Oregon Health Policy & Research Health Reform Efforts in Oregon Jeanene Smith MD, MPH Office for Oregon Health Policy and Research January 2007

Oregon Health Policy & Research

Health Reform Efforts in Oregon

Jeanene Smith MD, MPHOffice for Oregon Health Policy and Research

January 2007


Oregon historically been innovative in state health policy

• Pre-Oregon Health Plan - early pioneers in managed care in selected cities

• Oregon Health Plan (OHP) – Prioritized List, Hi-risk pool, created a policy office, aimed for an employer mandate

• OHP2 – Brought premium subsidy program in under Oregon’s Waiver but further reform efforts thwarted with budget cuts due to recession

• Now Broad Health Reform – multiple initiatives and ideas, lots of new energy


Original Goals of the Oregon Health Plan

• Health care for the uninsured- Public and Private vision and collaboration

• Basic benefit package of effective services• Broad participation by providers• Decrease cost shifting & charity care• A rational way to allocate resources for health

care


OHP 2: Attempt to broaden coverage to more uninsured

February 2003

• Benefit package separated:

– OHP Plus - categorically eligible population (TANF, Disabled)

– OHP Standard - “expansion” population (Adults/Couples < 100% of FPL)

• Benefits and copays adjusted for adult expansion (OHP Standard) population to try and afford to cover more lives


Budget crisis hit –Recession impacts OHP2

• Oregon struggled with high unemployment and budget deficits as OHP2 changes were implemented

• State funding for adult expansion population (OHP Standard) cut, partially made up by taxes on hospitals and managed care plans

• Resulted in deeper benefit cuts and loss of ~80,000 adults without coverage in OHP Standard


Broader Health Reform Efforts: New Energy & Much Discussion

• Multiple healthcare ballot initiative efforts with ongoing collaborative efforts to gain public input and discussion to outline priorities

• Governor’s HealthyKids initiative• Health Services Commission – re-looking at the

Prioritized List & Chronic Diseases• Oregon Health Policy Commission – Strategic

Health Planning directive for broad reform• Senate Interim Committee on Healthcare Access

and Affordability – broad reform


Governor’s Health Initiatives:Healthy Kids Plan

• Aim is to provide access to health insurance for every child under age 19 in Oregon thru current system and a new subsidized private market option

• Aggressive outreach to kids, especially those already eligible for the Oregon Health Plan or subsidized private insurance premiums via “FHIAP”

• Build on ease of access via school based clinics • Would start July 2008 if approved by current

Legislature


Health Services Commission’s Re -Prioritized List

• Re-aligned priorities on the List of Health Services for the Oregon Health Plan

• Reflects higher ranking of the treatment of chronic disease than ever before

• Discussions about a “second line” to define benefit package for OHP Standard

• Basis of broader health reforms’ benefit design package


Oregon Health Policy Commission Health Reform Concept

Goal: Affordable, accessible, and efficient health care for all Oregonians

• Bold, realistic reform implemented over 5 years

• Principle that everyone contributes to reform

• Strengthen and build on existing public and private insurance structures

• Complement other reform efforts


The Policy Commission’s Proposed Reform Concept

• Individual Coverage Mandate

• Employer Contribution

• Public Coverage, Subsidies & Incentives

• Health Insurance Exchange

• System Financing

• Efficiencies & Cost Control

• System Improvements: Quality & Transparency, Public Health, Service Delivery


Many other ideas in play in Oregon: Working towards Consensus

• Senate Interim Committee on Healthcare Access and Affordability Plan

• Oregon Business Council Plan• (Local) Providence Health System Plan• Archimedes Movement (Kitzhaber) Plan

Plus:• New National ideas – Senator Wyden’s Plan


For questions, more info…

Office for Oregon Health Policy and Research503-373-1625

[email protected]

Our website:

www.ohpr.state.or.us

Documents

Oregon Health Policy & Research Health Reform Efforts in Oregon Jeanene Smith MD, MPH Office for Oregon Health Policy and Research January 2007