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The Health Care Lottery

AIR DATE: Monday, January 28th 2008

Download the mp3 for this show.

This Monday the Oregon Health Plan opens registration for applicants for the first time since the program froze enrollment in 2002. So if you're a US citizen, over age 19, and earn less than $850 a month as an individual (or $1141 a month as a couple), you can put your name in the hat to get basic health coverage from the state. After a month-long registration period, a fancy computer system will randomly draw names of people to send applications to. At the end of the process, health plan administrators will probably insure about 5,000 more Oregonians through OHP.

To put this all in perspective, though, you can earn a full $10,201 a year and still not be eligible for the plan. And even after OHP's current open registration is complete, according to the State Medicaid Office, Oregon will have something like 455,000 uninsured adults throughout the state.

All of which brings up a ton of questions. When money is limited, is the random assignment of health insurance — state services by lottery, in other words — the best way to determine who gets covered? In this busy election season, when healthcare is near the top of the domestic agenda, should presidential candidates be looking to Oregon as an example of how — or how not — to insure the uninsured? What do you think of the Oregon Health Plan?

GUESTS:

• Jean Phillips: Deputy Administrator of the state medicaid office at the Department of Human Services
• Matthew Carlson: Associate professor of sociology and a member of Portland State University's Center for Health and Social Inequality Research
• John Kitzhaber: Ex-Governor of Oregon and the founder of the Foundation for Medical Excellence

Tagged as: insurance · lottery · oregon health plan

Thanks for raising this issue. I have an additonal question to throw into the mix: What about the kids? And specifically, what about teens who would like to enroll, but for one reason or another their parents won't or don't complete the required paperwork? We know there are thousands of eligible minors in the state who aren't enrolled. What if older teens (say 16 and up) were empowered to enroll themselves in OHP? Perhaps through school-based health clinics or other outreach sites? The City of Portland and Multnomah County have both adopted a "Children and Youth Bill of Rights" that affirms the right of young people to have a voice in their own healthcare. How about letting them enroll themselves for care? Any legal experts or system administrators out there that could weigh in on this one?

natewaasshull — Mon Jan. 28th 12:09p.m.

A letter from Bruce Goldberg, the director of Oregon's Department of Human Services, which manages the Oregon Health Plan:

http://dawgoregon.blogspot.com/2008/01/do-you-qualify.html

David Miller — Mon Jan. 28th 12:11p.m.

I can only see 2 comments. Is that all there are now? cincha

cincha — Mon Jan. 28th 12:27p.m.

There were! Some late sleepers on this cold Monday, apparently.

David Miller — Mon Jan. 28th 12:39p.m.

Hello, Having providers look at applications is sort of like having the fox watch the hen house. Insurance providers will invariably turn down applicants that have current or reoccurring health issues, simply based on a cost effective standpoint. Not even allowing the applicants in the "lottery".

ethan jakob — Mon Jan. 28th 12:29p.m.

And why does my pregnant wife, after qualifying financially for the Oregon Health Plan, get denied anything but emergency coverage simply because she is not a U.S. citizen? She's a permanent resident, married to an American. To me this is blatant discrimination.

ss29er — Mon Jan. 28th 12:30p.m.

Why doesn't OHP operate like a standard insurance company. Creating a viable state-run alternative to private insurance providers, could lower health care costs for all, not just the lowest incomes.

Nickel Arcade — Mon Jan. 28th 12:40p.m.

I'd like to ask your question, but can you explain a bit more what you mean? What would a state-run insurance company do?

David Miller — Mon Jan. 28th 12:43p.m.

If I understand your guest, A 25% administration overhead jump between private and public shows vast inefficiencies within the private sector. I am advocating a system that every oregonian could enter, can operate without the bloated costs of administrators, and could collectively bargain to lower the prices of drugs instead of being complacent in the price fixed system we are in today.

Nickel Arcade — Mon Jan. 28th 12:55p.m.

I agree with Nickel Arcade. My husband and I recently retired prior to Medicare qualification age and had to find independent insurance. We weren't too worried about the cost but were turned down by ODS and Blue Cross. We don't have any pre-existing conditions other than general stuff like trigger thumb, routine colonscopies, and the beginnings of osteoarthritis in my hands - who doesn't have some wear and tear by middle age. None of our issues caused us to generate large claims to our employer-based policies. Blue Cross was happy to have us enter the risk pool and collect an additional 25% increase in rate. We did finally get insurance through a private company but the rates will increase at 10% per year. I'd much rather send my premiums to a state-run program where I'd be helping out my fellow Oregonians and have the money used more efficiently. Why not a state-run health insurance option for all of us?

arborkin — Mon Jan. 28th 1:22p.m.

Well Nickel, that's how every other western country except the US does it. It's called national healthcare. You are right, it's exactly what the US needs. The only problem is insurance companies, hospitals, and pharmaceutical companies have way too much at stake financially to be willing to make any real change in the way things are. Take for example the recent Bush adminstration rule that prohibits Medicare, the largest group insurance pool in the country, from obtaining volume discounts on drugs. Instead our 'honored citizens' are required to pay premium prices for drugs that they should be getting significantly cheaper. Pretty unbelievable.

mattcarlson — Mon Jan. 28th 4:56p.m.

My mom was diagnosed with cancer 2 years ago and qualified for medi-caid in CA. I am her main care giver and live in Oregon, which obviously complicates matters. We have been investigating trying to move her to Oregon and apply for the OHP but it seems almost impossible. This has created a tremendous strain for our whole family. She is receiving Social Security Disability, would this qualify her for the OHP if she relocates to Oregon?

kirstensandahl — Mon Jan. 28th 12:45p.m.

It seems that if the state can only add arbout 5000 new recipiants, they are once again waisting money in the bueracracy to adminster these funds. Why don,t they just put those funds in to an emergency fund for children with catrostrophic illnesses?

mcgraths4@bendcable.com — Mon Jan. 28th 12:51p.m.

I understand that it's hard to get coverage with pre-existing conditions, but I don't understand what the big deal is, in general, about affording health insurance. I pay my own insurance - $144 a month. Sure, my deductible is $1,000, but I just keep that reserve in the bank in case. Co-pays would add up, but I just stay healthy as best I can and rarely go to the doctor. What am I missing here? Why are some people having such a hard time finding coverage? $144 is affordable when you prioritize (over cable payments, extra cell phone bells and whistles, etc.).

jensmith — Mon Jan. 28th 12:51p.m.

I think you missed something. There are a lot of people like my husband and I who have tried every provider we could find and our pr-existing conditions keep us form buying insurance. We had no problem in TN and were shocked once we settled in Oregon, got our business started that we couldn't find any. We work six eleven hour days a week, live in an older RV, don't have cable and ride our bikes to work, don't smoke, aren't over weight and watch every penny. I am paying over $400 dollars a month on medication. There is the high risk insurance, but it is expensive and would cost us 600 a month and wouldn't pay for pr-existing conditions for the first six months. So for the first six months we would need to come up with $1100 a month. We just don't have it. It is wonderful that you do not need to see the doctor often and that you could even get insurance here in Oregon. I wish we were in your shoes, but that is the point, many of us aren't. It is a little insulting to the many hard working people to imply that we are just squandering our money or not trying hard enough. But I think many politicians would agree with your assessment of the situation.

chdavis — Mon Jan. 28th 3:18p.m.

$144 sounds like a good deal. How old are you? Do you have any pre-existing conditions? Is there a cap on the amount this insurance will pay? Does it pay 100% after the $1000 deductible or do you continue to have co-pays? I found a plan that I thought was a good deal until I learned that the maximum for a lifetime was $20,000. What if I got cancer or needed a kidney transplant? $20,000 would barely get me started. Another one sounded possibly OK but, in addition to a high initial deductible, you had a 20% cop-pay after reaching that deductible.

coastrange — Mon Jan. 28th 7:31p.m.

Great show today!

Collin Oldham — Mon Jan. 28th 12:52p.m.

Of the approximately 500,000 uninsured Oregonians, approximately what percentage of that population is potentially eligible for OHP+ - related to this question, what percentage of the uninsured population is potentially eligible for other publicly funded healthcare?

Keary Knickerbocker — Mon Jan. 28th 12:56p.m.

It was wrongly stated on the show that non-citizens cannot get OHP Standard. As noted in the Department's training materials here at slide 8 and their rules here, non-citizens are eligible

csheketoff — Mon Jan. 28th 1:11p.m.

Barriers to health care will not be removed until the process for all of us, regardless of income, have simplified access to health care. I currently spend about 3-4 hours per week negotiating the difficult world of both public and private health insurance programs. To expect people with cognitive disablities to manage the fragmented process (as it currently exists) is not realistic. Dr. Carlson correctly points out that the administrative costs in the private insurance world is very high. Much of that expense is designed to find reasons (legitimate or not) to deny claims, and hope that patients will give up and pay out of pocket. This is how insurance executives earn their bonuses.

As important as having insurance to pay for care is access to quality providers (especially in the field of mental health). Even with insurance coverage (private, Medicaid, or both) many providers opt to refuse to take any insurance coverage. They take cash customers only - because they can. Finding a psychiatrist or social worker in Portland that takes insurance is not easy. Finding one that takes Medicaid is nearly impossible. Mentally ill patients on Medicaid are sent to quasi-public clinics that are over-crowded and (though well-intentioned) can not provide quality care that can lead to recovery.

Dave

davidkaplan — Mon Jan. 28th 1:15p.m.

Comments are now closed.