Photo courtesy of Ross Grami/Yes for Healthcare

On Tuesday, Oregon residents voted to fund the state Medicaid program by levying fees, known as assessments, on hospitals and insurance providers in the state. The ballot referendum, named Measure 101, had the support of virtually every healthcare advocacy organization in the state, including the organizations that would be paying for it.

Not only will the fees maintain Medicaid funding; because they should lead to more people getting preventative care, and therefore driving down costs, it’s estimated the measure could reduce premiums by up to $300 a year for those who buy their own insurance.

While this ballot measure got little national attention, it is both a welcome victory for healthcare access and, paradoxically, an illustration of much of what’s wrong with American governance today. Specifically, in this case: hardline conservative politicians inserting pointless procedural steps into the legislative process in order to confuse voters and hurt their most vulnerable constituents in the process.

Measure 101 shouldn’t have been on the ballot in the first place.


With a population of 4.1 million, Oregon is a relatively small state. But its residents have reaped big benefits from the passage of the Affordable Care Act, with Oregonians seeing one of the most dramatic increases in healthcare coverage of any state.

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In many ways, Oregon is the poster child of the successes of Obamacare. Since the law took effect, Oregon’s uninsured rate has fallen from 17 percent to 5 percent. Today, more than 95 percent of Oregon residents have healthcare coverage—compared to 91.2 percent nationally—and 98 percent of children in the state are covered.

Medicaid expansion has been crucial for Oregon. Roughly one in four Oregonians depend on Medicaid for their health coverage, and more than 400,000 Oregon children are enrolled.

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In 2017, Republicans and Democrats in the Oregon state legislature passed a funding package that included the Medicaid funding mechanism, with the support of virtually every stakeholder group and affected population. Then, a trio of hardline Republican state lawmakers decided to try to blow everything up.

After the state legislature passed the funding package, three Oregon state representatives, Julie Parrish, Cedric Hayden, and Sal Esquivel, decided to throw one crucial part of the package to a ballot referendum, a common Republican tactic in a state where it only takes around 60,000 signatures to put the repeal of a piece of legislation up to a public vote.

“This is a very small number of legislators that were frustrated by the process and are politicizing something that the vast majority of the organizations that work in this arena—that don’t always agree on everything—came together and agreed to,” said Chris Coughlin, the legislative director at Children First for Oregon.

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The measure to fund Medicaid passed handily Tuesday night. If it had failed, hundreds of thousands of Oregon families, seniors, and people with disabilities could lose their healthcare entirely. It would have also blown a gigantic hole in the state’s budget:

If the measure is defeated there will be a reduction of $210-$320 million in state revenue, resulting in a possible reduction of $630-$960 million, or more in federal Medicaid matching funds. The total revenue reduction to the 2017-19 state budget may be $840 million-$1.3 billion or more.

“The thing to realize is there is no Plan B here. This would break our Medicaid system, without a viable alternative to keep people covered,” Coughlin said. “We really feel that it’s irresponsible at best and cruel at worst.”

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The group Yes on Healthcare formed in response to the ballot measure, and collected a critical mass of support for the measure from healthcare and patient advocacy groups. Since this was a rare January special election with just one measure on the ballot, it was critical to get people to send in their ballots.

“It’s really expensive to live here, and it can be hard to find a living wage job, so Medicaid is really important to people,” Patty Wentz, the organization’s director, said. “Particularly for young people who have kids, [Oregon Health Plan] is a real lifeline.”

The Oregon hospitals and insurance providers who back Measure 101 understand that expanding healthcare coverage benefits all parties. When poor and sick people have health insurance, they are able to seek preventative care, rather than depending on expensive emergency room visits. Widespread preventative care drives down costs for everyone.

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So why did this become a ballot measure in the first place? The answer shows just how far down an ideological rabbit hole some Republican lawmakers have gone. Parrish, the Republican lawmaker who spearheaded the ballot measure, explained that she wanted to “break” the Medicaid system in the state. “You know, sometimes the way to heal that broken bone that didn’t heal right is to break it and reset it. And that’s kind of what Measure 101 is about,” she said at a debate in December.

The parallels between this story and Republicans’ efforts to repeal the Affordable Care Act nationally are clear. Both stories reveal rightwing Republican lawmakers’ undergirding mentality, a combination of misinformation and reckless nihilism. The most recent national example of this recklessness can be seen in Republicans’ refusal to reauthorize the Children’s Health Insurance Program, for no clear reason except to use it as possible leverage in negotiations with Democrats.

“Their position has been almost identical: ‘Let’s repeal it and we’ll replace it with something else. Just trust us,’” Wentz told me. “And we’re finding that people in Oregon do not trust that.”

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Today’s Republican lawmakers, across the country, operate under some combination of bad faith and ignorance. They have told us—are still telling us—that they don’t care about blowing up a system that provides health care to hundreds of thousands of children.

On Tuesday, a lot more Oregonians showed that they do care. After a year of hearing “no” from Republican lawmakers, in Oregon and nationally, voters in Oregon got their own chance to say yes.