By State Representative Rob Nosse
Well heck. Everything I am working on is still very much in process. The only “hot” issue of the moment is the Moda Center and I don’t think it would be good idea for me to process all my feelings about that right now.
In previous columns about education I talked about how people want a longer school year, no layoffs, a greater focus on attendance, better funding that takes into account poverty or disabilities. But no consensus has emerged about how to address any of these concerns so there is not much to report out.
More discussion needs to happen. Elections will need to play out. We need to see how the economy is performing in December, and who knows what other problems will seem just as pressing by the time the legislative session starts in January. I think I have a good sense of what we will be tackling, but that column seems more appropriate to the proverbial “how I spent my summer vacation” essay for September or maybe even for January before the legislative session starts.
So that leaves me with healthcare. I swear, I had a whole summer of Medicaid two years ago, and it turns out that I am having a Medicaid summer again. Maybe that is to be expected when you chair the healthcare committee. It is HR1’s fault. In case you don’t remember, HR1 is the “one, big, beautiful bill” that passed in the Republican controlled Congress and was signed by President Trump on July 4, 2025. HR1 made all kinds of sweeping changes in healthcare, food and nutrition, taxation, transportation and immigration policy, to name a few. That bill is slowly being implemented, and it is slowly ruining my life. The changes I need to contemplate so our Medicaid program conforms to the policy and budget goals of HR1 are bad.
Right now, the main challenge with HR1 is how to administer eligibility for Medicaid benefits every six months as opposed to annually. (In Oregon because of a “waiver” that we got, thanks to President Biden, we do Medicaid eligibility every two years.) We also must make sure that eligible applicants are adhering to new work requirements and can document that they are working or looking for work. These changes all have to be ready to implement in January 2027.
Setting up a system and employing people to provide more frequent application processing is challenging. We already have seen more than 68,000 Oregonians experience reductions or the outright loss of their food stamp benefits because of HR1. (Food stamp benefit changes/reductions are on a faster timeline for implementation under HR1 than the Medicaid changes/reduction, but the eligibility requirements are similar for both programs.) Most people who became eligible for Medicaid under the Affordable Health Care Act (ACA) are working. The policy goal of the ACA’s supporters was to provide health care for the working poor. Oregon got a waiver to do eligibility for Medicaid every two years rather than annually because we proved that biannual eligibility saves money in Medicaid operations and that the vast majority of people’s incomes rarely fluctuate so much as to suddenly make them ineligible for Medicaid over a two-year period. So, let’s be honest, the only reason we are doing a more strident examination of whether someone is working and doing an eligibility determination every six months is because it is the goal of HR1’s proponents to kick people off Medicaid.
HR1 also changes the ways states can cover their share of Medicaid’s costs. While the federal government provides most of the funding, the states have to come up with some money to cover their share. Oregon does that in part with hospital provider taxes and state directed payments. Explaining how they work is complicated technical writing. You just need to know that these two mechanisms have been used for a long time by our state and lots of others to help cover our share of the cost of Medicaid.
Right now, it is estimated that 200,000 people will lose their Medicaid benefit and that we will need to cut $421 million out of the program. If we cannot replace these cuts with general fund tax dollars (general fund tax dollars are the main source of the money we use to fund schools), and I don’t think we can, we have to make cuts to the benefit. “Cuts” means either provide less care or less compensation to providers.
Less compensation to providers means fewer providers will see patients on Medicaid because they won’t get the cost of the care they provided properly covered. That means it is harder to be seen when you have a chronic illness or an infection because there are not enough providers who will see a Medicaid patient at the rates that the state and our coordinated care organizations can pay. Of course, we could eliminate treatments and benefits outright like adult dental care or talk therapy. These two benefits are currently covered/provided under Oregon’s Medicaid program, but are technically “optional.” I suspect most of you think we should provide adult dental and talk therapy and they should not be eliminated.
Sigh. I know I ran for this job, but this is not what I signed up for. For the moment I don’t have any great choices but we are just getting started so a lot could change. Stay tuned as I like to say.
