Oregon to Look at Single-Payer Bill Next Session

Advocates for a dedicated tax to pay for basic health coverage want to introduce a single-payer bill next session

By David Rosenfeld for The Lund Report

A loose coalition of single-payer advocates in Oregon has taken the first steps toward developing legislation for the 2011 session

The bill would ultimately work in conjunction with the state’s ongoing efforts to form a health insurance exchange and possibly a public option, supporters say.

State Rep. Michael Dembrow, a first-term Democrat from northeast Portland, is interested in sponsoring a state-based single-payer bill, but first wants to give advocates a chance to reach consensus.

Groups involved in the effort include Portland Jobs with Justice, Physicians for a National Health Program with chapters in Corvallis and Portland, Health Care For All Oregon and the League of Women Voters.

“It’s all very preliminary,” Dembrow said. “There are many of us who feel that ultimately the best way to pay for healthcare is through a single-payer program – not deliver it, but pay for it. It’s something that needs to remain in the conversation.”

States including Vermont, Minnesota, Pennsylvania and California – where a Democratic-controlled legislature twice passed single-payer bills that were vetoed by Gov. Arnold Schwarzenegger – are also working on single-payer legislation this year.

A recent letter from U.S. Sen. Ron Wyden (D-Oregon) to Democratic and Republican leaders in the Oregon Legislature gave encouragement to the idea of seeking federal waivers so states can pursue innovative ideas that go further than the federal law. The letter did not, however, offer any specific concepts.

“I write to lend my support to your efforts to develop an Oregon-specific plan for our state to do health reform its own way,” the letter states. “I believe in the concept of ‘state choice,’ and that every state has the right to provide healthcare to its own residents in its own way, as long as the goal is to provide all citizens with quality, comprehensive coverage.”

Wyden said he authored section 1331 of the Patient Protection and Affordable Care Act to give states the ability to continue working toward cost-effective healthcare while retaining access to federal funding.

“We don’t see ourselves as acting in contradiction to anything people are doing in Salem,” said Peter Shapiro, an organizer with Portland Jobs with Justice. “We just see it as part of the mix.”

While the details of the proposed bill haven’t been ironed out, the tenets are strong. There would be a dedicated tax based on ability to pay, universal access, and a shared risk pool to increase purchasing power and reduce administrative costs.

“The basic principle is equity,” Shapiro said. “Everybody should have the same access to treatment regardless of how much risk they are or how much money they have in the bank.”

The group will soon begin working with a consultant on the costs of such a plan and the barriers, including ERISA that governs employee benefits, that could be overcome with federal waivers.

The Oregon State Public Interest Research Group is also pushing state healthcare leaders to do more with what’s already allowed in the federal law passed earlier this year. OSPIRG’s efforts, however, have focused on strengthening the health insurance exchange and creating a strong state-based public health insurance option, not a single-payer plan.

Laura Etherton, OSPIRG’s healthcare lobbyist, is pleased Oregon is among the first states to get out of the blocks to establish an exchange where individuals and small groups can purchase insurance that’s highly regulated and possibly subsidized. But, thus far, the draft plan which was released on Aug 14 falls short, Etherton said.

“Just an exchange by itself is not going to solve all the problems in healthcare,” she said. “But it’s a great tool to help us drive solutions.”

Etherton said the draft plan doesn’t allow the exchange to negotiate premiums on behalf of its members. It could include small businesses with more than 50 employees earlier. It needs stronger public accountability. And it lacks adequate protections to prevent the insurance industry from undermining the exchange’s stability, she said.

According to OSPIRG, the exchange as currently drafted would “let insurers cherry-pick only the healthiest people, and enroll them in plans only available outside the exchange. This would leave older, relatively less-healthy people inside the exchange.”

“The details matter,” Etherton wrote in comments to the draft plan on OSPIRG’s website. “Done right, the exchange will pool the buying power of hundreds of thousands of Oregonians, so all of us can get a better deal on healthcare. But done wrong, the exchange will just be a nifty website with the same expensive plans and spotty coverage.”

Single-payer advocates hope the state goes a whole lot further.

“There are a lot of people who want to see the conversation about single payer still happen,” Dembrow said. “I hope the federal plan will work. I’d like to see the state really seize the moment.”