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‘Skin-in-the-game’ Medicaid expansion did not work in Oregon

‘Skin-in-the-game’ Medicaid expansion did not work in Oregon

Brandon Hershey
July 23, 2014
July 23, 2014

The Oregon Medicaid expansion extended to low-income, childless adults that took place in 2001 holds many lessons that Idaho should heed. The idea of a “skin-in-the-game” approach is one of the lessons. Oregon officials chose the route of requiring copayments and premiums from Medicaid expansion enrollees, hoping to maintain costs and fund the expansion.

Their “ingenious” plan was a failure. The approach was a factor in the plan’s demise in 2004. Studies have shown that beneficiaries of the Medicaid expansion in Oregon did not receive adequate medical services needed due to a failure of ability to pay the high copayments. The high premiums drove many away from the program as enrollment in the Medicaid expansion dropped more than 50 percent by 2004.

The academic journal, “Health Affairs,” reports that more than 40 percent of enrollees dropped out of the program due to the rising premiums. Recipients of the expansion reported still accumulating medical debt under the program; those who dropped the program because of costs had on average $500 or more in debt than those that left for other reasons.

Oregon’s attempt to fund Medicaid expansion via high premiums and copayments proved an unsuccessful endeavor. As Medicaid costs grow—dramatically should Idaho choose to expand—implementing cost sharing will not help the poor in Idaho. As alternatives and solutions are discussed, this is one idea that should be thrown away. Medicaid expansion—no matter what the packaging is—will do nothing but place a burden on Idaho’s most vulnerable.

Other states have implemented cost sharing into their existing programs and have experienced the same affect. Copayment and premiums harm Medicaid beneficiaries who are already struggling financially. The Center on Budget and Policy Priorities concluded in a report from 2005 that cost sharing in Medicaid programs “tend(s) to cause low-income people to decrease their use of essential as well as other health care, and can trigger the subsequent use of more expensive forms of care such as emergency room care or hospitalization.”

Lawmakers and citizens should question those who are promoting Medicaid expansion as being a means of prosperity for the state’s low-income individuals.

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