Oregon Healthcare Policy Analysis Dashboard

Multi-Stakeholder Coverage and Fiscal Impact Modeling Tool

Based on OHA Medicaid Enrollment Report (2025) | OHA CY26 CCO Rate Model (September 2024)

Oregon Healthcare System Baseline (2025 Data)
243K
Uninsured (6%)
OHA 2025
1.4M
Total OHP Enrollees
OHA 2025
1.26M
Traditional OHP
OHA 2025
32K
Bridge Plan
OHA/KFF 2025
105K
Healthier Oregon
KFF/OHA 2025
$478
Avg CCO PMPM 2026
OHA 2024
0.3%
Hospital Margin
OHA Dashboard
$836M
Uncompensated Care
OHA FY24
5.0%
Unemployment Rate
BLS Aug 2025

Policy Parameters

Traditional OHP Coverage Reduction i Traditional OHP population: individuals <138% FPL (Federal Poverty Level). Current enrollment: 1,263,000. Average PMPM: $480. Excludes Bridge Plan and Healthier Oregon populations.
0
Bridge Plan Coverage Reduction i Bridge Plan population: adults 138-200% FPL. Current enrollment: 32,000. Average PMPM: $550. State-funded program bridging gap between traditional Medicaid eligibility and marketplace coverage. Receives enhanced ACA Medicaid expansion federal match rate of 90% (federal pays 90%, state pays 10%).
0
Healthier Oregon Coverage Reduction i Healthier Oregon population: individuals eligible for Medicaid regardless of immigration status. Current enrollment: 105,000 (88,903 adults + 14,925 children). Average PMPM: $478. 100% state-funded program with no federal match (ineligible for federal Medicaid funding due to immigration status requirements).
0
CCO Payment Rate Reduction i Percentage reduction to CCO capitation rates. Baseline statewide average PMPM: $478.47. Current trends: medical cost inflation +10% annually; actuarial rate increases +3.4% annually (creating -6.6% baseline margin pressure).
0%
Benefit Package Reduction i Percentage reduction in covered services. Service cost composition: dental (~8% of PMPM), vision (~2%), mental health (~12%), other services. Benefit reductions create deferred care patterns, with estimated 50% conversion to emergency department utilization at higher per-episode costs.
0%
Health Acuity Adjustment i When enabled, models differential impact of coverage cuts based on population health acuity levels (expected costs due to population mix). Research shows: • Low-acuity (healthy) populations: 40% more likely to disenroll • Medium-acuity (some chronic conditions): baseline disenrollment • High-acuity (complex/chronic conditions): 35% less likely to disenroll This adjustment affects how coverage cuts impact different populations, with healthier individuals disenrolling at higher rates during Medicaid contractions, concentrating higher-acuity members in the remaining population.
Off
Note: Coverage reductions are modeled as independent populations with no overlap. Fiscal impacts are calculated using CY26 actuarial rates. State share: 42.25%, Federal share: 57.75%.

State Impact

Total Uninsured Population i Baseline uninsured population: 243,000 (5.7% of Oregon's 4.24M residents). This metric increases as individuals lose coverage through OHP, Bridge Plan, or Healthier Oregon reductions. Assumes 100% coverage loss translates to uninsured status (conservative estimate; some may transition to marketplace or employer coverage).
243,000
Total Coverage Loss i Sum of coverage reductions across Traditional OHP (1.26M enrolled), Bridge Plan (32K enrolled), and Healthier Oregon (105K enrolled). Total baseline enrollment: 1.4M. Coverage reductions modeled as distinct populations without overlap. Displayed as negative number to indicate reduction.
0
Statewide Uninsured Rate i Percentage of Oregon population (4,237,256) without health insurance coverage. Baseline: 5.7% (243,000 uninsured). Rate increases proportionally with coverage reductions. Does not fully account for partial offsetting enrollment in marketplace or employer-sponsored insurance, as studies show only 30-40% of Medicaid disenrollees gain other coverage.
5.7%
State Medicaid Program Expenditure Change i Oregon's direct state budget impact from Medicaid policy changes. Different programs have different federal match rates: • Traditional OHP: 57.75% federal / 42.25% state • Bridge Plan (ACA Expansion): 90% federal / 10% state • Healthier Oregon: 0% federal / 100% state (state-only program) Calculation: 1. Coverage reductions: Calculate separately by program using program-specific match rates 2. Rate/benefit adjustments: Use traditional FMAP for remaining enrollment 3. State budget impact = sum of all state share changes Positive values indicate state budget savings; negative values indicate state budget costs. This metric reflects only Oregon's direct fiscal impact, not broader economic effects (see Economic Impact metric below).
$0
State share: 42.25% | Federal share: 57.75%
Economic Impact from Federal Funding Changes i Federal Medicaid dollars create multiplier effects throughout Oregon's economy. Research on federal Medicaid spending shows a gross state product multiplier of 1.37 for federal healthcare dollars. Calculation: 1. Federal funding change = changes in federally-matched programs only (OHP + Bridge Plan) 2. Economic impact = federal change × 1.37 multiplier Note: Healthier Oregon is excluded as it receives no federal funding (100% state-funded). The multiplier captures direct, indirect, and induced effects: - Direct: Healthcare provider revenue (hospitals, clinics, pharmacies) - Indirect: Vendor purchases (medical supplies, equipment, services) - Induced: Employee spending in local economy, generating additional jobs and tax revenue Negative values = net economic loss to Oregon. Positive values = net economic gain. This is separate from the State Budget Impact above.
$0
Federal multiplier: 1.37x

Hospital Impact

Uncompensated Care (Annual) i FY24 baseline: $835.7M ($668M charity care + $168M bad debt). Increases through two mechanisms: 1. Coverage loss: $3,439 per newly uninsured person annually (derived from FY24: $835.7M ÷ 243K uninsured) 2. Benefit reductions: Estimated 50% conversion rate of benefit cuts to deferred care, with subsequent ER utilization at similar per-capita costs Uncompensated care directly reduces hospital operating margins and financial stability, particularly affecting safety-net and rural facilities.
$836M
Hospital Operating Margin i Baseline: +0.3% statewide average; 47% of Oregon hospitals operate at negative margins. Medicaid reimbursement covers ~56% of actual care costs. Margin deterioration factors: 1. Uncompensated care: -0.01 percentage points per $100M increase 2. Rate reductions: -0.15 percentage points per 1% rate cut (pass-through effect) Sustained negative margins lead to service reductions, workforce cuts, facility closures, and reduced access—disproportionately affecting rural and safety-net providers.
+0.3%

CCO Impact

CCO Financial Status i CCO average operating margin: -6.6% (based on projected medical cost trend: +10% annually; capitation rate growth: +3.4% annually). IMPORTANT: Significant variation exists among individual CCOs. Not all CCOs operate at a deficit. Individual CCO financial status ranges from profitable to severely distressed based on regional factors, membership acuity mix, and operational efficiency. Note: 10% medical trend rate requires verification from actual rate filings and historical data. Risk-Based Capital (RBC): CCOs are required to maintain adequate RBC levels per ORS 415.011. RBC ratios provide critical context for financial solvency beyond operating margins, but this data is confidential. Margin deterioration: Rate reductions create direct pass-through impact on PMPM basis (e.g., -5% rate cut = ~-$24 PMPM reduction).
Baseline Deficit
CCO Operating Margin Change i Average CCO operating margin change displayed as percentage on PMPM basis. Average baseline: -6.6%. Calculation shows impact from rate reductions and acuity concentration effects. More negative values indicate greater financial stress. IMPORTANT: This represents an average across CCOs. Individual CCO margins vary significantly - some CCOs may be profitable while others face severe deficits. Regional factors, membership acuity mix, provider networks, and operational efficiency all contribute to variation in CCO financial performance.
-6.6%

Individual Market Impact

People Affected by Premium Increases i Baseline marketplace enrollment: 139,688 Oregonians. As Medicaid coverage contracts, healthier individuals disenroll while higher-acuity individuals remain enrolled. This creates adverse selection in the marketplace as some former Medicaid enrollees transition to marketplace coverage. Estimated 15-20% of those losing Medicaid will enter the individual market, affecting risk pool composition.
139,688
Premium Increase from Adverse Selection i Baseline: $272/month average post-subsidy premium. Premium increases driven by: 1. Adverse selection effect: 4-6% premium increase as healthier individuals drop coverage while sicker individuals maintain it, worsening the risk pool 2. Cost-shifting from uncompensated care: 25% of increased hospital uncompensated care transferred to commercial payers through rate adjustments 3. Risk pool dilution: Former Medicaid enrollees entering marketplace tend to be higher-cost ($1.20/month per 1,000 losing coverage) Research shows premium increases accelerate coverage loss among healthier enrollees, creating a "death spiral" feedback loop.
+$0/mo

Calculation Methodologies & Data Sources

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Coverage Loss

Total = OHP + Bridge + Healthier Oregon New Uninsured = 243,000 + Total Uninsured Rate = (New Uninsured ÷ 4,237,256) × 100

State Budget Impact

Coverage Cost = (OHP × $480 + Bridge × $550 + Healthier × $478) × 12 ÷ 1M Rate Savings = (Remaining × $478.47 × 12 × Rate%) ÷ 1M Benefit Savings = (Remaining × $478.47 × 12 × Benefit%) ÷ 1M Acuity Concentration Cost (if Acuity ON): PMPM Increase = Adjusted PMPM - Base PMPM Cost = (Remaining × PMPM Increase × 12 × 0.4225) ÷ 1M Total = -Coverage + Rate + Benefit - Acuity Concentration Cost State Impact = Total × 0.4225 (state share) Federal Impact = Total × 0.5775 (FMAP)

Acuity Adjustment (Optional)

When enabled, models adverse selection: Healthier enrollees leave first, concentrating high-acuity individuals in remaining population Enrollment Loss %: <10% → Mild (1.10× PMPM) 10-25% → Moderate (1.20× PMPM) >25% → Severe (1.30× PMPM) Adjusted PMPM = $478.47 × Multiplier Affects: • State fiscal impact (higher costs/member) • CCO margins (acuity concentration penalty) • Marketplace premiums (spillover effect)

Uncompensated Care

Coverage Impact = (People Lost × $3,439) ÷ 1M Benefit Impact = (Benefit% × 0.5 × Remaining) ÷ 1M (Deferred care → 2x ER usage) Total = $836M + Coverage + Benefit

Hospital Margin

Uncomp Impact = (Additional Care ÷ $10B) × -100 Payment Impact = (Rate% × 0.15) × -1 Acuity Revenue Effect (if Acuity ON): Additional Revenue = (Remaining × PMPM Increase × 12 × 0.40) ÷ 1M Margin Impact = (Additional Revenue ÷ $10B) × 100 New Margin = 0.3% + Uncomp + Payment + Acuity Revenue Note: Margin data based on charged amounts, which may not reflect actual operating costs. Actual costs are typically ~56% of charges, with significant geographic variation.

CCO Financial Status

Average Operating Margin: -6.6% (Based on projected costs +10%, rates +3.4%) Note: 10% trend rate requires verification from actual rate filings and historical data. Rate Impact = -Rate% Fixed Cost Impact: Base Fixed Cost/Member = 0.15 × $478 Total Fixed Costs = Total Enrollment × 0.15 × $478 New Fixed Cost/Member = Total Fixed / Remaining Increase = New - Base Margin Impact (PMPM %) = (Increase ÷ $478) × 100 New Average Margin = -6.6% - Rate% - Fixed Cost% Important: Significant variation exists among CCOs. Not all CCOs operate at a deficit. Individual CCO financial status ranges from profitable to severely distressed based on regional factors, membership mix, and operational efficiency. Risk-Based Capital (RBC) Ratios: CCOs are required to maintain adequate RBC levels per ORS 415.011. RBC data is confidential but critical for assessing financial solvency beyond operating margins. Margin displayed as % change on PMPM basis to better reflect per-member financial impact.

Marketplace Premium

Cost Shift = Additional Uncomp × 0.25 Risk Pool = (Coverage Loss ÷ 1,000) × $1.20 Total Increase = Cost Shift + Risk Pool

Primary Data Sources

Data Element Source Date Value
CY26 Statewide Average PMPM OHA CCO Rate Model (Mercer) Sep 2024 $478.47
Bridge Plan Enrollment OHA Medicaid Enrollment Report / KFF Early 2025 ~32,000
Healthier Oregon Enrollment KFF / OHA (Adults + Children) 2025 105,000 (88,903 adults + 14,925 children)
Traditional OHP Enrollment Oregon Health Authority 2025 1,263,000
Oregon Population U.S. Census (2020) 2020 4,237,256
Uninsured Count OHA Emergency Response Sep 2025 243,000 (6%)
Hospital Operating Margin OHA Hospital Dashboard 2024 0.3%
Uncompensated Care OHA Hospital Audited Financials FY24 FY 2024 $835.7M
Medicaid Payment-to-Cost Ratio Hospital Association of Oregon 2023 56%
CCO Cost Growth OHA CCO Financial Analysis 2024 10% annually
CCO Rate Growth OHA Rate Setting 2024-2025 3.4% annually
Traditional OHP FMAP KFF / CMS 2025 57.75% (federal)
Bridge Plan FMAP (ACA Expansion) KFF / CMS / ACA Section 1905(y) 2020-Present 90% (federal)
Healthier Oregon FMAP Oregon Health Authority 2025 0% (100% state-funded)
Federal Medicaid Multiplier KFF 2025 1.37
CCO Administrative Overhead Industry Standard 2025 15%

Research Sources for Enhanced Model Features

Model Feature Key Finding Source Year
Acuity Stratification (Disenrollment Rates) Members with chronic disease 30-40% less likely to disenroll from health plans Journal of Managed Care & Specialty Pharmacy; PMC Articles PMC10398183, PMC2607511 2019-2024
Coverage Loss Utilization Impact Primary care visits drop to 45% (vs 82% with stable coverage); uninsured use 44% less care PMC Article PMC1578659 (Oregon Health Plan study); Commonwealth Fund May 2025 2006-2025
Uncompensated Care per Uninsured $3,439 per newly uninsured person annually Oregon Hospital Association FY24; Health Affairs 2016 2016-2024
Medicaid Expansion Impact on ED Use Mixed evidence: some studies show decreases in non-emergent ED visits, others show increases in access-related visits PMC Articles PMC10616539, PMC9198732; Science Direct 2017 2017-2023
Adverse Selection in ACA Marketplace 4-6% premium increase from risk pool deterioration when healthier enrollees drop coverage Peterson-KFF Health System Tracker June 2025; AJMC Nov 2025 2025
Medicaid-to-Marketplace Transitions 15-20% of Medicaid disenrollees transition to marketplace; higher-cost enrollees affect risk pools Alvarez & Marsal Healthcare Analysis; Commonwealth Fund 2018 2018-2025
Oregon Unemployment Rate 5.0% unemployment rate (highest since 2016 outside pandemic) Bureau of Labor Statistics; Oregon Employment Department August 2025
Medicaid Unwinding Impacts 70% of 16M disenrollees lost coverage for procedural reasons (not ineligibility); significant coverage gaps KFF Medicaid Unwinding Tracker; PMC Article PMC11701976 2024
Hospital Financial Impact Uncompensated care decreased from 4.1% to 3.1% of operating costs in expansion states; would increase 5.7% to 4.0% without expansion Health Affairs 2016; Commonwealth Fund May 2025 2016-2025
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