‘Big Beautiful Bill’ to bring big changes to Medicaid
Three local health care providers shared their thoughts Wednesday evening on how H. R. 1, also known as the Big Beautiful Bill, may affect health care in Clatsop County. The bill, which passed in July, could make massive changes to Medicaid, which serves approximately 35% of Clatsop County’s population.
The event, hosted by Janie McDonald and Aretta Christie, free and open to the public, was held at 5 p.m. in the Flag Room at the Astoria Public Library. The presenters included: Erik Thorsen, CEO of Columbia Memorial Hospital; Dr. Dee Nguyen, a health officer with Clatsop County; and Shyra Merila-Simmons, executive director at Clatsop Behavioral Health.
Thorsen outlined several issues currently facing C.M.H., including provider shortages and increased cost inflation for services.
Normally, Medicaid would make up the gap; however, with H. R. 1 taking effect, the reimbursements are likely to shrink, Thorsen said. He said the first impacts from the bill would be felt in 2027.
“We predict that there will be cuts in what’s covered by Medicaid and how much money they ultimately reimburse hospitals,” he said.
Thorsen said that the Oregon Health Authority is predicting that 200,000 Medicaid members could lose coverage and the state budget could lose a billion dollars in Medicaid revenue.
“If no other legislative action is taken, the budget just continues to go down until 2032,” he said.
Nguyen looked at the bill from a county perspective. She said the new work requirements for Medicaid recipients and more frequent eligibility verifications will be a big burden on the administrative side of health care.
“We are doing a lot more paperwork on a lot more people,” she said.
According to Nguyen, the burden will not just affect health care providers, but patients as well.
Nguyen said with the new bill, the county is anticipating a higher demand on the services they offer. Plus, more pressure will be put on state resources.
“A lot of the state funding and resources are probably going to be redirected to offset Medicaid funding,” she said.
Nguyen shared some dire predictions for the future including higher disease risk, delayed diagnoses and restricted access to primary care.
However, she did share a note of optimism. In February, Oregon received $200 million in a rural health care transformation grant which could help bolster the county’s resources ahead of the cuts.
Merila-Simmons’ organization, Clatsop Behavioral Health, primarily serves the Medicaid population. Because of this, cuts to Medicaid can hit hardest, she said.
“We’re a Medicaid funded organization.”
According to Merila-Simmons, 60% of C.B.H.’s funding comes through a Medicaid contract and the other 40% comes from a state general fund.
She said the demand for their services will not be reduced. However, the funding to provide care will be — by how much is still unknown.
“It’s really financially destabilizing for community mental health programs across the state,” Merila-Simmons said.
Most community health programs have already seen reductions to their Medicaid contracts, she said. While C.B.H. has lost 13 full-time positions, Merila-Simmons said they have not had to lay anybody off yet.
To be proactive, she said that the organization is applying to become a certified community behavioral health clinic. The certification would allow them to receive funding from an additional stream, she said, which could mitigate some of the impacts.
These issues are compounding the already critically underfunded community behavioral health organization, according to Merila-Simmons.
Known unknowns
The three speakers offered three different perspectives on the effects that the Medicaid cuts will likely have on health care in the region. However, they all shared the same uncertainty with what the cuts may look like.
“The reality is — we don’t know yet,” said Merila-Simmons.
With nine months to go before the bill goes into effect, providers aren’t able to properly assess how the changes will affect them.
“It’s just too early,” said Thorsen. “We really need more information.”
Nguyen is also waiting for more guidance.
“Hopefully, in a few months before 2027, we’ll have better clarification on what (the bill) means for local county residents,” she said.
“Until we have (more) information, it’s very hard for us to make any significant operational changes,” said Thorsen.
What next?
Lynn McConnell, an audience member at Wednesday’s presentation, asked what the turning point might be in the future.
“We have to hope and advocate — and plan for the worst,” said Merila-Simmons. “That’s what we’re doing: Anticipating what could be coming but always holding onto the fact that things can change.”