With Oregon facing billions of dollars in cuts to Medicaid and food benefits under H.R. 1, the federal tax and spending bill, local health providers expressed frustration and concern during a roundtable Aug. 28 with U.S. Rep. Andrea Salinas (D-Ore.) while holding out hope that some of the bill’s provisions could eventually be repealed.
Salinas hosted the roundtable at the Oregon Nurses Association headquarters in Tualatin, where she said these cuts will make Oregonians “sicker, hungrier, and poorer.”
The Oregon Health Authority anticipates it will lose up to $11.7 billion in federal funding through the 2029-31 biennium, and up to 200,000 Oregon Health Plan members could lose their coverage.
The state Department of Human Services also estimates losing nearly $3 billion for SNAP — the federal Supplemental Nutrition Assistance Program — from 2025-29.
Congressional Republicans who voted in favor of H.R. 1 argue cuts are needed to reduce federal spending and target fraud, waste, and abuse within the programs. But providers told Salinas they worry it will result in the closure of rural hospitals and clinics, forcing patients to travel longer distances and experience increased wait times for care.
“No one is going to get out of this easy,” said Samantha Shepherd, CEO of CCO Oregon, which advocates for Oregon’s coordinated care model.
OHA Perspective
Vivian Levy, Deputy Medicaid Director at OHA, said the agency faces significant challenges as Medicaid provisions under the bill take effect.
Starting in fiscal year 2028, the maximum rate for the Hospital Provider Tax will be gradually lowered from 6% to 3.5% by fiscal year 2032, choking off billions of dollars in funding. Beginning in the first quarter of 2027, the state will also be required to reverify eligibility every six months rather than once every two years, accounting for new work requirements to stay insured. That will require additional administrative staff to handle the increased workload, Levy said.
As more people lose coverage, Levy said the state will bear more of the cost burden through Healthier Oregon, which provides free health coverage through the Oregon Health Plan to low-income and uninsured residents regardless of age or immigration status.
Though Levy said the state has a “solid plan” to ensure compliance, she admitted the next four years won’t be easy.
“We are working closely with our federal partners at CMS (the Centers for Medicare & Medicaid Services) to try and make sure we are doing what we are required to do, and at the same time doing what we always do in Oregon which is to take every action we can to make sure we’re taking care of eligible people,” Levy said.
Though providers on the roundtable panel did reserve some hope that Congress may revisit certain provisions, like the provider tax and six-month eligibility checks, Salinas told the Salem Business Journal that she remains skeptical.
“President Trump has such a stranglehold over this Republican conference in the House and in the Senate that I would be shocked if he let them roll back on anything,” Salinas said.
Providers React
Providers told Salinas the impacts from Medicaid cuts will be felt by patients and doctors alike.
Gil Muñoz, CEO of the Virginia Garcia Memorial Health Center, said his organization serves 52,000 people — including migrant and seasonal farmworkers — at 18 locations in Yamhill and Washington counties. Muñoz said they anticipate up to 25% of those in the expanded adult population will not be able to keep up with the new work requirements, meaning they fall off of Medicaid and increase the center’s uninsured population.
Meanwhile, the center still plans to open new location in Sheridan in October, though Muñoz said it now comes with “a lot more risky financial projections” given the erosion of eligibility on Medicaid and flatlining of federal grants.
“That’s going to put stress on a clinic in a rural area that is really focused on serving the broader population,” he said.
Christy Trotter, CEO of the Yakima Valley Farm Workers Clinic, said she worries about losing progress made in primary preventive care. According to a 2016 evaluation of Oregon’s Patient Centered Primary Care Home program, researchers found that for every $1 invested in primary care, it resulted in $13 in savings in other specialty and emergency services.
Paige Spence, with the Oregon Nurses Association, said more closures also mean lost jobs and the erosion of Oregon’s health care workforce.
“Our labor affiliates are looking at about 10,000 health care jobs that could lost in just one year,” Spence said.
Despite Oregon’s coordinated care system being a model for success across the country, Salinas said H.R. 1 creates instability that could topple the entire program. She urged providers to continue flagging their concerns as federal agencies conduct rule-making.
“It’s going to be really shaky. The whole model could disintegrate, it feels like,” Salinas said.
“The needs and acuity of patients are just increasing. With that comes increasing costs, and the payments are not keeping up. With this additional burden, it’s going to hurt our CCO system.”
