Thursday, April 20, 2006


Oregon Health Care Sinking

Oregon used to be considered a progressive state: maybe not in the sense of “progressive = left-wing,” but at least “progressive” in the sense of caring for it’s most vulnerable citizens. So did the United States, come to remember.

That’s all changed. I don’t know, for sure, if it’s a result of the narcissistic “me first” culture that began around the 1970s, or of the general right-ward swing of the government in D.C., or both. But things have got bad here in Oregon, and are getting worse. That this state should rank so low in watching out for the health of its children is pretty damn’ shameful. The problem will be finding the money. Health care seems to be a prosperous business: our local hospital is constantly expanding (and has been expanding since we moved here six years ago) and there are new medical buildings everywhere. Perhaps some sort of cost containment is worth considering: like raising taxes on various health corporations—or on corporations in general. Our state revenues come more from private incomes than from corporate incomes.

Children's coverage ailing in state
Health care - Oregon ranks fifth from the bottom in health insurance for the poor
Thursday, April 20, 2006
The Oregonian
Oregon lags below the national average in providing health insurance to poor people, especially children, an analysis by The Oregonian has found.

The findings, which put the state fifth from the bottom in covering children, come on the eve of a special legislative session called in part to fill a $136.2 million budget gap at the Department of Human Services. That gap in turn is driven largely by a $65 million hole in the Oregon Health Plan budget.

Oregon legislators and health officials say they can fill the gap this time without additional cuts. But they also agree that Oregon's renowned plan for insuring the poor has reached a crossroads between coverage and costs, forcing difficult choices soon, if not this week.

"The problem for us as a state," said Bruce Goldberg, director of human services, "is that -- although the economy is improving and certainly the state is seeing more revenues and there are more people working -- the costs of health care are increasing at a rate that is outpacing the economic recovery."

Rep. Dennis Richardson, R-Central Point, agrees with Goldberg's assessment, calling the plan "unsustainable."

Two trends illustrate the dilemma:

The percentage of Oregon residents enrolled in the health plan declined from its peak in the 1990s, which was above the national average. By 2003, the coverage rate had dropped to 16.8 percent of Oregonians, compared with a national average of 17.9 percent.

At the same time, those who have remained enrolled tend to be relatively costly patients. Oregon's cost of covering each patient has grown faster than average in part because people who have lost eligibility tend to be young and healthy, if poor.

The question left to future legislators and perhaps a future governor: How to regain the state's reputation as a health care leader while also keeping a lid on health care spending?

There are no easy answers, Richardson says. "While it is admirable to work toward a goal of having everyone receive coverage, the reality is that under the current health system in America, it can't be afforded."

Oregon stacks up

To see how the Oregon plan stacks up and where it might be improved, The Oregonian examined Medicaid spending data for all 50 states from 1990 through 2005 and enrollment data through 2003, the last year available from the federal government.

Among the findings: While health care costs have skyrocketed across the nation, Oregon's costs per patient have climbed faster than average.

Each enrollee in Oregon cost the state $1,966 in 2003, an increase of 166 percent over the 13-year period, according to an analysis of data from the National Association of State Budget Officers. By comparison, the U.S. average was $1,959 in 2003, an increase of 112 percent.

But the analysis also reveals opportunities for improvement -- and perhaps the means to pay for them.

Oregon lags behind in covering children. In Oregon, 39 percent of enrollees in 2003 were children, compared with a U.S. average of 46 percent, according to an analysis of data from the Center for Medicare and Medicaid Services. Only four states ranked lower than Oregon.

The analysis doesn't consider demographics, which may affect the rankings. But the Oregon ranking is consistent with other studies that show a low number of children with medical coverage.

The burden on Oregon taxpayers is relatively low, thanks largely to benefit and eligibility cuts. For every $1,000 of personal income earned by Oregonians, the state spent about $9 on patients enrolled in the plan in 2004. The national average was about $11.

Other states' experience

Richardson, who chairs the budget subcommittee on human services, said he and other legislators chose not to address the future of the Oregon Health Plan during the special session beginning today because the topic is too complex to address in the short session.

Rather, legislative leaders hope to spend the rest of 2006 laying the groundwork for a larger overhaul next year, Richardson said. Among other things, they plan to study the experience of other states -- what works and what does not.

"We don't need to reinvent the wheel," he said.

Among the states Richardson said Oregon might emulate is Massachusetts, which recently passed a law requiring citizens to buy health insurance. Richardson likes the idea of covering the poor by providing subsidies for policies offered by private-sector companies, adding an element of competition.

Goldberg, meanwhile, says Gov. Ted Kulongoski, a Democrat, wants to focus on cost-containment and accountability measures to squeeze more efficiency from the plan -- and to expand it to more people, particularly children.

One of the biggest problems the Oregon plan should address is the growing reluctance of employers to subsidize coverage of workers' families, Goldberg said. Although the number of children enrolled has grown, the number of uninsured children also has grown.

"We have all these families who are employed and can't afford to buy family coverage, and they're all turning to the state," Goldberg says. "To me, it's a telling and unfortunate trend. But it shows you where we are."

Goldberg says Oregonians should look at any expansion of the health plan as an investment in the state's future. The cutbacks of recent years have created unseen costs -- more patients who become sicker and costlier because they wait to be treated in emergency rooms.

"We've got to look at whether our values are such that we are going to make that investment in providing health care to the most vulnerable."

Richardson says he shares those values, but he also wants to protect taxpayers.

"What we need is our own plan," he says, "which will be a coalition between private-sector insurance and the need for everyone to be covered, but in a way that doesn't require the cost to be all borne by the taxpayers."

Jim Barnett: 503-294-7604;

©2006 The Oregonian

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