Talk Health Reform

Oregon Health Plan in the News

When the prioritized list that is used for the Oregon Health Plan was first unveiled, Oregon’s health care system made world news. Now, with the announcement that the state will be using a “health care lottery” to determine who gets covered when OHP reopens, Oregon is again on the national - and international - radar. And not all of the press is positive.

A segment called "Pick Sicks" that recently aired on Comedy Central's Colbert Report lampooned the OHP lottery. Even though his description of the situation is delivered in a humorous, "tongue-in-cheek" manner, the topic is a serious one. 

Understanding that there are limited funds in the current system and that the federal government does not allow sicker or higher risk people to be moved to the front of the line, is a lottery the best way to get eligible people covered?  What do you think about Oregon being the first state to try using a lottery for health care? 

Guest Post: CareOregon

This Guest Post is from CareOregon, a Medicaid managed care plan serving over 95,000 Oregon Health Plan members in 16 counties across the state.

The Oregon Health Plan (OHP), as initially envisioned in 1987, was supposed to provide access to care for all Oregonians with all segments of society sharing in the cost. However, twenty years after the development of OHP, we do not have enough state general funds allocated to either cover the intended OHP population or maximize our federal match. That means that for every dollar the state is not spending on OHP, we give up $1.57 from the federal government. Not fully funding the OHP “Standard” population means there are more uninsured Oregonians. When the uninsured get care, providers, payors and health care consumers pay for this care.

In order to get the federal dollars we are entitled to, we need to allocate additional state general fund dollars to OHP. But let’s not just keep putting money into a system without thinking about whether the system is designed to give us what we want for our population. The primary care system is a good place to start since it will improve patient care and reduce costs. Another way to improve our “bang for the buck” is to think about how we deliver and pay for care.

We know that coordination of care at a primary care level can result in better health for people and save significant money in the whole system. Paying for nurses to provide some of these services, rather than doctors, would save dollars in the system and improve outcomes. If health plans and insurers had more flexibility in how clinicians are paid, the delivery system could be transformed to provide the care people need for less cost. In addition, information that compared outcomes across programs would allow us to see if the money we are spending is well used.

Hopefully, the Health Fund Board and its committees will look for as many opportunities as possible to provide that flexibility and to maximize the state’s federal matching dollars. It’s a shame to leave that money on the table.