If Republicans in the U.S. Senate pass the “One Big Beautiful Bill Act,” Oregonians currently enrolled in Medicaid are more likely than people in nearly any other state to lose coverage and end up uninsured, according to analyses from several national think tanks.
The budget reconciliation bill reduces federal spending using a number of policies that will cut enrollment in Medicaid, including a work requirement for some and more frequent eligibility checks for all. The work requirement would take effect in January 2027.
Republicans have said those policies will reduce waste, fraud and abuse in the program. Democrats counter that they would increase red tape, resulting in many eligible people losing their health insurance.
In a social media post this week, President Donald Trump said he wants the bill on his desk by July 4.
In Oregon, 20% of people currently enrolled in Medicaid could lose their coverage, according to a detailed estimate of the bill’s impact by the State Health and Value Strategies Program at Princeton University. That would be the most significant percent loss of any state, according to the think tank’s state-by-state analysis.
Oregon is particularly vulnerable because it has focused for decades on expanding its Medicaid program, simplifying eligibility checks and making it easier for people to enroll and stay enrolled.
“Congress wants to layer back on those administrative burdens,” Heather Howard, director of the State Health and Value Strategies Program at Princeton University, said. “They’re reversing what in Oregon is almost 20 years of progress.”
Republican Rep. Cliff Bentz, who represents Oregon’s second congressional district, serves on the U.S. House subcommittee responsible for the cuts to Medicaid and says he helped craft the bill. He did not respond to a request for comment about its local impacts.
In a telephone town hall last week, Bentz said the bill accomplishes many of his personal priorities, including increasing spending on border security and extending the Trump tax cuts. He called Medicaid a necessary program and said he’d objected to an effort by some of his fellow Republicans to further restrict its federal funding.
Impacts across the state
Democrats in the Oregon legislature held an informational hearing Tuesday on the potential impact of the bill.
State Medicaid Director Emma Sandoe told state legislators that she would need to hire 800 to 1,200 additional eligibility workers to handle the more frequent reviews required by the bill.
Currently, adult Oregonians stay enrolled in Medicaid for two years at a time in between eligibility checks. Children are enrolled through their sixth birthday.
Under the reconciliation bill, eligibility renewals would be required for all Medicaid recipients every six months. State Sen. Deb Patterson (D- Salem), who chairs the Oregon Senate’s health care committee, likened that change to requiring Oregonians to start filing their taxes twice a year instead of annually.
Eric Hunter, the CEO of Care Oregon, the state’s largest Medicaid insurer, told legislators that most of their members already work or are eligible for an exemption to the proposed work requirement, but would struggle to complete the paperwork on time to prove it.
“Our members will always be on the edge of losing coverage, due to minor temporary fluctuations in income, administrative glitches or even moving to a different house and not getting the mail,” Hunter testified.
Historically, Oregon’s focus on stabilizing Medicaid and reducing the number of people who churn on and off coverage has helped it achieve among the lowest rates of uninsured people and medical debt in the country, according to Princeton’s Howard.
An analysis of the bill by the Kaiser Family Foundation projected Oregon will see a 4% increase in the uninsured rate - making it one of 10 states that would see the biggest swing.
During the Tuesday hearing, hospital CEOs and medical clinic directors in Oregon said they too believe the bill will drive up the uninsured rate, shifting the cost of uncompensated care to providers.
Oregon is also in the crosshairs of a provision that penalizes states that provide Medicaid coverage to undocumented immigrants.
The state’s program, called Healthier Oregon, uses exclusively state dollars to provide coverage to 14,925 children and 88,903 adults, according to KFF. Those numbers include some immigrants with legal status, like green card holders, and some without it.
The reconciliation bill would force Oregon to cut that coverage or face a reduction in the federal match rate it gets for other Medicaid members. That would amount to a loss of $1 billion in the 2027-2029 biennium, and billions more in future years, Sandoe said.
Most provisions in the reconciliation bill would not go into effect until after the midterm elections. One exception: a 10-year ban on all Medicaid funding for Planned Parenthood would take effect as soon as the bill is signed into law, potentially as early as next month.
The front of the Planned Parenthood clinic in Bend, Oregon, on June 28, 2022.Joni Land / OPBPlanned Parenthood Columbia Willamette’s CEO Dr. Sara Kennedy said 70% of their patients pay for visits with Medicaid.
“Health centers have a strong likelihood of closing across the state,” Kennedy said. “Abortion access will absolutely suffer.”
According to Kennedy, Planned Parenthood’s clinics across Oregon are also the single largest provider of many other types of primary care, including pap smears and STD testing.
“Our patients don’t have anywhere else to turn,” she said, noting that will likely result in patients not getting care.
Kennedy, a doctor herself, said fewer pap smears will mean more patients with cases of cervical cancer are missed at the early, treatable stage. Patients diagnosed later face a painful cancer that can be fatal.
“This is truly life or death,” she said.
Kennedy said they believe the bill is likely to pass and asked legislators to consider an immediate allocation of funding to Planned Parenthood to avoid disruptions while they plan a response.
Oregon lawmakers are currently hammering out a new two-year spending plan, and slowing economic growth in the state is forcing them to scale back.
At the hearing’s end, Rep. Rob Nosse (D-Portland) said if the reconciliation bill becomes a reality, it would deal a “fundamental blow” to Oregon’s near 30-year effort to keep people insured while containing costs.
The legislature, he said, would likely need a special session to respond to the cuts.
