PORTLAND, Ore. - Many Oregon adults who were uninsured and living near the poverty line used to have to sign a waiting list of thousands of names, and hope they were selected in a lottery-style drawing for health insurance. For them, the new year brings big changes.

Oregon is one of 26 states expanding its Medicaid programs under the Affordable Care Act. Medicaid coverage is known as the Oregon Health Plan, and up to 300,000 more people are now eligible for the coverage that starts on Jan. 1.

The lottery days are gone, says Erin Fair Taylor, director of Coordinated Care Organization (CCO) Partnership and Development for CareOregon.

"In essence, anyone who would have been income-eligible to enroll under the lottery program will now automatically be eligible to enroll in the Oregon Health Plan," explains Taylor. "There's no need for the lottery anymore, which is pretty exciting."

She adds the Oregon Health Plan expansion hasn't been plagued with the same problems as other parts of the state's healthcare reform rollout. The Department of Human Services pre-qualified many low-income individuals and families, and informed them of the expansion. More than 100,000 have responded by signing up.

Of course, the challenge to having more people with health insurance is the potential shortage of health care providers. Taylor says CareOregon and its partner CCOs anticipated this. In places like Jackson County, where one in four residents is Medicaid-eligible, they're working to convince more doctors and dentists to accept Medicaid. They're also working to make it possible for those who do, to see more patients.

"Whether it's helping them recruit additional providers, or helping them with some technology, or even in some cases, new office space or buildings, those kinds of things," says Taylor. "So, we're trying to take a creative approach, recognizing there isn't a one-size-fits-all to this, and that each community really has unique needs."

She notes there is no deadline for signing up for the Oregon Health Plan. Anyone whose income is at or below 138 percent of the federal poverty level is eligible, which equates to an annual income of about $32,000 a year for a family of four.



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Access to reduced-price medication is a necessity for many rural Missourians with low income.

Rep. Cindy O'Laughlin, R-Shelbina, the Senate Floor Leader, said Big Pharma is trying to confuse legislators with unrelated hot-button topics such as abortion access and illegal immigration in a last-ditch effort to stop the state from joining a program to force drugmakers to sell medicines at a discount.

"Appealing to nuclear topics, which really do not apply in this situation, is a disingenuous way to try to defeat a bill that is actually good for Missouri," O'Laughlin asserted.

O'Laughlin pointed out the program is transparent, and uses the tax money saved to help low-income families deal with chronic conditions such as diabetes.

The drugmakers object to the government forcing them to give significant discounts, arguing hospitals' and for-profit pharmacies' bottom lines, particularly those owned by pharmacy benefits managers, are being exploited. Nationally, 46% of contract pharmacy agreements involve pharmacies linked to the three largest benefits managers.

Rep. Tara Peters, R-Rolla, introduced the 340B contract pharmacy access billand said the lobbying is absurd.

"Federally, 340B program does not allow for abortion drugs," Peters stressed. "Why would any legislation that we're trying to pass in the state allow for that? I mean, the thought of that even being in existence is absolutely ludicrous."

The Missouri Senate passed the bill 27-3 on Monday and it now goes to the House.


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Alabama is running out of time to tackle Medicaid expansion this legislative session.

More than 230 people gathered earlier this month with the group Alabama Arise, urging state lawmakers to prioritize the issue. Their message: Access to health care isn't just a matter of policy, it can be a matter of life and death.

Debbie Smith, Cover Alabama campaign director for Alabama Arise, said as the session winds down, the group will continue to echo the call for increased access to health coverage. She thinks it would not only save lives but revitalize communities across the state.

"Over 80% of our rural hospitals are operating in the red," Smith pointed out. "Not a great stat. About 19 rural hospitals are at immediate risk of closure, and those are the lifeblood of those communities. They're on life support."

Smith emphasized hospitals at financial risk also put their workforce at risk. Those who are against Medicaid expansion believe it is ultimately unaffordable for the state. However, Smith argued it could save the state nearly $400 million over the next six years. According to the Public Affairs Research Council of Alabama, those savings would be enough to cover the cost.

The council's study also showed Medicaid expansion would generate nearly $2 billion of economic growth. Beyond economic benefits, Smith pointed to the stark disparities in maternal and infant mortality rates in Alabama.

She stressed Medicaid expansion would do more than provide health care coverage during pregnancy or postpartum, it is about ensuring comprehensive coverage.

"We've been lucky enough to expand Medicaid coverage up to 12 months postpartum but we still need to figure out how to cover people before they even get pregnant," Smith asserted. "It's really important for people to have health coverage so they can address any kind of issues they might have, like if they have diabetes or high blood pressure that might affect their pregnancy in the future."

With limited time left in the legislative session, she noted one option could be Gov. Kay Ivey's executive authority to enact Medicaid expansion. Smith added using the power could be the simplest path forward, backed by the promise of additional funding from the American Rescue Plan.

A Connecticut bill would expand the state's paid sick leave law.

The initial 2011 law requires 40 hours of paid sick leave for workers at employers with 50 businesses or more. The new bill covers all workers regardless of their employer's size.

Janée Woods Weber, executive director of the nonprofit She Leads Justice, said the legislation can benefit workers without access to paid sick leave.

"These are people for whom taking a few hours off when their child has a cold or perhaps they need to take themselves to a doctor's appointment are the kinds of challenges that many of us don't worry about, those of us who do have access to paid sick days," Woods Weber explained.

Small businesses were concerned about how the change could affect them. To address worries, the bill has a three-year implementation cycle giving them time to adapt. It also creates a task force studying the feasibility of providing tax credits to businesses with the smallest workforces. The bill passed the House and awaits a vote in the Senate.

An estimated 11% of workers are eligible for paid sick leave under the current criteria. Though expanding the law has taken over a decade, Woods Weber argued it has always been necessary.

"Nobody should be forced to make what is often times a very difficult and sometimes impossible choice between their livelihood," Woods Weber emphasized. "Getting a paycheck and getting to take paid time off to take care of themselves or a loved one if they get sick."

She added that once the bill is passed, the state can build off it by allowing people to earn more than 40 hours of paid sick time. Woods Weber said the isolation requirements during the pandemic forced anyone who got COVID-19 to use their allotted sick time all at once for isolation.


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