Roughly one in ten Oregonians lack health insurance, a coverage gap that hits communities of color, immigrants, women, LGBTQ individuals, and the working poor the hardest, according to a report released Tuesday.
Mend the Gap, a first-of-its-kind report, calls on the Democratic-held state legislature and health officials to roll out sweeping reforms to bridge a health coverage gap that has left 383,000 residents uninsured. The 24-page report is a product of the Oregon Health Equity Alliance, a coalition of community-based organizations.
Joseph Santos-Lyons, executive director of the Asian Pacific American Network of Oregon, one of the 41 coalition groups, said the report is a wake-up call for state policymakers.
“We want people to understand that there are a range of exclusions that people face,” Santos-Lyons told Rewire. “We hope the governor and legislature will move to enact a basic health plan in 2016 and 2017 … and lay the groundwork to cover 17,600 undocumented children with a state-based health insurance program.”
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Mend the Gap lays out several reforms, chief among them a basic statewide health program to address a gap in health-care coverage. Seventeen percent of Oregon residents make too much to qualify for Medicaid and too little to afford health insurance premiums and co-pays, according to the Asian Pacific American Network of Oregon.
Santos-Lyons said Oregon needs to expand coverage and provide fixed benefits and costs, similar to plans enacted in Minnesota and New York.
The report calls for all health insurance plans to cover a full range of reproductive services and rein in out-of-pocket costs that act as barriers to care for women.
The report notes that private insurance plans in Oregon are not required to cover abortion care, and when they do, the cost of a deductible can range from $1,000 to $6,600 for an in-network provider. The report suggests that more should be done to guarantee access to contraceptive and pregnancy related care, as nearly half of all Oregon pregnancies are unintended.
“It is critical that comprehensive reproductive health care, including abortion, is a part of our insurance coverage and that all people have access to the care they need to make important decisions about if and when to have a family,” Hannah Rosenau, senior policy and access coordinator with the Oregon Foundation for Reproductive Health, said in an email to Rewire.
The report cites the story of airport worker Kasil Kapriel, an uninsured mother of four, who earns the minimum wage. Unable to afford health insurance, she said she skips work and takes Tylenol when she is ill. She worries that this habit will eventually leave her without a job.
Passage of the Affordable Care Act has cut Oregon’s uninsured rate by more than one-third. In 2013, 14.7 percent of Oregonians lacked health insurance, according to the Oregon Center for Public Policy. That number dropped to 9.7 percent in 2014.
But experts say those gains have left behind communities of color, LGBTQ people, low-income residents, and others.
In 2014, 22 percent of American Indian and Alaska Native residents and 21 percent of Latinos lacked insurance, compared to 8 percent of their white counterpart. That same year, 23 percent of lesbian, gay, and bisexual adults in Oregon remained uninsured. Transgender individuals, as the report notes, are less likely than other groups to have health coverage, however, no comparable figures are available for them in the state.
The report indicates the coverage gap is also felt by the state’s low-wage workers, whose uninsured rate was twice that of higher-earning Oregonians.
The disparity hits Oregonians from Pacific Island nations particularly hard. Pacific Islanders are permitted under “compacts of free association,” or COFA, to live and work in the United States, but excluded by federal law from Medicaid.
Joe Enlet, organizing director of COFA Alliance National Network, said COFA citizens live in the state legally, but “basically pay into a system that we are barred from.”
“We end up between a rock and hard place,” Enlet said in an interview with Rewire.
Other recommended reforms would strengthen and extend health-care access to transgender residents, undocumented children and adults, and those living in rural communities.