On Jan. 23, Oregonians will decide the outcome of a rare, single-issue ballot. Let's walk through the key questions surrounding your vote.
For a video of our endorsement interview, see below:
What is the issue at stake?
In 2017, the Legislature cobbled together a funding package that preserves the Oregon Health Plan. That's the Medicaid provider that uses state and federal dollars to pay for care for low-income Oregonians, covering more than 1 in 4 people in the state.
Before President Obama signed the Affordable Care Act, 15 percent of Oregonians—about 600,000 people—had no health insurance. Today, because Oregon aggressively embraced the ACA's expansion of Medicaid, that number has dropped to 5 percent.
That's meant healthier Oregonians and healthier balance sheets for doctors and hospitals.
Medicaid is enormously expensive: It cost $9.3 billion to cover Oregonians last year. That's more than double what we spent a decade ago. The good news is, most of the money—more than 75 percent—comes from Washington, D.C., in federal matching funds.
But the federal government's generosity has limits. For the first five years the ACA was in effect, the feds covered 100 percent of the cost of new enrollees. But that number steps down to 95 percent this year and 90 percent in 2020. So as Medicaid rolls grow, Oregon's responsibility for the tab will increase.
The step-down in federal support created most of the $1.5 billion budget hole lawmakers initially faced in the 2017-19 state budget. To plug the hole, the Legislature increased the tax on large hospitals from 5.3 to 6 percent, and began taxing rural hospitals, Medicaid providers and individual health insurance policies.
It was a sausage-making exercise that thrilled nobody, but it won the three-fifths majority Oregon requires for tax increases.
Four months later, opponents gathered enough signatures to place a measure on the ballot that—if it fails—would repeal parts of the bill.
Who is behind the ballot measure?
Three GOP lawmakers—Reps. Julie Parrish (R-West Linn), Cedric Hayden (R-Roseburg) and Sal Esquivel (R-Medford)—couldn't abide the funding package in House Bill 2391.
What does a "yes" vote mean?
This is where your head may start spinning. Even though the tax bill's opponents referred it to voters, voting "yes" will ratify the funding package the Legislature passed. Basically, it preserves the status quo.
"We did something," says state Rep. Mitch Greenlick (D-Portland). "There were some people who said it's the wrong thing to do. We are going to ask the voters was it OK? If it was OK, vote 'yes.'"
If a majority of voters do that, everybody who's on Medicaid today would stay on Medicaid. Lawmakers have two years to craft a larger, more durable funding mechanism for Medicaid, because the funding in the bill expires after that.
What does a "no" vote mean?
If the measure fails, the impact would be huge: a loss of $210 to $320 million to the state's general fund and triple that amount in federal matching funds. Says the measure's fiscal impact statement: "The total reduction to the 2017-19 state budget may be $840 million-$1.3 billion or more."
It also means that some Medicaid patients—probably tens of thousands and perhaps more—would lose coverage. That would impact their health and cost doctors and hospitals money.
Who's for it and why?
The measure has enormous institutional support. These supporters include public employee unions, whose members have health care and social service jobs at stake and whose lower-paid members could lose coverage. And hospitals, even though they would pay a hefty tax increase. It's also supported by health insurers, who would also pay more in taxes.
Why would groups support a tax increase on themselves? First of all, they can pass the tax along to patients and insurance companies. Second, and more importantly, they benefit from the federal matching dollars.
Under the tax package passed in 2017, Oregon would increase to 6 percent the tax on patient revenues from large hospitals like Legacy Emanuel and begin taxing rural hospital and Medicaid providers. The feds would then match the state taxes with three times that amount, and all that money would be used to help cover the cost of Medicaid.
All Democratic politicians in the state support the tax, as do some Republicans. Senate Minority Leader Jackie Winters (R-Salem) and Sen. Alan DeBoer (R-Ashland) both favor Measure 101. "We totally rely on federal money," says DeBoer, one of Salem's staunchest fiscal conservatives. "The federal money is what makes health care work here and in every state."
Who's against it and why?
Parrish, Hayden and Esquivel say they referred the measure because the tax package that lawmakers passed favors big, self-insured companies and unions, which don't pay the tax, over regular Oregonians. They argue it burdens individual payers, some students and rural hospitals.
Their colleague, state Rep. Knute Buehler (R-Bend), who's an orthopedic surgeon running for governor, also opposes the measure and the taxes it would impose, maintaining they are unfair and only temporary. "I am interested in finding real solutions to providing health care to vulnerable people in Oregon, not short-term, Band-Aid solutions," Buehler said in a statement.
Critics also don't like the idea that the measure would give more money and power to a state agency, the Oregon Health Authority, that has a bad reputation.
Indeed, the OHA has earned its bad press.
Last fall, the agency admitted it had paid for services for some patients who were ineligible and failed to establish the eligibility of others in a timely fashion. The mistakes may have resulted in more than $150 million in duplicate or improper payments over the past three years.
There's no question that $150 million is real money. But let's put it in context: It was less than 1 percent of the agency's expenditures for that three-year period. And a state audit in November found that Oregon's rate of payment errors was in line with that of other states.
Yes, the Oregon Health Authority could do better—and now that Gov. Kate Brown has replaced top management at the agency, it should.
How should I vote?
WW urges a "yes" vote.
Blowing up the deal struck in the past legislative session would create an immediate budget hole of about $300 million and deprive Oregonians of almost a billion dollars in federal matching funds. From a more human perspective, it would leave some of the poorest Oregonians without primary care physicians and preventive care.
That budget hole would have to be filled somehow. The failure of Measure 101 would require cuts in the state's general fund, the largest portion of which goes to K-12 education. So voting "no" on Measure 101 could decrease school funding.
In their desire to punish the Oregon Health Authority, an agency that's already seen its top management fired, Parrish and her allies would deprive thousands of Oregonians of health insurance, sending them back to emergency rooms or the power of prayer. They'd create an artificial crisis by butchering a law that sunsets in two years anyway.
And they'd do so in defiance of a basic fact: Everybody needs health care. Better to pay for it up front, no matter how awkwardly, than return to a system in which the uninsured neglect themselves and pass along higher costs to the rest of us.
Vote yes on 101.