PHOTO: Cedar Sinai Park residents demonstrate with friends, family and community members along Southwest Beaverton Hillsdale Highway Saturday, Apr. 5 as part of nationwide "Hands Off" protest against federal cuts to benefit programs. (Rockne Roll/The Jewish Review)

By ROCKNE ROLL
The Jewish Review
On Saturday, Apr. 5, busloads of demonstrators unloaded on to the sidewalk of Southwest Beaverton Hillsdale Highway to protest proposed budgetary measures by President Donald Trump and Republican leadership in Congress – a sight not unusual in Portland, particularly not on a weekend of nationwide “Hands Off” protests around potential cuts to Social Security, Medicare and Medicaid. 
What may have been more unusual was what came off the bus after the demonstrators – their walkers. 
Dozens of residents of the Cedar Sinai Park complex, joined by family members, friends and a handful of community members, lined the highway next to the facility in a demonstration organized by residents. The honking of cars along the four-lane highway on the very edge of Portland reverberated in solidarity up the hill onto Southwest Boundary Street that runs between the Rose Schnitzer Manor and the Robison Jewish Health Center and Harold Schnitzer Center for Living. Those of all abilities and mobilities came, including one man whom fellow residents said had not left his room at the Harold Schnitzer Center for Living in years, but felt this moment was so important he could not miss out. 
The demonstration represented one of the largest organized demonstrations by Portland’s Jewish community against federal policy changes since the Trump administration retook office – fitting, considering how those changes stand to impact Portland’s Jewish population. 
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The focal point of these conversations is often referred to as the “budget blueprint;” legislation which will set targets for the federal budget for the next 10 years and instruct congressional committees to identify spending cuts to meet those targets. Of particular concern is a directive to the House Committee on Energy and Commerce to cut $880 billion in spending from programs it oversees in the next decade. 
The committee oversees mandatory spending that, at current levels, would amount to $8.8 trillion over the next decade. Of that amount, $8.2 trillion is for Medicaid, the state-administered but largely federally funded program of health insurance for low-income individuals and families. Because no specific policy changes have been outlined yet, it’s more challenging to estimate what these numbers will look like in practice, but KFF, the health policy think tank formerly known as the Kaiser Family Foundation, estimated those figures would represent a 16 percent cut in Medicaid spending. 
According to a report by the Center for Children and Families at Georgetown University’s McCort School of Public Policy, Oregon receives approximately $11.5 billion per year annually for Medicaid, which is known in Oregon as the Oregon Health Plan. The state receives $1.37 from the federal government for every dollar that it spends on the Oregon Health Plan.
One of the crucial costs Medicaid covers is residential care for seniors without the ability to pay out of pocket, as these facilities are not covered by the federally run Medicare program. David Fuks, who was Chief Executive Officer of Cedar Sinai Park for 18 years, estimates that during his tenure, approximately 60 percent of residents at the Robison Jewish Health Center were receiving Medicaid benefits to cover their stay. He said that level was likely similar at the Harold Schnitzer Center, as well. Those individuals have little alternative to pay for their care, Fuks explained, because Medicaid’s economic requirements and the high cost of such care have forced them to “spend down” their assets in order to receive support from Medicaid, the only program which covers this kind of care. 
“A lot of these folks who spend down, they’re the people who built our community,” Fuks said. “These are not profligate people. They just had jobs that didn’t provide them with huge numbers of assets.”
Claudia Bules, the current administrator of Cedar Sinai Park, did not respond to an interview request from The Jewish Review. 
Susan Greenberg, Executive Director of Jewish Family & Child Service in Portland, estimates that one-third of the Holocaust survivors that JFCS works with are also receiving Medicaid benefits. Many of the services that JFCS provides for survivors are funded through the Conference on Jewish Material Claims against Germany, but that money only goes so far.
“So, if all of a sudden a client loses their Medicaid dollars, or they’ve been cut considerably,” Greenberg said, “We may not be able to support the true care they need.”
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The effect of potential Medicaid cuts goes well beyond the elderly. A total of 14 percent of those surveyed in the Jewish Federation of Greater Portland’s 2023 Community Study responded that they were enrolled in either the Oregon Health Plan or Apple Health, the State of Washington’s Medicaid program, while 27 percent reported that they either can’t make ends meet financially or barely so. 
The study also found that 34 percent of Jewish Portlanders require mental health treatment of some kind, including the counseling services provided by JFCS. Douglass Ruth, the agency’s Clinical Director, said that between 40 and 50 percent of JFCS’ counseling clients use the Oregon Health Plan to pay for the services they receive. 
“It’s not just that necessarily cutting people off of getting benefits from Medicaid, there are other ways that can look at well,” Ruth explained. “Medicaid reimbursement rates can change and that means if I see somebody on Medicaid, they may reimburse for less money, which of course would affect the budget for JFCS. It might mean we are able to serve fewer folks on Medicaid.”
Ruth also explained that, to meet the high demand for mental health services, JFCS utilizes therapists who are still working toward full licensure and whose practice is supervised by Ruth. Known as Clinical Social Worker Associates, as opposed to the Licensed Clinical Social Worker title carried by Ruth, these professionals are limited in their ability to bill Medicare or private health insurance for their services but can be reimbursed through the Oregon Health Plan; an ability that would potentially be threatened by Medicaid cuts. 
Whether or not potential cuts come to pass, the mere threat of them is already producing ill-effects in the patients Ruth serves. 
“You still have to sit with the worry. ‘Am I going to have access to SNAP [Supplemental Nutrition Assistance Program, previously known as Food Stamps; another program that is threatened by potential federal spending reductions] next month? Am I going to have Medicaid in three months?’ In most of my sessions, they’re talking about that anxiety right now, ” Ruth said. “Whether it be depression, anxiety, suicidality, all these things are coming up more because of the unknowns and the fear.”
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With the Federal budget process creaking into motion, the unknowns are set to go on, though a few possibilities have floated out. 
Rep Cliff Bentz, a Republican represent Oregon’s Second Congressional District, is the only member of Oregon’s Congressional delegation to sit on the House’s Energy and Commerce committee that controls Medicaid spending. In a Feb. 27 interview with Oregon Public Broadcasting’s Dave Miller, Bentz said that tying employment to eligibility for Medicaid is something he’s looking at.
“The idea is… that if you want to be eligible for Medicaid, you’ll have to work or at least be making an effort to get a job,” he said.
Bentz also alleges, along with other Congressional Republicans, that fraud and abuse of benefits are significant drivers of Medicaid costs. 
When Miller asked if Bentz would vote for a final bill that would result in people being kicked off the Oregon Health Plan, Bentz replied that, “if Oregonians are kicked off the plan, it’s because they don’t deserve to be on it. When I say deserve, for whatever reason, they are fraudulently participating or they’re participating for reasons that have nothing to do with the original goals of the program.”
Fuks described the idea that work requirements would significantly decrease Medicaid enrollment is a “fantasy.”
“The fact is most people want to work. And a number of people who are working are working for $15 an hour in this state, or lower wages elsewhere. They may be working two jobs to try and make ends meet. They do not enjoy an employer’s healthcare program and it’s an enormous challenge for them,” he said.
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Oregon is working to hold up its end of the equation.
In Mid-March, the State Senate voted to pass House Bill 2010, which renews a pair of tax assessments – two percent on health insurance plans and six percent on hospitals’ net revenue – which directly support the Oregon Health Plan. Federation’s  Jewish Community Relations Council had lobbied for the bill’s passage. The bill passed the State House at the end of February; it now goes to Gov. Tina Kotek, who is expected to sign it into law. 
“HB 2010 will help ensure that those Oregonians continue to have access to care and that our hospitals and providers have the resources they need to serve all Oregonians,” House Speaker Julie Fahey, a Democrat from Western Lane County, said in a statement following the House’s passage of the bill. “Regardless of whether Congress cuts Medicaid funding this year, passing HB 2010 is the surest way to position us to accomplish those goals.”
What happens next with regards to the Oregon Health Plan will be determined on the other side of the continent. 
Fuks encouraged those concerned about these developments to speak up, “not only to those who are our advocates, but also to try and have an impact on the more conservative members in our state and in our country, to be able to say, ‘hey, to not have this program is pennywise and pound-foolish.’”