Senate hearing: bill would let insured Oregonians apply cash-pay prices to deductibles

The Oregon Senate Committee on Healthcare on April 17 heard public testimony on House Bill 2540A, which would require health insurers to apply certain direct payments a patient makes to a health care provider toward that patient’s deductible when the service is medically necessary, covered under the policy and the cash-pay price is lower than the insurer’s in‑network rate.

Supporters told the committee the measure would help Oregonians with high deductibles access affordable care and be credited for cost-conscious choices. Representative Ed Deal, the House sponsor, said the bill would introduce “deductible crediting” to Oregon and allow insured patients who find cheaper cash prices to have those payments count toward their deductible.

Representative Ed Deal, state representative for House District 17, said: “If an insured patient finds a cash-pay price for a procedure that's cheaper than what their in‑network providers are charging, their insurance company must apply that expense toward the patient's deductible.” He used a published comparison from another state to illustrate potential savings, noting “in one state ... the cash price for a colonoscopy was $541 while the insurer negotiated rate was an average of $2,400.”

Why it matters: Supporters said the policy could reduce immediate out‑of‑pocket costs for people with high deductibles and encourage price competition. Lacey Garcia Rivas, the LPRO analyst who summarized the bill for the committee, described the bill’s three eligibility criteria: the service must be medically necessary, it must be a service already covered by the patient’s policy, and the out‑of‑pocket payment must be less than the insurer’s in‑network payment for that service.

Physician testimony offered patient examples. Dr. Lorna Shanks, a family medicine physician who operates a direct primary care clinic in Portland, described a hypothetical patient, Maggie, who pays $400 for an MRI at a local radiology center while the insurer’s discounted average is $900. Shanks said HB 2540A would allow Maggie to receive a $400 credit toward a $5,000 deductible.

Shu Adi of Statecraft, representing the nonprofit Defend Workers, told the committee that nationally about 42% of people with employer-based insurance have a high deductible plan and that the bill’s three criteria were necessary guardrails. “It has to be medically necessary; it has to be covered under the existing policy; and it has to be cheaper than what they would find in network,” Adi said, adding that claims not meeting all criteria could be denied.

Supporters said negotiable outcomes include insurer concerns about administrative burden; the House-carried amendment permits insurers to require members to submit claims through the same systems providers use rather than via a manual process. Representative Deal said language addressing integrated delivery systems such as Kaiser was added and that Kaiser and PacificSource signaled neutrality after amendments.

The committee’s record for the April 17 hearing shows only public testimony and no final action; the hearing was closed at the end of testimony for HB 2540A.

The measure would not automatically change prices; it changes how insurers count qualifying out‑of‑pocket payments toward deductibles. The bill’s eligibility tests and insurer administration options were a focus of testimony and were cited by witnesses as essential to prevent improper claims.

No committee vote was recorded at the hearing.