Oregon adopts plan for universal health access

Washington -- Oregon will offer health insurance to all uninsured residents by 2010 if the state can carry out a recently adopted plan and if voters approve a cigarette tax.

In late June, Oregon Gov. Ted Kulongoski signed the Healthy Oregon Act, a 14-page road map for reforming the state's health care system and covering all of the state's roughly 615,000 uninsured residents -- about 17% of the population. The law calls for a health insurance pool for the uninsured and suggests an individual insurance mandate.

One of the measure's sponsors, Sen. Alan Bates, DO, compared the task at hand -- providing universal insurance access while improving health care quality and reducing costs -- to climbing Mount Everest. "We've just established base camp," said Dr. Bates, a family physician.

The measure creates the seven-member Oregon Health Fund Board to design a plan for the insurance pool and overall reforms. On July 9, Kulongoski appointed as the board's executive director Barney Speight, his deputy chief of staff and former deputy administrator for the Washington State Health Care Authority. The Oregon board will issue an interim report in February 2008 and final reform recommendations that October.

Democratic lawmakers also are asking voters to approve a constitutional amendment boosting the cigarette tax by 84.5 cents to provide health insurance for children up to age 19. The tax, part of Kulongoski's Healthy Kids Plan, would increase the cigarette levy to $2.025 and raise $152.7 million by 2009 to cover 117,000 uninsured kids. The vote split along party lines, so House Democrats didn't reach the 60% majority required for tax increase passage.

The Oregon Medical Assn. supports both efforts, said Scott Gallant, associate executive director.

It took months of discussions to pass the Healthy Oregon Act. It will take months or years more to see its recommendations through.

The drive to cover the uninsured began with a Senate commission Dr. Bates chaired in 2006.

After five months of committee hearings, the measure incorporated provisions from other reform ideas, such as a health insurance pool promoted by the Oregon Business Council, a group with more than 40 executives from large businesses in the state. The council supports the law, said Duncan Wise, council president.

The measure also incorporated parts of a plan from the Archimedes Movement, led by former Oregon Gov. John Kitzhaber, MD. That effort advocated an equitable, sustainable, inclusive health care system. Along those lines, the Health Fund Board is to suggest ways to refocus the health care system in Oregon to focus more on preventive and primary care.

Oregonians should expect a healthy debate over requiring people to have insurance. Nesbitt, who as the new health board's chair, will oversee the initial implementation of the act, said the law leaves the issue open. "I don't think the bill's language is prescriptive," he added.

Also open is how much it might cost to provide insurance to everyone. The medical association's Gallant said using Medicaid and other federal programs to cover everyone in Oregon at up to 300% of the federal poverty level would cost $684 million in the two years from 2007 to 2009, including $235 million from the state.

"For a state like Oregon, that's not pocket change," Gallant said.