How Oregon health officials are preparing for change under Trump

Oregon health care officials continue to brace themselves for policy and funding changes as incoming president Donald Trump gets ready to take office Jan. 20.

And though nothing has been proposed formally, the Oregon Health Authority has already started to prepare for a slew of potential changes, according to its director, Dr. Sejal Hathi.

“We conducted a tabletop exercise even before the election to identify the range of potential risks that a change in federal administration could pose,” she told The Lund Report recently.

The agency oversees free care to 1.4 million low-income Oregonians under the Oregon Health Plan, while also providing administration and support for care received by many other people in the state.

Of all state agencies, it’s likely facing the most immediate cuts and changes during Trump’s second term.

Not only that, but the state’s health care system could face more changes than in most states because of several Oregon-specific programs.

Hathi said the agency needs to be ready for anything, but “the reality is we don’t yet know what the next administration is going to bring.”

State officials and others tend to mull different responses to a new administration, she said, ranging between aggressive public “resistance” versus quietly safeguarding the work agencies are doing: “keep your head down. Don’t make noise.”

So far, Gov. Tina Kotek’s public statements suggest she’s charting a course in between. She’s said she’ll fight to preserve “Oregon values” against any partisan “attacks.”

Hathi stressed that it’s Kotek who will determine how Oregon responds to changes over the coming year.

Officials are readying for a range of possibilities

Within the health authority, Hathi’s office has set up an “incident management” structure similar to how agencies respond to severe weather or natural disasters. It will closely track proposed policies and executive orders, “and look at what we can do administratively as well as what might be required legislatively to counter any potential fallout for our programs” in terms of services and funding cuts, Hathi said.

Several areas where the new administration could make cuts or changes that disrupt the status quo in health care have drawn plenty of attention already:

• Though Trump waffled on abortion rights and eventually suggested the federal government should stay out of it, people continue to prepare for the worst.
• Trump’s campaign-trail attacks on youth transgender care could spawn federal efforts to eliminate or reduce coverage.
• Regarding immigration, the Trump campaign spoke of mass deportations and would likely also take steps affecting the six states, such as Oregon, that have extended coverage to people regardless of documentation.

Because of the unique nature of some of its programs, Oregon officials have to mull things on deeper level.

Related: How health care could change under the new Trump administration

More than 1M Oregonians could face cuts, changes

The Oregon Health Plan draws the bulk of its funding from the federal Medicaid program, where there are cuts and changes being discussed.

So Oregon officials are watching for several possibilities that could affect the one in three Oregonians covered by the program:

• Federal bureaucrats could reconsider their support of Oregon-specific programs that fund housing for some people, and transition benefits for people who are being released from state prisons. As Hathi puts it, that could come in the form of “stringent evaluations” or budget “riders,” meaning restrictions on how federal money is spent.
• Possible misuse of data shared with the federal government on communicable diseases and care programs.
• Some Republicans in Washington, D.C. have urged more frequent Medicaid eligibility checks, potentially as frequent as every six months. That would threaten Oregon’s system of two-year eligibility intended to keep people from losing coverage because they missed a letter or made an error in their paperwork.

Oregon program could shield some while costing others

There’s also the question of what happens if, as expected, Republicans let enhanced health insurance subsidies expire. Established by Biden to respond to the pandemic, the subsidies have brought down health insurance premiums for individuals and families that buy their own coverage but are not on Medicare.

If the subsidies go away, analysts say people making too much for Medicaid but less than four times the poverty level will pay much more for insurance. And in Oregon, some people will pay even more than others in the country due to a new state program — while others will see their premiums go away entirely.

In Oregon the lower range of those incomes would be protected due to the state’s new “Bridge” plan, which offers coverage similar to the Oregon Health Plan and is intended to prevent as many as 20,000 people from losing coverage. It will provide free care to those who are not on the Oregon Health Plan but make less than two times the federal poverty level, or $51,640 for a family of three in 2024,

But because of how the new program intersects with the vagaries of federal law, Oregonians who make between two and four times federal poverty level — $103,280 for a family of three in 2024 — stand to see bigger increases than in other states over the next three years thanks to the new state program. One insurer’s analysis found that 20,000 Oregonians would see yearly increases of $900 or more. That would be on top of average premium hikes of 27%-67% or more due to the loss of federal subsidies.

Public health, communication a focus

The nomination of Robert F. Kennedy Jr., the vaccine skeptic who dropped his presidential candidacy after making a deal with Trump, has sparked concern for public health officials in many states — who are already dealing with a drop in vaccination rates many attribute to Trump’s first term. Meanwhile, diseases like whooping cough are on the rise.

Hathi said state officials are preparing for “misinformation and disinformation” and are looking to reactivate “trusted messenger networks” that the state used during the pandemic, using contracts with community-based organizations to disseminate information about “common sense, evidence-based public health interventions.”

And given all the potential changes, Hathi said the state is exploring other outreach, too: “We’re already starting to get questions from OHP members and others about whether or not their coverage may be curtailed or impacted,” she said.

This story was originally published by The Lund Report, an independent nonprofit health news organization based in Oregon. You can reach Nick Budnick at nick@thelundreport.org or via X @NickBudnick.

This republished story is part of OPB’s broader effort to ensure that everyone in our region has access to quality journalism that informs, entertains and enriches their lives. To learn more, visit opb.org/partnerships.