Oregon to consider universal coverage proposals next year

Among the plans is one from a state Senate panel proposing health cards for citizens, with insurance funded by employers, workers, state and federal governments.

By Doug Trapp — Posted Dec. 4, 2006

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It's still early, but Oregon may be the next state to adopt some sort of universal health care reform.

Several major proposals are in the works that could be unified into a comprehensive bill to be considered by the Oregon Legislature when it convenes in January.

A leader in the push for reform is a Senate commission created one year ago to study problems with health care cost and access in Oregon and to recommend a legislative solution. About 613,000 Oregonians lack health coverage.

Other players are a commission created by the current governor, a former governor who has launched a campaign for universal health care reform, and the Oregon Business Council, which includes insurance companies.

All are pushing for comprehensive changes to Oregon's health care system. Final proposals from two of these groups are due to be released in December.

"I would say there is strong agreement on what the nature of the problem is: cost, quality and access. There's strong agreement on the desirability of comprehensive reform," said state Sen. Alan Bates, DO, chair of the Senate Commission on Health Care Access and Affordability and a family physician.

Dr. Bates said the Senate commission has tried to coordinate the reform efforts of the groups, which have been talking to each other for several months.

No more status quo

The Senate commission's final draft of legislation is due in mid-December, Dr. Bates said.

Its draft proposal, which doesn't have a cost estimate yet, would give Oregonians a health card allowing them to access basic medical care through private insurers certified by the state. The companies could be owned by doctors or corporations and could offer coverage to all of Oregon or just certain cities or counties.

Payment would come from a state-organized health care funding pool, Dr. Bates said. Employers, employees and the federal and state governments would contribute to that pool. Stakeholders are debating whether all employers should be forced to contribute and at what level.

Oregonians could opt to buy additional coverage from private insurers as well.

Dr. Bates said $350 is spent on health care each month on every Oregonian not in Medicare. He believes the proposal should at least be able to freeze health care spending at that level, ending years of double-digit health care cost inflation.

The Oregon Senate proposal is founded on past reforms in the state.

Almost a decade ago the state changed its Medicaid program by creating fully capitated health insurance plans.

These plans are almost entirely run and owned by doctors and advised by actuaries who annually estimate how much it should cost to provide health care to their members, Dr. Bates said. Insurance rates are based on those estimates, which account for the health risks in the population.

Capitated plans have limited the cumulative increases in health care costs to 2% or 3% over six years by emphasizing prevention and controlling drug costs, Dr. Bates said. The plans have also kept reimbursement rates high enough to keep doctors in the system, he said

Dr. Bates said about 75% of the response to the new Senate proposal has been positive. He challenged those opposed to it to come up with a better plan.

"You tell me what's better," Dr. Bates said. "You give me another way out of this dilemma, and I'll be there."

The Oregon Business Council supports comprehensive reform built on the employer-based system America already has, said Bill Kramer, a health care consultant working with the council's health care task force. The group is comprised of leaders of about 40 large companies.

Kramer said inconsistent health care quality and high prices motivated the council to begin a push for reform almost two years ago. Its principles for change are due in December.

Inspiration for reform

The group was inspired when Massachusetts in April passed its plan, which requires every resident to buy health insurance by July 1, 2007, and provides subsidies for the poor.

Oregon's effort also follows on the heels of Vermont, which adopted its own universal health care law in May, and Illinois, which passed a measure last year giving all children health coverage.

"One of the good things about Oregon is that it's a relatively small state, and there's a high value put on collaboration," Kramer said.

Other efforts in Oregon include:

  • Gov. Ted Kulongoski's Healthy Kids proposal. It would cover all uninsured children up to age 19 using a managed care model with sliding scale subsidies. It would cost about $200 million, would be funded by a cigarette tax, and would be compatible with the Senate plan.
  • The Oregon Health Commission, created by Gov. Kulongoski in 2003, which has been drafting its own principles for reform, most of which align with the Senate commission's draft proposal.
  • The Archimedes Movement, an effort by former Oregon Gov. John Kitzhaber, MD, that is attempting to galvanize public support for health care reform in Oregon.

The Oregon Medical Assn. has not yet taken a position on the proposals. It is finalizing principles by which to evaluate them, said spokeswoman Paige Webster.

Momentum for reform is also coming from the overwhelming passage of Ballot Measure 44, which expands the pool of uninsured Oregonians who can buy discounted prescription drugs from 150,000 to 458,000.

Almost 78% of Oregon voters approved the measure, 10% higher than any of the 10 other measures on the ballot Nov. 7.

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External links

The Archimedes Movement (link)

Oregon Health Policy Commission (link)

Oregon Gov. Ted Kulongoski's Healthy Kids Plan (link)

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