether the federal expansion will pick up the costs of 66,000 people already on the stripped-down state plan called OHP Standard. If it does, 225,000 people in all are expected to be funded by the feds in the coming budget. If the federal decision goes against Oregon, it would cost the state $530 million over the next four years; that's on top of the Urban Institute estimate.
Perhaps the bigger wild card is whether the federal law's cost sharing will unravel in the face of much-discussed budget pressures in Washington, D.C.
"I don't think there are any guarantees in life," says Oregon Health Authority director Bruce Goldberg, adding he considers it a risk worth taking. "Clearly, lives will be saved."
The Legislature convenes in January. And even if the Governor's budget is passed, lawyers for the Legislature believe that a separate law must approve the expansion as well, Goldberg said.
Regardless, gains by Democrats in the last election make its passage likely.
"I would hate to turn down the (federal) money if we can be covering 200,000 more," says Sen. Laurie Monnes Anderson, D-Gresham, chair of the Senate Health Care Committee.
Still, some Republicans question whether the expansion would be too much, too soon. Rep. Jim Thompson, R-Dallas, notes that only since August have new regional coordinated care organizations approved under this year's state reforms begun managing spending and care for the more than 600,000 already on the Oregon Health Plan.
"We've got the CCO's out there working hard in a very, very uphill environment," he says. "Can we expect them to work harder, faster?"
Kent's husband, who's ex-military and now studying to be a chef, gets coverage through the Veterans Administration, their children by the state-funded Healthy Kids program. But when they moved here, private insurance wouldn't cover her because of her pre-existing condition.
She credits the Portland nonprofit Project Access Now, which connected her with free care, for saving her life before the state accepted her. So she's happy that under the health changes, pre-existing conditions won't keep people from getting care.
"I think it's absolutely necessary," she says. "And it's wonderful."
Distributed by MCT Information Services
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