Dr. Nathan Defrees

Baker City doctor Nathan Defrees is worried about how proposed cuts to Medicaid, the federal health insurance program for lower-income residents, could affect his patients and others in Baker County.

“It concerns me that people would just end up being kicked off” the program, Defrees said on Wednesday, June 25.

He fears people who lose Medicaid coverage would wait longer to seek medical help. And when they did, Defrees said, they would have to go to a hospital emergency room where treatment is more expensive.

Because the law requires hospitals to treat everyone, regardless of their ability to pay, hospitals would have to pass on some of the cost to patients who have insurance, or reduce their services, or both, Defrees believes.

Ultimately, he said, Medicaid cuts could make health care less accessible for many people, and more expensive for everyone, he said.

That potential outcome prompted Defrees to join more than 600 other health care professionals in Oregon in signing a letter sent Tuesday, June 24, to the state’s congressional delegation and legislature, urging them to “protect Medicaid and overall federal and state health funding.”

Tony Swart, administrator for Saint Alphonsus Medical Center-Baker City, also signed the letter.

The letter cites a budget bill that the U.S. House of Representatives passed, and that the Senate is considering.

The bill “includes huge cuts to Medicaid and other critical health coverage,” the letter states.

It’s not clear how Medicaid costs would be trimmed, although the bill includes a requirement that adults enrolled in the program either work or do community service.

Defrees said many of his adult Medicaid patients already have at least part-time jobs.

The letter notes that Rep. Cliff Bentz, the lone Republican representative from Oregon, voted for the House bill, while the state’s five other representatives, all Democrats, voted no.

“Here in Oregon, Medicaid coverage is a lifeline for more than 1.4 million people, including more than 494,000 children and 70,000 seniors,” the letter states.

Defrees, who grew up in Sumpter Valley and returned to Baker County after medical school, works at St. Luke’s Eastern Oregon Medical Associates in Baker City.

He said about 30% of the clinic’s patients rely on Medicaid — through the Oregon Health Plan — for health insurance.

But Defrees said cuts in federal spending, which supplies about 75% of the money for the Oregon Health Plan, would disproportionately affect children and pregnant women. In his practice, about 70% of children and pregnant women are enrolled in the Oregon Health Plan, he said.

Defrees said he’s also concerned that Medicaid cuts, if enacted, would make it impossible for Saint Alphonsus, which closed the birthing center at the Baker City hospital in August 2023, from reopening the center.

Swart told Baker County commissioners in March of this year that he is “committed” to returning maternity care to the hospital, although he said there is timeframe for doing so.