States are the focus for the next stage of health care reform

If policymakers miss the boat, the Oregon exchange won’t be much more than an “Expedia for health insurance.”

By Laura Etherton of Portland, Oregon. Laura is a health policy advocate with OSPIRG, a non-profit, non-partisan consumer advocacy organization.

With the new federal health reform law in place, will Oregon consumers and employers actually see lower costs, higher quality, and more stable coverage?

The answer largely depends on what Oregon’s leaders do next.

According to a new OSPIRG report, Delivering on the Promise: A State Guide to the Next Steps for Health Care Reform, the new federal health care reform law puts state leaders in the driver’s seat, providing the tools – and funding – we need to make fundamental improvements in health care.

In many ways, Oregon is ahead of other states because 2009 Legislature passed a major package to address the rising cost of health care, and elements of that Oregon reform are already underway.

Stronger oversight over health insurance rate hikes took effect in April. The new rules prohibit excessive rate increases, and make public the insurance company justifications for rates.Oregon’s Insurance Division is now applying for million-dollar grant through federal reform to boost its rate review capacity.

The newly established Oregon Health Authority is hammering out details of plans to systematically cut administrative waste (pdf) and make smart use of health information technology (pdf), encourage best practices proven to boost quality, and keep Oregonians healthier in the first place. Like the Insurance Division, the Oregon Health Authority is pursuing new federal grant dollars to advance Oregon in these areas.

Most importantly perhaps, Oregon officials are already in the process of developing a plan for a health insurance “exchange.” Federal reform specifically gives each state the responsibility to set up an exchange, and Oregon is uniquely positioned to lead the way.

Done well, the exchange can be a real game-changer, giving individual consumers and small businesses the purchasing power to demand better quality, and drive a hard bargain. And by providing clear information and easy-to-use comparisons on insurance plans, it can promote competition on costs and quality. But if policymakers miss the boat, it won’t be much more than an “Expedia for health insurance.”

Oregon’s exchange should include key elements to make it a powerful force for consumers:

The Oregon Health Authority is scheduled to present a draft exchange plan to the August 10th meeting of the Oregon Health Policy Board. A final plan will go to the 2011 Legislative session for approval.

The bottom line is this: Whether Oregonians see relief from the rising cost of health care depends on what leaders do right here in Oregon. Washington, D.C. had its turn in the sun – now it’s Oregon’s time to shine.

The report is available on OSPIRG’s website.

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    Whether Oregonians see relief from the rising cost of health care depends on what leaders do right here in Oregon. Washington, D.C. had its turn in the sun – now it’s Oregon’s time to shine.

    Laura, I think that's exactly right. The fight for health care reform is hardly over -- despite what the national media would have us believe.

    In 2010, we need to continue to ride herd on policymakers - and make sure we elect leaders who know something about making health care work.

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    And let's see who's more prepared to lead that state based health reform. Is it Chris Dudley, basketball player, or John Kitzhaber, E.R. physician and author of the Oregon Health Plan?

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    "The fight for health care reform is hardly over -- despite what the national media would have us believe."

    Just to clarify, you're a single-payer kind of guy, right Kari? If so then tacking that direction would represent real reform to you. I get that just as I understand those who advocate for a purely free market system. What escapes me is how anyone could view the most recent congressional health care debate as a victory or even a small step in the right direction. At best it made for some political theater. From my vantage point the ultimate resolution does nothing to address the many key flaws in our current system. WTF?

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      Brian, I think that the health reform bill that passed at the national level is an historic and important reform -- but one that also put much of the power in the hands of the states. (Something that the Republicans used to support.)

      I'd support a single-payer plan, sure, but it ain't gonna happen - so I've long supported alternatives that make things better.

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    Are there any examples of state-based exchanges that had any salutory effect on costs? I'm not aware of any. The NW has had some of the most effective attempts, which is to say, meh. The whole point was that leaving it to the states is a big mistake--the pools aren't big enough, and there is little to no enforcement possible. We couldn't enforce the exchange adequately even if we had one.

    The bill that passed is good for Medicaid recipients, perhaps some folks who can take advantage of the community health increases--and that's about it. And nothing has been done about controlling costs. It's a political sellout to the industry, on our backs--and the most historic failure of the Democratic Party in decades.

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    AS TO THE CONTROLLING OF COSTS: there are ongoing efforts by the various committees of the OHPB and the OHA to address cost issues. Including a discussion of a REGIONAL, not just state level, exchange. I think what we must remember here is that whatever we do this next session (where the real HC reform will actually happen) will be a template for the rest of the country.

    I hope ALL stakeholders are at the table - and not just a series of public hearings with transcripts and comments published but decisions already made.

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      So far the only thing Oregon has done is add costs to middle class families. The OHPB and OHA have added additional, duplicative boards and commissions that have accomplished nothing. The democrat lead legislature raised health care insurance by 1% to consumers to pay for more free healthcare and then added the $500 stop smoking treatment mandate to all health plans. Then there is the EEBB that ran costs up by double digits for public education employees forced into that plan.

      Some template.

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