Pam Marsh’s Town Hall
“Maybe we should go to single payer at this point,” said Dr. Junyang Lou at Rep. Pam Marsh’s health care town hall Sunday at the Medford Library.
In taking questions from the audience, Dr. Lou was asked how he would address the issue of a shortage of health care professionals in the United States. He explained that the AMA determines the number of medical schools and therefore physicians and that foreign medical graduates are used to fill the gap. That is not a solution, he said.
Another questioner complained that student debt is preventing qualified people from attending medical school. He suggested that some students could be subsidized.
When District 5 Rep. Marsh took over the meeting, she told the audience, “We are having huge discussions at the state level on improving health care, but we have significant infrastructure problems.”
Rep. Marsh pointed out that 350,000 more Oregonians are now getting health care and that subsidies apply up to 138% of the federal poverty level. About 200,000 Oregonians are buying from the open market, she said.
At the beginning of the 2017 legislative session, she said, the Oregon health care budget deficit was $900 million. Legislators were able to cut $300 million of this deficit by negotiating a provider tax that is matched at the federal level. This increased provider tax was endorsed by the Oregon Association of Hospitals and Health Systems. In addition, a 1.5% tax on insurance premiums was endorsed by all state-operating insurance companies except one. Self-insured organizations are exempt from this tax, she said.
There was bipartisan support for the provider tax. “It’s a tax,” she pointed out, “so we couldn’t pass it without a super majority.” The Legislature pretty much divided along partisan lines, she said, on the issue of giving undocumented Oregonians health services.
She warned that Referendum 301, which may be on the ballot next January, seeks to eliminate part of that provider tax. “If it winds up on the ballot,” she warned, “payments will be suspended and the state will be in a fiscal crisis.” She asked her audience to resist signature gathering for this referendum.
A highlight of the legislative session, she said, is that “We passed Cover All Kids, which includes children who are undocumented.” She also cited reproductive equity, which establishes no deductible for reproductive services, including a full range of birth control options and abortions, and gives non-citizens access. For the 200,000 Oregonians buying insurance from the open market, we were able to reduce their premiums by an average of $25 a month, she said.
In the future, Rep. Marsh said, “We want to have a backup plan for rural counties,” which would be hardest hit by any retraction of the Affordable Care Act on the federal level. Single payer legislation had 31 sponsors. “We want to test the model by enlarging the market,” she said, by opening the public system to small employers. “We also want to change the way health care is delivered,” she said, for example by providing an air filtration unit to an asthmatic rather than treating that asthmatic in repeated emergency room visits.
One of the problems the state faces is that it “hasn’t fully integrated the state’s sixteen coordinated care organizations.” These, she explained, act as the middleman for the 50,000 people in Jackson County on Medicaid. After the Affordable Care Act launch debacle, she said, CCO’s set about requalifying these people for Medicaid after they were dropped from insurance rolls. There is an issue of transparency, and the CCO’s are not subject to open meeting laws. These organizations now don’t have to be nonprofit but must transition to becoming nonprofit.
To a question about eligibility and “cheating,” Marsh explained, “If you have a chronic condition, you may not take a job in order to stay on the Oregon Health Plan.” The state is trying to iron out the gray area of eligibility for people whose income sometimes falls below the eligibility level and sometimes above. “We must try not to fit people into a slot but to look at the situation globally.” AllCare, Jackson Care Connect, and Primary Health of Josephine County serve Jackson County, according to the CCO Oregon Web site.