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Universal Health Care Bill Awaits GOP's Return

June 24, 2019

Oregon appears poised to embark on a sweeping study of how to establish “universal health care,” although just what that means would be up to the task force the Oregon Legislature would create.

Assuming Democrats are able to bring absent Republicans back to the Legislature to produce a quorum, lawmakers predict the Democrat-controlled Senate and House will pass Senate Bill 770,  the universal health care study bill which now includes a Medicaid buy-in proposal from Rep. Andrea Salinas, D-Lake Oswego.

Don’t expect the revised bill to yield any immediate results.

The Task Force on Universal Health Care, which the bill would create, would hold statewide hearings and have until February 2021 to come up with recommendations.

Then it would be up to the Legislature to settle on key elements, including how such a system would be funded, and how it would treat the commercial health insurance market that covers private-sector employees and individuals.

Currently, about half of Oregon’s population of 4.1 million has health insurance paid for by the government: Medicaid (Oregon Health Plan) and Medicare (for the elderly). The great majority of the money for Medicaid and Medicare comes from the federal government.

The other half of the population – the commercial market – consists of people who have health insurance through work or buy plans for themselves and their family through the state health insurance exchange or directly from a particular insurer.

State Sen. James Manning, D-Eugene, a leading sponsor of SB 770, said one of his biggest concerns is individuals and small companies in the private sector who can’t afford to buy quality private health insurance plans. “People have inadequate coverage, or the price is too high,” he said.

It’ll be up to the SB 770s task force to solve that and other problems, Manning said.

Separately, SB 770 directs the Oregon Health Authority to come up with a plan by May 1, 2020 for how individuals or families who lack government-funded health insurance could buy into a Medicaid-like health insurance plan. The Medicaid-like buy-in concept has been studied for several years and offers the prospect of being less expensive than private insurance.

The Joint Committee on Ways and Means approved SB 770 on a 13-6 vote on June 18. The bill now heads to the House and Senate floors. The bill is heavily supported by many Democrats. All the opponents in the committee vote were Republicans. None of the opponents responded to requests for comment from The Lund Report.

The new bill is very different – and much more vague – than the initial draft Manning submitted at the beginning of the session. That draft had overarching specifics about how a universal health care system would work, including the imposition of new state taxes to fund the system. Those details have been scrubbed from the version that the committee approved.

Under the initial draft of SB 770, virtually all health care insurance in Oregon – for state and local government employees, Medicare and Medicaid recipients, private sector employees and others -- would be provided by the state under the “Health Care for All Oregon Plan.” Residents would pay no premiums, deductibles, co-pays or other costs. Rather, the system would be funded by existing revenues and as-yet unspecified new taxes.

“The plan must be financed by a system of dedicated, progressive taxes that are based on the payer’s ability to pay,” the bill read.

That’s all been stripped away and replaced by more general descriptions that give little clue about what a new system could look like.

Manning said that under the new language, all the specifics would be up to the task force, a 20-member group.

“I envision an Oregon where if you are a resident, you have quality health care,” Manning said. He said he didn’t want to set parameters for what the task force comes up with.

Through hearings, the task force “will be engaging the public throughout Oregon,” he said.

Manning said he believes the House and Senate will pass the measure. That assumes Democrats are able to round up enough Republicans for a quorum in the waning days of the session. Democrats hold a supermajority in the Oregon Legislature, but they still need some Republicans to be present to create quorums. Running to 23 pages, the new version of SB 770 contains a lot of general language about what the universal health plan must do, including “improving the health status” of residents, “protecting individuals from the financial consequences of ill health,” and “removing cost as a barrier to accessing health care.”

In public comment prior to the language changes, supporters asserted it’s crucial for Oregon to create a single-payer universal health care system, although few explained their ideas of how such a system would be funded. Critics, meanwhile, said the concept looked to be a costly boondoggle and they did not trust the Oregon Health Authority to run it.

In a written comment to the committee, Matt Laubach, a Eugene resident, lauded the bill. “I am a supporter of SB 770, which will implement a single payer health care system in Oregon. I believe health care should be a right, not a way to profit off of the misfortune of others. The prices are out of control. The USA pays (more) for health care than the rest of the developed world. Drug prices are too high. Families can't pay these expenses, because they are not affordable.”

Others opposed the idea of the state taking over or otherwise changing the private health care insurance system.

“You have much bigger concerns in this state than my private health care. Leave it alone! “ wrote Kori Sing, hometown unstated. 

A number of states have considered implementing universal-care type systems, but have either not approved them, or scrapped them soon after implementation.

The creation of a Medicaid-like buy-in system has gained traction as a stop-gap measure. Currently, the state, using federal and state money, pays regional coordinated care organizations roughly $6,000 per person per year to cover the health-care needs of each low-income resident who qualifies for the Oregon Health Plan, Oregon’s version of Medicaid. Under a buy-in system, people whose incomes disqualify them from the Oregon Health Plan could buy into a health plan that had the same benefits as the Oregon Health Plan, at the same cost as the state pays the CCOs. That might be cheaper than the perhaps $7,000 per year that such a plan would cost on the private market, according to tentative state estimates.

You can reach Christian Wihtol at [email protected].