The Childrens' Community Clinic on N.E. Killingsworth serves many uninsured children of all racial and ethnic backgrounds from Portland and Southwest Washington. Just three percent of the children served have private health insurance. Above, Dr. Nitikul Solomon examines patient Sophia Aeto, who is just three months old. Sophia's mother, Shawna Walton, is at right.
Low-income Oregonians without health insurance now have a chance of getting health care through the Oregon Health Plan. Between now and the end of February the plan will be taking names and addresses of adults who need health insurance.
"If you are interested and you are without health insurance, and you are 19 years or older, then get on the list," said Roger Staples, project specialist with the Department of Human Services, medical assistance programs. Anyone can get on the list, he said.
"We'll collect names through the entire month of February and in early March we'll … randomly select names. We'll select 3,000 names in March and mail out 3,000 applications and we'll do that every month until we reach our targets."
If you think this sounds like a lottery, you're right. Because the state doesn't have funds to cover everyone, workers will send out 3,000 applications a month until an average count of 24,000 people a month have been enrolled – measured over the two-year budget period. Staples said about 10,000 Oregonians will be added to the roles.
The new enrollment program is for adults. Close to 600,000 Oregon adults lack health insurance. Since 2004, when the Oregon Health Plan shut its doors to new enrollment, health insurance through government assistance has been available only for seniors, disabled people and pregnant women.
About 116,000 Oregon children also don't have insurance. According to Sean Kolmer about 60 percent of them are entitled to health insurance through state and federal medicaid programs. And children can apply for assistance at any time.
"Anyone (children and youth up to age 18) under 200 percent of poverty level … would be income eligible for health insurance," Kolmer said. "That would be about 70,000 children."
To be enrolled in the health plan, adults must be at or below the federal poverty level. Under new guidelines issued last week the federal poverty level for a family of three equals an annual income of $17,600. To rise above the 2008 poverty level, a full-time worker supporting a family of three would need to earn more than $8.46 per hour. Oregon's 2008 hourly minimum wage is $7.95.
However, Staples said every lower income Oregonian without insurance should submit their names. Even if you are above the federal poverty level right now, he points out, your circumstances may change, and many applications won't be sent out for some months.
Under the planned expansion of the health plan, large numbers of adults and children still will be without health insurance.
"This is good but it's a small improvement, far shy of full coverage for all Oregonians," said Michael Leachman, a policy analyst with Oregon Center for Public Policy. "Everyone knows that the cost of health care is skyrocketing and for a lot of families – not just low-income families, a health emergency can be disastrous."
Leachman said the poverty level formula used to determine eligibility for health plan coverage is an outdated measure based on 1950s research. In the 50s families spent about one third of their incomes on food, Leachman said.
"..so the formula estimates the cost of a meager basket of food for a month and multiplies it by three. But today housing, health care, and transportation are a much bigger portion of family expenditures. Several studies have shown that what families actually need to live a modest lifestyle is around twice the poverty line."
Kevin Finney, public policy director for the nonprofit Ecumenical Ministries of Oregon, said people without insurance are prey to more serious health problems that cost more to treat. Even middle class families are struggling to afford health care, he said.
"As we have seen the cost of health care has risen dramatically making it unaffordable; some families are paying far too high a portion of their income for insurance."
Finney said federal matching funds are available, that could be used to cover Oregon children, but to qualify for those the state too would have to spend more on health care.
Up to 5,000 more children may be added to the Oregon Health Plan, under a bill currently before the legislature. Rep. Tina Kotek, D-North Portland, said the bill, which is likely to become law in February, will reduce red tape so that instead of having to reapply every six months, eligible children are kept on the plan for a year.
"It'll make it a lot easier for families to keep kids on the plan," Rep. Kotek told the Skanner. "We know we are losing eligible kids every six months, so if we keep them on the plan they're going to have more continuity of care. It's small but the end result is we will have more kids covered."
To add a name to the Oregon Health Plan reservation list, all you need is the person's name, birth date and a mailing address. If the person is chosen in the lottery to apply, the actual application will be mailed. To add your name to the list, call 800-699-9075 between 7 a.m. and 7 p.m. Monday through Friday. You also can have anyone call for you. The call will take from 10-20 minutes. Forms are available from Department of Human Services offices, county health clinics most hospitals or online at www.oregon.gov/DHS/open/request-form.shtml
What wouldn't you do?
They come from all over the Portland metro area and Southwest Washington. From newborns to teens, White, Latino and African American: some are in pain, others are heading toward a serious health crisis.
They need everything from vaccinations to long term care. And most of these children arrive at the Childrens' Community Clinic on Northeast Killingsworth Street there because their families don't have health insurance.
"Imagine you are the parent of a small child who has an accident or wakes up with a very high temperature and you don't have health insurance," says Mardica Hicks, executive director of the nonprofit. "What wouldn't you do? Can you imagine that kind of stress?" Just about 3 percent of the children who seek help from the clinic have private insurance," Hicks says. Another 65 percent are on the Oregon Health Plan – in fact, the clinic helps identify eligible children. The rest have no insurance at all.
"The majority of our parents are working parents," Hicks notes. "Our families have jobs, but the jobs don't come with health benefits or they can't afford the cost of the insurance."
Part of the Coalition of Community Clinics, the Childrens' clinic is set up to offer "excellent, high quality medical care" for these children. Last year the clinic served 21,000 children. This year Hicks hopes to expand that number by 30 percent.
Helping the clinic fulfill its mission are a network of community partners that include other coalition clinics, Multnomah County, local hospitals such as Legacy Emmanuel, which offers testing facilities and Kaiser Permanente, and the Oregon Community Foundation which recently donated $16,500 to the clinic.
Because of the cost of providing health care, Hicks said, more community help and partnerships are needed. "There is a great need for more funding and support for clinics like ourselves that provide services to children who are uninsured or underinsured," Hicks said. "We need stable funding, not just for operating expenses but for high quality lab facilities so we can do basic tests and for the technical equipment clinics need to provide efficient and effective care."
Next the clinic will team up with Oregon Health and Sciences University and Portland Adventist, April 23, to offer a day of free health screenings: blood glucose, body mass index and blood pressure to help identify and prevent health problems. A location and more details will be announced nearer the date.
Hicks would like to see all children insured. "In the long term, the solution really is finding a way to provide medical care for all our citizens – not only those who happen be fortunate enough to have coverage at a low cost," she says. "The bottom line is that we all pay for this in one way or another."