Aging, AI, and Access: Redefining Healthcare Together

Event Overview

The Oregon City Business Alliance hosted a November forum focused on the evolving state of healthcare in Oregon, with particular attention to aging populations, access to care, Medicaid funding pressures, and the cascading impacts of federal policy changes under H.R. 1.

Moderated by Kristen Downey, the forum brought together leaders from hospital systems, community health centers, and Medicaid strategy to examine how healthcare delivery is changing—and what those changes mean for businesses, workers, and communities across Clackamas County.

The conversation addressed rising healthcare costs, workforce shortages, regulatory pressures, and the growing reliance on Medicaid funding. Panelists emphasized that hospitals and clinics are not only care providers, but also major economic engines whose stability directly affects local economies, employment, and quality of life.

Speakers

• Tom Phipps
  Chief Medical Officer, Providence Willamette Falls Medical Center
• Gil Munoz
  President & CEO, Virginia Garcia Memorial Health Center
• Megan McAninch-Jones
  Executive Director, Medicaid Strategy & Community Health, Providence
• Kristen Downey
  Executive Director, Government & Public Affairs, Providence (Moderator)

Key Takeaways

Oregon’s healthcare system is experiencing sustained financial strain, not a temporary downturn.
Speakers emphasized that despite patient volumes returning to pre-pandemic levels, hospitals across Oregon continue to face multi-year operating losses. Rising labor costs, inflation, supply chain expenses, and reimbursement rates that fail to cover the true cost of care are forcing systems to rethink staffing, service lines, and long-term sustainability.

Medicaid expansion has improved coverage while intensifying cost pressures.
Oregon has one of the highest Medicaid enrollment rates in the nation, covering roughly one-third of residents and more than half of children. While this has dramatically reduced the uninsured rate, Medicaid reimbursement typically covers only a portion of actual care costs, requiring hospitals and clinics to rely on cost-shifting to commercial insurance and philanthropy to remain viable.

Federal policy changes under H.R. 1 will disproportionately affect Oregon.
Panelists outlined how upcoming changes to Medicaid eligibility, enrollment verification, and provider tax structures could result in an estimated $15 billion reduction in Oregon healthcare funding over six years. Because Oregon’s system relies heavily on federal matching dollars, these changes pose serious risks to access, particularly for rural communities and vulnerable populations.

Hospitals and health centers function as major economic anchors.
Healthcare organizations are among Oregon’s largest employers and economic drivers. Decisions about service reductions, partnerships, or closures have ripple effects across local economies, affecting workforce retention, business attraction, and overall community stability, well beyond healthcare alone.

Care delivery is shifting, but local access remains a priority.
To adapt to workforce shortages and rising costs, systems are increasingly using telemedicine, regional specialty hubs, and non-physician providers. While these strategies improve efficiency, speakers stressed the importance of maintaining local access wherever possible, especially for emergency and primary care.

Key Topics & Speaker Highlights

Kristen Downey

Kristen Downey opened the forum by setting the statewide policy and economic context. She explained that Oregon entered the H.R. 1 era already operating from a deficit position in healthcare, making upcoming federal changes especially destabilizing. She identified three dominant system responses already underway: workforce reductions focused on non-clinical roles, strategic partnerships and joint ventures, and the difficult sunsetting of certain clinical services. Downey also highlighted Oregon’s uniquely heavy regulatory environment, which limits hospitals’ flexibility to adapt quickly.

Tom Phipps

Dr. Phipps focused on the local impact at Providence Willamette Falls Medical Center. He emphasized that most patients prefer receiving care close to home and that a significant portion of Oregon City residents interact with the hospital each year. He reviewed payer mix realities (where Medicare and Medicaid reimburse below cost) and explained how hospitals rely on commercially insured patients to offset losses. Phipps outlined local strategies including short-stay surgical units, telemedicine expansion for specialty care, cautious growth planning, and long-term emergency department capacity improvements.

Gil Munoz

Gil Munoz provided an overview of federally qualified health centers and the role they play as Oregon’s primary care safety net. He traced the 50-year history of Virginia Garcia Memorial Health Center and described its focus on comprehensive, preventive care across medical, dental, behavioral health, and community outreach services. Munoz highlighted emerging challenges including threats to 340B drug pricing, increased administrative burdens, and funding uncertainty—all of which could limit clinics’ ability to serve high-need populations if Medicaid enrollment declines.

Megan McAninch-Jones

Megan McAninch-Jones framed the discussion through a community health and Medicaid strategy lens. She emphasized collaboration between hospitals, community health centers, free clinics, and nonprofits to address health-related social needs such as housing instability, food insecurity, and transportation. She also discussed efforts to shore up donated care and safety-net services in anticipation of rising uninsured rates, noting that preventative and upstream investments are essential to avoiding higher downstream healthcare costs.

Q&A

Will reduced coverage push more people into emergency rooms?

Panelists noted that the larger concern is not overuse of emergency departments, but delayed or avoided care. Uninsured individuals are more likely to postpone treatment for chronic conditions such as diabetes, infections, or wounds, resulting in more severe and more expensive health crises when care is finally sought.

How will hospitals decide which services to maintain or reduce?

Healthcare leaders emphasized that systems will prioritize core community services, particularly emergency and essential care. Non-core services with low volume or high staffing risk may be consolidated regionally or discontinued. Strategic partnerships and referrals to higher-volume centers were described as necessary to preserve quality and safety.

What happens to specialty care for uninsured or underinsured patients?

Speakers discussed the anticipated return of donated and coordinated specialty care models as Medicaid enrollment declines. Programs such as Project Access Now were described as “paused rather than ended,” with health systems actively planning how to reinstate donated care capacity if demand increases.

How are hospitals addressing affordability and medical debt?

Oregon hospitals are required to provide robust financial assistance programs, including full charity care up to 300% of the federal poverty level and sliding-scale discounts beyond that threshold. Panelists acknowledged that while these programs reduce medical bankruptcy risk, they also increase financial strain on hospitals and contribute to cost-shifting pressures.

Will commercial insurance costs continue to rise?

Panelists explained that as Medicaid and self-pay shortfalls grow, cost-shifting to commercial insurance remains one of the few mechanisms available to sustain the system. While no one framed this as a desirable outcome, it was described as a structural reality under current reimbursement models.

How will rural and critical access hospitals be affected?

Critical access hospitals were described as somewhat more protected due to different reimbursement structures, but workforce shortages remain their greatest vulnerability. When rural services are reduced, it is more often due to the inability to recruit providers than lack of demand.

Conclusion

The November OCBA forum highlighted a healthcare system at an inflection point. Oregon’s success in expanding coverage and improving access now collides with fiscal realities, workforce shortages, and major federal policy shifts that threaten long-term sustainability.

Panelists stressed that healthcare institutions are not isolated service providers but foundational components of local economies and community resilience. As funding pressures intensify, maintaining access will require difficult prioritization, deeper collaboration across systems, and renewed attention to preventative and community-based care.

For business leaders and community stakeholders, the message was clear: the future of healthcare in Oregon will shape workforce stability, economic growth, and quality of life. Navigating what comes next will demand transparency, shared responsibility, and sustained civic engagement to protect access for the most vulnerable while preserving a system that serves the entire community.