Health Care/A Hidden Cost
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health coverage for their employ­
ees reaps twin benefits: a) healthy
workers are more productive; and
b) small businesses are motivated
to reduce the pool of uninsured
people in this state.
The use of lottery funds could
be successfully linked with risk
pools, as explained in Strategy I.
Since pooling alone cannot guar­
antee that group insurance will
remain affordable as the cost of
care rises, using lottery money as a
premium subsidy could defray
rising expenses.
There is at least one problem
with this approach: the funding
source is unstable. This glitch,
however, is not insoluble — we just
need to be aware of it.
• Financial reasons
prohibited 13.5 million
people from receiving
medical care;
• One million persons who
needed medical care were
turned away;
• A lack of health
insurance kept 20% of
uninsured pregnant women
from receiving medical
care during their first
trimester.
Strategy IV
Insurant? Voudiers)
With an exception for employ­
ers who already provide group
insurance, this proposal would
mandate that owners of small
businesses provide vouchers to
employees for the SOLE purpose
of buying health insurance. To
avoid fraud, the state could take
either of two approaches:
coverage. A portion of the employ­
ee’s contribution could be returned
as a tax credit, depending upon
the impact on state revenues.
Under this plan, a worker would be
prevented from turning the voucher
into cash because only insurers
collect the vouchers.
This approach allows employ­
ees to shop insurance markets for
the coverage which best fits the
individual. The emergence of this
new consumer group might even
encourage carriers to look for more
creative approaches to attract
them, a possible benefit to us all.
1) Mandate the level of
basic service to be
obtained. Or,
2) require access to coun­
seling that would help this
new stream of consumers
obtain packages tailored to
their specific needs.
The amount to be contributed
might be set by the legislature so
that a flat fee is established. In
Hospitals scramble to spread
the cost of the uninsured to
those who can pay.
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The number of people
without health insurance
coverage in Oregon probably
exceeds previous estimates of
425,000.
pay. Persons whose incomes are
higher would pay more than per­
sons who make only slightly more
than the minimum wage.
Strategy V
2. ALLOW SMALL BUSINESS
EMPLOYERS TO PURCHASE
HEALTH INSURANCE COVER­
AGE THROUGH THE MEDICAID
PROGRAM.
(Expanding Medicaid Eligibility -
THREE IP IW H K S )
As in the first instance, this
approach redefines and broadens
Medicaid is a joint federal-state
health insurance program for spe­
cific categories of low-income indi­
addition, depending on the chosen
plan, an employee might be re­
quired to contribute to the cost of
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viduals and families. It provides
health insurance coverage for
children, the disabled and elderly
persons. We can look at ways to
extend coverage under this plan,
but we will need cooperation at the
federal level.
One objection to expanding
eligibility surfaces immediately —
the issue of adverse selection. If we
target people who are medically
underserved and add them to the
system, we are adding to the pool
of those already making the great­
est demand on the system. In other
words, this approach fails to
spread the risk.
The objection is valid. How­
ever, because Medicaid was cre­
ated for the needy, it follows that
the federal government is the most
appropriate body to subsidize the
cost of adverse selection.
1. ALLOW PERSONS WHOSE
EMPLOYER DOES NOT PROVIDE
COVERAGE TO BUY INTO MEDI­
CAID FOR HEALTH INSURANCE.
This option builds upon the
existing system which was created
for a specific population. Here that
population is redefined and broad­
ened, adding premium charges
depending upon one’s ability to
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