On healthcare, Oregon’s top candidates for governor offer classic partisan politics with relatively few surprises.
Republican challenger Christine Drazan says burdensome taxes and state regulations are driving clinics out of business and forcing hospitals to cut their services. Incumbent Democrat Tina Kotek, meanwhile, blames out-of-state corporations who she says choose profits over the needs of communities in Oregon.
The differences in their worldviews are clear.
But across three debates, their websites and numerous ads and events, the two candidates have mostly avoided talking about how they will tackle one of the most important challenges facing the incoming governor: Medicaid cuts.
The cuts were set in motion by the tax break and spending bill passed last year by the Republican majority in Congress. They could affect 1 in 3 Oregonians and half of children in the state who rely on the Oregon Health Plan to pay for healthcare.
Congress left it up to state governors and legislatures to choose how to cut their programs to balance out the loss in federal funding. Over their four years in office, Oregon’s next governor will have to propose trimming as much as 10% of the state’s healthcare and Medicaid budget.
The hole in the state budget starts at $421 million in the upcoming budget cycle and will double the following biennium as stricter funding rules phase in, reaching an estimated $868 million.
Per state law, as sitting governor, Kotek is responsible for presenting a proposed budget to the state Legislature on Dec. 1. If Drazan wins, as governor-elect she’d get additional time to revise the budget prepared by Kotek’s team. Drazan’s proposal would be due to the Legislature on Feb. 1.
OPB sent both candidates more than a dozen detailed questions about how they would approach cutting Medicaid.
Drazan didn’t answer any of the questions. Her campaign spokesperson offered to make her available for an interview late last week, then withdrew the offer.
Kotek’s campaign answered just three of OPB’s questions, ignored the others, and instead sent a written statement.
Here’s what we know about where Kotek and Drazan stand on the changes coming to Medicaid, based on what they have said and their voting records.
Kotek convened a Medicaid advisory group, but has not announced a path to close the gap
One of Kotek’s frequent talking points during the campaign has been that she is fighting to protect Oregonians from Medicaid cuts orchestrated by President Trump and Republicans in Congress — and that Drazan will not.
To some extent, Kotek’s assertion that she’s fought the cuts is an honest reflection of her record. She publicly opposed H.R. 1 and urged Oregon’s congressional delegation to vote against it. She’s called the bill “cruel” and “out-of-touch,” and taken steps since the bill passed to counter some of its policies.
Oregon is among the states suing the Trump administration to try to simplify the paperwork medically frail people will have to submit to keep their medicaid coverage under the new work requirement rules. The state is also paying for healthcare for some groups of lawfully present immigrants whose federal benefits were eliminated by Congress.
Kotek’s narrative about fighting, though, sidesteps the dire reality of the Medicaid budget and the cuts she’s contemplating as governor.
Last year, Kotek convened a group of advisors to meet privately to develop options to close the state’s $421 million Medicaid budget hole.
She told those advisors her priority was keeping people enrolled. Kotek’s staff encouraged the group to find savings by trimming benefits and administrative costs and to consider cutting provider pay if the first two weren’t enough, according to records of their meetings.
In the end, the advisory group handed Kotek a list of more than 40 options to choose from — without any consensus on a path.
The governor has publicly backed just one of the options her advisors developed: centralizing approval and purchasing of prescription drugs for people on Medicaid. Kotek’s advisory group estimated the switch could save the state around $24 million over 18 months.
About 90% of Medicaid members’ current prescriptions would likely remain covered, but patients might have to seek prior authorization or pay out of pocket for some drugs, like oral diabetes medications and targeted immune modulators, according to a memo prepared for Kotek’s advisors.
With just over a month before the proposed budget is due, that still leaves nearly $400 million in spending cuts she isn’t discussing.
OPB sent written questions to Kotek’s campaign, asking what her approach would be to resolve the shortfall.
Kotek didn’t answer the questions or share a specific plan.
“My priority in the upcoming budget is to provide access to high-quality healthcare to as many Oregonians as possible with the best benefits possible,” she said in an emailed statement. “In my second term, I will focus on growing our healthcare workforce while continuing to defend the Oregon Health Plan from Trump’s Medicaid cuts.”
Drazan campaign quiet on Medicaid funding plans
When Drazan speaks about healthcare in Oregon, it’s usually in line with her overarching critique of how Democrats are running the state — too much heavy-handed regulation, she says, and not enough discipline over the size and cost of government.
When asked what state programs she’d like to cut during a debate on Oct. 7, Drazan brought up the Oregon Health Authority and its approximately 6,000 employees.
“I will commit that our government will understand its core mission and its core role,” she said. “And for the parts of our government that are currently acting like they’re going to be all things to all people, that’s where we’re going to cut.”
Although it makes up about a third of the state’s budget, Drazan rarely brings up Medicaid, the Oregon Health Plan or the cuts H.R. 1 is making to the safety net for low-income Oregonians — except to defend herself from Kotek’s attacks on the subject.
In an interview with OPB in late September, Drazan described the cuts congressional Republicans made to SNAP funding as a fair approach, meant to preserve the program’s funding for the people who need it most.
“They’re now taking a keen eye to what Oregon’s error rate looks like for SNAP benefits,” Drazan said. “Oregon needs to be accountable with its money.”
She didn’t discuss her position on Medicaid.
Last year, while serving as minority leader in the Oregon House of Representatives, Drazan voted against extending a 6% tax on hospitals and a 2% tax on some types of health insurance plans. The longstanding taxes, which were scheduled to sunset later that year, are a critical component of how Oregon pays for the Oregon Health Plan. The tax on health insurance plans helped Oregon expand the program to cover more people.
The state uses the hospital tax to boost reimbursements to hospitals caring for Medicaid patients so the government pays a rate closer to what commercial insurers pay.
Virtually every state uses similar taxes on providers to fund their Medicaid programs. Skeptics have said the taxes make it harder to track and control healthcare spending and shift the program’s costs from states to the federal government. Advocates say the taxes support fair payment to doctors who serve poor and uninsured patients, ensuring people on Medicaid aren’t turned away.
The Hospital Association of Oregon lobbied hard in favor of the bill, as did unions and large health insurers like Kaiser Permanente and Moda. It ultimately passed.
In multiple campaign ads and in their debates, Kotek has attacked Drazan for her vote against the bill.
“My opponent has voted to defund the Oregon Health Plan and will not be supportive of saving the Oregon Health Plan,” Kotek said during their second debate in Bend.
Drazan has defended her vote on the issue, saying she objected specifically to the 2% tax on health insurance plans and claiming it was driving up the cost of healthcare and insurance premiums.
“What the governor is referencing is a $5.5 billion tax which drove up costs of healthcare,” she said.
OPB asked Drazan to explain her concern that Oregon’s provider tax is contributing to rising healthcare costs. She didn’t answer the question.
Four years ago, in the final months of Drazan and Kotek’s first gubernatorial race, the Hospital Association of Oregon spent $250,000 trying to help Drazan get elected. It is the largest donation the group has ever made to a single candidate.
This year, in another tight race, the group has ignored Drazan while giving to a smattering of other Republicans and Democrats — including $50,000 to Kotek.
OPB asked Drazan what her plan would be to close the Medicaid budget gap. Drazan didn’t say what her approach would be, or whether she supports any of the specific ideas identified by Kotek’s advisory group.
Healthcare for immigrants without legal status
Neither Drazan nor Kotek has brought up what could be a particularly high-stakes policy difference between them: state funding for healthcare for immigrants without legal status. But their voting records suggest a stark difference in priorities.
In 2021, when Kotek was Speaker of the House, Democrats passed a bill that made Oregon one of the first states to effectively expand Medicaid to adult immigrants without legal status if they met the program’s poverty threshold. State and federal governments had previously only reimbursed hospitals for providing emergency room care for people in the country without legal status.
There are about 14,000 children and 73,000 adults currently enrolled in the program, now called the Healthier Oregon Program.
Drazan, then a Republican member of the House, voted against the bill.
Kotek views the program as part of her legacy. The Trump administration, meanwhile, has deliberately made it harder for states to fund and administer Medicaid for immigrants with and without legal status, as part of its crackdown on immigration.
Earlier this year, the governors of California and Washington announced that they were pausing new enrollment in their state healthcare programs for undocumented immigrants.
OPB asked both Drazan and Kotek to clarify whether they would support a similar pause, and whether they support state-funded care for immigrant children and adults who don’t have legal status.
Both candidates didn’t answer.
Editor’s note: OPB staff used Microsoft’s Copilot AI tool to search debate and interview transcripts and public records for this story. In accordance with OPB editorial policies, all material identified using AI was then reviewed and fact checked by human staff. All AI tools used by OPB have been reviewed prior to their use to ensure they meet our editorial, privacy and ethical standards.
