Oregon is on its way to becoming the third state in the nation to seek federal approval for a basic health program (BHP). This program, established under the Affordable Care Act, aims to provide insurance to those individuals who make income slightly more than the Medicaid threshold but not higher than the ACA Federal Marketplace level. That is between 138% and 200% of the Federal Poverty Level.

Why This Basic Health Program?

There has always been a coverage gap, what we call the issue of “churn”, where people’s household income sways between levels above and below the Medicaid Federal Poverty Level causing disparity in their eligibility for Medicaid. Why this sway? Mainly because of the inconsistent earnings of low-wage employees and workers.

If a household income is higher than 138% of the Federal Poverty Level they become ineligible for Medicaid. But they become qualified for subsidized plans, what we call ACA plans, from the federal marketplace.

The problem comes for people with wavering income. This makes them in and out of the eligibility layer.  And they end up above the Medicaid and below the ACA Marketplace plans with tax credits, and finally without any insurance. In Oregon, up to a third of Medicaid enrollees return to the program within a year due to income fluctuations, highlighting the need for a more stable healthcare solution.

When Will BHP Launch?

The Oregon Health Policy Board unanimously voted for Oregon’s blueprint application approval. This BHP is scheduled to launch in July 2024, and as said before will offer coverage to individuals earning between 138% and 200% of the federal poverty level, potentially benefiting around 100,000 people in Oregon. This is part of the many steps Oregon has been making in terms of their state policies to reach insurance coverage for all the people. And with this BHP they are going to fill the gap between the Medicaid and ACA household income levels.

New York and Minnesota have already implemented basic health programs, although their models involve co-pays and cost-sharing. But Oregon BHP will offer free healthcare without any co-pays, mirroring the state’s Medicaid program.


What are the Challenges of Implementing the BHP?

The Oregon Health Authority has to face the challenge of mitigating these premium increases and ensure a smooth transition for thousands of individuals from the federal marketplace to Oregon’s benefits system.

Despite the complexity and tight timeline, Oregon is making strides toward a more inclusive and accessible healthcare system, bringing the state closer to achieving health coverage for all its residents.


Can Individuals Stay with ACA Marketplace Plans?

As per the Oregon Health Authority, individuals currently enrolled in marketplace plans in Oregon can choose to stay in those plans and retain their tax credits for a year or two if they have used the autoenrollment feature of the Federal Marketplace. But those who become eligible for the Basic Health Program (BHP) will no longer qualify for ACA Subsidized plans.

So in the coming years, individuals in Oregon earning between 138% and 200% of the federal poverty level will be part of the BHP and will no longer have the option to select a subsidized plan on the federal exchange.