Oregon Health Care Plan Challenged in Congress Opponents of the State's Request to Waiver Medicaid Requirements Say Services to the Poor Would Be Rationed

Article excerpt

IN deciding how to spend limited public funds on health care for the poor, should officials draw the line at the number of people served - or the kinds of services provided?

This is the basic dilemma underlying Oregon's controversial and unique health plan, which follows the second path. The state has spent two years developing a program which now must be approved by the federal government.

Congressional hearings on the plan, which began this week, are being closely watched by other states searching for ways to address the exploding costs of Medicaid as well as congressional lawmakers groping toward a national system of health care.

Like all other states, Oregon has not been able to afford the federally mandated medical procedures for all those eligible under Medicaid. Tens of thousands of poor families have been turned away. In response, the state drew up a list of 709 health services and settled on a benefits package that covers what are seen to be the 587 most important.

These will be made available to all those eligible for Medicaid, raising the number of people covered from 205,000 to 325,000. Elderly and disabled Oregonians would be added to the program in 1993, as well as those requiring mental health or chemical-dependency services. The plan also requires employers to provide the benefits package to their workers by 1995, which would bring 300,000 currently uninsured into the program.

In testimony before Congress this week, Gov. Barbara Roberts (D) said those medical procedures not covered under the proposed plan fall into three categories: "conditions where heroic efforts are unlikely to change the outcome, conditions that get better on their own or with a home remedy, and conditions that are cosmetic or valuable only to the individual."

The Oregon health plan also provides some services not required under Medicaid, such as dental care, hospice care, and physical and occupational therapy.

State Senate president John Kitzhaber (a physician and chief author of the Oregon health plan) calls it a "comprehensive benefit package which covers the vast majority of those services needed by persons seeking care." He says that providing preventative care or early medical treatment will help avoid "the suffering and cost associated with more serious illnesses."

What Oregon wants from the federal government (through the Health Care Financing Administration) is a waiver of the Medicaid requirements defining the amount, duration, and scope of benefits provided. …