The chairman of a task force tasked with designing a universal health care plan for Oregonians discussed details of the plan with lawmakers on Thursday.
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The Universal Support Working Group was created following the passage of Senate Bill 770 in 2019. Following some delays due to the COVID-19 pandemic, the task force is expected to submit final recommendations for the health care plan to lawmakers by September. The chair of the task force, Dr. Bruce Goldberg, discussed elements of the plan with the Interim Senate Committee on Health Care.
If the plan passes, all Oregonians will be eligible for coverage through a simple sign-up process, Goldberg said. Out-of-state residents—and their heirs—who work for Oregon-based employers would also be eligible. Medicare-eligible Oregonians would be covered to the extent permitted by federal law.
Plan benefits would be comparable to those offered by Oregon Public Employees Benefits Commission (PEBB), Goldberg said. It would provide primary, preventive and specialist care, as well as prescription and hospital services. Oral health benefits would also be similar to those offered by PEBB.
Registrants would pay no deductible or co-insurance fees, Goldberg said. There will be a behavioral health benefit, but details of the benefits have not yet been determined. Long-term care services will continue to be funded by Medicaid and private plans.
“Providers participating in the plan will not be allowed to give preferential treatment to private patients or charge more for their care,” Goldberg said. “A single state entity will reimburse service providers directly. Reimbursement methods and rates will be regional.
Private insurance will have a limited role in the new system, Goldberg said. Insurers will be able to offer additional insurance for services not offered by the universal health plan. The plan will not cover plastic surgery services or all medications. Some services will have coverage limits.
Funding for the program will come from existing state and federal health care revenues, which will be pooled into a state trust. Additional revenue needs will be generated by a payroll tax, Goldberg said.
“Employers will pay a payroll tax to help fund the cost of health care for all residents,” Goldberg said. “Employers will no longer need to provide health benefits, but they will have the option to continue to offer ERISA plans.”
The preliminary cost estimate to implement the plan in 2026 is $57.13 billion, Goldberg said. The cost of financing Oregon’s current system in 2026 would be $58.12 billion, according to research by Optumas. This represents savings of $990 million.
“It would cost about $1 billion less and give most people better benefits,” he said. “We will see increased healthcare utilization under the plan. Uninsured people will now have access to care; this will increase costs. These were offset by a single payer system which would save us money. And there would be huge administrative savings, with less fraud, waste and abuse.
Sen. Lee Beyer (D-Springfield) asked if there are any concerns that medical professionals are fleeing the state in favor of areas where they think they can make more money if the single-payer system was implemented.
“Part of that is how the single payer would set reimbursement rates,” Goldberg said. “If prices were too low, doctors would flee and there would be access problems. When you look at reimbursement from the perspective that there are less administrative costs [fees], and other savings, we won’t have doctors leaving. Some providers do not want a single payer to set their rate. And there are others who say, ‘I’m going to get a fee that’s fair, and I can focus on my patients.’ »
Beyer also asked if wait times might increase for elective services. But Sen. James Manning (D-Eugene) said wait times are already a problem with the state’s current health care system.
“When we created the task force, I heard the same argument about wait times,” Manning said. “Right now, we are experiencing wait times without this new model. I had an appointment for back surgery and it took me six months to get it. I think the cost savings will attract more practitioners here, simply with the reduction in administrative overhead, which is a big part of why our healthcare system is suffering.
Lawmakers will review the task force’s finalized plan in September and possibly decide whether to implement it.