Sam Carpenter on the Oregon Health Authority

“In the first place, it was a mistake for the Legislature to create a separate Oregon Health Authority out of the Department of Human Services. Since then, we’ve seen disaster after disaster, debacle after debacle, costing taxpayers billions of dollars, while growing government by thousands of PERS-eligible employees – and achieving nothing.” – Sam Carpenter

Before the Legislature’s 2009 Act created the Oregon Health Authority as a separate agency, all of its functions were part of the Oregon Department of Human Services. In the 2007-2009 Biennium, before the creation of the Oregon Health Authority, the Oregon Department of Human Services had an operations budget of approximately $11 billion. Today, the two agencies combined budgets have exploded to a total of over $31 billion. That’s triple the cost in just one decade!

This is a perfect example of how government, left to itself, can quickly grow to be a bloated and inefficient entity.

Under federal law, no federal funding may be used to provide Medicaid services, other than limited emergency room treatment provided for all, to illegal aliens. However, Oregon has implemented numerous waiver programs to expand services for illegal aliens. Since 2013, pregnant illegal aliens have been eligible for the full benefits of the Oregon Health Plan under the CAWEM Expansion Program. This, along with sanctuary laws, provides an incentive for illegal aliens to come to Oregon and add to our public burden.

One of the biggest failures in the history of Oregon government is the now-infamous Cover Oregon debacle. As part of the implementation of Obamacare, Oregon made the decision to produce its own healthcare exchange internet site. Not only did the Oregon Health Authority spend over $300 million on a website that never enrolled a single customer, but it did so completely unnecessarily: the state exchange was optional, as many states instead chose to utilize the federal exchange. Ultimately, Oregon abandoned the entire project, turning to the federal exchange,, instead. Worst of all, top leaders from the Governor on down covered up and buried the mess until it was too late.

Another enormous failure has been the Oregon Health Plan’s Coordinated Care Organizations (CCOs). The CCO model is like a cumbersome HMO on bureaucratic steroids: one organization with total control over a patient’s care, receiving a fixed amount to pay for all the patient’s needs, with no incentive to provide service over profit. Worse, the Oregon Health Authority’s mismanagement of the CCOs has driven the non-profit FamilyCare, one of the largest Oregon Health Plan providers, out of the system by paying it at a significantly lower rate than the other providers that put profits ahead of patients. As a result, the Oregon Health Authority has jeopardized treatment for 115,000 Oregon Health Plan patients, while FamilyCare lays off over 300 medical providers.

The Oregon Health Plan itself is a flawed system of rationed care, with priorities that do not meet the real needs of Oregonians. Current funding, as of 2018, rations care to only the first 469 of the 660 lines of the Prioritized List of Services. That means, subject to the whim of an unelected board, no treatment for open wound of the eardrum (line 479), foreign body in the ear or nose (line 481), breast cysts (line 484), broken toes (line 492), and even deformities of upper body and limbs (line 530), and many other maladies. But, at the same time, The Oregon Health Plan covers transgender patients seeking sex change surgery and hormone treatments. And, since the 2017 legislative session, the Oregon Health Plan now covers abortion – and, unlike other Medicaid services that receive federal matching funds, it does so entirely with Oregon tax dollars, due to federal prohibition on using Medicaid for abortion.

The Oregon Health Plan has expanded its coverage to a much larger number of enrollees, as part of Obamacare’s Medicaid Expansion. While serving more Oregonians is a noble goal, the expansion has grown the Oregon Health Plan’s current enrollment to nearly a million Oregonians, or a quarter of the state’s population. This includes many who could obtain coverage through the private sector, rather than utilizing public programs. For example, children are eligible if their families earn up to three times the federal poverty level. For a family of four, that’s $75,000. Moreover, the Oregon Health Authority adopted the expansion under Obamacare’s temporary incentive of enhanced federal funding. That temporary period has lapsed – and, as a result, the Oregon Health Plan now has a funding gap in the billions of dollars. Oregon must end the expansion – but the current leadership simply refuses. The legislature has increased taxes on healthcare providers to make up the shortfall. But that new tax increase is up for a vote by the people – Sam Carpenter opposes the new healthcare tax, and has submitted an argument against it for the voter’s pamphlet.

Finally, recent audits from the Oregon Secretary of State have uncovered massive problems. One audit revealed that over 55 thousand ineligible recipients received services from the Oregon Health Plan, for a total of perhaps 150 million dollars. Another showed tens of millions of dollars in overpayments to the CCOs.

The waste and mismanagement is a nightmare.

“It’s time for Oregon to refocus its healthcare policy on actually providing care for those most vulnerable Oregonians with no other means of providing for themselves – and to hold accountable those who have mismanaged our healthcare for years.” – Sam Carpenter