Lawmaker proposes Medicaid buy-in and individual mandate for Oregonians

Representative Andrea Salinas, the new Chair of the House Health Care Committee, recently filed a bill that aims to establish a Medicaid buy-in option for Oregon residents. The bill, HB 2009, would also establish a “shared responsibility penalty,” or an individual mandate for Oregonians.

HB 2009 would essentially allow individuals who do not qualify for Medicaid, or for premium tax credits under the Affordable Care Act, to enroll in CCOs by paying premiums to cover their health services.

Eligible residents for the buy-in plan include those earning between 138 and 400 percent of the federal poverty levels (FPL). Individuals between 400 and 600 percent of FPL could also buy into the Medicaid benefit plan if they are required to pay the full cost of their premiums through their employer-sponsored health insurance.

 

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The bill would also establish the “State Shared Responsibility Penalty” for full-time residents who are not enrolled in “minimum essential coverage” for at least nine months of the year. Penalties collected would be deposited into the Oregon Health Authority Fund to be used for outreach and premium assistance for those enrolling in the buy-in plan.

Rep. Salinas gave us a preview of her plans for the Medicaid buy-in prior to filing the bill in this Q&A. In it, she estimates that the monthly premium for those buying into Medicaid could range from $500 to $600.

You know, I think the question is, is that Medicaid plan and that premium affordable enough?… But, recognizing that there are no costs at transaction times – so there’d be no co-pays, no deductibles — you know, for some people that could be really beneficial,” said Salinas.

However, Salinas expressed concern about how the reimbursement rates would impact provider availability.  

Essentially, they would get the same reimbursement rate under the buy-in option that the current Medicaid plan does. So would the networks stay in place and would we have providers? Because that’s kind of the idea — to expand access — and if you don’t have those providers because they don’t like the reimbursement rates, then it does no good.”

Rep. Salinas also filed a separate bill that would establish the Medicaid buy-in, but excludes the individual mandate and the associated penalty.

Also listed as chief sponsors of the two bills are Representative Rob Nosse and Senator Laurie Monnes Anderson.

Both bills were referred to the House Health Care committee on Wednesday.