Oregon board diagnosis: get health insurance for all
By DON McINTOSH
Associate Editor
For several months, six citizen
committees have been hammering out
a complicated plan to provide health
insurance to uninsured Oregonians —
all 600,000 of them.
Organized labor is well represented
on the committees, which were au-
thorized by the June 2007 passage of
Senate Bill 329 by the Oregon Legis-
lature. Governor Ted Kulongoski ap-
pointed the committee spots in Octo-
ber. SB 329, known as the Healthy
Oregon Act, was sponsored by state
senators Ben Westlund (D-Tupelo)
and Alan Bates (D-Ashland).
The committees are supposed to
make their recommendations public
by the end of April, kicking off
months of community meetings. Then
a seven-member Oregon Health Fund
Board will listen to public input and
sift through the committee proposals
to make a final recommendation to the
Legislature in October 2008. The Leg-
islature will take it up in January when
its 2009 session begins. And it’s likely
that Oregon voters will be asked to ap-
prove the result. If all goes according
to plan, Oregon could have something
like universal health coverage as of
2010.
But a great many details of how the
program will work are still up in the
air.
In its most basic form, the Oregon
Health Fund envisioned by SB 329
will require all uninsured Oregonians
to purchase insurance on something
like an income-based sliding scale —
and require all employers to contribute
something to cover the costs. The
poorest Oregonians would have their
insurance paid for entirely, while the
moderately low-income would get a
subsidy of some kind. And middle-
and upper-income individuals would
be able to buy insurance at rates more
affordable than they are now. Insurers
would not be allowed to deny cover-
age based on pre-existing health con-
ditions.
That’s the basic plan. But the Ore-
gon Health Fund also has ambitions to
be a kind of big-idea system-wide re-
form. SB 329 aims to restructure the
way health care is delivered and paid
for in Oregon so that the $20 billion or
so now spent annually on health care
in the state could be used more effi-
ciently and effectively.
It’s a reform that has the potential
to create big-time winners and losers.
The job of the Oregon Health Fund
Board will be to make sure all parties
win and lose a little, or else the politi-
cal backlash may kill the project be-
fore it gets off the ground.
The Oregon Health Fund Board
will oversee the process and select
from among the recommendations of
the six committees and several task
forces that are developing different
parts of the proposal. The committee
members aren’t paid, but are assisted
by a paid staff of eight number-
crunchers and policy analysts over-
seen by Barney Speight, a widely-re-
spected health policy expert and
former Kaiser Permanente vice presi-
dent.
Oregon AFL-CIO President Tom
Chamberlain is labor’s representative
on the Board, which also has repre-
Oregon and SW Washington
Fair Contractors Foundation
sentatives from business and commu-
nity groups. The union movement also
has representatives on most of the
committees, and the labor folks all
work together and meet periodically
to coordinate.
Unions have a big stake in health
care reform, both because they defend
the interests of working people in gen-
eral and because they’re having to
fight hard to hold on to the health ben-
efits that union employers provide.
And as much as 10 to 15 percent of
premiums may be going to paying the
cost of care for uninsured individuals
who can’t pay their bill. If Oregon can
figure out a way to insure everyone,
premiums for union-negotiated health
coverage could go down.
In the SB 329 process, one of the
most important, and contentious, com-
mittees has been the Finance Commit-
tee, which is supposed to figure out a
way to pay for the plan, even though
no one is sure how much it will cost.
Ballpark estimates are that covering
the currently uninsured would cost
$550 million a year. Money for the
Oregon Health Fund would come
from a number of sources.
“Everybody’s going to pay,” said
b h
m k
Maribeth Healey, executive director of
the union-supported non-profit Orego-
nians for Health Security. “Individuals
will pay, businesses will pay, govern-
ment will pay. It has to be fair.”
For starters, Oregon will be able to
use the money it’s already getting
from federal programs for poor indi-
viduals (Medicaid) and children in
low-income households (SCHIPS).
But how much of the remaining
cost should be borne by employers,
and how much by individuals, is a big
debate on the committee. Employers
would probably pay by means of a
payroll tax. Employers that provide
health coverage would get a rebate of
most or all of the payroll tax. From the
union perspective, that could be a
boon, because union employers some-
times are undercut by competitors that
don’t provide health care benefits.
On the 18-member Finance Com-
mittee, the union voices are Operating
Engineers Local 701 stationary coor-
dinator Cherry Harris and Lynn-Marie
Crider of Service Employees (SEIU)
Local 49, and they’re working to re-
strain the profiteers. That’s because
depending on how it’s formulated, the
(Turn to Page 16)
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APRIL 18, 2008