Oregon Health Plan

The Oregon Health Plan is Oregon's state Medicaid program.

History

The Oregon Health Plan was conceived and realized by emergency room doctor (and current Oregon governor) John Kitzhaber, then a state senator,^[1] and Dr. Ralph Crawshaw, a Portland activist.^[2]

It was intended to make health care more available to the working poor, while rationing benefits.^[1] At the time, Oregon was considered a national leader in health care reform.^[3] Oregon was one of the earliest states to end payments for unnecessary non-therapeutic circumcision.^[4]

The law passed in Oregon was not initially compatible with federal law, so a waiver was needed. President Bill Clinton approved the plan on March 20, 1993, though he required a revision to the plan due to a concern about whether disabled people would have equal access.^[5] At the time, Medicaid covered 240,000 Oregonians.^[5]

In 1994, the plan's first year of operation, nearly 120,000 new members signed up, and bad debts at Portland hospitals dropped 16%.^[1]

The plan's costs increased from $1.33 billion in 1993-1995 to $2.36 billion in 1999-2001.^[1] Significant cuts were made to the Oregon Health Plan's budget in 2003.^[6]

New enrollment in the program was closed from mid-2004^[7] until early 2008, when a lottery-based system was introduced. Tens of thousands of Oregonians signed up, competing for 3,000 new spots in the plan.^[8][9]

The Oregon Health Plan was expanded to cover 80,000 uninsured children through legislation that passed in 2009. ^[10] The program has enrolled 38,000 additional children through February, 2010. ^[11]

The legal foundation for the OHP is generally spelled out in Chapter 414 of the Oregon Revised Statutes.^[12]

Eligibility

Basic eligibility requires that the applicant be a resident of Oregon, as a citizen or otherwise. The level of coverage is based on income, age, mental and physical condition.

Coverage

Since a February 2003 adjustment to the Oregon Health Plan,^[7] it consists of two main plans, OHP Plus and OHP Standard.

OHP Plus

OHP Plus is a full benefit package offered to children and adults who are eligible for Medicaid or for the Children's Health Insurance Program. The OHP Plus package has no premiums, but some adults may be required to pay small copayments for outpatient services and some prescription drugs.

In January 2010, most vision and some dental benefits were cut from OHP Plus due to budget deficits. In January 2011, John Kitzhaber again took office for a third term as governor, and has proposed new reforms and cuts to OHP Plus.

OHP Standard

OHP Standard is a limited benefit package covering a limited number of uninsured adults who are not eligible for Medicaid. In 2003, when OHP Standard began requiring small premiums of most adult participants, around 40,000 Oregonians (many homeless, destitute or mentally ill) were unable to pay the premium and were disenrolled from the program.^[13] Significant cuts were made to the Oregon Health Plan's budget in 2003. Today, the monthly premiums are still required, but there are no copayments.^[14]

Controversy

The Oregon Health Plan became the focus of national scrutiny in 2003, after deep budget cuts led to 100,000 people in mental health and/or substance abuse treatment losing prescription coverage under the program.^[15]

During 2008 and 2009, the Oregon Health Plan stirred up controversy when enforcing 1994 guidelines^[16] to only cover comfort care, and not to cover cancer treatment such as chemotherapy, surgery and radiotherapy for patients with less than a 5% chance of survival over five years.^[17]

Springfield resident Barbara Wagner said her oncologist prescribed the chemotherapy drug Tarceva for her lung cancer, but that Oregon Health Plan officials sent her a letter declining coverage for the drug, and informing her that they will only pay for palliative care and physician-assisted suicide. She appealed the denial twice, but lost both times.^[18] Tarceva drugmaker Genentech agreed to supply her the $4000-a-month^[19] drug free of charge.^[20] Wagner's plight garnered a flurry of attention from the media,^[21] the blogosphere,^{[22][23][24][25]} and triggered protest from religious groups.^[26][27][28] Wagner died in October 2008.^[29]

Ongoing legislative efforts

Following the end of two terms as Governor of Oregon, Kitzhaber established the Archimedes Movement, which aims to be a grassroots effort toward crafting legislation and solving Oregon's health care problems. The Archimedes Movement also has a close relationship with the Foundation for Medical Excellence.^[30][31]

The 2007 Oregon legislative session passed the Healthy Oregon Act (Senate Bill 329), which established the Oregon Health Fund Board.^[32] This seven member advisory panel worked with former Governor Ted Kulongoski to propose legislation for the 2009 session. Among other challenges, the board has been advised that changes in federal requirements will affect funds that currently support 24,000 Oregonians on the OHP Standard plan.^[33]

References

v t e Topics in Oregon legislation Crime and sentencing Capital punishment · Measure 11 (1994) (mandatory minimum sentencing) · Measure 40 (1996) etc. (victims' rights) Abigail Scott Duniway was instrumental in establishing women's right to vote in Oregon. Elections and voting Direct Legislation League · Vote-by-mail · Term limits · List of Oregon ballot measures Gay rights Same-sex marriage · Oregon Citizens Alliance · Measure 9 (1992) (homosexuality and education) Environment Bottle bill · Nuclear power · Wind power · Solar power · Coal power Land use O&C Lands · Beach Bill (1967) · Senate Bill 100 (1973) · Measure 37 (2004) & 49 (2008) Health care Death with Dignity Act · Oregon Health Plan Minimum wage Measures 36 (1996), 25 (2002) Taxation Tax revolt · Measure 5 (1990) (landmark tax law) · Measures 47 (1996) and 50 (1997) (adjusted Measure 5) · Kicker (tax rebate) Miscellaneous Compulsory Education Act · Adoption rights · Alcoholic beverages in Oregon · Bicycle Bill · Cannabis in Oregon Influential people Loren Parks · Bill Sizemore Background, further reading Oregon legislature · Direct democracy in Oregon · Oregon government · Oregon history · Oregon ballot measures