Oregon Reinsurance Program

The Oregon Patient Protection and Affordable Care Act 1332 State Innovation Waiver’s - Oregon Reinsurance Program

The State of Oregon (Oregon) implemented a state-based reinsurance program using a Federal Patient Protection and Affordable Care Act 1332 Waiver (ACA) effective 2018. State Innovation Waiver's (also referred to as section 1332 waiver) allows states to pursue innovative strategies for providing residents with access to high quality, affordable health insurance while retaining the basic protections of the ACA. 

This program is similar to the federal transitional reinsurance program that existed in the early years of the ACA. Moreover, the Oregon Reinsurance Program (ORP) partially reimburses health insurance carriers on the individual insurance marketplace for enrollee's accumulated healthcare claims under eligible ACA individual plans from the Oregon Health Insurance Market Place. The  parameters are set annually to help lower premium rates, stabilize the individual health insurance market, and expand coverage throughout the state of Oregon. The parameters consist of a total value of healthcare cost per claimant, measured against a starting attachment point claim amount, below a maximum claim amount, and coinsurance rate.  The ORP shares the high cost claims with the Insurer which lessens the burden of the claimant.

The ORP is funded by grants from the U.S. Department of Health and Human Services and the U.S. Treasury and a 2 percent assessment imposed on commercial health premiums.  Further, of the 2 percent assessment, 0.3 percent is retained by the ORP to reimburse eligible health insurers on the individual health insurance market.  The remaining total assessment of approximately 1.7 percent is transferred to the Oregon Health Authority to fund Medicaid. As a result, State PPACA 1332 Innovation waiver's to help lower the cost of health insurance and expand health insurance plans options throughout the state of Oregon's 36 counties with at least 4 to 6 options per county.

The Departments must determine that the waiver will provide coverage that's at least as comprehensive as the coverage provided without the waiver; provide coverage and cost-sharing protections against excessive out-of-pocket spending that are a least as affordable without the waiver; provide coverage to at least a comparable number of resident as without the waiver; and not increase the federal deficit.  This is done by calculating Advanced Premium Tax Credits, member enrollment, federal poverty levels, and comprehensive health plans cost per member. The 'Departments' passes its net savings back to Oregon, to help fund the ORP.

2023 ORP Health Care Claims Presentation

Wed. June 21, 2023 
1:00 p.m. - 2:00 p.m..

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Meeting ID: 297 160 112 09
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+1 503-446-4951,,784900487# United States, Portland
Phone Conference ID: 784 900 487#

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