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In August, members of a workgroup tasked with designing a universal health care plan for Oregon were granted an extension to finish out their report to lawmakers. Its work wasn’t done, and its original Sept. 15 deadline got pushed back to December.
But the pressure soon returned. Last month, Universal Health Plan Governance Board board chair Helen Bellanca informed her colleagues that a state agency, the Department of Consumer and Business Services, needed several weeks with the report to ensure it was correctly formatted and presented before its official publication—meaning the final document would actually need to be out of the board’s hands by mid-October.
The rush has been on ever since, as the drafting committee and staff hurried to finish a report that was the culmination of years of work.
Some wondered why a little more time couldn’t be bought. “I would go, if I were you, all the way to the top,” board member Mary Lou Hennrich, the founding CEO of CareOregon, told Bellanca.
But a board staffer said the deadline was firm and the board chair said the team could pull this off. “We can do it, Mary Lou, don’t worry about it,” Bellanca said, to which Hennrich responded, “I don’t sleep at night.”
If this all sounds nerve-jangling, it’s because the group has a tall task: produce a comprehensive plan for universal health care coverage—something that exists elsewhere on earth but certainly nowhere in the U.S.—that some state lawmakers were hoping they could plug-and-play into a bill.
By all accounts, this final report will not be that; many feel the board, whether because of lack of funding, lack of execution, staffing churn, a vague mandate or a general lack of time, has failed to complete its weighty assignment with hoped-for detail.
But the plan for now is to deliver the plan they’ve got. The meeting Thursday was the last for board members to collectively recommend final revisions to the drafting committee before they will be asked to approve the document in a few days.
The late-stage draft before them was the product of years of work between the board and a prior task force (with which critics charge this board has been largely duplicative). It outlines the vision for a plan to cover all Oregonians with a common core set of health care benefits, a radical break from the current U.S. model in which most people’s health insurance is tied to their job or eligibility for federal assistance.
The draft report includes a vision for eligibility (any resident of Oregon), administration (a public nonprofit corporation), and how it would all get paid for (leveraging already-existing federal funds, and swapping the billions of dollars Oregon households and employers pay in premiums and other fees for billions of dollars in taxes.)
It also includes financial projections showing the massive increase in total state health care system costs expected in the coming years even if the state retains the patchwork status quo health care system (from $44.6 billion to an unholy $76.9 billion, according to one consulting firm’s Oregon projections).
And at the center of the report is a core argument: a universal health plan would result in lower statewide spending, broader coverage, simpler administration, and more transparency and equity.
The extent to which this is all true—or to which the plan is remotely doable—is and will remain a matter of fierce debate. Giving Oregon Health Plan-like coverage to every single Oregonian would radically upend a massive health care system whose fragmented parts are deeply interwoven with the much of the state’s social and economic fabric.
In other words, the political road ahead is daunting.
Thursday’s meeting had aspects of that road ahead in mind. For example, board members debated, what should the new income tax that would be assessed on households, to this point called a “healthcare personal income tax,” be called in the report?
Tax is a rough word. Should it be rebranded? Chunhuei Chi, the Oregon State health system expert, noted that Medicare uses terms like fees and premiums for its taxes. Founding Oregon Health Authority director Bruce Goldberg said, “I’ve never been comfortable with the tax word. I’m fine with contribution or premium.”
As the ensuing conversation showed, many terms contain uneasy connotations. “Premium” evokes a relationship with an insurance entity—the very world everyone involved in this effort wants to leave behind. “Contribution” seemed promising, evoking a collective payment into a common fund devoted to a common cause.
Said Cherryl Ramirez, the executive director of the Association of Oregon Community Mental Health Programs, “Either way we’re going to have to explain what we mean. It doesn’t matter what it’s called. So could we call it an ‘HCC’”— health care contribution—“and just say: ‘It’s income based, it replaces premiums, it is a tax?’ That all can be explained.”
It turned out “HCC” didn’t quite work because it was redundant with an already existing technical term, but this seemed closer to the mark. Bellanca took a casual poll of her board colleagues. Thus it was settled: The new progressive tax on households would—at least for now—be christened “HHCC,” for Household Health Care Contribution.
No one knows what will happen next. There are many who see this whole project as folly. And even many sympathetic to the cause doubt Oregon, especially in a very rough budget climate, is capable of pulling off what no other state has—what it itself failed to do decades ago, when voters handily rejected a similar measure.
And if the politics of the moment have changed, it’s clear that key players are not presently sold on the plan at all. In a recent interview with WW, Oregon Gov. Tina Kotek distanced herself from the work of the board, pointing to skepticism she’d expressed since its inception, when she wrote a critical letter even as she signed the law bringing it into being. In another interview, Oregon Health & Science University President Shereef Elnahal said he had not interacted with the board. Former Gov. John Kitzhaber’s big report this summer on Oregon’s crisis of upwardly-spiralling health care costs didn’t mention the universal health care vision at all.
But some advocates say it’s time to move. Valdez Bravo of Health Care for All Oregon says this has been no rush job. Though the universal healthcare idea is only now starting to come across many Oregonians’ radars, he points out that it’s the product of many years of legislature-directed labor.
He predicts the report will in the coming months turn into a bill. He says that bill, like a snowball, will gather force and size, as lawmakers decide whether to send this thing—the big one—to the voters in 2028.
Of course, it is quite possible that the legislature simply decides once again to kick the can down the road. But Valdez says he likes the odds on a bill this coming lawmaking session. “I think that there has been a lot of good work that has led up to this point,” he says. “And the work’s not over, and ultimately the legislature is the place where these recommendations and ideas and the representation of all the different constituencies and the people across Oregon will come together to decide if it is ready for primetime.”
He added that, even if the legislature does next year produce a measure to send to voters in 2028, the vision would not actually go into effect for several years hence. “If you look at it that way,” he said, “it’s definitely not happening too quickly.”
