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In health care, the safety net exists to “catch” those who would otherwise fall through the cracks – primarily those without health insurance but also the underinsured, who may have at least some coverage but lack access to health care providers.

OHSU Hospital and other health systems provide significant amounts of uncompensated care for low-income individuals in Oregon each year, and the clinic-based community safety net provides crucial access to primary and preventive care. Comprised largely of Federally Qualified Health Centers, these clinics have traditionally served specific groups – the homeless, migrant workers, low income, temporarily unemployed, and so on.  Generally, safety net clinics use a sliding fee scale tied to income.

In Oregon, our safety net is badly frayed. Demand for free or low-cost services is growing too fast. About 1 in 6 people in Oregon are uninsured, and the numbers continue to rise. There are 210,000 uninsured people in the Portland tri-country area alone. The underinsured, who now include those with Medicaid/Oregon Health Plan coverage, increasingly need the safety net too. According to the Oregon Medical Association, almost 60 percent of our primary care physicians either limit or do not see Medicaid patients at all.

Continue reading Patching Oregon’s frayed safety net


I just read about the new Institute of Medicine report on America's emergency care system being "At The Breaking Point" and while I'm usually a big fan of the IOM's work my first impression is they blew it this time. (Let me first put out the disclaimer that I have not yet read the entire report.)

The report discusses the major problems in our hospital-based EDs, including overcrowding, people using the ED because they cannot access primary care, and the burden of uninsured patients. I'm with them so far. But their recommendation seems to be to throw money at the hospital ED system. Huh?! EDs are widely acknowledged to be the most expensive and least cost effective way to deliver care, especially primary care. So why would we sink more money into building more EDs and paying them to see more people (inefficiently)? Wouldn't it make a heckuva lot more sense to build up the primary care system, especially the Community Health Centers and other safety net providers who specialize in caring for uninsured and disenfranchised individuals, and who provide great care for the lowest cost? Then there'd be more access, so fewer people would seek care in the ED, they'd have less overcrowding and less "burden." I think the IOM needs to try again on this one.

Continue reading IOM got it wrong


The people take to the streets to enact their own solutions.  That is just what has happened with health care this year.  During the 2005 legislative session a myriad of reform proposals were proposed, many passed the Senate, but were ultimately killed in the House.

The legislature’s failure to address the skyrocketing cost of health care left a void advocates are attempting to fill through the initiative process.  Seven ballot measures were proposed this year to address the health care crisis.  They include measures aimed at reducing cost, increasing access and ensuring accountability.  Many of them are modeled after or exact replicas of legislation that failed in 2005.  Four of the seven initiatives are racing toward the July 7 deadline to gather signatures.

To help people learn about the measures and share their ideas for health care reform, Oregonians for Health Security and our allies across the state have been holding a series of health care forums.  In addition to sharing their own experiences, voters discuss proposed solutions and offer their own ideas to make health care more affordable and accessible.  We are holding a Portland Health Care Forum Tuesday, June 13 from 7-9 PM at the St. Andrew’s Catholic Church (806 NE Alberta).  The Portland Forum is sponsored by Oregonians for Health Security, Oregon Action and Jobs with Justice.

Below is a taste of each of the initiatives, more detailed information and links to their websites are available at www.OregoniansForHealthSecurity.org or by contacting Oregonians for Health Security at 503-655-2793.

Continue reading What happens when the legislature fails to act?



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