The Oregon Health Plan - Essay Example

The Oregon Health Plan is a product of a private-public partnership that resulted in better access to health services among the poor and disadvantaged in Oregon. States can develop Oregon-type health programs in their respective states by harnessing the power of consultative processes and leading stakeholders to cooperate and develop a health program that can result in better services and that would not be costly for the government at the same time.

Thus, “instead of seeking early preventive care, the uninsured sought emergency care when their illnesses became severe” (Department of Human Services, 2006, p. 1). The “free” emergency treatment that the uninsured receive, however, was not genuinely costless because costs are merely passed on thereby increasing the cost of insurance premiums for those who can afford the premiums (Department of Human Services, 2006, p. 1).

            In 1987, Oregon Governor Neil Goldschmidt created a workgroup of health care providers, businesses, labor, insurers, and lawmakers to address three fundamental questions on the Oregon Health Plan: who is covered, what is covered, and how it is financed (Department of Human Services, 2006, p. 1). The workgroup agreed that all citizens should have full access to basic levels of care and that society is responsible for caring for poor people (Department of Human Services, 2006, p. 2). The workgroup also agreed on providing a basic health care package for low-income groups as well as health insurance reforms to make it more available and affordable (Department of Human Services, 2006, p. 2). The Oregon Health Plan sought to lower costs by reducing cost pass-on, emphasizing early intervention and primary care, and not covering ineffective care (Department of Human Services, 2006, p. 3). From 1987 to 1993, several legislative reforms were undertaken until “Medicaid was expanded to include Oregonians under 100% of Federal Poverty Level (FPL), providing a Basic health care benefits package via the Prioritized List” (Department of Human Services, 2006, pp. 3-5). Reforms were also introduced between 1994 and 2006 (Department of Human Services, 2006, pp. 5-11). In 2004, around 450,000 Oregonians had access to the Oregon Health Plan (Berkobien, 2004, p. 1). In 2005, however, the legislature suspended medical assistance for a person with serious mental illness who becomes an inmate in a public institution (Department of Health Services, 2006, p. 11).  In June 2006, the Oregon Health Plan no longer charges a premium whose household income is 10% or less of the Federal Poverty Level (Department of Health Services, 2006, p. 11). On the other hand, clients whose income is above 10% of the Federal Poverty Level pay the current and past-due premiums (Department of Health Services, 2006, p. 11).

            Based on the 2010 healthcare matrix of the Foundation for Health Coverage Education, the Oregon Health Plan has a publicly sponsored program for individuals with severe or chronic conditions, low-income children and families, women, Native American Indians, and trade-dislocated workers. For instance, according to the matrix, children 5 years old and younger from low-income families have a guaranteed coverage of 133% of the federal poverty level, children 6-18 or parents from low-income groups have a guaranteed coverage of 100% of the federal poverty level, and low-income groups have a 54% coverage under the federal poverty level.

            There is nothing wrong with the Oregon Health Plan as long as the plan is within the affordability level of States to implement. To create a similar one in each state, we can follow the template that the founders of the plan created: consult with stakeholders in designing the plan. After all, denying access to health services is not only unethical but it is also not costless because infectious diseases, for example, can spread and can infect all members of society. Thus, it may be less expensive to put certain individuals under the coverage of society’s health services rather than exclude him or her and infect or make the matter more costly for the entire society. This is one philosophical underpinning of the plan. Another important philosophical underpinning of the plan is that partnerships can result in better services, especially those in which stakeholders have been involved in the program design. An important advantage of public-private partnerships is that they can result in lower costs and better services. One important disadvantage of the plan is that it requires great skills in leading stakeholders to arrive at a consensus or near-consensus, especially when stakeholders may have conflicting interests. Plans similar to the Oregon health plan can be questioned in that it may be seen as a form of government refusal to fully fulfill its responsibilities on health care and difficulty to promote this plan nationwide may arise from the point. Citizens may also question whether it is ethical to blur the line between private and public given that a public-private partnership can lead to a monopoly or an oligopoly.

In the former, the poorest of the poor will probably be excluded from health services. In the latter, government spending would likely be huge and can result in the under-provision of health services.