What's Going on in Oregon?

Abstract

Few programs have attracted more attention than Oregon's recent Medicaid legislation. Whatever the ultimate verdict, there is no doubt that this program has become a focal point of debate on virtually every aspect of national health policy: access, cost, effectiveness, rationing, and basic care...In July 1989 the Oregon legislature passed the Oregon Basic Health Services Act, a three-part program designed to ensure that every person in Oregon would be covered for at least basic health care. The three components are to expand Medicaid to include all citizens with a family income below the federal poverty level, to require that employers offer workplace-based coverage for employees and their dependents through a small-business insurance pool, and to establish an all-payers' high-risk pool. Thus, the public sector would be responsible for everyone below the federal poverty level, while the private sector would be responsible for those above it. The act also stipulates that providers should be fully reimbursed for the cost of their services. A central feature of the program is to set priorities for health services. The act created the Oregon Health Services Commission and charged it with producing a ranked list of services that could be used to define a basic care package for coverage by Medicaid. The same package would also define the minimum set of services to be covered by the private sector insurance pools....