THE ROAD AHEAD A snapshot of what’s happening for health in rural Oregon

On a cold morning in January, a man with a wind-burnt face sits in front of large window at the Embers Grill in Joseph, Oregon. He wears muddy boots and a wool coat over a flannel shirt. Out the window, snow drifts reflect the sun and Wallowa Mountains. Above him a homemade flier reading “Save our Healthcare!” is taped to the wall announcing a local community meeting.

Asked to remain anonymous, he said that he works three jobs and sells firewood on the side to make ends meet. Noting that many of his neighbors work more than one job as well––calling it the “rural Oregon hustle”–– he lowers his head when he mentions that without the Oregon Health Plan, he and his neighbors would be without options for affordable healthcare if they were to get into an accident. Looking up at the healthcare flier, he said:

“This isn’t about politics or handouts. It’s about people working hard for a little peace of mind, knowing that an accident or the unexpected isn’t going to leave us homeless."
North Broadway Avenue in Burns, Oregon. Population 2,806. Rural southeast Oregon.

A decade ago, on the other side of the state, the temperature hovered at freezing while a pregnant mother stood at a bus stop with her two small children. She clutched the children in each hand, shielding their faces from the bite of the wind.

Her name is Allison Bonato-Garcia and, at this point in her life, was a recently single mother after her husband was incarcerated. On this particular day, she was taking her children in for routine check-ups, and planning how to move to Tillamook to stay with her parents.

Today, after a challenging decade and move––and with help from the community––Allison works in public health in Tillamook County where she helps the same young mothers and community members access critical health resources.

Allison Bonato-Garcia now helps those struggling to make ends meet in Tillamook County.

Thousands in rural Oregon struggle with similar challenges as well as access to public health services and healthcare options. Many don’t have the means or support systems to get to and from appointments. Others struggle to maneuver what seems like a maze of paperwork and bureaucracy. For others, keeping previously scheduled appointments falls to the bottom of any given day’s to-do list––often behind caring for young children and putting food on the table. Robin Watts, the nursing supervisor and manager of public health programs in Tillamook County recalled a few challenges she experiences on a daily basis:

"One couple that we worked with recently was staying seven miles up the Wilson River. The pregnant mom would walk fourteen miles roundtrip into town anytime that she had an appointment. Basic transportation options and life’s daily priorities often stand in the way of accessing healthcare for many in rural Oregon. And these challenges are there before we even start talking about access to affordable health insurance.”

She said improving health in rural Oregon is contingent upon increasing and improving access to both insurance for individuals and public health services in general. But geographically large rural counties––often requiring hours of travel time to the nearest town––and poverty create a challenging stage for making this happen, she added.

Health challenges in rural central Oregon.

A candid take on what rural communities need.

While Oregon’s 2017 legislative session doesn’t include funding for expanding improvements for public health services––community programs focused on disease prevention, clean air and water, exercise and nutrition, and emergency preparedness––the Oregon Health Authority and local county health departments are working to make service delivery more efficient and focusing on future needs. Local communities are working with OHA to streamline services and invest health funding for outcomes while helping communities connect sometimes disparate services. Dawna Roesener, the WIC coordinator for Tillamook County, pointed to results already underway:

"The state funds that are already available are making results happen on the ground here in rural northwest Oregon through WIC, early delivery services, Medicaid expansion and enrollment, and home visiting services.”

Coupled with working to increase access and availability of basic public health services, the Oregon Health Plan and Medicaid expansion have also significantly expanded access to affordable care. With 95% of Oregonians now insured––the largest percentage in Oregon history––Medicaid expansion and the OHP have brought opportunities and access to rural Oregon. And as the largest health plan in the state, it provides health care to nearly a million Oregonians struggling to make ends meet. In rural counties, as many as 40 percent are enrolled, and nearly half of those enrollees are employed and working.

BY THE NUMBERS.The expansion of OHP and Medicaid in Oregon has brought affordable access to insurance and healthcare never before experienced in Oregon:

  • LOWER COSTS: Federal and State government saved $1.4 billion in Medicaid costs just since 2012 and has avoided billions more since the inception of the Oregon Health Plan over two decades ago.
  • STATE SAVINGS: Oregon's health reforms are projected to save a total of $10.5 billion between 2012 and 2022 by holding down cost growth to not more than 3.4 percent per member per year.
  • BETTER OUTCOMES & CARE: Hospital readmissions have been cut by one-third. Substance misuse assessment, developmental screening, and prenatal care have all increased.
  • PROVIDING CARE AT THE RIGHT TIME AND PLACE: Avoidable emergency department use decreased by nearly 50 percent over five years.
Kelleni Camacho’s Story from Medford: Struggling with obesity and poor health, Kelleni and her husband and son chose to improve their health. Because she was on the Oregon Health Plan, Camacho’s coordinated care organization––Jackson Care Connect––was able to use flex spending funds to pay for her participation in YWCA programs. She lost 115 pounds and her husband and son lost nearly 40 each. They eliminated carbohydrates and added more proteins and vegetables from their diet. They increased their physical activity and the results have reduced their medications. Kellani said that she is living a happier, healthier life because of the Oregon Health Plan’s investment in her and her family. (Photo credit: CareOregon/Jackson Care Connect)
Kayla and Mel’s story from Lincoln City: Mel is a 90 year old military veteran who is mostly blind and requires recurring eye surgeries. He recently lost his home to a fire and walking anywhere is very challenging due to severe foot pain. Kayla is Mel’s home visiting provider and check in on him regularly to ensure that he has what he needs. Kayla is a single mother of four who struggles with severe bipolar disorder and the OHP gives her the tools to manage her symptoms and work while providing a future for her family. Kayla said: “My mental health challenges make every day hard. The Oregon Health Plan gives me the tools to manage my disorder and hold a job, helpingmake sure people like Melvin have someone to lean on and that my children have a roof over their heads. The Oregon Health Plan is lifesaving for many of us in rural Oregon.”

For more information about the Affordable Care Act in Oregon, visit

How rural challenges affect health care.

The role of public health in rural Oregon.

A conversation about rural outreach and access to health.

While today’s political climate provides more questions than answers about the future of national healthcare, Oregon just this year secured federal approval to advance its new healthcare model through the state’s Medicaid program and the Oregon Health Plan. Because Oregon operates on a state-specific model focused on individual communities, it distributes federal dollars for healthcare under a waiver system. The five-year extension to June 2022 allows Oregon to continue building on its coordinated care model and finding solutions for the challenges faced in rural Oregon.

In Tillamook, they’re already seeing results.

“Our mental health community is already growing and it’s getting easier for people to get mental health and dental work done. From a public health perspective, OHP and Medicaid expansion has made this possible and we’re getting adults and kids in at greater numbers,” said Watts.

Oregon health leaders regularly receive stories from around the state pointing to impactful experiences with the Oregon Health Plan and Medicaid expansion. From a mother in southwest Oregon who shared her story about how being on the Oregon Health Plan helped treat her 10 year-old daughter’s undiagnosed Hodgkin’s Lymphoma, to a man who’s life and financial livelihood were spared after suffering what could have been a deadly rattlesnake bite in the John Day River canyon.

Tillamook Regional Medical Center in Tillamook, Oregon.

And Allison Bonato-Garcia, the single mother at the bus stop who’s since remarried and helping people write their own healthy success stories, credits OHP expansion for setting in motion better health and care in rural Oregon.

“Now there’s so much more opportunity to have access to healthcare in a wider variety of clinics and settings. We can all qualify now and know where to turn. The barrier to access has been eased.”

Oregon Health Authority director Lynne Saxton recognizes that the road ahead for continuing to increase access to affordable care and services in rural Oregon is an ongoing journey of improvement. But she’s optimistic about what’s already underway.

“The health initiatives underway in rural Oregon are unprecedented in many ways,” said Saxton. “With improving access to affordable care one of our top priorities, we’ve also launched strategies to support rural hospitals and providers, reduce prescription drug costs, and build a strong rural healthcare workforce.”

“This work requires the collaboration of many and a commitment to long-term improvements for local communities,” continued Saxton. “I’m confident that with so many dedicated people working to improve the lives of Oregonians, the future of healthcare is brighter in rural Oregon.”

Author, project manager and photographer: Tony Andersen

Video Director: Britt Parrott

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