Health care advocates and organizations in Oregon say they’ve been recently “inundated” with calls from people trying to understand how a massive federal law slashing spending on social service programs could impact their health coverage.
Among the areas of confusion is Medicare — the federal insurance program for seniors and some disabled people, which covers roughly a million Oregonians.
The One Big Beautiful Bill Act passed by Congressional Republicans in July cuts nearly a trillion in Medicaid spending over ten years. That program, which is run by states with federal and state money, pays health care costs for low-income Oregonians through the Oregon Health Plan.
Changes to Medicare are far less sweeping, local and state experts said. Some refugees and immigrants in the U.S. will no longer be legally eligible for Medicare coverage starting in January 2027. The bill also scales back a Biden-administration law that allowed the federal government to negotiate prices for some drugs starting in 2026.
“There is a great deal of confusion and concern, especially among elderly and disabled patients,” said Maggie Hudson, president and CEO of Santiam Hospital and Clinics in an email.
Hudson said “the exact services affected by Medicare changes are still unfolding.”
For Oregonians who remain eligible for Medicare, nothing in coverage will immediately change. But a piece of the new law could pave the way for multi-billion dollar cuts to the program starting in 2026.
The state of Oregon plays less of a role in Medicare, which is federally managed, than it does for the low-income Medicaid program.
Sara Campos, a spokeswoman for the Oregon Department of Human Services, said the department does not expect long-term, significant impacts on the pieces of Medicare the state manages. The state’s role is limited to running a Medicare Savings Program, which makes Medicare more affordable for low-income recipients.
Hospitals in Marion County rely heavily on funding from Medicare. Over a third of Salem Health and Santiam Hospital and Clinics patients used Medicare in 2024.
Nearly $500 billion in Medicare funding could be lost nationwide between 2027 and 2034, the Congressional Budget Office reported in May. That’s because the law allows federal Medicare spending to be cut by up to 4% per year if Congress increases the federal deficit.
If those cuts happen, it would take money out of the pockets of doctors, hospitals and other providers, said Scott Palmer, chief of staff of the Oregon Nurses Association. He said this could cause doctors to stop taking Medicare patients.
Despite being a labor union for nurses, the association has seen an influx of calls from the public in recent months, with callers asking how their health coverage could change, Palmer said.
Concerns for dual-enrolled patients, drug coverage
The bill’s changes are of particular concern to families who rely on both federal insurance programs, Medicare and Medicaid, to pay for health care, Hudson said.
CBO estimated that 1.3 million of American seniors and disabled people enrolled in both programs could lose Medicaid, leaving them with just one insurance that doesn’t cover some of the care they need.
Medicaid programs like Oregon Health Plan can fill gaps in Medicare coverage. The low-income program covers some things that Medicare does not, including long-term care for seniors. Changes to Medicaid put some 200,000 Oregonians at risk of losing coverage, Oregon Health Authority estimates.
Among the changes to Medicaid are more frequent checks to make sure patients remain eligible for the program. That could cause some seniors or people with disabilities to lose coverage if they miss paperwork, Hudson said.
For seniors staying in a long term care facility through Oregon Health Plan, losing this coverage would put them on the streets.
“You don’t get to stay in a hotel if you’re not paying,” Palmer said.
Prescription drug costs are another area of concern. The bill’s changes mean that Medicare will negotiate prices on fewer drugs starting in 2026.
Breanna Conklin said she’s concerned for her husband, who’s 42 and uses Medicare and Medicaid. The Mount Angel couple travels to Salem for medical care at Salem Hospital and a Salem Health clinic.
For her husband, Medicare pays for an expensive prescription that treats a chronic mental health condition.
Without Medicare, the couple would pay anywhere from $1,000 per month for the drug, and $1,500 for all of his medications.
“If we lose that help, we’d have to live on less than $1,000 a month ourselves, somehow,” she said.
The Conklins are considering a switch to private insurance in the case of “extreme circumstances,” especially if Medicare stops covering the drugs they need.
Palmer recommended people start preparing for these changes now by talking with their health insurance and anyone who assists with health insurance, like health care advocates.
Have a news tip? Contact reporter Hailey Cook: [email protected] or (208) 515-4097.
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Hailey Cook is an intern at the Salem Reporter through the University of Oregon’s Charles Snowden Program for Excellence in Journalism. She works as a photojournalist and reporter, with a focus on public health and policy, among other topics.