Oregon Health Plan under-funded
The Oregonian
September 25, 2002
Kaiser backs out of Oregon Health Plan
By Joe Rojas-Burke
Kaiser Permanente, Oregon's largest health maintenance organization, plans
to withdraw from the Oregon Health Plan, a state and federally funded
program for people who are poor or disabled.
The withdrawal effectively ends the state's attempt to use commercial HMOs
to provide health care to the low-income population. The four largest
commercial plans have dropped tens of thousands of Oregon Health Plan
enrollees during the past two years, saying state reimbursements don't cover
rising expenses.
Those dropped by Kaiser will remain covered by the Oregon Health Plan. But
they may struggle to find doctors willing to accept the state's low rate of
payment.
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Comment: The Oregon Health Plan is an admirable attempt to provide coverage
for low-income individuals, for high-risk individuals, and for those without
employer-based coverage. It has met some of its goals but has fallen short
on others. Overall it has improved the allocation of the very limited health
care funds available for these sectors of the patient population. But one
tradeoff is that services with high cost or low potential of preserving life
are not covered.
Besides rationing, a greater problem persists. These individuals do not have
enough of a political voice to assure that adequate funding of this coverage
would be provided. Commercial HMOs have been losing money in this program,
and direct-to-provider payments are so low that providers may no longer be
willing or even able to participate. Coverage means very little if
participating providers are not readily available.
There are excesses in health care, especially in administration. Reducing
that waste by eliminating the middleman health plans, and redirecting those
funds to health care could assure adequate funding for comprehensive health
care for everyone. Placing everyone in the same risk pool would eliminate
the tendency to under-fund care for low-income or high-risk individuals. And
everyone else would be assured that they would have coverage for benefits
and expenses that are not now covered by their current plans.
Measure 23, the Oregon Comprehensive Health Care Finance Act of 2002, would
do just that. The voters of Oregon will have the opportunity to vote on this
initiative in the November election.