What health care reform means to Oregonians

and Rep. Mitch Greenlick

This week, health insurance reform became law in the United States. This monumental legislation will benefit millions of Americans, and begins to reform our national health care system.

In anticipation of this, the Oregon Legislature passed HB 2009, guided by Sen. Alan Bates and Rep. Mitch Greenlick. Now, Oregon is in a position to realize significant additional benefits, including cost savings in our state health care system. We'd like to offer a primer on the status of health care reform in Oregon, and how the provisions of the federal legislation intersect to benefit Oregonians immediately.

These reforms expand health insurance coverage, improve the quality of health care and begin to rein in out-of-control costs in the years ahead. All Oregonians will benefit from insurance reforms that take effect over the next six months:

  • There can be no lifetime limit on benefits.
  • Insurers cannot rescind coverage for those already enrolled in a plan except in cases of fraud.
  • Many preventive services and immunizations will be covered.
  • Unmarried children can remain on their parents' plans until age 26 even if they are not students.
  • Children cannot be denied coverage on employment-based plans for pre-existing conditions.
  • A Medicaid option will allow individuals with disabilities to receive home and community-based services.
  • A $250 rebate will be available for the seniors in the Medicare drug coverage "donut hole" who pay for drugs out of pocket.
  • Medicare preventive care, such as cancer screening, will be free of co-payments and deductibles.

Thanks to Oregon's congressional delegation, especially Rep. Peter DeFazio, Oregon's senior citizens will receive improved access to health care because Oregon's Medicare reimbursement rate will be higher.

It is a little-known fact that a 40-year-old payment formula set reimbursement rates for Oregon doctors and hospitals well below the national average. As a result, some providers stopped accepting Medicare patients. (Medicare pays three and a half times less to doctors in Oregon than it does to doctors in other states, placing Oregon's rates near the lowest in the nation at 48th place.) Because Oregon's physicians will no longer be expected to treat Medicare patients at less than their cost, Oregon seniors will keep their doctors.

In addition, Oregon small businesses are immediately eligible for tax credits up to 35 percent of premiums when the employer pays at least 50 percent of the premium cost, and these tax credits increase to 50 percent over time. This will make health insurance more affordable for the employers who choose to offer it and for the employees who need it.

Furthermore, the federal legislation establishes health insurance exchanges in the states for people and small businesses that don't have group coverage to shop and compare prices and policies, and provides federal grant funds for states to plan and implement those exchanges. However, Oregon's HB 2009 had already shaped the Oregon Health Authority to integrate state purchasing of health services, state health policy and health insurance planning, policy and function — including an insurance exchange in Oregon. Since that work began last July, Oregon meets or exceeds the eligibility requirements and can immediately apply for grants to offset those costs.

Because the national legislation permits the U.S. government to contract with states that operate a high-risk pool to guarantee coverage for people with pre-existing conditions, Oregon is also eligible to apply for some of the $5 billion in federal funds set aside for this purpose. The Oregon Medical Insurance Pool has been up and running since 1990, and is often cited as a national model.

The federal law also provides various incentives for states that design systems to reward hospitals for improved outcomes, connect physicians to patients by electronic medical records and establish quality standards for health care providers and hospitals. Again, since the Oregon Health Authority has already begun this work, the incentives will serve to accelerate Oregon's efforts on these reforms. This is one of many ways that Oregon gains recognition as a national leader in health care.

Finally, the federal legislation provides an extra $5 billion in federal Medicaid funds to Oregon over the next 10 years. As a result, two legislative goals are within reach: the expansion of the Oregon Health Plan to more working families, and affordable health care for all Oregonians by the year 2015.

The United States is no longer the only wealthy, industrialized nation that does not ensure that all citizens have health care coverage, and the rewards for Oregonians are substantial.

State Sen. Alan Bates represents Southern Oregon's District 3. He is co-chairman of the Ways and Means Subcommittee on Human Services and a member of the Joint Ways and Means Committee, the Senate Health Care Committee and the Emergency Board. He is a primary care physician who has been in practice for over 30 years in the Rogue Valley. State Rep. Mitch Greenlick represents Portland's District 33. He is chairman of the House Health Care Committee and a member of the Business and Labor Subcommittee on Work Force Development. He is a health services researcher and a member of the Institute of Medicine of the National Academies.

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