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Ambitious Oregon universal health board launches amid questions

After Gov. Kotek raised questions over its justification, appointed board will try to forge clear, specific answers to how the state could succeed where others have not
Members of Oregon's Universal Health Plan Governance Board meet for the first time in Salem on April 16, 2024. From left, Dr. Helen Bellanca, the board's chair; Dr. Bruce Goldberg, a veteran public health official; Debra Diaz, a physicians associate; Warren George, a retired businessman and the board's vice-chair. | JAKE THOMAS
April 18, 2024

This article has been updated with additional comment from Tom Sincic. 

A new state board could put Oregon on a path to radically reshape its health care system, ensuring universal access and removing financial barriers for patients. 

Or it could be the latest state-backed effort exploring universal health care without success. 

Approved by the Legislature in 2023, the nine-member Universal Health Plan Governance Board held its first meeting in a nondescript room in a state building in Salem. With only a few people in the audience, board members and staff outlined their mission of designing the administrative and financial structure of a “Universal Health Plan” that improves residents’ health while shielding them from costly bills.

The board comes in the wake of a legislative task force in 2022 that supported a generous public health insurance system that covered everyone, to be paid for with federal revenue and $22 billion in state taxes that would replace revenue from commercial insurance premiums. 

The board amounts to the latest state-led attempt to offer universal health care after others — including in Colorado and California — faltered over cost and feasibility questions. Oregon continues to struggle with escalating health care costs, and backers hope the board will succeed where others have failed. 

“I know you guys are going to do some phenomenal things,” state Rep. Travis Nelson, a Portland Democrat who cosponsored the bill creating the board, said during the meeting. 

Nelson said that he looked forward to sponsoring legislation in the “not-too-distant future” based on the board’s recommendations. 

“The governance board needs to get dramatic. If they don’t piss off somebody important, then they know they've failed,”

Questions swirl around mission

Before that happens, the board needs to work through a long to-do list. The bill creating the board requires it to answer key questions about what will be called the “Universal Health Plan,” a new insurance plan that promises greater patient choice for health care services “from birth to death.” 

For instance, does universal health care necessarily mean single-player, meaning a government plan, or could it be some hybrid of commercial and public efforts?

In addition to the complicated tasks before the board, questions remain about its core mission and if it has all the resources it needs. 

While she signed the bill, Gov. Tina Kotek raised significant concerns about the new state effort. She wrote that it created “a potential risk of duplicative efforts and inefficient spending” of the nearly $2 million allocated to support the board for two years. 

She cited the earlier task force and how Oregon has expanded coverage using Medicaid, a federal low-income insurance that funds the Oregon Health Plan and other state programs. 

She added that the legislation creating the bill likely underfunded it and asked legislative leaders to “provide clearer direction” to the board during the 2024 session that concluded in March. 

During the meeting, board member Dr. Helen Bellanca asked if there had been any legislative response to Kotek’s letter. 

“I don’t believe that clarification happened in any formal way,” Morgan Cowling, the board’s executive director, responded. 

Kotek spokesperson Elisabeth Shepard told The Lund Report in an email that the governor’s office is in contact with Cowling regarding the board’s objectives and the questions raised in the signing letter. 

“The Governor’s Office looks forward to seeing their work progress,” she wrote. 

The bill creating the board directs it to consider the Oregon Universal Health Care Task Force’s 2022 recommendations, including a single-payer health care financing system. But the bill doesn’t explicitly call on the board to craft a single-payer system, where all Oregon residents would be covered by one health insurance plan that eliminates patients’ out-of-pocket costs. 

In August, Dr. Samuel Metz, as vice president of  Oregon Physicians for a National Health Program, wrote a letter to Kotek asking her to direct the board to design a single-payer plan. 

Metz, a retired physician and universal health care advocate who served on the previous task force, told the Lund Report that the board is already facing a “critical breaking point,” adding that it has“no clear charge other than the vague, easily fungible language of the bill itself.”

He said board members can take a “giant leap forward” by embracing a comprehensive single-payer health care that will provide better care at a lower cost than what he described as the current “sinking” system. He wants the board to shun less sweeping plans that he said would “rearrange the deck chairs on the Titanic” and avoid offending established interests.  

“The governance board needs to get dramatic,” he said. “If they don’t piss off somebody important, then they know they've failed.”

“What should be the kind of underlying ethical foundation that we are building in this system?”

Funding, legal authority are key points

The board’s members, appointed by Gov. Tina Kotek, include a mix of advocates, academics, doctors, along with a physicians associate and a retired businessman. The board members don’t receive salaries, but are eligible for compensation for travel and other expenses related to their work. 

Three members of the public showed up to observe the board’s two-hour meeting on Tuesday. The board unanimously elected Bellanca, a family physician, as chair and Warren George, a retired titanium production plant manager and business consultant, as vice-chair. Dr. Bruce Goldberg, founding director of the Oregon Health Authority and member of the board, nominated both for the positions. 

Much of the meeting focus was on what the board needed to accomplish before September 15, 2026, the deadline to submit to lawmakers and the governor a final roadmap to implementing the Universal Health Plan. 

“We have a tight timeline,” said Bellanca. She said the board will have to simultaneously get up to speed on the issues it’s facing, while setting up committees and drafting a work plan. 

The board is expected to evaluate how its plan will fit in with the existing web of hospitals, private insurance companies, health care providers, regional low-income insurers and state agencies. The legislation creating the board requires the new health plan to defend “against threats to the health” of residents while ensuring they can choose their provider. 

In addition to the plan, the board has to come up with “secondary or mini plans” that address how to pay for it as well as what information technology and legal authority it would need, Morgan Cowling, the board’s executive director, said. The board could end up overseeing an independent public corporation that would administer the plan and be funded by a trust that comes from public and private money, she said. 

The board includes Chunhuei Chi, a professor at the Oregon State University College of Health who previously worked on Taiwan’s universal health care system. He said that when Taiwan went through six years of planning its universal health care plan it left out key questions that Oregon’s board should consider. 

“What should be the kind of underlying ethical foundation that we are building in this system?” he said. Based on that answer, he said the board should ask what the “objective” of Oregon’s new system will be. 

Tom Sincic, a retired nurse practitioner and single-payer advocate, said during the public comment period the board will a need more funding to hire consultants. He also responded to Chi, saying that previous legislation provided the board with a “moral compass." Sincic said in a followup email to The Lund Report that the bill creating the board reflects basic principles on ensuring patients' broad access to health care. Those principles should form the "moral compass" for the board's work, he said. 


You can reach Jake Thomas at [email protected] or via @jakethomas2009.