OR: Universal Health Care Proposal Takes Shape

An Oregon State Senate commission has approved a framework to provide universal health care in the state and to control costs. State Senator Alan Bates, who co-chairs the Commission on Health Care Access and Affordability, called the agreement "the first step on a very, very long journey." While the Commission has broadly described the proposal, important details are unclear and questions remain.

The Oregon Health Card: Under the proposal, the state would create a "health care funding pool" to serve an oversight role and collect money from various sources. The "pool" would provide an "Oregon Health Card" to each resident qualifying them for a health care package of "essential medical care" offered by insurers. Insurers, who would be required to accept anyone with a card, would compete for card-holders.

The "Oregon Health Card," as outlined, appears similar to a voucher system under which people receive a health care voucher to access a standard, or minimum, level of benefits. These systems can be problematic if the level of benefits is not comprehensive and low and middle income participants can't afford supplemental insurance to access necessary care. However, the Commission has stated that the package of benefits be based on evidence-based medicine and that new drugs, procedures and technologies be evaluated for their cost effectiveness.

The benefit design will emphasize primary and preventive care and the management of chronic illness. This is promising, but progressive and consumer advocates will need to watch closely as "essential medical care" is defined. To contain costs, Oregonians will also be required to sign an "End of Life Directive" detailing the level of end-of-life care they want -- thereby reducing use of expensive extraordinary measures for people who don't want them.

Premiums and Funding: The Commission states that most "Oregonians will be expected to participate in the funding of their own health care, but in a way that ensures if is affordable." According to The Oregonian, the estimated monthly premium for an individual will be $350, but it's unclear at this point what subsidies will be available for lower-income families to make premiums more affordable. Employers that choose not to provide coverage to their employees will be assessed an annual fee of $395; or, if self-insured, to show that the company plan is at least of equal value to the state plan. This employer fee will be pooled with other resources to fund the Health Card.

It is unclear if the Commission's proposal is a truly universal plan or a voluntary system of expanded access. In a welcome departure from the path that Massachusetts has taken, the Oregon proposal does not hinge on an individual mandate. However, the fee employers must pay for not providing coverage, at 1/12th the estimated annual premium costs, is unlikely a strong enough deterrent to employers dropping coverage.

To fund the Health Card, the Commission proposes to pool money from public and private programs, draw down additional Federal Medicaid dollars, and create savings in the system through its cost containment proposals. These include creating a system of electronic medical records, and emphasizing preventive care and improving care for chronic disease.

Moving Forward: The Commission has not been working in a vacuum. Elsewhere in Oregon, the Archimedes Movement, a project of former Gov. John Kitzhaber, is developing its own proposal for universal health care. In fact, Gov. kitzhaber has presented to the Commission, and, according to Commission staff, the idea of pooling resources is attributable, at least in part, to the former Governor.

In its draft Case Statement, the Commission says "incremental change will not solve our state's health care crises. Spending more money to do more of the same is not a solution. Comprehensive reform is required." Such statements are promising. Progressive States will be watching closely as the Commission fills in the details in its proposals for universal health care in the state.

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