By State Representative Rob Nosse
I am struggling with my sleep. I keep waking up in the middle of the night having the same anxiety dream I have always had—I cannot figure out how to graduate from college. Why? Back in January, I mentioned that many of the bills I filed for the session deal with Medicaid. I focus intensely on Medicaid not because our state’s Medicaid system is in a crisis (unlike transportation, schools or wildfire response—all of which will require significant cash infusions to stabilize), but because Oregon has a Medicaid program we can be proud of, and it is one of my primary jobs to help keep it that way.
How do I know this? Last summer, I went to two conferences that were all about Medicaid. I had two big takeaways. First, after 10 years in the legislature, I am finally conversant on Medicaid, a pretty good thing when you are the main policy leader in the legislature for the program. But I learned something even more important. While many other states are proud to have reduced coverage, Oregon made health care more accessible to an ever-growing list of Oregonians. Our state was/is proud to make healthcare available via Medicaid to its residents. I am proud of it too.
So why am I waking up in the middle of the night? It’s because so many national news headlines say that Republicans in Congress are hell bent on cutting Medicaid funding to help finance the tax cuts that President Trump is seeking.
Here is what is at risk. 1.4 million Oregonians are covered by Medicaid, which we also call the Oregon Health Plan (OHP). This is a third of our state’s residents. We were one of the first states in the country to expand eligibility when President Obama and Congress passed the Affordable Care Act. Our latest expansion happened last summer when our state implemented the OHP Bridge program, which lifted eligibility from 138 percent of the federal poverty limit (FPL) to 200 percent of the FPL for Medicaid style health insurance.
Our state also operates a unique model for delivering Medicaid, which is based on coordinated care organizations (CCO) taking proactive steps to ensure patients receive preventative care. In some instances, CCOs even provide housing, transportation and food assistance. All of this is designed to reduce emergency room visits and strengthen primary and preventative care. And guess what? The system works!
All of Oregon’s progress expanding lifesaving coverage and access is in real danger from massive cuts that are being contemplated by Congress and President Trump as Congressional Republicans are considering whacking a whopping $2.3 trillion from Medicaid.
State Medicaid programs are funded using a mix of state dollars and a federal match (FMAP). The base FMAP is 61.14 percent, meaning the federal government picks up 61.14 percent of the tab for Oregon’s Medicaid program. For states like ours who expanded under the Affordable Care Act, the federal government pays 90 percent of the cost of the care on the expansion population. That is a lot of federal money coming into our state to help people access healthcare.
All told, the federal share of the OHP budget in the 2023-2025 biennium was $17.53 billion. For context, replacing the I-5 bridge is estimated to cost less than $8 billion.
Let me make this really clear: if President Trump, Elon Musk and Congressional Republicans get their way, 639,000 Oregonians will lose their Medicaid coverage. Medicaid enrollment in our state would get cut in half. Um, that’s the population of Portland.
No other state in the country would see as drastic a cut to their Medicaid program as we would. Sure, California would see more Medicaid patients lose coverage, but only because there are more people in California than Oregon. Only Virginia would experience a similar enrollment drop, as 681,000 Virginians would lose Medicaid coverage, or 45 percent of total enrollees.
But wait, there’s more. Congressional Republicans are looking at work requirements. In essence requiring someone on Medicaid to work a minimum number of hours to keep their coverage. The vast majority of those who have Medicaid are working. The requirement ignores real world challenges for some Medicaid enrollees, like childcare, people who are laid off or even those with chronic illness. It also ignores experiments with work requirements that other states tried that did not work.
I have previously written about all the major challenges Oregon is attempting to tackle this session, top among those is finding a way to shore up ODOT’s budget and save Oregon’s streets. We are also trying to find relief for communities impacted by wildfires and provide better funding for schools. All those are hard topics, but I cannot imagine the financial difficulties our state budget will certainly experience should Congress and President Trump follow through with a vote on these kinds of cuts this spring. That’s why I am losing sleep.
I will end with this. Medicaid enrollment varies county by county in Oregon. The cruelest irony is that the 10 Oregon counties with the highest Medicaid enrollment rates are also all counties that President Trump carried. President Trump and Congressional Republicans aren’t cutting Medicaid for some sham reason like efficiency or reducing government bloat. They’re choosing to give President Trump’s donors a tax cut at the expense of his voters. Let’s hope they cannot muster the votes to do it. No wonder I need a nap.
