Health Care for All Oregon

Dear supporter of healthcare reform,

We’ve laid the foundation for our health care house with federal reform and passage of HB 2009 in the last session of the Oregon legislature. But we’re not done yet!

Oregon’s HB2009 has already added some of the framing for the house: proposed an essential benefits plan, identified various ways to make health care more efficient and control costs, developed quality standards for management of chronic disease, and proposed that we all have medical homes to coordinate our care. (You can find links with more information about health care reform in Oregon in our Oregon legislation section.)

The next construction phase will determine how the insurance marketplace can operate so that it is user-friendly, controls costs, and includes a Public Plan. Properly constructed, the proposed Health Insurance Exchange could provide a marketplace where individuals and small business can find help in selecting from a menu of health plans. Among the private plans in the Exchange, Oregonians should have the choice of a publicly owned and publicly administered plan … a health plan that puts your interest first, is cost-effective, user-friendly, and accountable to the public, not shareholders.

HB2009 requires that ALL Oregonians have access to health coverage by 2015. ALL Oregonians need to participate in building our health care house—we will be living in our house for many years to come. You, your friends and neighbors are urged to attend the public forum in your town or nearby this September. Talk with the architects and builders of our health care house (the Oregon Health Policy Board), voice your likes and ideas for the insurance marketplace, the publicly owned and administered health plan, and the essential benefits. You can find information on the public forums in the Oregon Legislation section of this Web site, as well as what HCAO thinks the Board needs to hear.

Whether or not you can attend, be sure to write the Board and your legislator demanding a strong, large insurance exchange that includes a publicly owned and publicly administered plan and holds all health plans accountable for improving quality, ensuring access, and reducing cost. You can send your input by e-mail to ohpb.info@state.or.us Lawmakers will decide on the details of the Exchange and the Public Plan this fall. Health insurance lobbyists will be hard at work attempting to keep things as they are. But the Health Insurance Exchange could be set up to pool the purchasing power of many Oregonians, so we can get a better deal on health care. It could also allow you to compare different health care plans in a simpler, clearer way, and to carry your plan from one job to another.

Next: an Oregon single payer bill. But passing a strong Insurance Exchange and Publicly Owned and Administered Plan under HB2009 is only the first step. In order to put a roof on our health care house that covers all essential services and shelters all Oregonians at an affordable price, HCAO is also working with Jobs with Justice, Physicians for a National Health Program, and other advocates on an Oregon single payer bill. Oregon legislators have committed to seeing the bill at least gets a committee hearing. The best case is, with enough push from Oregonians, the Legislature would refer the bill to voters.

The public funding of elections is almost certainly a necessary first step toward any really meaningful reform in health care (or anything else).

HR 1826, Fair Elections Now Act, was introduced by John Larson, D-CT, and currently has 156 co-sponsors, including Oregon’s Earl Blumenauer, Peter deFazio, and David Wu. The last action taken, however, was almost a year ago, when, like most good ideas, it was being shuffled from one committee to another. Much the same has happened to the similar Senate bill, introduced by Dick Durbin, D-IL, which has 21 co-sponsors, including Jeff Merkley.

Now, Common Cause and Public Campaign have joined forces to launch the Campaign for Fair Elections

Oregon needs fair elections too. Check out what Oregon activists are doing here

And here is why we need publicly funded health care:

Americans spend twice as much as residents of other developed countries on healthcare, but get lower quality, less efficiency and have the least equitable system, according to a recently released report .

The United States ranked last when compared to six other countries — Britain, Canada, Germany, Netherlands, Australia and New Zealand, the Commonwealth Fund report found.

It was probably our best chance ever at health care reform at the federal level — a Democratic president, a Democratic majority in Congress, and health care costs still soaring out of control. But many health care reformers think it was a badly fumbled opportunity.

Some significant changes are on the way as the result of the Patient Protection and Affordable Health Care Act signed into law by President Obama on March 23, 2010. On September 23, 2010, six months after the bill was signed, it will become easier for parents to cover adult children, harder for insurance companies to cancel health policies, and more economical for small employers to provide health insurance for their employees.

Many other reforms begin in 2014, including expansion of coverage under Medicaid (Oregon Health Plan). Most of us will be required to have health insurance and the federal government will subsidize that coverage for some of us. A new health insurance exchange is intended to lower premium costs.

Oregon is in a unique position to move forward quickly with federal reforms, especially the insurance exchange, because of the work of the new Oregon Health Authority and Health Policy Board, which were created after the passage of HB 2009 in June 2009. The law requires that the Health Policy Board propose a plan to the 2011 legislature to achieve universal coverage by 2015. Meanwhile, work is progressing on plans for an insurance exchange and a public plan, strengthening community health centers, improving quality of care and reducing disparities in health care quality and access.

Health Care for All-Oregon advocates were actively involved in the passage of HB2009 and have been monitoring its implementation, particularly regarding the insurance exchange and the public plan. The public plan, of course, was a very controversial issue in the federal legislative debate and was ultimately omitted; a public plan will be included in the proposal presented to the Oregon legislature in 2011, but the details are not yet clear. Oregon could lead the nation with this step towards the more comprehensive public plan we are working to achieve. Your help is needed: contact the Oregon Health Policy Board and your state legislators and let them know we want a strong public plan.

There is still much to be done to achieve quality, affordable health care for ALL Oregonians. Your voice and involvement are critically important. You can find more information about the work of Oregon Health Authority and Oregon Health Policy Board at http://www.oregon.gov/oha/ohpb

The federal health care reform will do little to control costs or provide universal access to secure and affordable health care for all Americans. The bill clearly throws health care reform back to the states for the time being. In addition to working on the reforms listed above, HCAO is working with other advocates to try to craft an Oregon single payer bill for the Oregon legislature to consider in their next session—stay tuned!

In an article in the Cleveland Plain Dealer, Dr. Johnathon Ross asks, “Would you add a third floor to a house that has a crumbling foundation? Because that is what Congress just did.” Instead, we must build on the solid foundation of Medicare, tax-financed and low-overhead. Read the article at http://www.pnhp.org/news/2010/june/build-foundation-for-health-care-on-medicare.

A note on the insurance bill by Rose Ann DeMoro, Executive Director, National Nurses United, AFL-CIO and California Nurses
Association and member of the Executive Council of the AFL-CIO (edited by HCAO)

Passage of President Obama’s healthcare bill proves that Congress can enact comprehensive social legislation in the face of virulent right-wing opposition. Now that we have an insurance bill, can we move on to healthcare reform?

The legislation fails to deliver on the promise of a single standard of excellence in care for all and instead makes piecemeal adjustments to the current privatized, for-profit healthcare behemoth.

What the bill does provide:

– Expansion of government-funded Medicaid to cover 16 million additional low-income people, though the program remains significantly under funded. This limits access to its enrollees as its reimbursement rates are lower than either Medicare or private insurance, with the result some providers find it impossible to participate. Though the federal government will provide additional subsidies to states, those expire in 2016, leaving the program a top target to budget-cutting governors and legislatures.

– Increased funding for community health centers, thanks to an amendment by Sen. Bernie Sanders.

– Reducing but not eliminating the infamous “donut hole” gap in prescription drug coverage for Medicare enrollees.

– Insurance regulations covering members’ dependent children until age 26, and new restrictions on limits on annual and lifetime on lifetime insurance coverage, and exclusion of policies for children with pre-existing conditions.

– Permission for individual states — though weakened from the version sponsored by Rep. Dennis Kucinich — to waive some federal regulations to adopt innovative state programs like an expanded Medicare.

All of these reforms could, and should, have been enacted on their own without the poison pills that accompanied them.

Where the bill falls short:

– The mandate forcing people without coverage to buy insurance, a gift worth hundreds of billions of dollars to reward the very insurance industry that created the present crisis through price gouging, care denials, and other abuses.

– Inadequate healthcare cost controls for individuals and families.

1. Insurance premiums will continue to climb. After Anthem Blue Cross of California announced 39 percent premium hikes, the administration promised to crack down with a federal rate insurance authority, but this idea was dropped from the bill.

2. There is no standard benefits package, only a reference that benefits should be “comparable to” current employer provided plans.

3. An illusory limit on out-of-pocket medical expenses. Even in the regulated state exchanges, insurers remain in control of what they offer and what will be a covered service. Insurers are likely to design plans to attract healthier customers, and many enrollees will likely find the federal guarantees do not protect them for medical treatments they actually need.

– No meaningful restrictions on claims denials insurers don’t want to pay for. The “internal review process” remains in the hands of the insurers, and the “external” review will be up to the states, many of which have systems now in place that are dominated by the insurance industry with little enforcement mechanism.

– Significant loopholes in the much touted insurance reforms:

1. Provisions permitting insurers and companies to more than double charges to employees who fail “wellness” programs because they have diabetes, high blood pressure, high cholesterol readings, or other medical conditions.

2. Permitting insurers to sell policies “across state lines will set up a race to the bottom to the least regulated state, threatening public protections won by consumers in various states.

3. Allowing insurers to charge three times more based on age plus more for certain conditions, and continue to use marketing techniques to cherry-pick healthier, less costly enrollees.

4. Insurers may continue to rescind policies, drop coverage, for “fraud or intentional misrepresentation” — the main pretext insurance companies now use.

– Taxing health benefits for the first time. Though modified, the tax on benefits remains, a 40 percent tax on plans whose value exceeds $10,200 for individuals or $27,500 for families. With no real checks on premium hikes, many plans will reach that amount by the start date, 2018, rapidly. The result will be more cost shifting from employers to workers and more people switching to skeletal plans that leave them vulnerable to financial ruin.

– Erosion of women’s reproductive rights, with a new executive order from the President enshrining a deal to get the votes of anti-abortion Democrats and a burdensome segregation of funds, that in practice will likely mean few insurers will cover abortion and perhaps other reproductive medical services.

– A windfall for pharmaceutical companies. The administration blocked provisions to give the government more power to negotiate drug prices and gave the name brand drug makers 12 years of marketing monopoly against competition from generic competition on biologic drugs, including cancer treatments.

Most critically, the bill strengthens the economic and political power of a private insurance-based system based on profit rather than patient need.

As former Labor Secretary Robert Reich wrote after the vote: “Don’t believe anyone who says Obama’s healthcare legislation marks a swing of the pendulum back toward the Great Society and the New Deal. Obama’s health bill is a very conservative piece of legislation, building on a Republican (a private market approach) rather than a New Deal foundation. The New Deal foundation would have offered Medicare to all Americans or, at the very least, featured a public insurance option.”

Too many people will remain uninsured, individual and family healthcare costs will continue to rise, and private insurers will
still be able to deny claims with little recourse for patients.

If, as the President and his supporters insist, the bill is just a start, let’s hold them to that promise. Let’s see the same resolve and mobilization from legislators and constituency groups who pushed through this bill to go farther, and achieve a permanent, lasting solution to our healthcare crisis with universal, guaranteed healthcare by expanding and improving Medicare to cover everyone.

Rightwing opponents fought as hard to block this legislation as they would have against a Medicare for all plan. As more Americans recognize the bill does not resemble the distortions peddled by the right, and become disappointed by their rising medical bills and ongoing fights with insurers for needed care, there will be new opportunity to press the case for real reform. Next time, let’s get it done right.

What does the bill mean for you? Who are the winners and losers?

Obama is a political winner and, depending on how popular the reform proves, the Democrats could be winners too.

If you are uninsured and have not been able to afford a policy, you are probably a winner. The subsidies are fairly generous.

The insurance companies must be counted among the big winners. They are going to get tens of millions of new customers, with their premiums subsidized by taxpayers. And many of those new customers will be winners too, as will people who have been unable to get insurance because of a pre-existing condition.

Insurers will have to offer coverage to people with pre-existing conditions in 2014; there will eventually be some review of premium increases; and there will be limits on how much they can spend on administration and profits (15 percent of premiums for large group plans, 20 percent for individuals and small group plans — but this is still many times higher than the administrative overhead for Medicare).

Medicare Advantage plans will get subsidized rather less by taxpayers. (The media have been calling this “cuts to Medicare” but old-fashioned Medicare won’t be affected.) The Medicare “donut hole” will be eliminated in 2020.

The state-run insurance exchanges through which individuals and small businesses can buy insurance won’t be up and running till 2014. But people with pre-existing conditions who have been uninsured for six months or more can sign up in 90 days for a high-risk program.

If you are a young woman not covered by a group plan and you might get pregnant, you are a winner. Currently, most individual plans don’t cover pregnancy. But the standard benefits to be provided by the insurance exchange will include pregnancy coverage — but wait! Not till 2014.

Want an abortion? Not so fortunate. You are on your own.

People who lose their jobs (or choose to leave them) after 2014 will, of course, still lose their employers’ coverage, but will be able to get insurance right away through the exchange.

More people will be covered by Medicaid (those with family incomes up to 133 percent of federal poverty level).

If your family income is $250,000, you’ll be asked to contribute more to Medicare funding and to pay a small tax on your investment income.

Now you may be thinking that this is all horribly complicated, and that it would have been a lot simpler to just cover everyone. We at HCAO would agree with you.

There is more information about the overhaul on the Federal Legislation page.

“Should they succeed in blocking reform, Republicans should take no consolation. When Congress next attempts reform, in a decade or more, health costs and the number of uninsured and underinsured will have escalated — and the likely outcome will be the single-payer system that Republicans most abhor.”

(William F. Pewen is a former senior health policy adviser for Senator Olympia Snowe, Republican of Maine.)

William Pewen expresses the view of the majority of well-informed moderates and conservatives: the likely eventual outcome of further deterioration in health care financing will be a single payer system, like it or not.

Although they may be opposed to single payer based on ideology, they understand simple math. A decade from now a family with an income of $100,000 will not be able to pay an insurance premium of $25,000 plus a $25,000 deductible plus a coinsurance of 30% of the balance of the medical expenses.

What is Single Payer?
It is a publicly financed, universal health care system, sometimes called Medicare for All or National Health Insurance.

Some single payer systems (such as that in Great Britain and, though we don’t often think about this, the U.S. Veterans Administration) also employ the doctors and fund the hospitals. But most single payer advocates in the U.S. want a system that will simply pay the bills from a single source and cover everyone. Doctors and hospitals will remain in the private sector, and will send their bills to the single payer.

All your questions about single payer answered here by Physicians for a National Health Program

Is health care a right or a privilege? What do you think? Is it OK that 18,000 people die each year in the U.S. because they don’t have access to care?