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Oregon's Health Care Plan: Just Another Medicaid Cutback
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10496 |
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Section : |
CURRENT ISSUES
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| Issue
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1 / 1993 |
2,101 Words |
| Author
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Joseph Tiang-Yau Liu
Joseph Tiang-Yau Liu is a senior health associate with the
Children's Defense Fund. |
Oregon's proposed Medicaid health rationing experiment has been surrounded by a storm of controversy. In August, after seeming to support the proposal, the Bush administration denied Oregon's waiver request because the experiment would violate the Americans with Disabilities Act (ADA). Proponents argue that it represents the best in hard, tough thinking about the future of the health system. They say that rationing already exists and that prioritizing illnesses and treatments is a more logical approach.
In reality, the Oregon Medicaid experiment is just another in a long line of proposals to cut health benefits for the poor. Only the poor would be subjected to the crude, mechanistic, and draconian approach to prioritizing health conditions and treatments. Stripped of its pseudoscientific air, the Medicaid rationing experiments is just another Medicaid cutback.
THE OREGON HEALTH PLAN
In 1989 and 1991, the Oregon legislature passed a series of bills that make up the Oregon health plan. The plan includes a mandate on employers to provide health insurance for their employees and an expansion of Medicaid to cover all residents with gross incomes below the poverty. The plan also creates a high-risk pool for people above poverty who cannot purchase private coverage and reforms the small group health insurance market.
However, the state has conditioned the employer mandate and the Medicaid expansion on a number of fundamental changes in Medicaid that must receive waivers from federal law. The plan would cap Medicaid expenditures by the state and limit benefits according to the availability of funds.
Beneficiaries would not be guaranteed a minimum benefit package. Instead, the state created a "prioritization list" by ranking 709 "condition-treatment pairs." The list ranks conditions and the treatments for those conditions based on "community health care values" and the "net benefit" produced by providing treatment for a specified condition. Beneficiaries could only receive those services that ranked above a cutoff line.
A lengthy analysis of Oregon's Medicaid waiver conducted by the Office of Technology Assessment--Congress' nonpartisan research arm--expressed "serious reservations." The OTA found that "classifying health care by general service categories and [condition-treatment] pairs in order to prioritize services is not an especially promising
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