Opening Day Crowd Shows Growing Support for Single-Payer

A house bill sponsored by Rep. Michael Dembrow, D-Portland, is not expected to pass, but advocates claim momentum

February 5, 2013 -- Nearly a thousand people swarmed the front of the Oregon Capitol Building for the opening session Monday, demanding that Oregon become the second state to enact single-payer healthcare legislation, which would set up a government financing system to pay for and provide health care coverage and access for all Oregon residents.

Protestors at the Health Care for All Oregon rally hoisted signs, listened to speeches, heard woeful tales of the current health care system, and sang along to bluesman Norman Sylvester: “I don’t care what party you’re in, Democrat or Republican, we don’t need to fight, healthcare is a human right.”

“The brother said we don’t need a fight, but they’re going to fight us,” said Rep. Michael Dembrow, D-Portland, leading the crowd. Dembrow is the chief sponsor of the single-payer legislation, Legislative Concept 1914. “We don’t necessarily need to fight back, we need to organize. Let’s go forward and organize this state, everybody in, nobody out.”

Dembrow said LC 1914 and proposed companion legislation in the Senate already had 19 co-sponsors, all Democrats — eight more sponsors than its predecessor from the last session, HB 3510.

One of those new sponsors, Rep. Jennifer Williamson, D-Portland, said she supported the legislation because her sister was one of the thousands of Oregonians who each year file for bankruptcy under the weight of medical bills.

“I’ve been a legislator for three weeks now,” Williamson said. “The first bill I signed onto as chief legislator was a bill for universal healthcare.”

Dr. Paul Gorman, a member of Physicians for a National Health Program, said he saw a patient who came in complaining of pain in his abdomen. The man had no insurance and he put off seeing a doctor for a long time, allowing his pain to get worse and worse. “By the time he came to see us, his liver cancer was advanced, and he died.” Gorman said 500 Oregonians die each year because they don’t have insurance.

Health Care for All Oregon argued that while the Affordable Care Act signed into law by President Obama in 2010 does improve access for some people — expanding Medicaid and offering private health insurance subsidies to others — the single-payer advocates said the reforms were inadequate and would do little to rein in skyrocketing costs.

Single-payer healthcare would work similar to Medicare, with a single government fund paid for through taxes rather than paying premiums to several private companies.

A single-payer bill isn’t expected to pass the Legislature or even come to the floor for a vote this session. But Dembrow expected to double the number of legislative sponsors and asked everyone in the crowd to lobby their representatives to support single-payer, hoping to find three more legislators by the end of the day.

The number of sponsors didn’t immediately grow to the goal of 22 legislators, but Marissa Johnson, an aide for Dembrow said they hoped to exceed that goal by the end of the week.

“We have interest from more than a handful of representatives and [Dembrow] will be following up with them today,” Johnson said.

Dembrow said at the rally he expected a million votes would be needed to pass a statewide measure while withstanding millions of dollars of negative advertising from groups like the for-profit private health insurance industry, which would be cut out of healthcare under the proposed system.

“The real work is not going to be done inside this building,” he said. “It’s going to be solved by a million people in Oregon, organized.”

“I think it’s going to take a lot of people stepping outside their comfort zones,” said Rio Davidson of Newport, who volunteered at the end of the rally handing out lists of legislators and asking people to contact their representatives. “Unfortunately, a lot of people who want single-payer are working low-wage jobs.”

Longtime advocate Betty Johnson said afterward that 60 organizations had been involved in the Health Care for All Oregon rally, and the group had recently hired a full-time field organizer. “Absolutely we are growing. We are organizing a number of chapters throughout the state,” she said.

Gov. John Kitzhaber has not shown support for single-payer, putting his energies instead into implementing a private health insurance exchange and transforming the healthcare delivery system through coordinated care organizations. Despite his position, Johnson said she hoped he would meet with single-payer advocates to discuss how it could work in tandem with the CCO model.

“He’s strengthening the delivery system,” Johnson said. “We really want to change the financing system. When we pass single-payer, the CCO system will work alongside it.”

Dembrow said there are restrictions in the federal Affordable Care Act that prevent states from passing single-payer laws without special permission before 2017. He lamented the added restriction, but said it also gave single-payer supporters three years to build support, get better organized, and develop a plan that would work for Oregon.

The state of Vermont enacted single-payer legislation in 2011 to cover all of its residents, but funding mechanisms are still being worked out and the state will also have to wait until 2017 to receive federal waivers.

Dembrow is introducing a second bill this session that would call on the Legislature to support a formal study of how single-payer would work in Oregon. Activists on Monday called on supporters to ask their legislators for public money, but Johnson said Dembrow believes the study could be paid for with private money.

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Thanks for this fair-minded coverage. A couple of points of clarification. Michael Dembrow's main piece of legislation is not yet a bill with a number, it is a draft called a "legislative concept," so it is LC 1914. It will have a different number as an HB I think. Also, states can pass legislation, but under the ACA cannot implement a system different from the ACA model of 1) primary reliance on existing Medicare and private employer based insurance, 2) expanded Medicaid using Accountable Care Organizations (called Coordinated Care Organizations in Oregon under its existing Medicaid waiver) 3) an Exchange (now called Cover Oregon here) to allow uninsured individuals and small businesses to buy health insurance, under penalty of fine, with possibility of subsidy, from selected private insurers, and 4) exclusion of undocumented persons from any federally funded part of the system. 2017 is the first year waivers under the ACA will be available to create a different structure. Vermont has tried to come close to a single payer model by making Green Mountain Care the only option in the Vermont Exchange, but because of ACA rules about availability of different kinds of plans the integration is incomplete, as several "levels" of GMC must be offered as well as plans for small business purchase. It also is not entirely clear whether waivers will be granted automatically if they meet the comparable or better requirements. On the study, in other states including Vermont, the studies have not just looked at a single payer plan, but compared it to a couple of alternatives to see which would meet defined criteria of coverage, quality and cost best. Conceptually, "single payer," despite being the movement term, does not convey a good picture of what we are talking about. It could be called public universal health insurance. The idea is not only to have a single payer (which greatly reduces administrative waste and provider burdens, while relieving employers entirely), but a single risk pool, a social insurance model that distributes risk as broadly as possible, rather than trying to exclude high risk people which the the natural tendency of competing private insurers. HCAO will be working to build a mass movement in the next couple of years with the capacity to change the political realities so that no one can avoid a debate by saying "not politically realistic." We believe that in an argument on the merits we can win intellectually, and we are building a movement that can win politically. Interested people can find us at hcao [dot] org.

As noted in the forgoing link to the Rutland, Vermont news article, Governor Shumlin has authorized $300,000 for a study of the financing of their plan. I believe the data produced by a study here will be compelling, revealing that not only can we provide coverage for all of Oregon’s 600,000 uninsured, 200,000 of which will still not be covered after Obamacare and the CCO’s are implemented, at no extra cost over what we now pay for care, it will eliminate the pressure of rising medical costs on family, governmental and institutional budgets freeing resources for a range of public needs. There is no wisdom in scrimping on the study, especially while the state has received $25.8 million dollars from CMS in CHIP bonus funds to spend as our legislature and the Governor choose. We should have a voice in this and less than 1% for the study would be a wise investment.