In March 2014, the Centers for Medicare & Medicaid Services (CMS) issued final rules establishing standards for the Basic Health Program, which would allow states to use federal funds to establish an alternative program with subsidies for low-income individuals who don’t qualify for expanded Medicaid.

To make health care affordable to all, the Affordable Care Act expanded Medicaid to millions of low-income people who earn up to 138 percent of the federal poverty level, or $15,856 a year for an individual and $21,404 for a couple. The law provides financial assistance for those earning more than that in the form of subsidized premiums and lower out-of-pocket expenses through the exchanges.

Thousands of Oregonians Still Uninsured

According to the Oregon Center for Public Policy, about 120,000 Oregonians who must get insurance or pay a fine under the Affordable Care Act will remain uninsured by 2019. Of this group, nearly half will be low-income people with earnings below 200 percent of the federal poverty line ($22,980 annually for an individual), who earn too much to qualify for expanded Medicaid through the Oregon Health Plan.

Assistance through the Basic Health Program

Those earning from 138 to 200 percent of the federal poverty level without employer-based health insurance may be eligible for federal assistance through the federally subsidized Basic Health Program.

A study by the Urban Institute indicates that the average annual premium through the exchanges will cost $1,218, while in a Basic Health Program the cost would be only $100. The Urban Institute also estimates that national average annual additional out-of-pocket costs, such as costs for co-payments, for the same plan would be $434 in a state exchange and $96 in a Basic Health Program.

Oregon Legislature to Study Feasibility of Basic Health Program

The Oregon legislature recently passed a law calling for the Oregon Health Authority to study this option. Basic Health Program benefits will be available to states starting January 1, 2015, giving Oregon a year for the study.

Author: Rizk Law

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