OR: The beginnings of a universal health care bill

Calling it the "first step on a very, very long journey," State Senator Alan Bates, who co-chairs Oregone's Senate Commission on Health Care Access and Affordability, said the commission will draft a bill for the 2007 Legislature that will "make Oregon the first state to provide universal health care with a system to contain costs." While the proposal has been broadly described by the Commission, important details and questions remain. As outlined, the proposal seeks to cover all residents while initiating reforms to achieve a more efficient and effective health care system. To achieve universal coverage, every resident would get an Oregon health card" to purchase "essential medical care" from insurers. Insurers would be required to accept anyone with a card and would have to compete for card-holders. Progressives will need to watch closely as "essential medical care" is defined and the levels of contributions required of workers and businesses is determined. In a welcome departure from the path that Massachusetts has taken, the Oregon proposal does not hinge on an individual mandate and appears to be more serious about employer participation. As outlined by the commission, employers will be required to participate or pay a fee of $395 per employee annually, or, if self-insured, show that the company plan is at least of equal value to the state plan. However, since the annual fee is about the same cost as the estimated monthly premium ($350) and is therefore about 1/12th the estimated annual premium costs, it is to be seen if the Commission will propose other incentives or penalties for employers that do not participate. Here is where the Oregon proposal gets really interesting and where Commission members are showing their teeth on cost containment, in order to get a health card, residents will have to sign "advanced directives" declaring the level of end-of-life care they want. This could save money in the long run by reducing use of expensive extraordinary measures for people who don't want them. But it will be good to see what, if any, cost containment measures the proposal will require of insurers and hospital systems. The Commission has also discussed promising system reforms that include electronic medical records, emphasizing preventive care and improving chronic disease care. We will await the details on these and other proposals. There are many similarities in this proposal to what we've seen recently in Maine, Massachusetts and Vermont - an offering of new insurance or subsidized insurance jointly through the state and private insurers, an emphasis on preventive care, and system reforms to reduce cost growth. Oregon appears to be going Maine's way by emphasizing employer sponsored coverage, rather than the individual mandate found in Massachusetts. This is promising. However, it is unclear if the Oregon proposal is a truly universal plan or a voluntary system of expanded access. Reports so far do not address what happens to unemployed Oregonians who don't qualify for Medicaid, which may be expanded but would otherwise remain in its current form under this proposal, and to self-employed workers who don't have coverage elsewhere. Will they be mandated to purchase coverage with the health card? Finally, the last and most important detail yet to be fully worked out is the funding, which is where most health care reform initiatives get hung up. The Commission has said it wants to pool money, draw down additional Federal Medicaid dollars, and create savings in the system through its cost containment proposals. Every state that takes on serious health care reform, which usually requires putting proposals on the table that make stakeholders uncomfortable, particularly insurers and big corporations, deserves credit and support. As health reform in Oregon unfolds, Progressive States will be watching.