Oregon Health Authority outlines plans for new state-based health insurance marketplace

The Joint Committee on Ways and Means Subcommittee on Human Services convened on April 16, 2025, to discuss significant developments regarding the Oregon Health Insurance Marketplace. The meeting focused on the transition from a federally facilitated marketplace to a state-based system, aimed at improving healthcare access for Oregonians.

The Oregon Health Insurance Marketplace, part of the Health Policy and Analytics Division at the Oregon Health Authority (OHA), currently assists individuals who do not qualify for employer-sponsored or public healthcare programs. In 2025, approximately 140,000 Oregonians enrolled in private health insurance through the marketplace, with over 110,000 utilizing premium tax credits to offset costs. However, the existing system, which operates through healthcare.gov, presents challenges, including limited customization for Oregon's unique needs and issues with conflicting information from the federal platform.

Senate Bill 972 of 2023 mandates OHA to develop a state-based marketplace solution, which will enhance interoperability with Oregon's eligibility systems and provide real-time data access. This transition is expected to reduce enrollment churn and allow for more targeted outreach strategies. The new marketplace is scheduled to launch on November 1, 2026, coinciding with the start of the open enrollment period for the 2027 plan year.

Key benefits of the transition include improved customer service, tailored public outreach, and the ability to incorporate feedback from diverse communities to address health equity barriers. The OHA aims to maintain enrollment levels during the transition and ensure the project remains within budget.

The implementation of the state-based marketplace will involve a structured governance model, including an executive steering committee and collaboration with various state partners. Independent quality management will also be employed to ensure transparency and effective management of technology investments.

In summary, the meeting underscored the importance of transitioning to a state-based marketplace to enhance healthcare access and service delivery for Oregonians, with a clear timeline and governance structure in place to guide the process.