RACHEL MARTIN, HOST:
When the Affordable Care Act became law, the state of Oregon embraced it. As a result, some 95 percent of Oregonians now have health insurance, one of the highest rates in the nation. That's due in part to Medicaid expansion. Today, that's going to be put to the test as Oregonians vote on the tax package to pay for it.
Kristian Foden-Vencil of Oregon Public Broadcasting reports.
KRISTIAN FODEN-VENCIL, BYLINE: The federal government gave states plenty of notice that Medicaid payments would be trimmed after the Affordable Care Act was introduced. So here in Oregon, Democrats joined with Republicans, hospital owners and health insurance CEOs to come up with a tax to pay for it. Even though it's hundreds of millions of dollars a year, hospitals and insurance companies agreed to pay it. But under state law here, voters can use the initiative process to collect signatures and force a public vote on a new tax. And that's what Julie Parrish did.
JULIE PARRISH: They passed the tax to the people without a lobbyist - right? - small businesses, mom-and-pop businesses, individuals who have to buy their own.
FODEN-VENCIL: Parrish is a Republican state representative who grew up on Medicaid. But she doesn't like the tax package. She says it's inequitable because it doesn't apply to big corporations and unions.
PARRISH: This was about a fundamental disagreement that taxing other people's insurance is the way to fund Medicaid.
FODEN-VENCIL: So Measure 101 is now on the ballot. Some Republicans want a no vote. They don't like the new tax. And they don't trust the Oregon Health Authority with the money. On the yes side are all kinds of advocacy groups and the vast majority of Oregon's health organizations, who say 48 other states have some form of this new tax.
Andy Van Pelt is the executive director of the Oregon Association of Hospitals and Health Systems.
ANDY VAN PELT: The alternative of lack of coverage - we're talking kids, seniors, people with disabilities - is unacceptable.
FODEN-VENCIL: He says it's cheaper to treat people with health insurance than to treat them without insurance when they turn up sick in emergency rooms anyway.
VAN PELT: There's a real possibility that people could lose their coverage. It will just destabilize the Medicaid program for hundreds of thousands of people. And that would be utter chaos.
FODEN-VENCIL: While the Trump administration hasn't managed to repeal the Affordable Care Act, it has taken several steps to dismantle it. The effect of Measure 101 on Oregon's Medicaid expansion remains to be seen. But if it fails, state lawmakers will spend the next couple of months searching for new ways to pay for it.
For NPR News, I'm Kristian Foden-Vencil in Portland.