Dear Congressman Bentz,
As a former 3-term Oregon governor and emergency physician in rural Douglas County, I want to emphasize the violence that the so-called “Big Beautiful Bill” will inflict on the people of your district and on the people of our state. Today, over 1.4 million Oregonians—and nearly 40% of your constituents—depend on Medicaid to gain access to needed medical care. Many of these are women and children.
Under the Senate version of the bill, that you will be voting on this week, approximately 237,500 Oregonians will lose Medicaid coverage, many of them in your district. In addition, the state will lose in the neighborhood of $33.9 billion in federal revenue over the next ten years. The hypocrisy here is stunning. While these cruel cuts to Medicaid are an effort to offset the cost of a huge tax cut for billionaires and large corporations, the legislation will actually increase the national debt by over $3.9 trillion, according to the Congressional Budget Office, leaving the mounting bill for our children and grandchildren to pay.
At the same time, the bill is shifting a $33.9 billion cost to Oregon, which will precipitate a budget crisis in your state. As you know, Oregon is constitutionally required to operate on a balanced budget. Since our legislature does not have the luxury of pushing their difficult political choices into a deficit, they will be forced to pit health care funding directly against funding for schools and public safety.
Denying nearly a quarter million low income Oregonians a way to pay for their health care is not only immoral, it will not save money in the long run. People who lose insurance still get care. When they get sick enough, they show up in the emergency room, where federal law—The Emergency Medical Treatment and Labor Act—(EMTALA) requires that they be seen and treated. So, in many cases, the systemwide cost is higher, not lower. The only way to avoid this, would be to repeal EMTALA and say, in essence, that if you show up in the ER without insurance, we will let you die on the ambulance ramp. I can’t imagine that anyone wants to go there.
This legislation will be especially detrimental to the many small rural hospitals in your district, where Medicaid payments are a major part of their operating revenue. Those most vulnerable to this revenue loss are the Morrow County Health District in Heppner, Lake Health District in Lakeview, Harney District Hospital in Burns and Blue Mountain District Hospital in John Day. These hospitals are also the major employer in their communities. If they fail, not only will people in rural Oregon lose access to needed medical services, the economic ripple effect across the community will be profound, in an area that is already struggling.
Regarding the new work requirements, most “able bodied” people on Medicaid are already working, or have good reasons if they are not — like the students enrolled in the community colleges and universities in your district. This legislation will force many of these students to choose between health care and their education. Furthermore, the administrative cost of complying with these requirements will likely exceed any cost savings that might accrue.
Can we make Medicaid more efficient? Absolutely, as we have demonstrated with our Coordinated Care Organizations, that you helped create when you were in the Oregon legislature in 2011. Between 2011-2021, CCOs realized a net cumulative savings of approximately $3.7 billion. But we accomplished this without cutting enrollment or benefits, without sacrificing quality, and without stigmatizing and marginalizing those members of our community who depend on this program.
The bill you will be voting on this week does exactly the opposite—it throws hundreds of thousands of Oregonians off Medicaid, adds layers of paperwork and bureaucracy, and stigmatizes the nearly 40% of your constituents who depend on this program to access quality, affordable medical care.
Congressman, budgets are more than just numbers. They are value statements. They reflect our values and our priorities as a society. There is little in this legislation that reflects the values held by most Oregonians—values like fairness, compassion, opportunity and fiscal discipline.
This bill passed the House by only one vote. That means you are in a position to help prevent the catastrophe that is bearing down the people of your district, across our state and throughout the nation. I urge you to vote against the Senate version of the bill when it comes back to the House this week.
Respectfully,
John A. Kitzhaber, M.D.
