Two Democratic governors of Oregon are lobbying the only Republican in the state’s congressional delegation to vote against the multi-trillion-dollar reconciliation bill passed by the U.S. Senate this week.
U.S. Rep. Cliff Bentz voted for the version of the bill passed by the U.S. House of Representatives in May and has said the federal tax cuts it extends are critical to spur economic growth.
But the version of the bill passed by the Senate on Tuesday and now awaiting a vote in the House includes new cuts to Medicaid that were not in the House version of the bill.
Bentz did not respond to a request for comment or emailed questions. He has not said publicly how he’ll vote on this new version of the bill.
The Medicaid cuts would be triggered by new restrictions on local taxes that states use to fund their Medicaid programs. This would cost Oregon an estimated $11.7 billion in lost federal and state revenue over ten years, according to the state health authority.
In a town hall last month, Bentz took credit for keeping a similar provision limiting local taxes out of the House version of the bill, saying it would have been too harmful to rural hospitals.
On a call with reporters Wednesday, Gov. Tina Kotek said the Senate’s new cuts to Medicaid would trigger a state budget crisis.
“This is a five-alarm fire,” Kotek said.
The governor said she and Bentz had spoken Tuesday, after the Senate’s bill passed.
“He’s a born and raised multigeneration Oregonian,” she said. “The conversation I had with him was what this will mean for his district. I urged him on behalf of his state to vote no.”
Former Oregon Gov. John Kitzhaber also published an open letter urging Bentz to vote against the Senate’s version of the bill.
Kitzhaber was the architect of Oregon’s approach to Medicaid, which has used managed care to enroll more people while containing the program’s costs.
Bentz, who serves on the Medicaid subcommittee of the House Energy and Commerce Committee, reached out to Kitzhaber earlier this year. The two have said they worked closely on ideas for the House version of the bill as it was being crafted, with Kitzhaber convening a work group on the issue with Bentz.
“I’ve spoken to him almost once a week,” Bentz said of Kitzhaber, during his May telephone town hall.
In his letter Wednesday, Kitzhaber urged Bentz to vote against the new version of the bill.
“This bill passed the House by only one vote. That means you are in a position to help prevent the catastrophe that is bearing down the people of your district, across our state and throughout the nation,” he wrote.
Oregon has been particularly effective at using federal dollars to expand Medicaid and, as a result, could be hit particularly hard by funding losses and an increase in the uninsured.
Bentz’s district, which includes Medford, Bend and Ontario, is among the most reliant on Medicaid of any district in the country. About 40% of its residents are on the Oregon Health Plan.
The Senate version of the bill overlaps substantially with a House version Bentz voted for in May. But the bill, which is more than 800 pages long, also has significant differences.
One of the biggest additions to the Senate version of the bill is changes to the rules that govern a type of local tax, known as a provider tax, that virtually every state uses to help fund its local contributions to Medicaid.
Bentz told constituents during the town hall in June that one reason Republicans didn’t change provider taxes was because he intervened to protect the status quo.
Every state but Alaska has a version of a provider tax. The Oregon legislature recently extended the state’s through 2032, in a bipartisan effort.
Bentz, who spent 18 years as an attorney for a hospital in Ontario, said he’d reached out to representatives of Oregon’s rural hospitals while the House bill was being written. He said they convinced him to protect the status quo.
“I think I can take some credit for saying clearly in the committee meeting we can’t let our rural hospitals lose this,” Bentz said.
The taxes are arguably similar to a kick-back scheme. States tax hospitals or medical practices to qualify for federal matching dollars for Medicaid. The providers then get some or all of the money back in the form of reimbursements for care they provide to Medicaid patients. The taxes can serve as a way to redistribute money from larger and more successful hospitals to those that see more Medicaid patients.
“Many people call it a shell game,” Bentz said in the town hall. “It kind of is, but the hospitals, many of the small ones in particular, have become very, very reliant on that particular funding stream.”
Republicans in the Senate took a different view of the issue. New rules limiting provider taxes are back in the bill that is now back before House members, including Bentz.
Becky Hultberg, president and CEO of the Hospital Association of Oregon, said the Senate’s version of the bill would be catastrophic for Oregon.
Hultberg said Oregon uses its provider tax to cover more than a quarter of the costs of the Oregon Health Plan.
“Dramatic changes to the provider tax program--and other programs impacted by this bill--are going to put more pressure on Oregon hospitals, that’s pressure they can’t withstand,” she said in a statement. “Our hospitals simply can’t absorb any more losses without serious consequences to patients and communities.”
