ADA Analyses of the Oregon Health Care Plan

Issues in Law & Medicine, Spring 1994 | Go to article overview

ADA Analyses of the Oregon Health Care Plan


Introduction

In 1989, the Oregon legislature approved a plan to provide comprehensive health care coverage to all Oregon residents.(1) The plan would initially include Medicaid recipients(2) and would employ two innovations: managed competition and a prioritized benefits package.(3) The legislature created the Oregon Health Services Commission" to prioritize individual health services "from the most important to the least important."(5) The commission began work in September 1989 and completed a final priority list of 709 treatments for the legislature in May 1991.(6) The legislature adopted the list and determined that the state Medicaid budget could finance the first 587 treatments.(7)

Oregon could not implement the new plan without obtaining several waivers of Medicaid regulations from the federal government.(8) On August 16, 1991, the Oregon Department of Human Resources applied to the Health Care Financing Administration of the United States Department of Health and Human Services (HHS) for the necessary waivers.(9) While Oregon's proposal engendered opposition because it would ration health services for the poor,(10) its approval by the federal government appeared likely.(11)

Acting on requests by Congressman Chris Smith(12) for legal analysis, the National Legal Center for the Medically Dependent & Disabled, Inc., was the first organization to fault the plan for failing to comply with the Americans with Disabilities Act (ADA) and section 504 of the Rehabilitation Act of 1973.(13)

HHS denied Oregon's application on August 3, 1992, raising ADA objections similar to those made by the National Legal Center.(14) Like the National Legal Center, HHS objected to Oregon's reliance on quality of life" criteria for ranking individual treatments.(15) HHS advised Oregon to resubmit its application after eliminating the objectionable elements and reranking its priority list accordingly.(16)

Oregon submitted a new plan to HHS on November 13, 1992.(17) The revised plan no longer incorporated quality of life measurements of specific conditions. Oregon proposed, however, to downrank treatments that left individuals in a "symptomatic" state.(18)

Congressman Smith again requested the National Legal Center's legal analysis of the Oregon plan.(19) In response, the National Legal Center found that the revised plan would violate the ADA by downranking treatments on the basis of residual symptomatic conditions.(20)

The federal government failed to act on Oregon's resubmission before the end of President George Bush's administration, though the United States Department of justice advised HHS in a January 19, 1993, letter to reject the proposal on the basis of the ADA.(21) On March 19, 1993, after the term of President Bill Clinton began, HHS approved the revised plan but required Oregon to rerank its priority list yet again without taking into account "whether treatment returned an individual to an asymptomatic state."(22)

The issues raised with respect to the ADA and the Oregon plan foreshadow those that will likely arise in the national debate over health care financing reform. (23) The Oregon plan debate also anticipates larger debates over the ethics of health care rationing.(24) For these reasons, Issues in Law & Medicine is publishing several otherwise unpublished documents referred to above that applied the ADA's provisions to one state's efforts to reform health care financing.

December 5, 1991

Honorable Christopher H. Smith United States Representative 2440 Rayburn HOB Washington, D.C. 20515

Dear Representative Smith:

We hereby respond to your October 23, 1991, request for a legal opinion on whether the Oregon Health Plan would violate the Americans with Disabilities Act (ADA). The National Legal Center for the Medically Dependent & Disabled, inc., appreciates the opportunity to evaluate the plan's impact on indigent persons with disabilities.

The rest of this article is only available to active members of Questia

Sign up now for a free, 1-day trial and receive full access to:

  • Questia's entire collection
  • Automatic bibliography creation
  • More helpful research tools like notes, citations, and highlights
  • Ad-free environment

Already a member? Log in now.

Notes for this article

Add a new note
If you are trying to select text to create highlights or citations, remember that you must now click or tap on the first word, and then click or tap on the last word.
One moment ...
Project items

Items saved from this article

This article has been saved
Highlights (0)
Some of your highlights are legacy items.

Highlights saved before July 30, 2012 will not be displayed on their respective source pages.

You can easily re-create the highlights by opening the book page or article, selecting the text, and clicking “Highlight.”

Citations (0)
Some of your citations are legacy items.

Any citation created before July 30, 2012 will labeled as a “Cited page.” New citations will be saved as cited passages, pages or articles.

We also added the ability to view new citations from your projects or the book or article where you created them.

Notes (0)
Bookmarks (0)

You have no saved items from this article

Project items include:
  • Saved book/article
  • Highlights
  • Quotes/citations
  • Notes
  • Bookmarks
Notes
Cite this article

Cited article

Style
Citations are available only to our active members.
Sign up now to cite pages or passages in MLA, APA and Chicago citation styles.

(Einhorn, 1992, p. 25)

(Einhorn 25)

1

1. Lois J. Einhorn, Abraham Lincoln, the Orator: Penetrating the Lincoln Legend (Westport, CT: Greenwood Press, 1992), 25, http://www.questia.com/read/27419298.

Cited article

ADA Analyses of the Oregon Health Care Plan
Settings

Settings

Typeface
Text size Smaller Larger
Search within

Search within this article

Look up

Look up a word

  • Dictionary
  • Thesaurus
Please submit a word or phrase above.
Print this page

Print this page

Why can't I print more than one page at a time?

Full screen

matching results for page

Cited passage

Style
Citations are available only to our active members.
Sign up now to cite pages or passages in MLA, APA and Chicago citation styles.

"Portraying himself as an honest, ordinary person helped Lincoln identify with his audiences." (Einhorn, 1992, p. 25).

"Portraying himself as an honest, ordinary person helped Lincoln identify with his audiences." (Einhorn 25)

"Portraying himself as an honest, ordinary person helped Lincoln identify with his audiences."1

1. Lois J. Einhorn, Abraham Lincoln, the Orator: Penetrating the Lincoln Legend (Westport, CT: Greenwood Press, 1992), 25, http://www.questia.com/read/27419298.

Cited passage

Welcome to the new Questia Reader

The Questia Reader has been updated to provide you with an even better online reading experience.  It is now 100% Responsive, which means you can read our books and articles on any sized device you wish.  All of your favorite tools like notes, highlights, and citations are still here, but the way you select text has been updated to be easier to use, especially on touchscreen devices.  Here's how:

1. Click or tap the first word you want to select.
2. Click or tap the last word you want to select.

OK, got it!

Thanks for trying Questia!

Please continue trying out our research tools, but please note, full functionality is available only to our active members.

Your work will be lost once you leave this Web page.

For full access in an ad-free environment, sign up now for a FREE, 1-day trial.

Already a member? Log in now.