Senate panel OKs draft of universal health care plan

A Senate commission has endorsed the framework for a universal health care plan for Oregon that it will ask the 2007 Legislature to approve.

The commission's draft bill lacks crucial details, such as costs, but it does outline a broad proposal for dramatically changing how Oregonians would buy and receive health care.

"We are trying to do something that has not been done in this state or this country before," said Sen. Ben Westlund, an independent from Bend who co-chairs the Senate Interim Commission on Health Care Access and Affordability. "All eyes are once again on Oregon."

Commission leaders, who met Friday in Wilsonville, say the plan would give every Oregonian a health card that could be used to buy a complete health care package -- including dental, mental health and vision coverage -- for less than most businesses and individuals now pay.

In addition to the goal of expanding access, the plan includes features to control costs and improve quality. The same three goals for comprehensive reform are being pursued by the Oregon Health Policy Commission, the Oregon Business Council and former Gov. John Kitzhaber's Archimedes Movement.

With the convergence of views and interests on health care reform and an urgency to staunch the growing number of uninsured, the stars are lining up for major health reform in Oregon, health policy leaders say.

"This is a tremendously exciting time," said Bill Kramer, president of a Portland health consulting firm. "This is a once-in-a-decade opportunity for Oregon and the country to come up with proposals to address the crisis in our health care system."

During the commission's public hearing Friday, a handful of people representing health care interests expressed support for the broad plan but concerns over particulars. So did members of the commission, which includes four state senators and 17 business and health industry representatives.

Doctors and hospitals worry that the new system will bring lower payments for their services. Insurers and businesses worry that they'll bear the brunt of costs for change. But they all want to push forward with a comprehensive plan, said Maribeth Healey, executive director of Oregonians for Health Security.

"All of those interest groups have been at the table," said Healey, a commission member. "All I can say is, they haven't left the table."

Everyone knows the health care system has to change, said Scott Gallant, associate executive director of the Oregon Medical Association. "If you talk to the average physician on an average day during an average week, she would say the system is absolutely broken," he said. "It is irrational. It has the wrong incentives for both physicians and patients."

Creating a trust fund

The Senate commission's plan would require all employers and individuals to contribute money to a common pool called the Oregon Health Care Trust Fund. Residents who earn less than 250 percent of the poverty level would not have to pay to be in the plan. The fund also would include public employee and federal Medicaid contributions.

The plan would collect money, possibly a payroll tax, from businesses. Large companies with self-insurance plans would have their contributions reimbursed.

An 11-member Health Care Trust Fund Commission or board, appointed by the governor, would adopt regulations and administer the trust. Businesses and individuals could choose health plans, which would be paid through the trust with rates set by the trust commission.

The Senate group decided that the trust commission should function like a corporate board, with an executive director and staff. Much of the debate Friday was over who should be represented on the board.

Advanced directives

The plan would cover all Oregonians, including the more than 600,000 who now lack health insurance. Individuals who choose not to participate in the plan would lose their personal state income tax deduction. All participants would be required to write an advance directive, describing the level of care they would want at the end of life.

The directive is one of many features in the plan designed to contain costs and improve quality. Insurers, for example, would compete for health-card holders. The state also would increase competition by requiring hospitals and doctors to reveal their charges and costs.

Despite enthusiasm for the plan, leaders say they expect tough battles over details.

Businesses, for example, are wary of moving too fast or of being compelled to put the money they now spend on health care into a state pool, said Peggy Fowler, Portland General Electric's president and chief executive officer.

"There is going to have to be more money," said Fowler, who heads the Oregon Business Council's health care task force. "It is not an easy solution any way you look at it."

The commission's plan will be refined into a bill that will go to a Senate committee early next year for further debate. Commission members will be asked to keep meeting as the bill works its way through the Legislature, said Sen. Alan Bates, D-Ashland, a physician and commission co-chair.

If the bill passes, it will establish only the trust fund commission and a small semi-independent agency that will work out details for the plan, including costs, Bates said. Then, after about 18 months, the Legislature would have to pass another bill to put money into the fund.

That means Oregonians would not see health cards before 2009.

Bill Graves: 503-221-8549;billgraves@news.oregonian.com