Cuts to Medicaid as part of the “Big Beautiful Bill” signed July 4 have local healthcare providers concerned.
According to the Oregon Health Authority up to 200,000 people could lose access to the Oregon Health Plan, which is about 14% of OHP’s enrollment and 31% of the group eligible through Medicaid’s expansion. If these cuts are proportional to current enrollment, it would mean 18,045 people in Lane County would lose their health insurance.
How Medicaid changes could leave more people uninsured
Community members march to the steps of the Oregon State Capitol to protest potential Medicaid cuts on Wednesday, April 16, 2025 in Salem, Ore.
The bill limits who is eligible for Medicaid through changes such as new work requirements and more frequent eligibility checks.
It will take a while for the full brunt of the changes to be known. States have until Jan. 1, 2027, to implement the required changes, but may begin rolling them out sooner.
Health policy think tank KFF said after Arkansas imposed a Medicaid work requirement, about 25% of Medicaid enrollees lost coverage primarily because they failed to regularly report work status or document eligibility for an exemption.
Emma Sandoe, the medicaid director of Oregon Health Authority, speaks during a Senate Committee public hearing on health care at the Oregon State Capitol on Tuesday, June 3, 2025, in Salem, Ore.
Local health care providers said this increase in people without health insurance will have systemwide impacts.
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Local health care providers worry about unreimbursed costs
Private clinics aren’t required to serve patients without insurance who can’t pay, but the public Federally Qualified Health Centers run by Lane County and emergency rooms are, driving up unreimbursed costs. This can be seen through financial data from before and after the Affordable Care Act expanded Medicaid access.
Most of the ACA’s major provisions went into effect in January 2014. According to Oregon Health Authority data PeaceHealth Riverbend reported $42.7 million in “charity care” for uninsured patients in fiscal year 2013. This dropped to $36.3 million in FY 2014, and $10.7 million in FY 2015. However, it has climbed back up, and was $43.5 million in FY 2024.
Dr. Jim McGovern, chief hospital executive for PeaceHealth, said PeaceHealth hospitals have had “negative margins for the last several years” and 20% of payers are Medicaid patients.
“We can’t afford more free care,” he said. “I have a lot of fear for where our health care system in Oregon and nationally is going to be because of these cuts.”
Matt Calzia, a nurse speaking on behalf of the Oregon Nurses Association, predicted a reversion would lead to layoffs at hospitals. Jim Murez, a spokesperson for PeaceHealth, said it’s too early to predict how the bill will affect the organization “with any real detail.”
Beyond the ER: Medicaid pays for more than doctor visits
Eve Gray, director of Lane County Health and Human Services, said in Lane County’s clinics, roughly 70% of the patients are insured through Medicaid.
Gray also noted many services community members may not immediately think of as funded by health insurance are paid through Medicaid.
This includes nonprofits that provide behavioral health care such as Looking Glass youth homeless shelters, vouchers for air conditioning and generators for people with disabilities or who need to keep medication refrigerated, housing vouchers and food assistance for Medicaid recipients, community health workers such as doulas, and Lane County’s Developmental Disability Services.
“We provide case management for every person in Lane County who has an intellectual or developmental disability that prevents them from fully participating in society,” Gray said. “All of that is Medicaid dollars.”
Gray added Medicaid pays for caregivers and family members who can’t work full-time because they must care for people with developmental disabilities.
“When you look at the breadth and scope of what Medicaid pays for, it’s massive,” she said.
Lane County Commissioner Laurie Trieger mentioned Lane County’s behavioral health stabilization center as a program threatened by Medicaid cuts. It has secured money for construction, but for operational revenue county staff previously predicted this center would serve 70% Medicaid patients.
At a roundtable where they heard from providers, lawmakers representing Oregon were sympathetic and critical of Republicans who voted for the bill.
“People understood when we began the Trump administration, there was going to be a debate about about health care. But this goes way further, further than anybody’s talking about, so this is the most important issue.” said Sen. Ron Wyden, D-Oregon. “If you or your loved ones don’t have their health care, everything else falls apart.”
Healthier Oregon and immigrant healthcare
A crowd of about 100 people gathered in the Illinois Capitol on Wednesday, Feb. 26, 2025, for a rally urging state lawmakers to continue to support pro-immigrant policies, including Illinois’ programs for non-citizen health care, in addition to opposing the Trump administration’s executive orders on immigrations.
The bill also specifically states that undocumented immigrants cannot receive Medicaid benefits. Federal money already doesn’t pay for this coverage, but a few states, including Oregon, use state tax dollars.
In Oregon, the Healthier Oregon Medicaid expansion covers immigrants ineligible for traditional Medicaid. In OHA’s 2025-27 budget, the state legislature allocated $948 million to Healthier Oregon for the biennium. This includes both the insurance coverage and the staff who run the program.
According to OHA data, 728 children and 4,243 adults in Lane County are insured through Healthier Oregon.
Gray said it was too early to tell what the changes would look like. Federal officials haven’t yet drafted new rules or outlined penalties for states funding Medicaid coverage themselves.
Gray said Oregon offers Medicaid to immigrants “for good reason.”
“If someone is living in our community, the most expensive place that they could seek care would be the emergency room,” she said. “So it’s better off in terms of our overall community’s health as well as potential costs … if folks are insured and they can receive care at the least expensive place possible, at the earliest point possible.”
Abortion and gender-affirming care rules unclear
The bill singles out gender-affirming care and abortion as services Medicaid will no longer cover.
Gray said for gender-affirming care, it’s not clear if this is an all-out prohibition or applies to certain situations. She’s waiting for more information, but said the state has legal protections for this care, and would cover it even if not federally reimbursed.
The bill goes further on abortion, saying no abortion provider can receive Medicaid funding, even if it’s for other health care services. Last month, a judge blocked this provision, but Amy Handler, chief executive officer of Planned Parenthood of Southwest Oregon, said the policy has been “bouncing back and forth” in the courts, and right now, Planned Parenthood isn’t able to bill Medicaid.
In a statement, Christopher Coburn, executive director of Planned Parenthood Action Oregon, said 70% of Planned Parenthood patients use Medicaid, and if the change goes through, it would amount to a “backdoor abortion ban” that would close health centers.
Handler said Planned Parenthood of Southwest Oregon is evaluating whether it will have to close clinics. She said there are no immediate plans to do so but the future is uncertain.
Alan Torres covers local government for the Register-Guard. He can be reached byemail at atorres@registerguard.com, on X @alanfryetorres or on Reddit at u/AlfrytRG.
This article originally appeared on Register-Guard: How changes to Medicaid will affect health care in Lane County