Oregon has plenty to lose when it comes to President-elect Donald Trump’s vow to change the nation’s health care system.

His surprise victory threatens state officials’ hope of plugging a looming budget hole with $1.25 billion in federal health care reform payments, and his vow to immediately repeal Obamacare creates uncertainty for more than 470,000 Oregonians who received coverage or subsidies under the law.

However, Trump already has signaled a willingness to reconsider aspects of the federal Patient Protection and Affordable Care Act, and observers believe nobody’s coverage is in immediate danger. Any changes could take until 2018 to filter down.

Here’s what Oregonians should know as Trump prepares to take office in January.

About 1 million Oregonians are enrolled in the state’s version of Medicaid, the government low-income health care program.

Of those, 378,607 adults qualified under Obamacare’s expansion of Medicaid, which in Oregon boosted the maximum income to qualify from 100 percent of the federal poverty level to 133 percent. Instead of having to earn $20,160 or less to qualify, a family of three could make a little more than $26,800 under the new cap.

But while Trump has vowed to repeal and replace Obamacare, it’s unclear how that might affect Medicaid expansion.

Jeff Heatherington, CEO of Portland-based Family Care, one of 16 organizations around the state providing for Oregon Health Plan members, echoes other health care officials in saying it’s unlikely Republicans will strip millions of Americans of their health care.

“I think it would be a crazy disaster,” he says, “The hospitals and the pharmaceutical companies would argue against doing that because they’re making too much money.”

Robert Gootee, president and CEO of Moda Health, which operates the Eastern Oregon Coordinated Care Organization, also sounded a note of optimism. “I remain confident the uncertainties of today will transition to opportunities for sustainable long-term solutions, so that our members throughout Eastern Oregon can secure broader choices, with lower costs, and greater flexibility in their access to health care,” he said.

Trump has proposed turning Medicaid into a program that gives states block grants rather than placing restrictions on the spending. Republicans in Congress, meanwhile, have long sought to add conditions to the program such as premiums or work requirements.

Oregon could avoid any major changes under an application for a five-year waiver from standard Medicaid rules. President Barack Obama could approve the plan before leaving office.

Gov. Kate Brown’s office released the following statement: “There will be a lot of speculation in the next couple of months, but we have to work with the facts we have, which is that Oregon has a successful coordinated care model that is improving the quality of care while holding down costs.”

Oregon faces a nearly $1.4 billion budget hole over the next two years.

The state’s waiver application includes a request for $1.2 billion over the next five years from the federal government, which could do a lot to help plug that hole. A similar request by Gov. John Kitzhaber in 2012 yielded $1.9 billion.

But even if the state’s Medicaid waiver request is approved by Obama, any funding that goes with it could be cut off by the Trump administration at any time, officials say. “I think that could be at risk, said Health Share of Oregon CEO Janet Meyer.

It’s too soon to say, but the resulting budget pressures could affect how the state administers the Oregon Health Plan.

More than 220,000 Oregonians not covered by employers or Medicare buy their own insurance policies in a market that has undergone a radical makeover under the Patient Protection and Affordable Care Act.

Obamacare bans insurers from discriminating against people with pre-existing medical conditions and levies a tax penalty against many of those who don’t have health coverage, while offering subsidies to those with incomes of 400 percent of federal poverty level or less.

About 130,000 Oregonians signed up through the federal website HealthCare.Gov, and of those 95,000 qualified for tax credits to offset their premiums, averaging $250 a month.

Premiums for the 130,000 Oregonians who don’t receive subsidies have skyrocketed, however. On the national level, such hikes have driven the push to repeal Obamacare.

Since being elected, Trump has said he favors preserving Obamacare’s guarantee that sick people can’t be denied coverage — triggering speculation that the changes to Obamacare may not be as widespread as advocates of the law feared.

What does the future hold? “We can’t answer that right now — it’s too early to tell what changes may be made,” said Lisa Morawski, a state spokeswoman.

Morawski says people should keep enrolling for 2017 private health insurance. Those who do are guaranteed no changes in terms for the coming year.

More than 750,000 Oregonians receive benefits under Medicare, the health insurance program for people 65 and older.

Trump has vowed to preserve and modernize Medicare, but congressional Republican leaders want to turn it over to private insurers.

Nick Budnick is a reporter for the Pamplin Media Group’s Portland Tribune.

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