Oregon hospitals more than doubled their average spending on financial assistance in the first full fiscal year under a state law requiring them to proactively screen patients for aid, Tradeoffs and KFF Health News reported Oct. 21.
Seven things to know:
1. The law took effect in July 2024. It requires hospitals to screen uninsured patients, Medicaid enrollees and patients whose bills exceed a set threshold for presumptive eligibility and apply free or discounted care before billing, so most patients no longer have to apply.
2. About two-thirds of Oregon hospitals have federal data available. Among them, financial assistance rose to 2.7% of operating expenses from 1.4%, on average. That tops the roughly 2.4% national average for nonprofit hospitals from 2021 to 2024, according to Johns Hopkins University researcher Hossein Zare.
3. At Portland, Ore.-based Oregon Health & Science University, 64% of patients automatically qualified for aid in the law’s early months, up from 12%. OHSU spent about $64 million on free and discounted care in the first year.
4. Insured patients saw major relief. Lawrence Furnstahl, OHSU’s CFO at the time, said at a January 2025 public meeting that insured patients often hadn’t applied for aid before the law, instead paying their share of the bills. OHSU’s aid for insured patients reached about $39 million in the first year, roughly five times the amount in prior years.
5. Hospitals supported the original law, according to Sean Kolmer, executive vice president of the Hospital Association of Oregon, but they now face mounting financial pressure. Mr. Kolmer said the group expects the state’s uninsured rate to climb to 10% or higher from about 3% before the law passed. Hospitals also reported that their screening data was less accurate for higher-income patients, leading some patients who didn’t qualify to receive aid.
6. In April, Oregon raised the single-visit screening threshold to $1,500 from $500. Hospitals must still screen all Medicaid and uninsured patients. Democratic state Sen. Lisa Reynolds, MD, who introduced the original law, agreed to the change to give hospitals some relief while they refine their screening.
7. Other states are adopting similar requirements. North Carolina expanded its screening requirement this year to patients with incomes up to triple the poverty line. California and Delaware will require hospitals to automatically grant financial aid by July 2027.
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