Greenlick Wants Oregon to Step into Void on Healthcare Improvement

With the federal government in retreat, a new task force of insurers, healthcare providers and single-payer activists will debate ways Oregon can take the lead toward universal healthcare and a more equitable system of providing quality care to all Oregonians, regardless of income or employment status.

Rep. Mitch Greenlick, D-Portland, has launched a universal healthcare taskforce, dedicated to the goal of incremental improvement of the healthcare system to make it fairer and more cost-effective.

“If the federal government continues to destroy their ability to help us, we need to do it ourselves,” said Greenlick, the chairman of the Oregon House Health Committee.

The task force will be chaired by newly appointed Rep. Andrea Salinas, D-Lake Oswego, and will be composed of single-payer healthcare advocates, unions, hospitals and health insurance companies as well as two other legislators -- Rep. Barbara Smith Warner, D-Portland, and Rep. Rich Vial, R-Wilsonville.

Its charter statement clearly defines the group’s agenda, building on a Rand study commissioned by the Legislature in 2015: “The goal is to help the Legislature develop a vision for change – an incremental roadmap to creating a system of universal and affordable health coverage for all Oregon residents; one which would promote choice of providers, transparency and accountability, and would improve the health of Oregonians.”

The charter then lists more specific instructions, calling for incremental changes that minimize disruption of citizens’ current healthcare services, while also analyzing how much of a barrier the current system of employer-sponsored health insurance is to a more equitable approach. A comprehensive report is due no later than November 2018.

Before the passage of the Affordable Care Act, Oregon had already considered a private health insurance exchange, implemented rational cost controls to its Medicaid program and guaranteed insurance to almost all of the state’s children. Oregon all but closed that gap earlier this year by extending coverage to immigrant children, regardless of their federal legal status.

The work of the new healthcare task force becomes more critical as President Trump and Congressional Republicans have worked zealously to roll back the healthcare legacy of President Obama and to deprive millions of Americans of access to healthcare.

“The real world impact I’m worried about the most is screwing up the Medicaid expansion,” said Greenlick.”We’re waiting to see what’s going on in Washington. We don’t have a Plan B.”

This week, Congress passed dramatic tax cuts for corporations while including a provision that will, starting in 2019, end the tax penalty for going uninsured. The repeal of the unpopular individual mandate could precipitate a death spiral for the individual health insurance market, since younger, healthier people would leave the market, and people paying unsubsidized premiums could see their costs go through the roof. Meanwhile, escalating subsidies to keep health plans affordable may prove unsustainable for the federal government.

Several Democratic states, including Maryland, are considering imposing a state income tax penalty to keep people locked into buying health insurance. Massachusetts already has such a penalty on the books, since the Obamacare framework was modeled on its successful so-called Romneycare program. Greenlick said an Oregon tax penalty has not yet been debated but it would be among the items discussed by the new task force.

In addition to undermining Obamacare, House Speaker Paul Ryan, R-Wis., has told reporters that he will seek to pay for the $1.5 trillion in tax cuts next year by pursuing his career-long goal of scaling back Medicare and Social Security, putting the healthcare for millions of elderly people at risk.

But Oregon has not always been a great champion in healthcare, either. It badly botched a state-run Obamacare health insurance exchange, wasting more than $300 million federal dollars before switching to the default federal platform, healthcare.gov. The Oregon Health Authority has been rife with mismanagement, keeping people on Medicaid without proof they were eligible and then being required to pay back the federal government an estimated $74 million for miscategorizing Medicaid recipients.

The state’s second-largest provider of Medicaid services, FamilyCare Health, is abandoning the market at the end of the year amid charges that OHA paid FamilyCare below costs while heavily favoring its competitor, Health Share, a charge that gained added weight when a secret plan to sabotage the public image of FamilyCare was made public in August, leading to the swift downfall of OHA Director Lynne Saxton.

A group of Oregon Republicans have successfully called a referendum on a tax package to fund the Oregon Health Plan, requiring state Democrats to pass a ballot measure on Jan. 23 just to keep current state programs funded.

Still, even with the Keystone Cops running the show, about 95 percent of Oregonians have insurance, and that’s a position from which Greenlick does not wish to retreat. He plans to push a ballot measure next fall to ask voters if guaranteeing healthcare access to all residents is a constitutional right, and the new task force will consider solutions to that end.

The task force includes both single-payer advocates and representatives of health insurance companies, including PacificSource Health Plans, Providence Health & Services and Kaiser Permanente, as well as unions including the Oregon Nurses Association and the International Brotherhood of Electrical Workers.

The inclusion of health insurance companies might preclude a radical government-financing system, but all three companies are moving toward vertical integration with hospitals and health providers, making them less dependent on the profits from their health financing divisions.

And health insurers are heavily involved in the administration of both Medicaid and Medicare, despite the payment for those health insurance programs coming primarily through taxes.

“I hope they go into it with an open mind and they aren’t going to just fight everything,” said Charlie Swanson, a Eugene healthcare activist named to the task force. “My ideal goal would be a pathway to universal healthcare in Oregon. I’m not sure we’ll get that far but I think we’ll get a good start in that direction.”

Swanson hoped the task force would also help lead Oregon to join with California and Washington to purchase pharmaceutical drugs on a larger scale, giving the state negotiating power against the drugmakers that they currently lack.

Reach Chris Gray at chris@thelundreport.org.

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