Like it or Hate it, the Affordable Care Act is Here

Whatever one might think of the Affordable Care Act, its implementation continues and its future, in part or in full, is up in the air. Implementation or repeal will depend on which party wins the 2016 presidential election. If Hillary Clinton wins, the implementation of the Affordable Care Act will proceed ahead. If Donald Trump wins, he said "on day one of the Trump Administration, we will ask Congress to immediately deliver a full repeal of Obamacare." SOURCE

We don’t know what’s going to happen with the Affordable Care Act at the federal level. We’re in an extended period of churn regardless of the Affordable Care Act’s survival or overhaul. But Dr. “Bud” Pierce promises a practical and pragmatic approach to ensuring healthcare access for all Oregonians that is affordable and puts them in charge of making healthcare choices that meet their needs. 

Oregonians Need “Adequate” Insurance Plans

Bud Pierce believes every Oregonian should have an "adequate" insurance plan that is either individually purchased or employer purchased by those with adequate income, or "subsidized" for low-income Oregonians.  A vigorous and competitive private insurance market would sell a variety of insurance products.  He sees a competitive and transparent insurance market as a means to cost containment. Bud Pierce favors insurance for all—an adequate basic plan for all and supplemental insurance products for those who wish to have more coverage. He would also work to create incentives for providers to provide "charity services" for those without adequate income or supplemental insurance for those with conditions not covered by their insurance plan.  

There is No One-Size-Fits-All Solution

Bud Pierce can also assure Oregonians that, whether the Affordable Care Act lives or dies at the federal level, he will fight any state-run, one-size-fits-all, single-payer healthcare system or any attempt to herd more and more Oregonians into the Oregon Health Plan Medicaid program. He’s not ready to give the state government full control over healthcare after witnessing the “Cover Oregon” debacle and the out-sized premium increases Oregonians have seen under the Affordable Care Act. 

Oregonians Need to be Healthier

Bud Pierce believes real healthcare savings will only occur if Oregonians are healthier.  We have been able to reduce smoking from roughly 85% to around 15% through a change in our culture. Obesity is a major contributor to diabetes, cancer, and the need for joint replacement. If we can lower Oregon's obesity rate to 5-10% from its current 30% rate, we can save billions of dollars in health care spending. If Oregonians can participate in just 2.5 hours of moderate aerobic exercise a week, they will be dramatically healthier. Bud Pierce will work with the state’s advertisers, insurance companies, and private and public healthcare providers to help Oregonians achieve this goal.

He will also continue Oregon’s push to provide greater help for Oregon’s mentally ill. There really is no health without mental health. Helping the mentally ill will dramatically lower our murder rate, our incarceration rate, and our homeless rate, all of which contribute to our health care costs. 

How Does Oregon Maintain the Oregon Health Plan?

Beyond the Cover Oregon mess—and the gross politicization and bureaucratic ineptitude that Cover Oregon showcased—the hallmark of healthcare reform/transformation in Oregon has been the expansion of the Oregon Health Plan. The increase in healthcare coverage has come as a result of the Medicaid expansion subsidized (at least, temporarily) by the federal government. Medicaid now covers roughly one million Oregonians—that’s almost one in four Oregonians. Our state has seen a 68% enrollment increase since the July-September 2013 enrollment period. Nationwide, Medicaid growth is almost 23% for the same period. Oregon has extended eligibility to adult Oregonians who earn 138% of the federal poverty level. (See figures below for comparison to some other states.) Only Kentucky has experienced higher annual growth in Medicaid enrollment. SOURCE

Those federal subsidies will start to go away in the 2015-17 budget, with Oregon taxpayers having to make up the difference ($380 million by the end of 2016), and it will be further reduced starting in the 2017-19 biennium.  Reduced federal participation will serve to nearly double Oregon’s share of the cost by 2020. According to Senator Doug Whitsett, the 2017-19 Human Services budgets will cost at least $1 billion more due to these and other factors. Many states that expanded Medicaid coverage with federal dollars have started to rein in costs. Oregon, which expanded its Medicaid population far more than most states, has not. The next Oregon governor will face this looming—and growing—fiscal challenge. Bud Pierce’s whole life has prepared him to face this fiscal and healthcare challenge.

How? Bud Pierce Favors the Following: 

  • Slashing administrative bloat in our state’s healthcare bureaucracy.  2015-2017 Human Services spending will be around $29 billion dollars; administration costs will be around $11.5 billion dollars.  Eliminating a fraction of the bloat in our broken government will allow us to find the money and fill budgetary gaps.
  • Ensuring that Oregon Health Plan coverage decisions are made at the local level by the Coordinated Care Organizations (CCOs). These CCOs should develop priority lists to determine what is and is not covered. Local control is the key. When coverage for a condition is denied, the person or groups making the denial must be identifiable and accountable.
  • Overseeing Oregon’s healthcare delivery system to ensure that de-facto monopolies that come about control costs.  
  • Eliminating Oregon services not required by federal law and services added since 2009.