1. United States
2. Ore.
3. Letter

I am an employee at Legacy Health in Portland, Oregon, and I am writing to share concerns about the growing financial strain on our healthcare system and its impact on both workers and patients. This week, staff received communication regarding cost-containment measures in response to a projected budget shortfall of nearly $40 million. While employees are being asked to make sacrifices—including hiring freezes and other internal cutbacks—it is increasingly clear to me that these challenges are not simply operational, but systemic. In particular, I believe a significant root cause lies in the structure of our health insurance system. For example, Legacy Health was recently engaged in negotiations with Blue Cross Blue Shield over reimbursement rates that more accurately reflect the true cost of care. Situations like this highlight the persistent gap between what healthcare providers spend to deliver care and what insurers are willing to pay. I have also witnessed, through colleagues’ experiences, how severe this gap can be. In one recent case, a patient covered by UnitedHealthcare Medicare reportedly had only a small fraction of their observation stay costs reimbursed. When insurers fail to adequately cover necessary care, hospitals are often left to absorb the losses—placing further strain on already stretched systems. I urge you to consider the following policy actions to address these structural imbalances: * Reform Medicare reimbursement rates to better reflect the actual cost of delivering care, particularly for hospitals serving complex or high-need populations. * Establish a public option to introduce greater competition and accountability in the insurance market, helping to ensure more consistent and fair coverage. * Strengthen oversight and regulation of private insurers to prevent underpayment for medically necessary services and reduce the frequency of claim denials or inadequate reimbursements. * Increase transparency requirements so that reimbursement rates and coverage decisions are clearer to providers, patients, and regulators. Without meaningful reform, the burden will continue to fall on healthcare workers, institutions, and ultimately patients. I urge you to prioritize policies that support a sustainable healthcare system and protect access to care in our communities. Thank you for your time and for your attention to this critical issue.