Medicare

Oregon’s Vicarious Congressional Race in Southwest Washington

Democrat Carolyn Long is mounting what many consider a more serious challenge than expected to GOP incumbent Congresswoman Jaime Herrera Beutler in Southwest Washington’s 3rd Congressional District. The House seat is on the watch list of ones that could flip in the midterm election if the so-called “Blue Wave” materializes.

Democrat Carolyn Long is mounting what many consider a more serious challenge than expected to GOP incumbent Congresswoman Jaime Herrera Beutler in Southwest Washington’s 3rd Congressional District. The House seat is on the watch list of ones that could flip in the midterm election if the so-called “Blue Wave” materializes.

Oregon’s five congressional races are a snore, but there is a competitive contest in Southwest Washington that Oregonians can enjoy vicariously via Portland TV.

Incumbent GOP Congresswoman Jaime Herrera Beutler faces a stiffer-than-expected challenge from Democrat Carolyn Long. The best evidence Washington’s 3rd Congressional District is in play are the negative TV ads both candidates are running.

Herrera Beutler’s ad claims Long supports a Medicare for All health care proposal, which she says would bankrupt the nation. Long has countered with an ad that calls Herrera Beutler a career politician who has sold out to special interests and voted multiple times to scuttle the Affordable Care Act without offering an alternative.

The spirited race attracted a standing-room-only crowd for a debate in Woodland September 18. They jointly appeared before The Columbian’s editorial board in August for what turned out to be a two-hour debate that touched on health care, tax reform, border security, President Trump and impeachment. Another debate is scheduled October 17 in Goldendale.

Political pundits believe Democrats have a serious chance to flip control in the House in the 2018 midterm election. They identify around 80 congressional seats, mostly held now by Republicans, that could flip. Washington’s 8th Congressional District, which stretches east from Seattle’s suburbs to Ellensburg, is held by GOP Congressman Dave Reichert, has been in Republican hands since 1983 and is on the list. Washington’s 3rd Congressional District, which has been won by both Republicans and Democrats, is on the list, but viewed as likely to stay in GOP control.

Competitive congressional races have been fueled in significant part by women, either as candidates or as mobilizers around issues such as the #MeToo movement. The Herrera Beutler-Long race is one of 33 congressional races nationwide that features a woman running against another woman.

As election day nears, the performance and behavior of Trump is becoming a larger issue, especially in districts where international trade is a critical part of a local economy, as it is in Southwest Washington. Another motivating issue is the fear continued GOP control in the House will lead to cuts in Medicare, Medicaid and Social Security to reduce a growing federal budget deficit.

Herrera Beutler has not been an outspoken defender of Trump, but generally has supported his agenda and that of the House GOP leadership. Long has followed a typical Democratic campaign script, condemning the GOP-backed tax cut, warning about Medicare budget cuts and expressing support for impeaching Trump.

The candidates’ base of support tracks with the red-blue political divide. Primary results showed Herrera Beutler leading in more rural parts of Southwest Washington and Long leading in Clark County, which includes Vancouver.

Herrera Beutler grew up in Southwest Washington, played varsity basketball at Prairie High School, graduate from the University of Washington and lives in Battle Ground. After serving in the Washington legislature, she was elected to Congress in 2010 at the age of 31 and is the first Hispanic to represent Washington in Congress. She and her husband started their family – they have a daughter and son – while she served in Congress, leading her to champion maternity care issues.

Long grew up in Oregon, attended the University of Oregon and paid for college by working for Safeway, eventually becoming a produce department manager and a journeyman with UFCW Local 555. After earning her graduate degree from Rutgers, Long joined the faculty of Washington State University’s campus in Vancouver in 1995 and has worked there since then. She is married and has a 12-yer-old daughter. Her campaign website features her “award-winning jam recipes.”

 

Oregon Health Plan Goes from Secure to Shaky

 Congressional inaction to continue funding for the Children’s Health Insurance Program is just the latest financial challenge facing Oregon policymakers and putting Oregon’s health plans on shakier ground.

 Congressional inaction to continue funding for the Children’s Health Insurance Program is just the latest financial challenge facing Oregon policymakers and putting Oregon’s health plans on shakier ground.

When the 2017 Oregon legislature adjourned in early July, the state’s health care exchanges and Medicaid program seemed secure for at least another biennium. A lot has changed since then, and the stakes continue to grow.

The funding package to sustain the Oregon Health Plan faces a likely referral vote in January. Congress allowed federal funding for the Children’s Health Insurance Plan (CHIP) to lapse as it debated, but failed to repeal and replace the Affordable Care Act. The Trump administration continues to threaten actions to undermine the Affordable Care Act.

No matter how you spin the situation, Oregon could feel a financial pinch as early as mid-November when its funding runs out for health insurance for thousands of children in the state. The legislature won’t convene until February, so a potential gap in coverage could lead to a reduction in benefits and new enrollments.

Oregon Senator Ron Wyden is working with Senate Finance Chair Orrin Hatch on a bipartisan funding plan for CHIP, but House GOP leaders want to tie continued funding to spending cuts for Medicare, community clinics and grace periods for Affordable Care Act payments.

Oregon policymakers could have an even bigger problem on their hands if voters reject the $320 million funding package that includes a health insurance tax and a new hospital tax. While the majority of the $320 million will shore up the state’s Medicaid program, it also would fund a reinsurance pool that limits individual insurers’ financial exposure for high-cost patients.

The Oregon Reinsurance Program calmed Oregon’s market and paved the way for 6 percent lower insurance premiums. The shaky status of the reinsurance program could affect Oregon’s pending application for a waiver from the Centers of Medicare and Medicaid to administer its programs flexibly. If Oregon’s funding package is rejected, the waiver request could be in jeopardy – along with lower insurance premiums.

According to the Portland Business Journal, Alaska requested a similar waiver, which was approved. However, waiver applications by other states have been rejected or withdrawn. The Washington Post reported Trump intervened to block a waiver request from Iowa, which was seeking ways to increase competition and bring down premiums. Oklahoma withdrew its application after CMS inaction. Minnesota was granted a waiver, but CMS reportedly cut a low-income enrollee program.

The longer-term view isn’t any better. The US House has approved a budget resolution that will be used as the vehicle to move a major federal tax cut and that calls for massive cuts over the next decade to Medicare and Medicaid.

Surprise Decision Strains Reform Support

The decision caught almost everyone by surprise last week. The Governor's Office and the Oregon Health Authority said they would not make any of the $2 billion in new federal money obtained by the Administration available for the first year of health care reform in Oregon.

"Members of the new groups (Coordinated Care Organizations, CCOs) are crying foul," reported The Oregonian, "after a directive Thursday that they'll receive no new funds for the additional responsibilities they've agreed to take on — mental health care, prevention efforts, quality measurements and new patient-care staff, among others."

In fact, managers of the new, still-not-yet-approved CCOs have been told they will have to live with last year's rates, which themselves represented an 11 percent cut. Leaders of the new groups say their success relates directly to the new money to fund them. They say it takes money to revamp care for more than 600,000 Oregonians covered by Medicaid, the joint federal-state program that provides care for low-income citizens.

In touting health care reforms such as CCOs and the Health Insurance Exchange, Kitzhaber has stressed the need to control costs through competition and innovation.

For many in the health care reform orbit, all of this conjures up images of the original Oregon Health Plan more than 15 years ago, also designed by Governor Kitzhaber in his earlier service as Oregon Senate President and as governor in his first term. A key tenet of the plan then was that providers would be paid close to their costs for delivering services. The clear objective was to limit the cost shift onto the backs of private health insurance payers.

Well, that tenet apparently has been lost in the intervening years.

Today, those with private health insurance pay about 20 per cent more in premiums as they bear the "hidden tax" of paying for Medicaid underfunding. In a 2008 study, the Milliman Group estimated underfunding of Medicaid and Medicare amounted to more than $90 billion annually.  Though four years old, the study is still applicable today.

The Possibility of a Nuanced Ruling

Most media focused last week on oral arguments before the U.S. Supreme Court on the controversial federal health insurance mandate for individual Americans. However, justices also heard arguments on other aspects of the legal challenge to what has become known as ObamaCare that could lead to a more nuanced decision and perhaps even more complexity for states.

Justices listened to arguments on whether the constitutional challenge of the individual mandate is ripe because it hasn't gone into effect yet. Commentators expressed doubt the court would effectively punt a big decision for this reason. They also considered the severability of the federal health care reform act. They wanted to know if voiding the individual mandate would void the popular ban on excluding health insurance because of pre-existing conditions. 

A ruling isn't expected until late June, which will allow for a lot of media speculation, political bombast and unease by state officials who will play a key role in implementing health care reform in whatever form it survives from the court case.

Based on the intense questioning by justices and the balky performance of the U.S. attorney arguing the government's case, you could easily conclude the federal individual health insurance mandate is in trouble. The court seems clearly split, but the split echoing from the questioning suggests at best a 5-4 rejection of the mandate.

However, the mandate underpins a grander bargain. Creating the largest possible pool of people with health insurance coverage gives health insurers the ability to absorb and spread costs, including from new insureds who may be combating cancer or suffering from a chronic disease. Dispatching the mandate could put even more pressure on health insurance premiums, which are continuing to rise. That, in turn, could erode the quality of existing employer-provided health insurance and, in some cases, cause employers to drop coverage for employees altogether.

The unspoken part of the story crowded out by commentary on the mandate is what happens if we return to the status quo before Congress approved ObamaCare. The truth is, that status quo has disappeared. 

  • The exclusion of pre-existing conditions and expansion of family coverage to children up to age 26 are very popular provisions, which few would want to lose — especially in an election year.

  • Many employers facing stiff domestic and international competition are looking for ways to trim their health insurance costs. One way is to hire temporary workers without benefits.

  • The public safety net has more holes in it, as Medicaid participation has been limited and funding cut for public health care clinics.

  • Heath care technology continues its steady march ahead, opening new diagnostic and treatment options and adding more costs.