By State Representative Rob Nosse
By the time you’re reading this, the legislative session is probably over. I have to submit this column before the legislative deadline, and I didn’t feel comfortable making predictions about how things will end. There are still bills that I care about that might make it and the transportation package that I wrote about a few months ago has not yet passed. Instead of attempting to guess the future, I decided I would write about one of my favorite topics—Medicaid. It’s basically been Medicaid all the time for me for the last year and a half. Unfortunately, the news is not great.
At the end of May, the US House of Representatives passed what has been coined the “Big Beautiful Bill,” though in reality it’s more of a “Big Bad Bill.” It passed on a razor-thin 214-215 vote, (thank you so much, Congressman Bentz). It does multiple things that harm the Medicaid program—known here in our state as the Oregon Health Plan (OHP). Here are a few highlights which are really more like downsides.
Over the next 10 years, our state could lose over $7 billion that comes to us to fund healthcare. That’s not an abstract budget cut, it’s money that pays for doctor visits, hospital stays, prescriptions, mental health treatment, substance use support, dental care and more for 1.4 million Oregonians.
The bill would require eligibility checks every six months. Yes, you would need to re-apply every six months. This adds bureaucratic hurdles that lead to people falling off the rolls even when they still qualify and when they’re legally entitled to care. It’s red tape for red tape’s sake, and the people who will suffer the most are the ones who can least afford the consequences.
It also forces our state to slash funding for immigrant health care and makes it nearly impossible for Planned Parenthood to serve Medicaid patients by banning reimbursement to their clinics. Currently, the bill prohibits Medicaid funds from being spent to pay providers that, “are nonprofit organizations that are primarily engaged in family planning services or reproductive services, provide for abortions other than for Hyde Amendment exceptions, and which received $1,000,000 or more (to either the provider or the provider’s affiliates) in payments from Medicaid in 2024.” That’s not just ideological overreach, it’s a direct attack on health care services and the people who rely on them.
This bill also introduces mandatory copays, ending Oregon’s no-cost-sharing policy we’ve had since 2016.
It’s estimated that 100,000 to 200,000 Oregonians could lose Medicaid coverage simply because of the increased difficulty of proving continued eligibility. And while the bill targets Medicaid directly, its effects may ripple further—many private insurers model their coverage on Medicaid standards, so cuts to covered services could affect people across the state, not just those on the OHP.
If this sounds bad, it’s because it is bad. These changes will hit Oregon harder than most states because we have chosen, time and time again, to be a leader when it comes to inclusive healthcare. We have worked to maximize coverage under the program, particularly under the ACA expansion back when Obama was President. We also cover immigrants without a legal status who don’t yet qualify under federal Medicaid rules. (The bill will punish our state financially if we continue to do this.) We’ve expanded access for children and for communities who’ve historically been shut out of care. We’ve built a system that reflects our values. Per our state constitution, healthcare is a right, not a privilege and we’ve tried to act accordingly. The “Big Beautiful Bill” would punish states like ours for doing the right thing.
It is disgraceful that Republicans in Congress are dressing up a bill that is also a tax cut for the wealthy while cutting health care for the poor in the language of “government efficiency.” This deficit-busting gut punch of the “Big Beautiful Bill” is a big, beautiful handout to the wealthiest among us.
As I write this, the US Senate is taking up the bill and their version harms Medicaid further, reducing one of the funding mechanisms our state uses, capping them at 3.5 percent for expansion states, down from the current 6 percent that we utilize. (The House bill just freezes it at the current rates.) The Senate version also reduces state-directed payments to providers. This is a type of funding cut as well.
Some say it’s unlikely to pass, and I hope they’re right, but I remember feeling confident it wouldn’t get out of the House and then it passed in the middle of the night by a single vote. (Again, thanks, Congressman Bentz.) I’m not making any predictions about this time either.
However, if the Senate moves forward on this bill, in theory they want to be done by July 4, and something passes, Oregon will have to respond. We’ll have to ask ourselves what we’re willing to do—and spend—to maintain the care we’ve promised to our communities. That’s not going to be easy.
I’ll be watching this closely. If the US Senate makes progress on its version of the bill, do I write about that in my August column or do I share my observations about the ups and downs of the Session? Stay tuned; we will see what feels more newsworthy.
