Editor’s Note: Let’s Talk Tillamook is a community series that shares how federal policies affect
our lives in Tillamook County. This Q&A is based on an interview with Dr. Tim
Borman, a semi-retired local physician, on what changes to Medicaid mean for our
community. Listen to the full interview at: https://www.youtube.com/watch?
v=YM-B9Kbuh90
Let’s Talk Tillamook: Understanding the Future of the Oregon Health Plan
By Dr. Tim Borman, Semi-Retired Local Physician
Q: What is Medicaid, and how does it work in Oregon?
A: Medicaid is a joint federal and state program that helps cover medical costs for
people with limited income. In Oregon, it’s called the Oregon Health Plan (OHP).
OHP serves children, pregnant women, people with disabilities, and elderly adults.
Currently, the federal government pays about 76% of the cost, and Oregon pays
about 24%.
Q: How does Medicaid differ from Medicare?
A: Medicare is a federal health insurance program for people age 65 and older, as
well as some younger people with disabilities. Unlike OHP, Medicare has the same
rules across all states and typically requires participants to pay premiums,
deductibles, and coinsurance. Medicare generally does not cover long-term nursing
home care. That gap is filled by OHP, which pays for services for about 60% of
nursing home residents in Oregon.
Q: How many people rely on OHP in Oregon and here in Tillamook?
A: Across the state, 59% of children and 34% of adults are covered. Nearly half
of all births in Oregon are paid for through OHP. Here in Tillamook County, about
8,000–8,500 people—roughly one-third of the population—are enrolled.
Q: Who qualifies for OHP?
A: Eligibility depends on income, family size, and health status. For example, a
family of four with an annual income below about $43,000 may qualify. OHP is
designed to help people who might not otherwise afford health insurance.
Q: What changes are coming to OHP?
A: Beginning January 2027, Oregon will receive less federal Medicaid funding.
That means fewer services and fewer people eligible for OHP. Rural areas like
Tillamook are expected to feel the cuts hardest. Without insurance, people often
delay care until it becomes urgent, leading to worse outcomes and much higher
costs. For example, an urgent care visit might cost $150–$250, while an ER visit
for the same condition could be $1,500–$3,000. If small hospitals can’t keep up,
some may close.
Eric Swanson, president of Adventist Health Tillamook, notes that 35% of the
hospital’s patients rely on OHP. He warns that cuts will be “devastating to
people on Medicaid.”
Q: What about the new work requirement?
A: Also in 2027, most OHP members ages 19–64 will have to document at least 80
hours of work per month (or prove exemption) to keep coverage. While 71% of
OHP members already work, many who don’t are elderly or disabled. The online
reporting system may create barriers, especially for rural residents with limited
internet access.
Q: What can people do now?
A: If you think you may qualify for OHP, it’s best to apply before December 2026,
when enrollment will likely become more complicated. Visit the Oregon Health
Plan website or contact the Tillamook County Community Health Center for help
applying.
