1. Oregon Health Policy & Research Health Reform Efforts in Oregon Jeanene Smith MD, MPH Office for Oregon Health Policy and Research January 2007

2. Oregon Health Policy & Research Oregon historically been innovative in state health policy Pre-Oregon Health Plan - early pioneers in managed care in selected cities Oregon Health Plan (OHP) – Prioritized List, Hi- risk pool, created a policy office, aimed for an employer mandate OHP2 – Brought premium subsidy program in under Oregon’s Waiver but further reform efforts thwarted with budget cuts due to recession Now Broad Health Reform – multiple initiatives and ideas, lots of new energy

3. Oregon Health Policy & Research Original Goals of the Oregon Health Plan Health care for the uninsured- Public and Private vision and collaboration Basic benefit package of effective services Broad participation by providers Decrease cost shifting & charity care A rational way to allocate resources for health care

4. Oregon Health Policy & Research OHP 2: Attempt to broaden coverage to more uninsured February 2003 Benefit package separated: –OHP Plus - categorically eligible population (TANF, Disabled) –OHP Standard - “expansion” population (Adults/Couples < 100% of FPL) Benefits and copays adjusted for adult expansion (OHP Standard) population to try and afford to cover more lives

5. Oregon Health Policy & Research Budget crisis hit –Recession impacts OHP2 Oregon struggled with high unemployment and budget deficits as OHP2 changes were implemented State funding for adult expansion population (OHP Standard) cut, partially made up by taxes on hospitals and managed care plans Resulted in deeper benefit cuts and loss of ~80,000 adults without coverage in OHP Standard

6. Oregon Health Policy & Research Broader Health Reform Efforts: New Energy & Much Discussion Multiple healthcare ballot initiative efforts with ongoing collaborative efforts to gain public input and discussion to outline priorities Governor’s HealthyKids initiative Health Services Commission – re-looking at the Prioritized List & Chronic Diseases Oregon Health Policy Commission – Strategic Health Planning directive for broad reform Senate Interim Committee on Healthcare Access and Affordability – broad reform

7. Oregon Health Policy & Research Governor’s Health Initiatives: Healthy Kids Plan Aim is to provide access to health insurance for every child under age 19 in Oregon thru current system and a new subsidized private market option Aggressive outreach to kids, especially those already eligible for the Oregon Health Plan or subsidized private insurance premiums via “FHIAP” Build on ease of access via school based clinics Would start July 2008 if approved by current Legislature

8. Oregon Health Policy & Research Health Services Commission’s Re -Prioritized List Re-aligned priorities on the List of Health Services for the Oregon Health Plan Reflects higher ranking of the treatment of chronic disease than ever before Discussions about a “second line” to define benefit package for OHP Standard Basis of broader health reforms’ benefit design package

9. Oregon Health Policy & Research Oregon Health Policy Commission Health Reform Concept Goal: Affordable, accessible, and efficient health care for all Oregonians Bold, realistic reform implemented over 5 years Principle that everyone contributes to reform Strengthen and build on existing public and private insurance structures Complement other reform efforts

10. Oregon Health Policy & Research The Policy Commission’s Proposed Reform Concept Individual Coverage Mandate Employer Contribution Public Coverage, Subsidies & Incentives Health Insurance Exchange System Financing Efficiencies & Cost Control System Improvements: Quality & Transparency, Public Health, Service Delivery

11. Oregon Health Policy & Research Many other ideas in play in Oregon: Working towards Consensus Senate Interim Committee on Healthcare Access and Affordability Plan Oregon Business Council Plan (Local) Providence Health System Plan Archimedes Movement (Kitzhaber) Plan Plus: New National ideas – Senator Wyden’s Plan

12. Oregon Health Policy & Research For questions, more info… Office for Oregon Health Policy and Research 503-373-1625 jeanene.smith@state.or.us Our website: www.ohpr.state.or.us