This interview is part of KHN's video series "Supreme Uncertainty: What's Next After The Court Rules," which solicits views from public officials and policy experts about the upcoming Supreme Court ruling on the health law and its implications for the future of health care.
In many ways, Oregon is already making changes called for in the health law. And even if the Supreme Court overturns the law, Chris DeMars, a senior program officer at Oregon’s Northwest Health Foundation, expects the state to move forward with insurance exchanges and an effort to coordinate care, especially among the state’s Medicaid patients. DeMars cautions, however, that without help from Washington, Oregon may have to scale back what it will do.
Here's an edited transcript of the interview:
MARILYN WERBER SERAFINI: So what happens to health care in Oregon if the Supreme Court strikes down the health law?
CHRIS DEMARS: We had a health insurance exchange bill that had been passed before the [Affordable Care Act] was passed, so once again we were already moving down that path. So as I understand it, if the ACA is struck down, if the subsidies go away, if the additional funds go away, we may need to scale back the subsidies that we provide to some of that expanded population that we were hoping to come in. But we will still have an exchange and we will still be implementing our coordinated care organizations.
Oregon has been going through almost a decade long process of transforming our health system. It’s been a real public process, but also led through legislators and, most recently, our governor. Governor Kitzhaber—who’s been in office since early 2011 -has spearheaded an effort to develop something called coordinated care organizations, or CCOs. There are teams of providers that will be really diverse groups of stakeholders— health systems, primary care providers in some communities, public health departments, maybe social service organizations that will all come together and provide care for Medicaid recipients in a coordinated way - physical health, mental health and oral-health care.
They also will be paid through a global budget, so they will be paid to enhance health. They will be paid for the services they provide, but they will be paid to ensure that the population is healthy, so it’s really an innovative approach. These are being developed right now, the first wave will be up and running in just a few months here.
Oregon has been engaged in this effort since before [Affordable Care Act] was being debated, and we will go forward with our CCO implementation, even if the [Affordable Care Act] is struck down. Now, the other piece of that or the other piece of Oregon’s health reform is the health insurance exchange.
MARILYN WERBER SERAFINI: What happens if the Supreme Court upholds the health law? Does it make a difference?
CHRIS DEMARS: What it does is it amplifies what we’re doing in Oregon. If the Supreme Court upholds the [Affordable Care Act], we will be able to receive additional dollars to move forward with our expansion to the Medicaid population, and for subsidies for low income individuals to receive insurance through the exchange. So, it will just enhance what we are doing already.