June 8, 2025 • 29 mins
Federal budget cuts could have a major impact on Medicaid in Oregon. Gambling addiction problems are growing, due to online access to gambling. Portland City Council quadrupled the settlement amounts with families that were displaced by urban renewal. OSU research helps wineries adjust to wildfire smoke.
Mark as Played
Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Speaker 1 (00:04):
Welcome to local Voices. I'm brad Ford. This week, the
Oregon Health Authority is working to learn what's ahead from
Medicaid under changes from President Trump's Big Beautiful Bill Act.
Gambling is on the rise because of easier access online.
We'll look at connections between mental health and gambling. Port
and City Council made a major decision this week affecting
(00:25):
families who were displaced by urban projects dating back to
the nineteen sixties. They approved an economic settlement with those
families that was four times higher than expected. At an
Oregon State University researcher is working with wineries to help
them understand what they can do with grapes that are
tainted by wildfire smoke. President Trump's Big Beautiful Bill Act
(00:54):
currently includes changes to Medicaid that will affect Oregon. Emmisando
is the Medicaid director for the Health Authority. She's told
Oregon legislators They've worked hard to increase the number of
Oregonians who have health insurance in Oregon.
Speaker 2 (01:07):
We have done quite a number of things to ensure
that healthcare is available to all Oregonians, and we and
OHA have recently put out information that ninety seven percent
of all people in Oregon have health insurance and that
is a record high that we had never achieved before
(01:31):
in our state. And according to the most recent data,
this is in large part due to the organ Health
Plan that ensures one point four million people in our state,
or about thirty three percent of the population Medicaid. As
you all are well aware, and I know I've talked
in this committee before, it provides a variety of services
(01:55):
from covering nearly half of all berths in the state
more about fifty seven percent of children, as well as
a variety of different long term services and support and
for people with disabilities, and other types of services across
the healthcare spectrum. The work that we have done in
Oregon is is very much applauded by the RUSSA country
(02:18):
as a bipartisan way of ensuring healthcare access to two people,
and it has been used as a vehicle or used
as an example for the rests of country to expand
healthcare access and health insurance.
Speaker 1 (02:38):
The President's Big Beautiful Bill Act seeks to reduce spending
on Medicaid in a variety of ways.
Speaker 2 (02:44):
There are three different ways in which lawmakers and policy
makers could approach reducing Medicaid expenditures and Medicaid funding, and
one is through reducing the number of people that are
enrolled in the medicaid program. One is reducing provider rates,
(03:05):
and one is reducing the number of services that are
covered by a medicaid program. The budget bill predominantly is
in the first bucket the reducing the number of people
that are enrolled in the program, and it does so
through a variety of different complex eligibility rules and increased
(03:25):
paperwork for OHP members, which I'll get into a lot
of detail in the coming slides, but I want to
at a high level, want to just note that what
this means is we do estimate that it would increase
the administrative burden not only on members, a sort of
(03:49):
requirement to continue to provide paperwork to prove your your eligibility,
your your status whether or not your working or doing
other activities, as well as high administrative costs to the
state to be verifying that information, making the it changes,
et cetera. All of this to say is that north
(04:10):
of one hundred thousand folks within the state could lose coverage,
and that's that is if organ we're organ the number
would be a lot higher. We have put together and
proved time and time again from our own winding and
other initiatives that we've put into place, that we do
(04:31):
what we can to reduce the burden on the individual
to we were a number one or number two or
number three in the country in a variety of different
measures on ensuring that people coming out of the COVID
nineteen unwinding maintained coverage because we instituted a number of
policies to maintain coverage and keep people enrolled. But this
(04:54):
a lot of the research has shown that the increased
paperwork burden, no matter how many it system changes and
different policies you put in place to reduce the burden
on the people, it's the paperwork is still such a
significant burden that people end up not staying enrolled in
(05:16):
coverage or not enrolling to begin with because of the
significantly high paperwork burden.
Speaker 1 (05:21):
Emma Sandaw was the Medicaid director for the Oregon Health Authority.
She explained to Oregon legislators how President Trump's Big Beautiful
Bill Act might affect Medicaid in the state. Sandel says,
it will affect the healthcare system statewide.
Speaker 2 (05:34):
We know in Oregon that when more people are enrolled
in coverage, that is not only good for the individual
that is enrolled because you can catch disease earlier in
the in the disease life cycle, as well as that
it's good for the whole healthcare system because you're able
to make sure that people are getting paid for the
(05:57):
healthcare services that they are providing. That keeps providers in business,
which impacts everyone in the community when a provider is
in business, So for example, in eastern Oregon, in Malhere County,
for instance, fifty one percent of the population is in
a role in Medicaid, so providers in those counties rely
(06:21):
heavily on Medicaid funding, and if those providers aren't able
to stay in business, not only does it impact the
fifty one percent of people that have Medicaid coverage, it
also impacts the forty nine percent of the people that
rely on other health insurance coverage to see those providers
in that area.
Speaker 1 (06:39):
Sando says the state would also be penalized for programs
like the Healthier organ Program.
Speaker 2 (06:44):
This program covers people that do not meet documentations requirements
for immigration in the Medicaid program, and the Healthier organ
program provides coverage to people that don't meet those documents
tation standards. And this bill puts a ten percent federal
(07:05):
matching rate reduction for the Medicaid expansion set of funding
for states that have these these programs, and so this
would mean about a billion dollars in reduced Medicaid a
federal money coming in through through the because of this
(07:26):
policy in the biennium.
Speaker 1 (07:28):
Sando says that there would be a significant impact on
rural healthcare.
Speaker 2 (07:32):
In no place does the impact to the financial impact
is more felt than in rural parts of our state
where we know, as I mentioned, Medicaid plays such a
large role in ensuring that providers are paid for their services,
and we have a variety of different funding mechanisms in
(07:55):
addition to ensuring that that providers in rural communities are paid,
and Medicaid is often one of the largest payers and
in rural parts of the state, and reduced Medicaid expenditures
in rural portions of the state does mean reduced abilities
for those providers to stay in business.
Speaker 1 (08:15):
Sando says that the cuts could be expensive for Oregon
taxpayers when we.
Speaker 2 (08:20):
Have instances that providers go out of out of business
or particularly for example f qhcs or other providers that
provide primary care services. Then we're not able to do
what we do really well in Oregon, which is to
ensure that we're treating the person early in the their
(08:41):
health care conditions and before it becomes at a stage
of needing needing higher cost and and ultimately when a
person is sick, they end up do using the healthcare
system in some capacity, and that having a higher cost
does cost everyone more if it's uncompensated care or other
(09:07):
things like that.
Speaker 1 (09:07):
Sando say. Is one of the new requirements to get
Medicaid is proof that a person is working.
Speaker 2 (09:12):
This require, as written in the House bill, would require
a person to prove to the state at least twice
a year if they are in the Medicaid Expansion Eligibility group,
that they either work eighty hours a week a month,
(09:34):
or participate in community service for at least eighty hours
a month, or looking for work at that amount. This
would the implementation date of this is December thirty first,
twenty twenty six. And what this really functionally would be
(09:54):
doing is requiring that paperwork to be sent to the
person requiring them to prove over and over and over again.
And one thing to note here is that national estimates
and other other sources and research has shown us that
about two thirds of Medicaid members, most all Medicaid members
(10:16):
are working that are in this elegeb ability category. They're
either working part time jobs, contracting jobs like if you're
working at Uber, we don't know how many hours you're
working at Uber, and so that burden will will need
to be figured out as part of this policy or
other other activities like that. And then the the one
(10:38):
third of folks would qualify for one of the exemptions,
or most all would qualify for one of the exemptions,
such as being a parent or caretaker of an older
individual or somebody in their family, being in school, being
a number of other activities, being engaged in substance use
disorder treatment, et cetera. What this would requires that we
(11:01):
ask that do you meet these criteria? Do you meet
these exemptions? Are you enrolled in school? And that burden
that then does fall on the member, and as we
know that that could lead to a lot of people
that would qualify for the exemption to lose coverage at
some very pivotal times, such as if a person has
(11:21):
just recently found out that they are pregnant, but we
don't have that information, and then they lose healthcare coverage
right when they're trying to get pregnancy services.
Speaker 1 (11:29):
That Semasando, Medicaid director for the Oregon Health Authority, with
details on potential impacts from President Trump's Big Beautiful Bill
Act on Medicaid in Oregon. Gambling disorders are on the
rise because online gambling makes it easier to access. Gambling
(11:52):
disorders often take time to develop. Kaiser prominente Northwest psychiatrist
doctor Eric fran says, it takes time for clients to
realize they have a problem. Is there a connection between
mental health and gambling addiction?
Speaker 3 (12:04):
You know?
Speaker 4 (12:04):
I kind of think of the line between addiction and
mental health issues as being kind of an artificial when
they inform each other. Someone who has mental health difficulties,
issues diseases can often lead to substances or behaviors that
are considered addictions in order to either relieve or vent
(12:28):
off issues that they have, and then the addictions themselves,
whether their behavioral or substance, can then feedback onto the
mental health issues themselves, so they seem, if not entirely related,
at least very well related to each other.
Speaker 1 (12:45):
What are some early warning science that gambling is becoming
a problem.
Speaker 4 (12:50):
I often work with my clients to help figure out
what their values are in their lives. Any sort of
behavior or any kind of any kind of use really
in their lives, whether that's alcohol, drugs, nicotine, marijuana, eating,
or these behavioral issues that we're talking about, including addiction, pornography,
(13:11):
what have you. All these may be within the client's
value system. It may feel good to them, it may
be pleasured to them, and may be culturally appropriate for them.
Where I sort of start to get involved is when
the client says, you know, this is not aligned with
how I want to live my life, And that might
be they're using substances or gambling more than they want
(13:34):
to the consequences of gambling maybe more than they're able
to compensate with, whether that's loss of time, loss of control,
loss of financial resources, or whether or not it starts
to interfere with their other things that they enjoy in
their lifetime, with their family, employment, spiritual beliefs.
Speaker 1 (13:58):
So does family history and genetics have an effect on
gambling risk?
Speaker 4 (14:03):
That absolutely does. I think we often ask what is
nature versus nurture, And I think that's usually a kind
of an academic question. If someone is raised by someone
with gambling addiction or problematic gambling behavior, they can learn
that that's sort of a normalized way of operating in
the world, or they don't see other ways of being
(14:26):
in the world. They're a strong genetic components. Seeing someone
who is has a family history who's not then raised
by the family certainly at a higher risk of developing
problematic gambling behaviors.
Speaker 1 (14:38):
How can integrated personalized mental health care result in improved
outcomes for people who have problems with gambling?
Speaker 4 (14:45):
I think most of our data scientific data is normed
towards large populations. But from what I learned in medical
school is that you can't apply population data to individuals.
Humans are born into specific contexts and then live their
lives in specific contexts which include cultural, gender, ethnic, socioeconomic
(15:11):
issues that are hard to norm towards the general population.
So I think what really good care looks like is
involving a team of people who have different specialties instead
of skills, to really look at the patient and see
what they value, what circumstances they're living in, what tools
they have available to them, what resources are meaningful to them,
(15:34):
and how they access those in ways that make sense
for them as an individual person.
Speaker 1 (15:38):
How do early intervention tools like the vive app help
reduce stigma and access barriers to care?
Speaker 4 (15:47):
Addiction is a lifelong issue. Even when someone is completely
sober or abstinent, or is reduced their problematic use or behaviors,
it's still something that pro and capello for the rest
of their lives. Something that I tell a lot of
my clients is, in a non cynical way, I expect
(16:07):
you to return to you or have slip ups or
not meet your goals all the time. That's just another
way for us to come back to the drawing board
and say, what worked, What more do you need? And therefore,
the earlier interventions you have, the more chances you have
to come back to the drawing board in a way
that feels safe productive.
Speaker 1 (16:27):
Do you have any tips for helping a loved one
who may be struggling with a gambling addiction.
Speaker 4 (16:33):
I think it's often very difficult to understand addiction as
a not a moral failing. I think it's hard to
understand that addiction is motive by, motivated by things that
have in some ways nothing to do with us as
loved ones. An addiction in some ways often defive what
(16:55):
we may consider logical processes. So when I work with
people who have loved ones with addiction issues, it's often
to then set their own boundaries in terms of what
feels right for the person doing the loving intervention, how
much of the issue they're taking on themselves, how much
(17:17):
they're trying to control the other person, and what feels
right for their relationship.
Speaker 1 (17:22):
Where can they go to get help? And I ask that,
either for a person who thinks they might have a
gambling problem or for a family member, what are some
first steps or ways that people can seek out help?
Speaker 4 (17:36):
Because everyone has such an individual sort of kind of life.
I also love that there's so many different access points
to get treatment, and that can look different for every
single person. Someone who's really involved in religious communities, for example,
that reach out to their religious leaders, and I know a.
Speaker 1 (17:53):
Lot of.
Speaker 4 (17:55):
Sites of worship also hosts a lot of meetings for
people who have addiction issues. You can certainly seek it
out from your healthcare providers, whether that's your primary care provider,
whether that's your mental health provider, including your therapist or psychiatrist.
You can also access it through a lot of community
to members too. So since a lot of people who
(18:18):
suffer from one addiction often suffer from many, the organizations
are often linked to each other, so looking at local
AA meetings, Smart Recovery, Gambler's Anonymous sex addicts anonymous, but
often link to each other as well.
Speaker 1 (18:32):
Doctor, try anything else you'd like to add.
Speaker 4 (18:34):
One of the reasons I went into addiction work is
that it is an incredibly fulfilling field to see someone
truly ask large life questions of themselves that otherwise those
of us who consider ourselves not having an addiction sort
of blow right past. And maybe this is an invitation
for us all to think of ourselves as on a
spectrum and look about how this healing process might affect
(18:58):
all of us.
Speaker 1 (18:58):
Doctor Tran, thanks for joining on local voices. That's kinds
of promonente Northwest psychiatrist doctor Eric Trann discussing gambling addiction
and how to get help. Golden City Council has approved
a settlement with families from the Albina neighborhood who were
displaced by urban renewals starting the nineteen sixties that includes
(19:21):
construction of Interstate five, Memorial Coliseum, and Emmanuel Hospital. The
original settlement was two million dollars and council quadrupled it
to eight and a half million dollars. Council Member Loretta
Smith explains the importance of the settlement.
Speaker 5 (19:35):
We must also recognize our broader obligation concerning the other
three hundred families who were displaced by cities, including race
based zoning laws, unconscionable urban renewal policies, and ill advised
use of imminent domain. These policies, although very tough to
(19:58):
listen to, deliberately marginalized back black communities and left lasting
scars when residents were pushed out of Albina without reparations,
leaving an inevitable mark on our city's history. And we
have a new council today, We have new ears, we
(20:18):
have new eyes, and our response must be deliberate, comprehensive,
and rooted in fairness and justice so that both sides
feel they engaged in good faith negotiations. And this issue
was not solely about monetary reparations. It is a moral
(20:40):
imperative to restore dignity and to rebuild trust and to
foster resilience within affected communities as we deliberate, so I
urge each of us to consider, how can justice be
adequately and appropriately quantified and what measures can we implement
(21:07):
to prevent future displacements. So our collective responsibility is clear
to advance efforts towards community recovery and healing, and to
pursue restorative justice that lays the groundwork for a more
equitable Portland for everyone. And that's what I hope that
(21:32):
can come from today's proceedings, because this is not just
an ordinary risk claim. This is about people, families being uprooted,
moved from one community to the next, coming from a
space where they were traumatized when they were flooded in Banpoort,
(21:55):
and moving to Albina and again, moved again and again.
And so for me, this is not ordinary, but extraordinary
circumstances happened to ordinary people, and so we have to
do extraordinary things to make the harm be lessened than
(22:22):
what it is. I didn't expect today to be as big.
Speaker 1 (22:28):
As it was.
Speaker 5 (22:29):
I wrote it because I knew that it was big,
but it wasn't really felt until I listened to the testimony,
until I really saw the faces of the people. I
know some of you, but I know your parents and
your grandparents right and knowing that it takes some savviness
(22:51):
to get to where you are. And so I appreciate
the leaders of this group, the leaders who understand good
that they're going to have to spend some time and
some money and resources, and you all did that. So
for me, I think just waiting just a little bit
(23:13):
longer to hear what we're going to say will be helpful.
But understanding there was a third leg to this component
that we have to restore to the community at large.
We won't be able to help each and every person,
but we definitely can identify policies and procedures that will
(23:36):
increase and help communities who need to have downpayment assistance,
who need workforce development, who need to understand the policies
of the cities. We have a number of things that
we already have in play that we just need to
let you know what we're doing. So I just want
(23:58):
to thank all of you all for coming to and
for persevering, because this was sixty years for sure, and
the gravity of this moment is going to be historical.
It is already historical, and I don't know when we
all signed up for this, the ninety eight people who
ran for council. If we ever thought that we were
(24:21):
going to be in this kind of space making these
kinds of decisions.
Speaker 1 (24:29):
Immediately, Council President Elena pel Guinea, as.
Speaker 3 (24:32):
A counselor from district to I feel a unique sense
of duty to make sure that we own our history
and colleagues, our history has left a hole in our district.
And as we heard, it is a physical hole, a
place that is not homes and is not businesses, and
is not parks or other intentional space. But it is
also much more than a physical hole. It is a
(24:55):
gaping hole in community. It's a shadow, a whisper of
what was once family homes, neighborhood businesses, and a network
of community who got to live in proximity to their
family and friends and build something together. And that was taken,
and it was taken not by accident. It happened through
public policy, through urban renewal and eminent domain and zoning
(25:19):
and decisions made by government, including by our predecessors on
this city Council, and it displaced black Portlanders and disrupted
generational progress. And as we heard today, the redevelopment that
was promised never even came in some cases. So I
want to acknowledge the families who have carried this fight
(25:41):
and this pain and this process through years of negotiations.
And I want to be clear that this settlement is
not a full restoration, because it never can be. But
nonetheless it is important. When our attorneys colleagues bring us
a settlement, I typically trust their careful balancing of our
legal responsibilities and the limitations of what is possible, and
(26:05):
I generally would not amend that. But this case calls
for us to do something different, not just legally but morally.
So I want to thank our colleague, Counselor Smith for
putting forward a proposal that helps us to do more
for these plaintiffs today, and I want to affirm my
commitment to doing more, not just today, but as we
(26:28):
move forward, not just for but with the black community
in my district and across our city. If we're serious
about rebuilding trust in our city, we must continue to
act with transparency, accountability, and urgency to create a stronger,
more just future for all of our communities. Thank you
(26:51):
for bringing this forward, and you will have my support.
Speaker 1 (26:54):
That's Portan City Council President, Elena Perl Guinea explaining her
vote to approve a settlement for families of the Albina
neighborhood that quadruples the amount of money from two million
dollars to eight and a half million dollars. Smoke impacted
grapes might not be as detrimental to the wine industry
(27:16):
as first thought. According to new research from Oregon State University,
Oregon's twenty twenty Labor Day fires costs more than three
billion dollars in losses for West Coast wineries, largely due
to smoke taint in the grapes.
Speaker 6 (27:29):
So for a long time people thought all smoke was
a problem.
Speaker 1 (27:32):
O Issue analogy professor Elizabeth Thomasino says the economic impact
was extraordinary for the industry.
Speaker 6 (27:38):
More than three point four billion dollars were lost due
to damages, and that's not even the total, because of
course it impacts future years.
Speaker 1 (27:45):
An O issue study led by Thomasino's team found some
consumers are open to smoke impacted wine.
Speaker 6 (27:51):
You do know that it is dependent on the smoke.
It's dependent on how close you are to where the
actual fire is, because you tend to have higher concentrations
of the things that cause these problems.
Speaker 1 (28:01):
She says the most receptive tended to be people without
a preconceived idea of what a certain wine or brand
was supposed to taste like.
Speaker 6 (28:09):
You might not like it, but there is someone who does,
and you have to find out who that person is.
Speaker 1 (28:14):
That means wineries need to consider different options for those wines.
Speaker 6 (28:17):
Wineries have their products, they're beautiful, they have their consumers
who love those products. This is sort of saying you
might need to do a shift. Maybe you create a
different product, maybe you go to a different market.
Speaker 1 (28:28):
Thom Asino hopes to study opens doors for winemakers who
would otherwise be forced to throw out entire crops after
a tough wildfire season.
Speaker 6 (28:36):
I think for a long time people have looked at
it as like we can't release our wine because it's
not going to be the same, and it's not. But
we're hoping winemakers think of this as opening up another
avenue for their product.
Speaker 1 (28:48):
That's Oregon State University's analogy professor Elizabeth Thomasino and details
about her research into smoke affected grapes that are used
to make wines. Thanks for listening to local voices, I'm
brad Ford. You can hear past episodes on the iHeartRadio
app under the podcast tab. Local Voices is a public
(29:09):
affairs presentation from iHeartRadio.
Welcome to local Voices. I'm brad Ford. This week, the
Oregon Health Authority is working to learn what's ahead from
Medicaid under changes from President Trump's Big Beautiful Bill Act.
Gambling is on the rise because of easier access online.
We'll look at connections between mental health and gambling. Port
and City Council made a major decision this week affecting
(00:25):
families who were displaced by urban projects dating back to
the nineteen sixties. They approved an economic settlement with those
families that was four times higher than expected. At an
Oregon State University researcher is working with wineries to help
them understand what they can do with grapes that are
tainted by wildfire smoke. President Trump's Big Beautiful Bill Act
(00:54):
currently includes changes to Medicaid that will affect Oregon. Emmisando
is the Medicaid director for the Health Authority. She's told
Oregon legislators They've worked hard to increase the number of
Oregonians who have health insurance in Oregon.
Speaker 2 (01:07):
We have done quite a number of things to ensure
that healthcare is available to all Oregonians, and we and
OHA have recently put out information that ninety seven percent
of all people in Oregon have health insurance and that
is a record high that we had never achieved before
(01:31):
in our state. And according to the most recent data,
this is in large part due to the organ Health
Plan that ensures one point four million people in our state,
or about thirty three percent of the population Medicaid. As
you all are well aware, and I know I've talked
in this committee before, it provides a variety of services
(01:55):
from covering nearly half of all berths in the state
more about fifty seven percent of children, as well as
a variety of different long term services and support and
for people with disabilities, and other types of services across
the healthcare spectrum. The work that we have done in
Oregon is is very much applauded by the RUSSA country
(02:18):
as a bipartisan way of ensuring healthcare access to two people,
and it has been used as a vehicle or used
as an example for the rests of country to expand
healthcare access and health insurance.
Speaker 1 (02:38):
The President's Big Beautiful Bill Act seeks to reduce spending
on Medicaid in a variety of ways.
Speaker 2 (02:44):
There are three different ways in which lawmakers and policy
makers could approach reducing Medicaid expenditures and Medicaid funding, and
one is through reducing the number of people that are
enrolled in the medicaid program. One is reducing provider rates,
(03:05):
and one is reducing the number of services that are
covered by a medicaid program. The budget bill predominantly is
in the first bucket the reducing the number of people
that are enrolled in the program, and it does so
through a variety of different complex eligibility rules and increased
(03:25):
paperwork for OHP members, which I'll get into a lot
of detail in the coming slides, but I want to
at a high level, want to just note that what
this means is we do estimate that it would increase
the administrative burden not only on members, a sort of
(03:49):
requirement to continue to provide paperwork to prove your your eligibility,
your your status whether or not your working or doing
other activities, as well as high administrative costs to the
state to be verifying that information, making the it changes,
et cetera. All of this to say is that north
(04:10):
of one hundred thousand folks within the state could lose coverage,
and that's that is if organ we're organ the number
would be a lot higher. We have put together and
proved time and time again from our own winding and
other initiatives that we've put into place, that we do
(04:31):
what we can to reduce the burden on the individual
to we were a number one or number two or
number three in the country in a variety of different
measures on ensuring that people coming out of the COVID
nineteen unwinding maintained coverage because we instituted a number of
policies to maintain coverage and keep people enrolled. But this
(04:54):
a lot of the research has shown that the increased
paperwork burden, no matter how many it system changes and
different policies you put in place to reduce the burden
on the people, it's the paperwork is still such a
significant burden that people end up not staying enrolled in
(05:16):
coverage or not enrolling to begin with because of the
significantly high paperwork burden.
Speaker 1 (05:21):
Emma Sandaw was the Medicaid director for the Oregon Health Authority.
She explained to Oregon legislators how President Trump's Big Beautiful
Bill Act might affect Medicaid in the state. Sandel says,
it will affect the healthcare system statewide.
Speaker 2 (05:34):
We know in Oregon that when more people are enrolled
in coverage, that is not only good for the individual
that is enrolled because you can catch disease earlier in
the in the disease life cycle, as well as that
it's good for the whole healthcare system because you're able
to make sure that people are getting paid for the
(05:57):
healthcare services that they are providing. That keeps providers in business,
which impacts everyone in the community when a provider is
in business, So for example, in eastern Oregon, in Malhere County,
for instance, fifty one percent of the population is in
a role in Medicaid, so providers in those counties rely
(06:21):
heavily on Medicaid funding, and if those providers aren't able
to stay in business, not only does it impact the
fifty one percent of people that have Medicaid coverage, it
also impacts the forty nine percent of the people that
rely on other health insurance coverage to see those providers
in that area.
Speaker 1 (06:39):
Sando says the state would also be penalized for programs
like the Healthier organ Program.
Speaker 2 (06:44):
This program covers people that do not meet documentations requirements
for immigration in the Medicaid program, and the Healthier organ
program provides coverage to people that don't meet those documents
tation standards. And this bill puts a ten percent federal
(07:05):
matching rate reduction for the Medicaid expansion set of funding
for states that have these these programs, and so this
would mean about a billion dollars in reduced Medicaid a
federal money coming in through through the because of this
(07:26):
policy in the biennium.
Speaker 1 (07:28):
Sando says that there would be a significant impact on
rural healthcare.
Speaker 2 (07:32):
In no place does the impact to the financial impact
is more felt than in rural parts of our state
where we know, as I mentioned, Medicaid plays such a
large role in ensuring that providers are paid for their services,
and we have a variety of different funding mechanisms in
(07:55):
addition to ensuring that that providers in rural communities are paid,
and Medicaid is often one of the largest payers and
in rural parts of the state, and reduced Medicaid expenditures
in rural portions of the state does mean reduced abilities
for those providers to stay in business.
Speaker 1 (08:15):
Sando says that the cuts could be expensive for Oregon
taxpayers when we.
Speaker 2 (08:20):
Have instances that providers go out of out of business
or particularly for example f qhcs or other providers that
provide primary care services. Then we're not able to do
what we do really well in Oregon, which is to
ensure that we're treating the person early in the their
(08:41):
health care conditions and before it becomes at a stage
of needing needing higher cost and and ultimately when a
person is sick, they end up do using the healthcare
system in some capacity, and that having a higher cost
does cost everyone more if it's uncompensated care or other
(09:07):
things like that.
Speaker 1 (09:07):
Sando say. Is one of the new requirements to get
Medicaid is proof that a person is working.
Speaker 2 (09:12):
This require, as written in the House bill, would require
a person to prove to the state at least twice
a year if they are in the Medicaid Expansion Eligibility group,
that they either work eighty hours a week a month,
(09:34):
or participate in community service for at least eighty hours
a month, or looking for work at that amount. This
would the implementation date of this is December thirty first,
twenty twenty six. And what this really functionally would be
(09:54):
doing is requiring that paperwork to be sent to the
person requiring them to prove over and over and over again.
And one thing to note here is that national estimates
and other other sources and research has shown us that
about two thirds of Medicaid members, most all Medicaid members
(10:16):
are working that are in this elegeb ability category. They're
either working part time jobs, contracting jobs like if you're
working at Uber, we don't know how many hours you're
working at Uber, and so that burden will will need
to be figured out as part of this policy or
other other activities like that. And then the the one
(10:38):
third of folks would qualify for one of the exemptions,
or most all would qualify for one of the exemptions,
such as being a parent or caretaker of an older
individual or somebody in their family, being in school, being
a number of other activities, being engaged in substance use
disorder treatment, et cetera. What this would requires that we
(11:01):
ask that do you meet these criteria? Do you meet
these exemptions? Are you enrolled in school? And that burden
that then does fall on the member, and as we
know that that could lead to a lot of people
that would qualify for the exemption to lose coverage at
some very pivotal times, such as if a person has
(11:21):
just recently found out that they are pregnant, but we
don't have that information, and then they lose healthcare coverage
right when they're trying to get pregnancy services.
Speaker 1 (11:29):
That Semasando, Medicaid director for the Oregon Health Authority, with
details on potential impacts from President Trump's Big Beautiful Bill
Act on Medicaid in Oregon. Gambling disorders are on the
rise because online gambling makes it easier to access. Gambling
(11:52):
disorders often take time to develop. Kaiser prominente Northwest psychiatrist
doctor Eric fran says, it takes time for clients to
realize they have a problem. Is there a connection between
mental health and gambling addiction?
Speaker 3 (12:04):
You know?
Speaker 4 (12:04):
I kind of think of the line between addiction and
mental health issues as being kind of an artificial when
they inform each other. Someone who has mental health difficulties,
issues diseases can often lead to substances or behaviors that
are considered addictions in order to either relieve or vent
(12:28):
off issues that they have, and then the addictions themselves,
whether their behavioral or substance, can then feedback onto the
mental health issues themselves, so they seem, if not entirely related,
at least very well related to each other.
Speaker 1 (12:45):
What are some early warning science that gambling is becoming
a problem.
Speaker 4 (12:50):
I often work with my clients to help figure out
what their values are in their lives. Any sort of
behavior or any kind of any kind of use really
in their lives, whether that's alcohol, drugs, nicotine, marijuana, eating,
or these behavioral issues that we're talking about, including addiction, pornography,
(13:11):
what have you. All these may be within the client's
value system. It may feel good to them, it may
be pleasured to them, and may be culturally appropriate for them.
Where I sort of start to get involved is when
the client says, you know, this is not aligned with
how I want to live my life, And that might
be they're using substances or gambling more than they want
(13:34):
to the consequences of gambling maybe more than they're able
to compensate with, whether that's loss of time, loss of control,
loss of financial resources, or whether or not it starts
to interfere with their other things that they enjoy in
their lifetime, with their family, employment, spiritual beliefs.
Speaker 1 (13:58):
So does family history and genetics have an effect on
gambling risk?
Speaker 4 (14:03):
That absolutely does. I think we often ask what is
nature versus nurture, And I think that's usually a kind
of an academic question. If someone is raised by someone
with gambling addiction or problematic gambling behavior, they can learn
that that's sort of a normalized way of operating in
the world, or they don't see other ways of being
(14:26):
in the world. They're a strong genetic components. Seeing someone
who is has a family history who's not then raised
by the family certainly at a higher risk of developing
problematic gambling behaviors.
Speaker 1 (14:38):
How can integrated personalized mental health care result in improved
outcomes for people who have problems with gambling?
Speaker 4 (14:45):
I think most of our data scientific data is normed
towards large populations. But from what I learned in medical
school is that you can't apply population data to individuals.
Humans are born into specific contexts and then live their
lives in specific contexts which include cultural, gender, ethnic, socioeconomic
(15:11):
issues that are hard to norm towards the general population.
So I think what really good care looks like is
involving a team of people who have different specialties instead
of skills, to really look at the patient and see
what they value, what circumstances they're living in, what tools
they have available to them, what resources are meaningful to them,
(15:34):
and how they access those in ways that make sense
for them as an individual person.
Speaker 1 (15:38):
How do early intervention tools like the vive app help
reduce stigma and access barriers to care?
Speaker 4 (15:47):
Addiction is a lifelong issue. Even when someone is completely
sober or abstinent, or is reduced their problematic use or behaviors,
it's still something that pro and capello for the rest
of their lives. Something that I tell a lot of
my clients is, in a non cynical way, I expect
(16:07):
you to return to you or have slip ups or
not meet your goals all the time. That's just another
way for us to come back to the drawing board
and say, what worked, What more do you need? And therefore,
the earlier interventions you have, the more chances you have
to come back to the drawing board in a way
that feels safe productive.
Speaker 1 (16:27):
Do you have any tips for helping a loved one
who may be struggling with a gambling addiction.
Speaker 4 (16:33):
I think it's often very difficult to understand addiction as
a not a moral failing. I think it's hard to
understand that addiction is motive by, motivated by things that
have in some ways nothing to do with us as
loved ones. An addiction in some ways often defive what
(16:55):
we may consider logical processes. So when I work with
people who have loved ones with addiction issues, it's often
to then set their own boundaries in terms of what
feels right for the person doing the loving intervention, how
much of the issue they're taking on themselves, how much
(17:17):
they're trying to control the other person, and what feels
right for their relationship.
Speaker 1 (17:22):
Where can they go to get help? And I ask that,
either for a person who thinks they might have a
gambling problem or for a family member, what are some
first steps or ways that people can seek out help?
Speaker 4 (17:36):
Because everyone has such an individual sort of kind of life.
I also love that there's so many different access points
to get treatment, and that can look different for every
single person. Someone who's really involved in religious communities, for example,
that reach out to their religious leaders, and I know a.
Speaker 1 (17:53):
Lot of.
Speaker 4 (17:55):
Sites of worship also hosts a lot of meetings for
people who have addiction issues. You can certainly seek it
out from your healthcare providers, whether that's your primary care provider,
whether that's your mental health provider, including your therapist or psychiatrist.
You can also access it through a lot of community
to members too. So since a lot of people who
(18:18):
suffer from one addiction often suffer from many, the organizations
are often linked to each other, so looking at local
AA meetings, Smart Recovery, Gambler's Anonymous sex addicts anonymous, but
often link to each other as well.
Speaker 1 (18:32):
Doctor, try anything else you'd like to add.
Speaker 4 (18:34):
One of the reasons I went into addiction work is
that it is an incredibly fulfilling field to see someone
truly ask large life questions of themselves that otherwise those
of us who consider ourselves not having an addiction sort
of blow right past. And maybe this is an invitation
for us all to think of ourselves as on a
spectrum and look about how this healing process might affect
(18:58):
all of us.
Speaker 1 (18:58):
Doctor Tran, thanks for joining on local voices. That's kinds
of promonente Northwest psychiatrist doctor Eric Trann discussing gambling addiction
and how to get help. Golden City Council has approved
a settlement with families from the Albina neighborhood who were
displaced by urban renewals starting the nineteen sixties that includes
(19:21):
construction of Interstate five, Memorial Coliseum, and Emmanuel Hospital. The
original settlement was two million dollars and council quadrupled it
to eight and a half million dollars. Council Member Loretta
Smith explains the importance of the settlement.
Speaker 5 (19:35):
We must also recognize our broader obligation concerning the other
three hundred families who were displaced by cities, including race
based zoning laws, unconscionable urban renewal policies, and ill advised
use of imminent domain. These policies, although very tough to
(19:58):
listen to, deliberately marginalized back black communities and left lasting
scars when residents were pushed out of Albina without reparations,
leaving an inevitable mark on our city's history. And we
have a new council today, We have new ears, we
(20:18):
have new eyes, and our response must be deliberate, comprehensive,
and rooted in fairness and justice so that both sides
feel they engaged in good faith negotiations. And this issue
was not solely about monetary reparations. It is a moral
(20:40):
imperative to restore dignity and to rebuild trust and to
foster resilience within affected communities as we deliberate, so I
urge each of us to consider, how can justice be
adequately and appropriately quantified and what measures can we implement
(21:07):
to prevent future displacements. So our collective responsibility is clear
to advance efforts towards community recovery and healing, and to
pursue restorative justice that lays the groundwork for a more
equitable Portland for everyone. And that's what I hope that
(21:32):
can come from today's proceedings, because this is not just
an ordinary risk claim. This is about people, families being uprooted,
moved from one community to the next, coming from a
space where they were traumatized when they were flooded in Banpoort,
(21:55):
and moving to Albina and again, moved again and again.
And so for me, this is not ordinary, but extraordinary
circumstances happened to ordinary people, and so we have to
do extraordinary things to make the harm be lessened than
(22:22):
what it is. I didn't expect today to be as big.
Speaker 1 (22:28):
As it was.
Speaker 5 (22:29):
I wrote it because I knew that it was big,
but it wasn't really felt until I listened to the testimony,
until I really saw the faces of the people. I
know some of you, but I know your parents and
your grandparents right and knowing that it takes some savviness
(22:51):
to get to where you are. And so I appreciate
the leaders of this group, the leaders who understand good
that they're going to have to spend some time and
some money and resources, and you all did that. So
for me, I think just waiting just a little bit
(23:13):
longer to hear what we're going to say will be helpful.
But understanding there was a third leg to this component
that we have to restore to the community at large.
We won't be able to help each and every person,
but we definitely can identify policies and procedures that will
(23:36):
increase and help communities who need to have downpayment assistance,
who need workforce development, who need to understand the policies
of the cities. We have a number of things that
we already have in play that we just need to
let you know what we're doing. So I just want
(23:58):
to thank all of you all for coming to and
for persevering, because this was sixty years for sure, and
the gravity of this moment is going to be historical.
It is already historical, and I don't know when we
all signed up for this, the ninety eight people who
ran for council. If we ever thought that we were
(24:21):
going to be in this kind of space making these
kinds of decisions.
Speaker 1 (24:29):
Immediately, Council President Elena pel Guinea, as.
Speaker 3 (24:32):
A counselor from district to I feel a unique sense
of duty to make sure that we own our history
and colleagues, our history has left a hole in our district.
And as we heard, it is a physical hole, a
place that is not homes and is not businesses, and
is not parks or other intentional space. But it is
also much more than a physical hole. It is a
(24:55):
gaping hole in community. It's a shadow, a whisper of
what was once family homes, neighborhood businesses, and a network
of community who got to live in proximity to their
family and friends and build something together. And that was taken,
and it was taken not by accident. It happened through
public policy, through urban renewal and eminent domain and zoning
(25:19):
and decisions made by government, including by our predecessors on
this city Council, and it displaced black Portlanders and disrupted
generational progress. And as we heard today, the redevelopment that
was promised never even came in some cases. So I
want to acknowledge the families who have carried this fight
(25:41):
and this pain and this process through years of negotiations.
And I want to be clear that this settlement is
not a full restoration, because it never can be. But
nonetheless it is important. When our attorneys colleagues bring us
a settlement, I typically trust their careful balancing of our
legal responsibilities and the limitations of what is possible, and
(26:05):
I generally would not amend that. But this case calls
for us to do something different, not just legally but morally.
So I want to thank our colleague, Counselor Smith for
putting forward a proposal that helps us to do more
for these plaintiffs today, and I want to affirm my
commitment to doing more, not just today, but as we
(26:28):
move forward, not just for but with the black community
in my district and across our city. If we're serious
about rebuilding trust in our city, we must continue to
act with transparency, accountability, and urgency to create a stronger,
more just future for all of our communities. Thank you
(26:51):
for bringing this forward, and you will have my support.
Speaker 1 (26:54):
That's Portan City Council President, Elena Perl Guinea explaining her
vote to approve a settlement for families of the Albina
neighborhood that quadruples the amount of money from two million
dollars to eight and a half million dollars. Smoke impacted
grapes might not be as detrimental to the wine industry
(27:16):
as first thought. According to new research from Oregon State University,
Oregon's twenty twenty Labor Day fires costs more than three
billion dollars in losses for West Coast wineries, largely due
to smoke taint in the grapes.
Speaker 6 (27:29):
So for a long time people thought all smoke was
a problem.
Speaker 1 (27:32):
O Issue analogy professor Elizabeth Thomasino says the economic impact
was extraordinary for the industry.
Speaker 6 (27:38):
More than three point four billion dollars were lost due
to damages, and that's not even the total, because of
course it impacts future years.
Speaker 1 (27:45):
An O issue study led by Thomasino's team found some
consumers are open to smoke impacted wine.
Speaker 6 (27:51):
You do know that it is dependent on the smoke.
It's dependent on how close you are to where the
actual fire is, because you tend to have higher concentrations
of the things that cause these problems.
Speaker 1 (28:01):
She says the most receptive tended to be people without
a preconceived idea of what a certain wine or brand
was supposed to taste like.
Speaker 6 (28:09):
You might not like it, but there is someone who does,
and you have to find out who that person is.
Speaker 1 (28:14):
That means wineries need to consider different options for those wines.
Speaker 6 (28:17):
Wineries have their products, they're beautiful, they have their consumers
who love those products. This is sort of saying you
might need to do a shift. Maybe you create a
different product, maybe you go to a different market.
Speaker 1 (28:28):
Thom Asino hopes to study opens doors for winemakers who
would otherwise be forced to throw out entire crops after
a tough wildfire season.
Speaker 6 (28:36):
I think for a long time people have looked at
it as like we can't release our wine because it's
not going to be the same, and it's not. But
we're hoping winemakers think of this as opening up another
avenue for their product.
Speaker 1 (28:48):
That's Oregon State University's analogy professor Elizabeth Thomasino and details
about her research into smoke affected grapes that are used
to make wines. Thanks for listening to local voices, I'm
brad Ford. You can hear past episodes on the iHeartRadio
app under the podcast tab. Local Voices is a public
(29:09):
affairs presentation from iHeartRadio.
Popular Podcasts
On Purpose with Jay Shetty
I’m Jay Shetty host of On Purpose the worlds #1 Mental Health podcast and I’m so grateful you found us. I started this podcast 5 years ago to invite you into conversations and workshops that are designed to help make you happier, healthier and more healed. I believe that when you (yes you) feel seen, heard and understood you’re able to deal with relationship struggles, work challenges and life’s ups and downs with more ease and grace. I interview experts, celebrities, thought leaders and athletes so that we can grow our mindset, build better habits and uncover a side of them we’ve never seen before. New episodes every Monday and Friday. Your support means the world to me and I don’t take it for granted — click the follow button and leave a review to help us spread the love with On Purpose. I can’t wait for you to listen to your first or 500th episode!
Crime Junkie
Does hearing about a true crime case always leave you scouring the internet for the truth behind the story? Dive into your next mystery with Crime Junkie. Every Monday, join your host Ashley Flowers as she unravels all the details of infamous and underreported true crime cases with her best friend Brit Prawat. From cold cases to missing persons and heroes in our community who seek justice, Crime Junkie is your destination for theories and stories you won’t hear anywhere else. Whether you're a seasoned true crime enthusiast or new to the genre, you'll find yourself on the edge of your seat awaiting a new episode every Monday. If you can never get enough true crime... Congratulations, you’ve found your people. Follow to join a community of Crime Junkies! Crime Junkie is presented by audiochuck Media Company.
Ridiculous History
History is beautiful, brutal and, often, ridiculous. Join Ben Bowlin and Noel Brown as they dive into some of the weirdest stories from across the span of human civilization in Ridiculous History, a podcast by iHeartRadio.