Oregonians lack health coverage

The ranks of uninsured, the most since 1992, exceed the national rate, and reflect a smaller Oregon Health Plan, the economy and rising costs for all Tuesday, January 18, 2005

DON COLBURN



One in six Oregonians lacks health insurance, the highest rate since 1992, according to a new survey by the Oregon Progress Board.



The estimated total of 609,000 residents with no medical coverage is the most since the agency started tracking statewide trends in 1990. Seventeen percent of Oregonians are uninsured, an increase from 14 percent two years ago.



For the first time in a decade, Oregon appears to have a greater proportion of uninsured residents than the nation as a whole. The most recent national estimate is 15.6 percent, based on 2003 data.



Analysts cite three intertwined factors: a sputtering economy, a shrinking Oregon Health Plan for low-income residents and escalating health care costs for all.



"This is very sobering -- and sad," said Dr. Bruce Goldberg, head of the Office for Oregon Health Policy and Research, which advises the governor and the Legislature on health issues.



Goldberg said the numbers "reinforce that the leading unsolved health policy problem in Oregon is our failure to provide an adequate level of health care to every citizen."



The new numbers come from the 2004 Oregon Population Survey, based on interviews with about 4,500 Oregon households in August and September. The question on health insurance has a margin of error of less than 1 percentage point. The Progress Board will release the complete results today.



The survey covers about 90 measures -- from jobs and education to child care and use of technology -- that collectively paint a portrait of Oregon and its people.



Besides the 609,000 Oregonians who lacked insurance at the time of the survey, another 257,000 said they had gone without coverage at some point during the past year.



The survey divides Oregon into eight regions. The uninsured rate ranges from 13.5 percent in five southwestern counties -- Coos, Curry, Douglas, Jackson and Josephine -- to 24.6 percent in four counties in Eastern Oregon -- Baker, Malheur, Union and Wallowa.



The Portland area ranks in between. In Clackamas, Multnomah, Washington and Yamhill counties, 16.5 percent of residents have no health insurance.



Among them are Vern and Cheryl Smith of Northeast Portland. Vern Smith, 50, is unemployed and has chronic illnesses, including diabetes, kidney disease and liver problems.



The Smiths moved off the Oregon Health Plan last year, when Cheryl took a job as a nursing assistant at a residential care center. The downside: They lost health insurance because her new employer doesn't provide coverage.



Most are not poor



Like the Smiths, most uninsured are not officially poor. Their household incomes exceed the federal poverty level of about $19,000 for a family of four.



The survey suggests that four out of five uninsured Oregonians are employed or live in a household where someone has a job.



But with medical costs outpacing inflation, fewer employers offer health coverage as a benefit, and fewer workers can afford the premiums for optional insurance.



Nationwide, employer-sponsored health insurance premiums jumped 11 percent last year, the fourth straight year of double-digit increases.



Joe and Valinda Butterfield and their two college-age sons have gone without health insurance since Joe was laid off as a Pitney Bowes sales representative in late 2002. He works at a car dealership in Ashland, but company-paid health insurance does not come with the job.



"We're part of that statistic," said Valinda Butterfield, referring to Oregon's burgeoning uninsured population.



In between



With a household income of about $40,000 a year, the Butterfields are not eligible for the Oregon Health Plan. Valinda Butterfield runs a small business designing greeting cards out of their home in Jacksonville.



They're too young for Medicare, too "affluent" for Medicaid and too strapped to pay the employee premiums for insurance offered through Joe Butterfield's job.



Coverage for their family of four would cost about $500 a month, Valinda Butterfield said. They've decided, for now, to remain uncovered and put that $6,000 a year toward college tuition -- both sons attend Oregon State University -- and other uses.



"You really concentrate on being healthy and hoping nobody gets an appendicitis," she said.



The only doctor appointment Joe Butterfield has had since he lost health coverage was the one required when he bought a life insurance policy. Valinda Butterfield has had none -- "no routine physical, no gynecological exam, no Pap test."



"If you did that and they found something, what do you do then?" she said.



Catastrophic coverage



The Butterfields, both in their late 40s, are considering a cheaper policy with an annual deductible of $7,500 that would not pay for routine care but would protect against the cost of treating a major illness or injury.



"It would keep us from having our house taken away" in the event of catastrophic medical bills, Valinda Butterfield said.



"The leading cause of personal bankruptcy today is inability to pay medical bills," said former Gov. John Kitzhaber, a doctor who championed the Oregon Health Plan during the 1990s.



The health plan started in 1994 as a bold reform aimed at expanding Medicaid to include the working poor while limiting coverage to the most cost-effective treatments. It had immediate impact.



The health plan helped reduce Oregon's rate of uninsured from 18 percent in 1992 to 11 percent in 1996. But the trend reversed direction in 2000, and the number of uninsured Oregonians has been growing since.



Health plan shrinks



OHP Standard, the part of the health plan for low-income adults who don't qualify for federally mandated coverage, is shrinking rapidly under budget constraints. To contain costs, the state trimmed benefits and added premiums during the past legislative session. On Aug. 1, it closed enrollment to new applicants.



Enrollment has fallen from 100,000 to 39,000 in two years.



"We've basically gone back to the old Medicaid program," Kitzhaber said.



Studies have shown that uninsured people are less likely than others to get timely care -- and more likely to die sooner.



"There's an implied assumption that when people lose health insurance they simply go away," Kitzhaber said. "They don't.



"The fact is, they end up in the hospital emergency room."