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The Oregon Health Plan: Boon or Bust?, Part 2

(The Oregon Health Plan . . . )

Rhetoric & Reality How has the Oregon Health Plan stacked up against claims made by both its proponents and opponents? How has it changed over time? Where is it going from here?

Rhetoric: The Oregon Health Plan is a public-private partnership intended to provide universal coverage.

Reality: The public-private partnership evaporated with the weakening and ultimate repeal of the employer mandate in 1997. The State fulfilled at least part of its public commitment—to provide health services to people below poverty. But that valiant effort has made little impact on the percentage of Oregonians without health insurance. One in six (17%) Oregonians were uninsured before the Oregon Health Plan. Today, one in seven (14%) Oregonians remain uninsured.

Rhetoric: The work of the Health Services Commission, the Prioritized List of Services, will set the standard for all insurance plans sold in the state.

Reality: In a strange twist, the courts ruled that the Oregon Health Plan standard of benefits (comprehensive coverage including mental health, prescription drugs, all diagnostic tests and dental care) had to be included in at least one package of benefits among the plans that insurers offered to any Oregon business. In reality, insurers continue to offer only packages that provide much fewer benefits. In addition, out-of-pocket costs for those with private insurance put comprehensive and accessible health services out of reach of thousands of insured Oregonians. The Oregon Health Plan was supposed to provide a floor of benefits, not a ceiling.

Rhetoric: The Oregon Health Plan will get away from Medicaid business as usual. It will no longer cut people off from services. When money does run short, Oregon will cut health services in an open, public legislative process.

Reality: In changes made by the Emergency Board (E-Board), Oregon imposed: premium requirements; an assets test of $5,000; and a three month income test on Oregon Health Plan enrollees. Additionally, the E-Board eliminated full-time college students from the Oregon Health Plan. (Recently, they reinstated coverage only to college students eligible for Pell grants.)

Some 15,000 people lost coverage when those changes were made. In addition, 600 people cannot re-enroll in the Oregon Health Plan each month because they are past due on their premiums. The state will forgive their debts in three years. What no one can compute is how many eligible people give up on ever trying to enroll in the Oregon Health Plan because the application has become too confusing or because they are afraid they will not be able to afford the premiums. Today, 15,000 Oregon children below poverty are uninsured.

Rhetoric: The Oregon Health Plan will no longer cut reimbursement to providers to save money. We should expect more providers to accept Medicaid consumers as a result.

Reality: Access to providers has improved slightly under the Oregon Health Plan. But people on the Oregon Health Plan and Medicaid still have a hard time finding providers within their plans to accept their Medicaid “cards”—in reality 8.5 x 11 sheets of paper that brand them as poor and the ultimate payor as the state. Providers, flooded with thousands of new patients and under the thumb of managed care plans, are under pressure in many ways to move people through their offices quickly. As a result, established, comforting provider-patient relationships are more of a dream now than they were in the old “fee for service” Medicaid program.

Rhetoric: The Oregon Health Plan will focus on prevention as a priority.

Reality: Managed care and providers respond quickly to a call for urgent care, like a broken leg. Not so for prevention. The hardest appointment to make is for health screening or provider consultation, the basis of good prevention. It may take six to eight weeks to get in the door. And doctors are put under pressure by plans to churn their patients out. A half hour is now considered too much time to spend with one patient. Can’t you just hear it? “You (the doctor) have got plenty more patients to see and we (the Plan) get paid only a flat amount per patient per month. It does not enhance our bottom line to provide prevention to these patients. These folks will be required to re-enroll in 6 months. They may be ineligible for coverage at that time, or they may choose a new plan. We have no long-term incentive to prevent their future illnesses.”

Rhetoric: The Oregon Health Plan is not a plan for poor people only. It is a plan which will cover all Oregonians with a basic, prevention-oriented package of health benefits.

Reality: Although the Oregon Health Plan was intended to be much more than Medicaid expansion and a prioritized list of health services, the truth is that the Oregon Health Plan is just that. It is no longer universal coverage. The employer mandate was repealed. When 85% of Oregon’s uninsured are workers and their dependents, you cannot get to universal coverage without requiring all employers to contribute to health care.

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