‘If Congress pulls the ACA threads, Oregon’s health reform would likely unravel’

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CJR recently invited contributions from journalists whose work focuses on the healthcare challenges specific to their communities. We asked each reporter the same question: “As the nation anticipates passage of the Better Care Reconciliation Act, what are the health stories that are most urgent for journalists to tell in your region?” As the Senate moves towards a vote, we’ll publish more dispatches here, to encourage journalists to cover the changing health care landscape from the ground up.

HEALTH LEGISLATION PASSED on the federal level has variable local impacts, but with fewer dedicated health care reporters at smaller regional and local papers, the stories of those impacts often go untold. That lack of coverage is particularly evident in some of the larger Western states, like Oregon, where health care services are highly concentrated in just a few large urban centers.

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Health policies that make sense on a national scale might not be nearly as effective in states where large swaths of territory receive a relatively sparse supply of services. In Oregon, the vast majority of hospitals and doctors are located in Portland and other more populous parts of the Willamette Valley. Much of the population in eastern Oregon or along the Pacific Coast has little choice about which hospital to use. That’s given hospitals in less populous areas of the state tremendous negotiating power, leading to higher payment rates from insurance plans and fewer plans to choose from.

Hospitals with monopoly power in their regions have few incentives to cut rates for insurance companies. Insurance plans must then pass on those higher payment rates to consumers, or avoid that market altogether.

Public and private health plans are increasingly using financial incentives to nudge hospitals and doctors toward more efficient, higher quality care. But such incentives don’t always work as well in underserved areas. Medicare implemented financial penalties for hospitals with high readmission rates. But a study found that rural areas of Oregon had fewer pharmacies, which in turn led to higher readmission rates. That policy penalized rural hospitals for something they don’t control.

Oregon wove together provisions of the ACA with its own health reform efforts, fundamentally redesigning the way healthcare is delivered in the state.

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Bottom line: Local reporters often try to cover the daily back-and-forth over new legislation in Washington, DC. While it’s important to consider the potential local impacts of such proposals, the play-by-play of the legislative process is best left to reporters on Capitol Hill. Local reporters should continue to ferret out existing problems in their own backyard to help inform the debate. And, with the Trump administration seemingly intent on rolling back the Affordable Care Act, it’s up to local newspapers and media outlets to show how the ACA is actually functioning in their states, and what the potential impact of its repeal and replacement may be. No one is better positioned to do so.

Oregon wove together provisions of the ACA with its own health reform efforts, fundamentally redesigning the way healthcare is delivered in the state. Oregon established regional coordinated care organizations to manage its Medicaid population. The state planned to gradually shift Oregon’s public employees into those health plans as well. For the most part, the plan has worked. The CCOs have had to meet specific spending targets and quality benchmarks that have bent the cost curve for the program while expanding access to care. If Congress pulls the ACA threads, Oregon’s health reform would likely unravel.

According to a recent report from the Urban Institute, the House GOP’s version of the health care bill would have the greatest impact on states that have experienced the largest Medicaid enrollment increases under the ACA. Only Kentucky faces a larger percentage drop than Oregon.

Health care is a horribly complex topic; it crosses over into business, politics, science, law, and a myriad of other beats. Newspapers of all sizes would do well to cultivate health care expertise in their newsroom—and to hang on at all cost to reporters who can write expertly about it.

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Markian Hawryluk is a health reporter with the Bend Bulletin. He spent 10 years as a health policy reporter in Washington, DC, and has written for various publications including the Houston Chronicle and American Medical News. He was a 2013 Knight Wallace Fellow and has won numerous awards for his health reporting.