Now it's official: After years of near-death experiences under the blades of budget cuts, Oregon's most important health-care option for the poor will finally be put on life support.
This week, the state Department of Human Services will begin mailing letters to the 51,000 remaining clients of Oregon Health Plan Standard, notifying them that the program will stop accepting new clients as of July 1.
"This is going to have a huge effect across the state," says Vanetta Abdellatif, a top health official for Multnomah County. "It will just reduce access for other uninsured patients in the community."
When OHP began in 1994, it was a groundbreaking attempt at providing health care to anyone in need. Under federal Medicare and Medicaid law, groups like the elderly and the disabled are guaranteed medical coverage. But Oregon went a huge step farther, by extending an insurance program to extremely low-income clients who previously had no health-care options.
To help offset the cost of covering more people (120,000 new clients enrolled the first year), Oregon got a waiver from the federal government allowing it to withhold treatment for some medical conditions typically covered under Medicaid. But hundreds of millions of dollars from the state's general fund also were needed.
When Oregon's economy was healthy, the formula worked and OHP flourished. Then, as the state's financial condition took a turn for the worse, the general-fund allocation for OHP started getting slimmer. OHP couldn't keep up with the cuts it had to make and was forced to take dramatic action.
In February 2003, the state split OHP into two groups. The larger, OHP Plus, consisted of the 350,000 clients who were already entitled to health care under federal law. The remaining 102,000 indigent patients, those not covered by the traditional Medicaid program, went to OHP Standard--a stripped-down plan with new rules like $5 to $10 copayments aimed at reducing the state's costs.
But even that wasn't enough. As of July 1, the only Oregonians able to join the Oregon Health Plan will be those who qualified for the traditional Medicaid program. The rest, even the prospective clients who earn less than the federal poverty level of $775 per month, will pay for their own health insurance--or, more likely, go without it.
"This is a total nightmare," says Ellen Pinney, executive director of the Oregon Health Action Campaign and a prominent backer of the health plan. "But it allows for a skeleton of OHP Standard to continue until the Legislature reconvenes and we might be able to save it."
In the meantime, those who remain on Standard face strict rules about payment. Any OHP Standard client who is late on a bill--even by one day--will be dropped from the plan, immediately and indefinitely.
State officials say that as a result of the 2003 changes, the number of people on OHP Standard has been cut in half, to 51,000 today.
The net effect of all of this will be increased stress on county health clinics, which treat the uninsured, and more trips to emergency rooms for ailments that could have been prevented. Oregon Health & Science University's emergency department, for example, saw a 17 percent jump in visits from the uninsured during the first three months last year's new restrictions were in place.
Health-advocacy groups are encouraging all Oregonians who qualify for OHP to enroll before July 1. But according to DHS deputy director Cindy Becker, more new patients will only mean more cuts in the future; the state needs to slash OHP Standard in half once again, to 24,000 patients, by July 2005. (DHS hopes to be able to pay for their coverage with a planned self-tax on hospitals and other health-care providers.)
There is some good news for those few who manage to hold on to their OHP Standard coverage, however. In May, a federal district court judge in Oregon ruled that the state had no authority to require OHP patients to make copayments for services. (Researchers had also found that even a $5 copayment was enough to discourage poor patients from getting needed care.) Judge Garr King gave the state until June 19 to stop requiring copayments.
Also, beginning Aug. 1, OHP Standard patients will be entitled to substance-abuse and mental-health treatment.
But for those who saw OHP as the model for a fair, progressively minded health plan, July 1 marks the date when health care in Oregon will take a leap backward into the 20th century. OHP's self-induced coma is a major setback in a health-care landscape that has become increasingly hostile to the poor and uninsured--and those who serve them.
"It's just a train wreck," says Jennie Hamilton, spokeswoman for the Oregon Primary Care Association, a nonprofit health-advocacy group. "With all that's happening and changing with OHP, I can hardly keep up--and it's my job."