Voters will be asked to approve a measure next month that could slightly increase their health insurance costs but keep Medicaid dollars available for a quarter of the state’s population.

Voters are urged to register or ensure their voter information is updated before the Jan. 2 registration deadline so they can cast ballots in the Jan. 23 special election.

The only question on the ballot is Measure 101, which asks voters to place a two-year, 0.7 percent fee on certain hospitals, and a 1.5 percent fee on the Public Employees’ Benefit Board, managed care organizations and insurance companies, to fund a Medicaid shortfall.

The money will also help the state obtain additional federal healthcare dollars.

Why it’s here

The legislature in July approved a bill that would implement such a fee, but Rep. Julie Parrish, R-Tualatin, felt voters needed a say and gathered enough signatures to get the question on the ballot.

The measure is needed, proponents say, because a five-year federal commitment supporting Oregon’s healthcare expires at the end of this year. That commitment was, itself, designed to fill a shortfall in Medicaid funds.

The measure would not affect Curry General Hospital in Gold Beach, said Curry Health Network CEO Ginny Razo.

“The hospital tax on the ballot measure does not impact critical access hospitals,” she said, “and will not in any way increase the cost of care to our patients.”

Small groups that buy health insurance for employees will see a 1.5 percent increase on their health insurance, and large groups that negotiate with insurance companies could see higher premiums as well, as their rates are not set by the state Department of Business and Consumer Services (DBCS).

Under the wording of the measure, insurance premiums cannot increase more than 1.5 percent as a result of the assessment on insurance companies.

Part of the package also directs 20 percent of money collected to the State Reinsurance Program to reimburse hospitals for the typically high cost of the very sick or injured. That would also stabilize rates for other, healthier people whose insurance often ends up paying for others’ high medical expenses.

According to the DBCS, the reinsurance program would also lower premiums of those who buy their own insurance by 6 percent, an average of $300 per year. That affects about 210,000 Oregonians.

If the measure fails, those who are currently insured under the Oregon Health Plan and those who purchase health insurance through the exchange could be hit the hardest.

According to the Oregon Health Authority, the 350,000 adults and children covered by the Medicaid expansion under the Affordable Care Act, 120,000 children under the Children’s Health Insurance Program (CHIP) and a few hundred women with cancer and covered under the Breast and Cervical Cancer Treatment Program could also be hit hard. No decisions have been made as to what programs might be cut if Measure 101 fails.

The reinsurance program would also end, although there’s enough money to fund it through next year. Come 2019, however, rural counties could face having no options for health insurance through the Affordable Care Act, a situation that threatened many in the state two years ago until the legislature outlawed insurance companies from giving preferential treatment to some counties with coverage options.

Measure 101 also ensures at least one insurance option is available to customers in rural markets.

Pros and …

Medicaid provides healthcare to 25 percent of Oregonians, of whom 400,000 are children.

Proponents note that passage of the measure would bring between $210 million and $320 million to state coffers; without it, Oregon could lose up to $5 billion in federal healthcare funding.

Ironically, hospitals that will be impacted are most supportive of the measure, many have said.

“I assume that’s because they realize that paying this tax will be less costly than the increase in bad debt that might result in fewer Medicaid services and a fewer number of lives covered,” Razo said.

Proponents also say the measure will help stabilize health insurance rates by providing people with less expensive preventive care, rather than forcing people to wait until a condition gets so bad they need emergency room help.

In some rural counties, more than a third of families rely on Medicaid, the website reads. Without Measure 101 enacted, Medicaid funding would be slashed.

… cons

The only group formally opposing the measure is called Stop Healthcare Taxes. Its website, however, offers little in the way of argument against the measure, other than to note it is opposed to taxing healthcare services.

Some say there should be a more equitable way to fund Medicaid, and that legislators had enough time to craft one.

The legislative session began with a deficit because of the healthcare bill and growing pension costs. An Oregonian editorial blames leadership for opting to increase pay for public employees and its failure to rein in the skyrocketing costs of its retirement benefits.

“Instead of treating Medicaid as the shared responsibility that it is, Oregon’s elected leaders adopted a funding strategy that includes a tax on premiums for healthcare plans bought by small businesses, K-12 school districts, nonprofits and thousands of college students — about 1.25 million Oregonians in all,” it reads.

“The 1.5 percent tax, however, will not be assessed on healthcare plans for 727,000 people enrolled through their self-insured employers, nor on hundreds of thousands of seniors and veterans enrolled in Medicare or plans for veterans, due to federal restrictions on such state-imposed taxes.”