All Oregonians would have access to basic benefits

by Peter Wong

Oregon has undertaken sweeping changes in health care before, but lawmakers hope their latest effort will reach beyond the one in six Oregonians now without insurance coverage.

A Senate committee is aiming to set up the framework for such an effort by mid-April.

Sen. Ben Westlund, D-Tumalo, its co-chairman, said soaring costs and falling coverage make health care an issue for more than the almost 600,000 Oregonians without insurance.

"What is fundamentally different this time is that businesses -- which are usually responsible for paying the bills -- are crying to change the system," Westlund said. "You have to be an extremely profitable business, or have a dull pencil, not to be concerned about where the costs of health care are going."

Westlund and co-chairman Alan Bates, D-Ashland, concluded a series of presentations across the state last week. They said costs have risen by 73 percent since 2000 -- and coverage by employers has dropped steadily.

The committee is welding common elements from plans offered by an interim Senate group headed by Bates and Westlund; the Archimedes Movement led by former Gov. John Kitzhaber; the Oregon Health Policy Commission; and the Oregon Business Council.

Their draft legislation would pool several sources of money into an Oregon Health Fund, from which a board would determine a package of essential benefits to which all Oregonians would have access. Businesses and individuals could choose to buy additional coverage.

Some questions are still being resolved, such as the makeup of the board.

The legislation is only a framework for developing a new health-care system that will emerge in two to four years.

Much of it echoes the 1989 legislation, which Kitzhaber sponsored as Senate president, that eventually transformed Oregon's Medicaid program into basic coverage for all people under the federal poverty level. But spending cuts in the past four years have slashed the number of people covered under it.

"Everybody is working collaboratively to help make this a reality in Oregon," Westlund said of the latest effort.

Although few have voiced opposition to Oregon's effort, one out-of-state analyst questioned similar efforts in Massachusetts and California during an appearance last week in the Capitol.

"There has been a tremendous outcry in America about the number of uninsured people, so the idea of universal coverage through individual mandates has become popular," said Sally Pipes, president and chief executive officer of the Pacific Research Institute, based in San Francisco. "But it's not the way to solve the problem."

Massachusetts' plan, advocated by then Gov. (now presidential candidate) Mitt Romney, would require individuals to obtain coverage if they do not have it from another source. California Gov. Arnold Schwarzenegger would incorporate a similar requirement in his plan.

Pipes said states should deregulate insurance markets, reduce the number of required services under insurance coverage, and promote alternatives to doctors and hospitals such as nurse practitioners and community clinics. She also said insurance should be tapped for true emergencies, not commonplace needs such as doctor visits.

"Let's let people decide what type of insurance fits their needs," she said.

Pipes, a Canadian who has become a naturalized U.S. citizen, spoke at a forum sponsored by the Cascade Policy Institute, a free-market think-tank based in Portland.

Westlund said he thinks the Oregon plan will lead to less government and medical bureaucracy -- and eventually lower costs. He said the Oregon effort is not aimed at playing off one group against another.

"I think that concern is best answered not by what you do, but how you are doing it," he said of the effort.

One of those watching closely is Phyllis Rand of Salem, who was around when the 1989 Legislature required businesses to cover their workers -- a requirement that later died -- and the state to set up an insurance pool for people with higher-risk medical conditions.

"We tried to do health care for all, we worked at it, but it did not get off the ground," she said. "So I am glad to see this is happening. It's an issue that's always been high on my list."

The committee also has yet to resolve whether it should seek federal permission to include in a state pool Oregon's share of Medicare, the federal program of health insurance for people age 65 and older, and for some with disabilities. Kitzhaber's plan proposes it -- which would require an act of Congress -- but other plans do not.

Oregon AARP has been particularly wary of the idea, although Westlund said the committee is working on a compromise.

Rand said she does not speak for AARP on this issue, although she is a citizen advocate for AARP.

"I believe we are going to have the framework for the kind of health care we need in Oregon," she said. "It is not going to be perfect, but you have to begin somewhere. Our health-care system is broken. It doesn't serve people, and it costs too much."