Concerns Over Access to Salem Health for Low-Income Residents

In Marion and Polk counties, over 140,000 low-income individuals might struggle to secure appointments at Salem Health next year.

A letter from PacificSource Community Solutions, sent out during Thanksgiving week, informed members that Salem’s primary hospital could be removed from its network. This nonprofit manages the Oregon Health Plan across several counties, including Marion and Polk.

The letter indicated, “Salem Health may leave our network on January 1, 2026.”

As Salem’s largest healthcare provider, Salem Health not only runs the only hospital in the city but also West Valley Hospital in Dallas. Their services encompass family and emergency medicine, cardiology, obstetrics, gynecology, orthopedics, urology, and more.

This news is yet another setback for those in the Salem area relying on the Oregon Health Plan for healthcare.

A few months back, Mark Edwards received a notice that he would no longer be able to see his doctor at Salem Clinic starting in January 2026. This change resulted from failed negotiations between the clinic and PacificSource regarding coverage for most patients under Oregon Health Insurance.

In light of this, Edwards took the initiative to schedule various medical appointments with his endocrinologist and family physician of 15 years, just to ensure that all necessary exams and physicals were completed at Salem Clinic.

Having experienced two heart attacks and a stroke, he has also been consulting specialists at Salem Hospital for preventive care. Now, he faces the daunting task of finding new healthcare options again. “All the specialists I see have now left Pacific Source, and I don’t know why,” he expressed.

About a third of the population in both counties is enrolled in Pacific Source’s Oregon Health Plan. As reported, there were around 144,000 registered patients in these counties as of October.

On Monday, Salem Health announced that it had reached an agreement with Pacific Source concerning patients with commercial insurance and Medicare. Negotiations for Oregon Health Plan patients are still ongoing.

Salem Health’s spokesperson, Lisa Wood, stated in an email that the contract for Oregon Health Plan patients expires on December 31. She specified that Medicaid “open card” patients are not impacted by these negotiations.

While urgent care is available for out-of-network patients under certain protections, they cannot schedule routine tests or appointments with specialists at Salem Health facilities.

Wood mentioned that it wasn’t possible to arrange an interview for further discussion about the situation before the deadline set by Salem Reporter.

Pacific Source’s representative, Amber Conger, also did not respond to a request for an interview. She said, “At this time, we remain focused on finding a solution with Salem Health. If things change, we will contact our members directly to ensure continuity of care.”

Neither party provided clarity on what specific issues are causing the dispute.

If an agreement isn’t reached, it could significantly impact healthcare options for Oregon Health Plan members in Salem, particularly in a year characterized by dwindling choices. With rising costs of living complicating matters, low-income individuals using healthcare programs are feeling the strain all the more.

Earlier this year, Pacific Source declared it would withdraw from managing the Oregon Health Plan in Lane County starting January 1, citing that state compensation for patient care hasn’t aligned with the escalating costs of services. CEO Dr. John Espinola remarked on this situation as a “canary in the coal mine moment.”

Salem Health has previously pointed out the heavy burden of the Medicaid payment model on their resources. In January, CEO Sheryl Wolf noted that over one in four patients at the hospital were on the Oregon Health Plan, which covers roughly 60 percent of the costs for obstetric care. The gap for the 2023 fiscal year is anticipated to exceed $66 million.

The pressure of medical costs is also reaching into the private sector. This year, Salem Health ceased accepting Regence Blue Cross Blue Shield insurance, failing to strike a deal after requesting a 35 percent rate increase to cope with inflation. Regence, in contrast, proposed a much lower rate increase aligned with state targets. Their negotiations fell apart after weeks of discussions without a resolution.

Pacific Source took over the coordination for the Oregon Health Plan in 2019 after the resignation of the Willamette Valley Regional Health Collaborative Care Organization. The company utilizes state funds to cover treatments for patients under the plan.

The Oregon Health Authority has stated that they understand concerns regarding the ongoing contract negotiations. They reiterated that there are no immediate changes to Oregon Health Plan membership and are committed to providing timely information to members and providers.

Mark Edwards, who is among about 10,000 primary care, urgent care, and endocrinology patients at Salem Clinic, is exploring alternative options after being informed of the clinic’s inability to finalize an agreement with Pacific Source. However, obstetrics and gynecological Medicaid patients will continue to receive care there.

Edwards, 54, and his wife have been long-time patients at Salem Clinic, but she has managed to remain there as a Medicare patient. “I’m on Pacific Source. I have to go where they go,” he acknowledged. He collaborated with his doctor to ensure he could refill prescriptions for the upcoming year. Commutes to specialists outside Salem pose challenges, given that his wife relies on a power wheelchair. They’ve been using the local LIFT transportation service for over a decade.

“There are no other endocrinologists in Salem,” Edwards pointed out. “The nearest one will be in Portland, which raises concerns about transportation costs. What’s the cost-effectiveness?” He added that losing access to Salem Health would complicate healthcare access even more.

With mounting frustration, he asked, “If I have another stroke, where do I go? What if another heart attack occurs?”

He feels a profound loss regarding the relationships he developed with local doctors over the years. He recalls a compassionate internist at Salem Clinic who had a straightforward manner. After a heart attack a decade ago, Salem Hospital provided him with a blood pressure monitor to take home, highlighting their consideration for his healthcare needs.

“Whenever there was a significant event in my life, they reached out,” Edwards remembered. “When my mother passed away, the staff called and even sent me cards—prescriptions for smoking cessation and anxiety were provided. They were attentive without me even having to reach out.”

He expressed that he feels his doctors understand him and will seek to resolve this challenging situation. Yet, he consistently encounters frustrating responses from insurance companies, which adds another layer to his already overwhelming responsibilities. “One of my biggest jobs is managing my insurance,” he noted.

He also expressed concern about the potential ramifications of federal cuts to insurance plans under new legislation, fearing he might altogether lose his insurance. The pressures are already substantial; he and his wife recently reverted to survival mode when food stamp benefits were delayed in October.

Despite the uncertainty, he remains hopeful that Salem Health and Pacific Source will find common ground. However, he’s uncertain how he and others will adapt, should the situation lead to overflow at smaller clinics or longer trips up Interstate 5 for appointments.

Reflecting on his childhood experiences driving long distances for healthcare, he remarked, “In the 21st century, I thought those days were behind us. You’d expect this kind of struggle to happen in smaller towns, not in our state capital. It’s disheartening. We need better solutions, but where will the funding come from? It’s a tough situation.”