Oregon eyes insuring the undocumented as pandemic exposes racial gaps in health care

(The Center Square) – A pair of bills in the Oregon Legislature aim to close racial gaps in health care coverage as disparate case rates in the pandemic have highlighted.

The first piece of legislation, House Bill 2164, would have the governor submit health care equity recommendations to state lawmakers by fall of 2022 with the intent of setting up a state-based health care program for all Oregonians.

The second piece of legislation, House Bill 3352, or Care For All People, would build on the state’s Healthcare for All Oregon Children program, which made health care coverage available to kids and teens from families making up to 300% of the federal poverty level. In 2017, the program was extended to children of all immigration statuses. Care For All People would extend that coverage even further to adults of any immigration status making 138% of the federal poverty level. Pregnant women would see that threshold raised to 190%.

HB 2164 is among the first product of Gov. Kate Brown’s Racial Justice Council Health Equity Committee, which is committed to closing racial gaps in the state’s health care system by 2030.

State data from the Oregon Health Authority (OHA) has pegged the number of insured Oregonians at 94% in 2019, but that figure still left out some 248,000 people. Of those people, young adults ages 34 and younger accounted for 12%, the highest among any age group. About 15% of Hispanics and Latinos remained uninsured, the highest of any racial minority group.

By the U.S. Census Bureau’s current estimates, people of color make up 24.9% of Oregon. Hispanics and Latinos make up 13.4% of the state while Asians make up 4%, and Black and African-Americans make up 2.2%.

By contrast, white people account for 49% of COVID-19 cases in Oregon to date. Hispanics and Latinos account for 26% of all cases while Asians make up 3.1%, and Black and African-Americans make up 2.4%.

Racial inequities continue to characterize Oregon’s vaccine rollout. In February, OHA Director Patrick Allen noted that white individuals accounted for 74% of the state’s vaccinations while vaccinations for Latinos and African-Americans totaled 5% or less.

Case rates in the state among Hispanics and Latinos are largely connected to their critical role in Oregon agriculture. In 2017, 14% of Oregon’s agricultural industry and 12% of its construction workers were undocumented immigrants who have to wait until March 29 for priority vaccinations.

HB 3352 is just as personal for some working in the halls of the state legislature. Born to two migrant farmworkers, state Rep. Teresa Alonso Leon, D-Woodburn, told the House Health Care Committee how she and her parents would walk to the next town over where they would have to choose between paying for care or putting food on the table for their children. They put their children first, she said.

“Similar to my parents, we still have many immigrants, agricultural workers, small business owners, and others who forgo seeking treatment and wait until it becomes an emergency to seek health care,” Leon said. “Lack of accessible and affordable health care results in the perpetuation of inequitable systems and weight Oregonians and their families with unnecessary economic burdens.”

Gov. Brown said on Tuesday to the House Health Care Committee that HB 2164 could pay for itself in the long term. In 2019, uncompensated care including services like emergency room visits, totaled $680 million in Oregon.

State Rep. WInsvey Campos, D-Oregon, acknowledged on Tuesday that even as a sponsor of HB 3352, the bill is more of a conversation starter right now without a fiscal note, but it’s one that her peers need to get started on now.

“I know that the cost of this step forward maybe higher than we think we can pay,” Campos said. “But the cost of the lives of our community members will be far higher.”

Testifying to members of the committee, OHA Director Patrick agreed with Brown that expanding coverage made good economic sense, but he said it’s important to building trust health care community.

“Coverage isn’t an end in and of itself,” Allen said. “It’s a tool to provide care. Most importantly, it’s a tool to provide an ongoing relationship with a doctor, a nurse, a clinic, a place where trusted relationships are built, where chronic diseases can be managed, where health can be improved.”

The two bills have seen wide support from doctors, civic activists, and the Oregon League of Women Voters. A few people testifying on Tuesday clung to the brief that widely available health insurance would draw undesired individuals into the country.

For José Jaime, owner and CEO of J and L Jaime Translations, caring for one another is not a hard decision.

“The members of our undocumented community are part of your neighborhood, they are your constituents, they are your colleagues, your kids play with the kids whose parents are undocumented,” Jaime said. “Caring for all members of our community shouldn’t be a radical act.”

Health care is among Brown’s top priorities in her $25.6 billion proposed budget which includes a $10 million pilot program to expand coverage for undocumented and uninsured Oregonians. It is unclear if the state will hold off on building the addiction centers approved by voters last fall through Measure 110 as Oregon is set to pocket $4.2 billion in federal stimulus money.

All 50 states are expected to open priority vaccinations to the general public by May 1 at the direction of President Joe Biden. Allen has since confirmed to Oregon Public Broadcasting on Wednesday that Oregon plans to abide by the federal timeline following non-committal remarks by Brown last Friday.

Oregon has now seen 160,050 cases of COVID-19 and 2,346 deaths from the virus since it reported its first case on February 28.

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