Oregon Health Plan

What went wrong with the Oregon Health Plan, and what does it say about the prospects for coverage expansion initiatives in other states? Those are the questions addressed by Jonathan Oberlander in a Health Affairs Web Exclusive published today.

When it was first enacted in 1989, and approved by the federal government as a Section 1115 Medicaid demonstration project in 1993, OHP represented a leading state policy innovation that sparked a national debate on rationing health care. OHP was "intended to expand Medicaid to more people by covering fewer services," says author Jonathan Oberlander. But now the plan is "covering both fewer services and fewer people, and the elimination of entire benefit categories and rollback in enrolled beneficiaries looks more like the arbitrary cuts common in other states than the rational and equitable model of prioritization to which Oregon aspired."

You can read the article at: http://content.healthaffairs.org/cgi/content/abstract/hlthaff.26.1.w96

By Mónica Arce

I have found it very interesting that there is a lot of talk about reducing costs, and that our health care system's survival depends on it.  I would like to know what percentage of the expenses of the Oregon Health Plan and federal health programs pay for maternity care, including prenatal care, labor and delivery and postpartum.  The use of nurse-midwives has been shown in several studies to reduce the amount of interventions during labor and delivery.  Midwives have outcomes that are the same or better than Ob/Gyn doctors.  I would like to see more talk about the money-saving advantages of hiring and using more midwives in our hospitals and community health care centers.

Homebirths have also been shown to be as safe as hospital birth and use less interventions in birth, keeping costs down.  Several countries around the world with better mortality/morbidity rates than the United States use midwives as their primary care providers for pregnant women, and only have Ob/Gyn doctors when a pregnancy becomes complicated or high risk.  I would like to see more conversation around this issue.

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.

Welcome to the health care reform blog. I look forward to sharing ideas and “blogging” with you about health care reform.

I have been privileged to serve as OHSU’s president since 1988 and, during this time, I’ve witnessed huge leaps in medicine. However, extraordinary medical breakthroughs and technology advances lose some of their luster when so many people can’t afford them. As you know, health care for many people is a serious economic challenge. In Oregon alone, over 600,000 people are uninsured. Hundreds of thousands of others are underinsured.

This is an unacceptable situation. I think we can all agree that everyone deserves access to basic health care. The question is: how do we as a society come together to create a health care system to achieve this? The answer to this question is not clear and the problems our current health care system faces are huge. But we must begin the process of change despite how daunting the task.