PORTLAND, Ore. (KTVZ) — The Oregon Health Authority announced Tuesday that its biannual Oregon Medicare Survey data showed a record 95.4% of Oregonians had health coverage in 2021, up from 94% in 2019.
It was the first year since the expansion of the ACA that insurance coverage increased significantly. Gains were largely driven by changes to federal pandemic rules for Medicaid, which ensured that people enrolled in Medicaid coverage remained covered. The largest coverage gains were among low-income adults, as significantly fewer people reported being uninsured due to loss of Medicaid coverage. In fact, people reporting Medicaid coverage fell from 25% in 2019 to 29% in 2021. At the same time, employer-based insurance coverage continued its slow, multi-year decline, while Medicare and Individual remained stable.
One of the key factors in the improved coverage rate has been the virtual elimination of “turnover” in the Medicaid population – people returning to Medicaid coverage after less than a year. In September 2019, the “high churn” population made up 34% of new signups that month. With continuous enrollment policies during the public health emergency (PHE), only 8% of new enrollees returned after less than a year. The number of people entering Medicaid per month who have never been on Medicaid before has remained stable before and during the pandemic at around 9,000 people per month.
“We know that keeping people enrolled in health insurance – whether it’s a public program or their employment-based coverage – is key to reducing our uninsured rate so that people can access essential health care services,” said Jeremy Vandehey, Director of Health Policy. and analytics at the OHA. “Specifically, this two-year period shows that people who cycle with intermittent insurance mean they end up losing their coverage. Therefore, it is extremely important to break these cycles and keep people signed up permanently. For low-income families, we know incomes fluctuate, but access to health care shouldn’t.
Oregon has made progress in reducing disparities in health coverage caused by health inequities and structural racism during this time. Notably, the uninsured rate for Black/African Americans fell from 8.2% to 5% between 2019 and 2021. In other communities, the improvement was less pronounced: uninsured rates among Hispanic/Latin communities declined slightly, as among American Indian/Alaskan. Indigenous communities. Native Hawaiian or Pacific Islander communities have shown an increase in ininsurance, which the OHA will seek to understand and address.
“With our goal of ending health inequities by 2030, the OHA is committed to adopting policies that continue our progress,” Vandehey added. “A key area where we seek to sustain this improvement is our upcoming Medicaid waiver, where we are asking the federal government for permission to implement policies such as continued Medicaid enrollment for children through their sixth birthday. and two-year rolling enrollment for those ages 6 and up. at the top. We now have evidence that such policies will make a meaningful difference for Oregon families — especially those harmed by historical and contemporary racism.
Meanwhile, OHP coverage has also increased in rural and border areas of the state. Although insurance coverage lags behind the state average, coverage increased from 91.0% to 92.3% at the border and to 94.6% from 93.8% in the rural areas of the state. In some rural and border counties, such as Jefferson, Josephine, Malheur, and Klamath, 2 out of 5 residents have OHP health coverage, well above the state average. And in border areas of the state as a whole, about 2 in 5 people who are still uninsured are eligible for Medicaid.
“The OHA’s goal is to ensure that when the public health emergency ends, we work systematically to get people covered,” Vandehey said. “For those no longer eligible for OHP, we will work to ensure they access a Marketplace plan or connect to other programs. This transfer is critical, as the data shows, because we cannot lose people when they leave Medicaid. If we do, much of that hard-earned hedging gain will be lost.
The OHA’s current transition plan includes:
- Implement a strong outreach and communications plan to inform Medicaid members what to expect and encourage them to update their contact information so that their coverage can be renewed.
- Create ongoing coordination between Medicaid and Marketplace to ensure members who lose Medicaid coverage are supported in their transition to a private plan.
- Maximize the existing automated renewal process to reduce member burden. If coverage cannot be automatically renewed, members receive a pre-populated renewal notice which they must sign and return.
- Engage community partners to help connect people leaving OHP to other sources of medical coverage, such as through employment.
 In March 2020, Congress passed the Family First Coronavirus Recovery Act which:
1) Provided 6.2% enhanced federal Medicaid funding to states to maintain continuous Medicaid coverage and not de-enroll Medicaid enrollees for the duration of the Federal Public Health Emergency (PHE).
2) Removal of administrative barriers to registration, such as
- Allow applicants to attest to most eligibility criteria
- Expand presumptive eligibility and remote support options
Do not terminate coverage for those deemed ineligible during annual renewals.