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Dropping premiums, boosting health care.

Byline: David Steves The Register-Guard

SALEM - After watching tens of thousands of low-income Oregonians lose access to the Oregon Health Plan because they failed to pay premiums, Gov. Ted Kulongoski and legislators on Tuesday lauded a bill that makes the program more affordable.

Senate Bill 782, which eliminates premium payments for the very poorest of Oregon Health Plan enrollees, is one of a handful of changes made by the recently adjourned Legislature when it comes to health care for the poor and uninsured.

Compared with the big expansions of the health insurance program in the 1990s and deep cuts earlier this decade to save money, the recent changes amounted to tweaks that ensure the health plan's survival for 2005-07. But they don't do much more than that.

"It's on life support. It's there," said Maribeth Healey, executive director of Oregonians for Health Security, a labor-backed group that advocates for expanded health coverage for low-income Oregonians. "That's probably the good news, that they at least didn't scale it back totally to just a Medicaid program."

Backers of SB 782, including Sen. Bill Morrisette, said the premiums, although small at $6 to $20 a month, proved too much to expect from the poorest of Oregonians.

"It's difficult for people with zero income to come up with the money," said the Springfield Democrat, a chief sponsor of the measure, which was praised Tuesday at a governor's office ceremony. Kulongoski had signed the bill into law three weeks earlier.

By no longer requiring the poorest beneficiaries to pay premiums, the state would lose about $4 million in revenue in the 2005-07 biennium, and would make that up by trimming the rolls of the Health Plan by 500 people, the state estimated. In effect, the legislation helps the very poorest, but does so by hurting some others.

After its 1994 launch, the Oregon Health Plan expanded coverage beyond those low-income Oregonians eligible for the federal Medicaid program by also covering poor, able-bodied adults and less impoverished working-poor adults and children. The health plan also provided some benefits not covered by Medicaid, such as prescription drugs and treatment for chemical dependency.

In large part, this expanded coverage relied on savings through the rationing of care. Treatments were prioritized. Coverage was excluded for treatments that were considered low priorities because they were costly or not deemed vital. Oregon had to obtain federal approval to implement the groundbreaking system.

The financial rationale of the plan is that it's more cost-effective to provide poor people with insurance, and let them access routine treatment, than it is to allow them to live without insurance and obtain treatment only by visiting emergency rooms when their ailments become severe and complicated.

But the state's willingness to allocate its own dollars to the program was key. During the economic downturn of 2001-2003, the plan and its poor and uninsured working enrollees found themselves in a free fall. State revenue plunged, and the state said it could no longer afford the same level of coverage.

In early 2003, the plan's "Standard" version covered about 90,000 poor, childless adults who weren't eligible for Medicaid, along with about 350,000 people for whom Medicaid law requires coverage: mainly the aged, blind, disabled, children and pregnant women. Since then, the number of enrollees in OHP Standard has plunged to about 25,000.

Critics blame the enrollment drop on the Legislature's decision to impose monthly premiums that year. Those who failed to make a premium payment were banished from the plan for six months. Effectively, though, they were permanently removed from coverage, since the budget squeeze had prompted the state to stop enrolling new or returning patients to OHP Standard.

"It was a disaster. The decision to charge premiums was a disaster," said Ellen Pinney, director of the Oregon Health Action Committee, which advocates for medical coverage for the poor.

Under SB 782, the state no longer charges premiums for those OHP Standard enrollees whose income is less than 10 percent of the federal poverty level - about $80 a month for a single person. An estimated 40 percent of OHP Standard enrollees fall into this income level.

All other OHP Standard recipients must continue to pay premiums.

But under the new law, those who continue to be charged premiums will have a six-month grace period to pay overdue premiums before they would be removed from the health plan.

While the Legislature largely kept the Oregon Health Plan in place, it did order the Department of Human Services to cut benefits and other costs by about $28 million in the 2005-2007 biennium. Changes under consideration for Medicaid-eligible OHP Plus enrollees include the elimination of vision coverage, cuts in spending for prescription drugs and dental care, and reduced stays at urban hospitals. Other savings would be made through reduced patient transportation spending, closer scrutiny of spending for emergency room treatments and costly testing, and the withholding of cost-of-living increases for doctors, hospitals and other providers.

Jim Edge, deputy director of the Oregon Medical Assistance Program, said his agency must finalize its cost savings plan by September. A Sept. 8 public hearing is scheduled at the Capitol before a final decision, which must be approved by the federal government.

Sen. Ben Westlund, R-Bend, took little pride in the Legislature's maintenance of the status quo on the Oregon Health Plan.

"This session's performance on improving access to health care for Oregonians was dismal," he said. "We did not add back one human being to the Oregon Health Plan."

Westlund sponsored several bills meant to contain health care costs and increase the affordability of medical care, and to restore past cuts to the health plan. All those bills failed, either because of opposition from the hospital and insurance lobbies or because of the cost.

That was the case with a proposed ballot referral that would have asked voters to increase the cigarette tax by 60 cents a pack - with the resulting state revenue and matching federal Medicaid funds totaling nearly $500 million every two years. The GOP-controlled House refused to consider the proposal.

Westlund and a bipartisan group of lawmakers are sponsoring an initiative that would declare health care a basic right and constitutionally mandate that the Legislature devise a plan to provide coverage.

The group also is considering sponsoring an initiative to raise the cigarette tax, similar to the failed legislative referral.

"We're just being ostriches, burying our heads in the sand," Westlund said. "If we don't solve this crisis - and by any measure it's a crisis - then it will bury us."
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Title Annotation:Legislature; A measure passed by the 2005 Legislature makes the Oregon Health Plan more affordable to the neediest recipients
Publication:The Register-Guard (Eugene, OR)
Date:Aug 24, 2005
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