On ObamaCare and Medicaid, let’s learn from Oregon and pivot toward what’s working
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At the end of 2013, our call center employees kept telling us that they had the best jobs ever.

They were making calls to people who, thanks to the 2014 Medicaid expansion, were eligible for health coverage they could finally afford. Many of the new enrollees were so grateful to have health coverage—after years or even a lifetime of avoiding doctor visits they couldn’t afford and relying on the emergency room—that they were moved to thank the workers who called to help them understand their benefits or choose a plan. Their gratitude overwhelmed our call center team. Theirs was indeed the best possible job.

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In the three years since the Medicaid expansion, the uninsured rate in Oregon has plummeted from 14.7 percent to 6.1 percent. Oregon’s more than 400,000 new Medicaid members can now go to the doctor, see a dentist, and get any mental health support they need.

This, in itself, is remarkable. But we cannot measure the quality of our health care system solely by the number of people who have access to it. To build a better health system, we need to succeed in making Americans healthier while also keeping health care affordable.  This is where Oregon stands out.

Oregon’s home-grown health care transformation, as well as our Medicaid waiver, is why we can have a healthier population for less money. Our story is particularly important as Congress and President-elect Trump turn up the volume about repealing President Obama’s signature health law and making substantial changes to the Medicaid program.

Medicaid waivers have always given states the flexibility to deliver the program in innovative ways. Coordinated care organizations, like Health Share of Oregon, formed as part of a 2012 waiver, are Oregon’s latest innovation.

Coordinated care organizations are a true public/private solution getting real results. They bridge the gaps within America’s complicated, fragmented health care system so our members get the care they need, when they need it, with a strong emphasis on prevention. Our role encompasses everything from building a data sharing system for health providers, to creating a regional mental health system, to strengthening 911 services. We are held accountable to the State, as well as Oregonians, through outcome-oriented quality measures and financial rules capping our per-member annual cost growth.

Our community paramedicine program, aimed at reducing hospital readmissions, is one example of how we’re innovating to provide better care at lower costs. With community paramedicine, we identify high-risk patients during an initial stay in the hospital then follow up with them at home to ensure a successful transition.

In one instance, a Health Share home visit revealed that a patient who had been admitted for chest pain still had an irregular heartbeat a few days after being released from the hospital.  Paramedics were able to call the patient’s primary care provider, get him an appointment the same day, get his heart rate under control, and send him home with a new medication—all without another costly trip to the hospital.

Programs like this have contributed to a transformation of Medicaid in Oregon. Hospital readmissions are down by one-third since the coordinated care model launched in 2012. Avoidable visits to the emergency room have decreased nearly 50 percent. We’re assessing more people for substance use problems and providing more women with prenatal care. We’re saving money, too. By 2022, Oregon’s health reforms are projected to save federal and state governments $10.5 billion.

Repealing the Affordable Care Act and making substantial changes to the Medicaid program puts Oregon’s, and many other states’, gains in jeopardy. It’s unclear if a new health law would allow models like ours to continue, let alone support them with adequate federal funds. The political fight against “ObamaCare” could stop in its tracks a model for Medicaid that truly works.

The Affordable Care Act and its Medicaid expansion have not been the be-all, end-all solution for our country’s health care woes. But in Oregon, continued flexibility of the Medicaid program and adequate federal funding have allowed us to take a giant leap toward a health system that does what health systems are meant to do: care for people when they need it, not when it’s too late.

On ObamaCare, I hope we can forget about what it’s called or who takes credit. Instead, let’s learn from what’s working in the states and pivot toward a healthier America.

Janet L. Meyer is chief executive officer of Health Share of Oregon, the state's largest Medicaid coordinated care organization that serves more than 220,000 Oregon Health Plan members.


The views expressed by authors are their own and not the views of The Hill.