What Can We Learn From: California

As the Oregon Health Fund Board develops a comprehensive reform plan, many other states are moving in the same direction.  Some are ahead of us, others behind.  Are there lessons from other states’ experiences that could influence the success or failure of our own plan? At Talk Health Reform, we'll be looking at other states' experience planning and implementing reform and asking if these examples hold lessons for Oregon's reform efforts.

This week: California

Looking at the rise and fall of health care reform in California, what can we take away from our neighbor's experience?  Were there elements of California's proposal that you think we should either incorporate or avoid?  Like California, Oregon is trying to significantly expand coverage, enact comprehensive market reforms, and address failures in the delivery system.  The scale of the problem is similar in California and Oregon, too – 19% of California’s population is uninsured, compared to 17% in Oregon.

California’s plan included:

• The concept of “shared responsibility”, where individuals, employers, and the State all contribute to the health care system. 

• Both an individual mandate and a requirement that employers provide coverage or help pay into the system to help pay for insurance for lower income Californians.

• State contributions to help lower-income individuals and families pay for coverage.

• Tax credits for others so that the cost of health care does not exceed 5% of a family’s income.

• A health insurance pool, or “exchange”, where people with subsidies or tax credits could purchase individual coverage.

• An increase in the cigarette tax and new hospital fees to help finance the program.

More details on California’s plan can be found on the California Healthcare Foundation’s health reform website.  Health Affairs is also hosting on blog on California’s “shelved health care reform”.

The plan had support from businesses, labor, consumers, providers, and health plans, and yet it did not pass the Senate.  As our state considers a similar approach to covering our uninsured, how can we succeed where California failed?  Are there other states that you think have lessons for Oregon?  How can we be a leader for other states as well?