Health-Care Reform Plan Excludes Medicare

PETER WONG
Statesman Journal
April 10, 2007
Oregon's share of federal Medicare money will be excluded, at least for now, from an effort to reshape Oregon's health-care system and extend coverage to about 600,000 people.
Committee leaders decided against seeking federal permission to include Oregon's share of Medicare, the federal program of health insurance for people age 65 and older, as part of a pooling of several sources of money into an Oregon Health Fund. Including Medicare would require an act of Congress, not just a waiver of rules by a federal agency.
"While Medicare is important, a more important consideration to us is getting a financial reimbursement rate that brings use at least to the national average," Sen. Ben Westlund, D-Tumalo, the committee co-chairman, said in an earlier interview.
Reimbursement rates for Medicare providers in Oregon rank at the bottom of the states.
Westlund said an increase to the national average would produce another $1.5 billion annually on top of the estimated $6 billion spent on health care in Oregon.
The legislation would not actually extend coverage to people without it, at least for a couple of years.
It would set up a seven-member board, which would determine basic benefits for Oregonians, better ways of delivering services, a pool of money to pay for them, and other details. It would maintain a mixed public-private system.
The board's work would be submitted to the 2009 Legislature.
"Health care in Oregon is like two people in a boat rowing in opposite directions, and we're not getting anywhere," said Bates, a physician and the other co-chairman. "We have the opportunity to pull together and get the boat moving forward."
AARP Oregon, formerly the American Association of Retired Persons, raised concerns about including Medicare money in any state pool.
But AARP never said so in testimony on his own proposal, Kitzhaber said, and he has never had a chance to offer amendments that might allay those concerns.
Kitzhaber, also a physician, spoke Monday after a luncheon appearance before the Salem Area Chamber of Commerce.
Omission of Medicare, he said, "would leave a flawed process that excludes a discussion of the very program on which more and more Americans are going to depend on, even as it moves the health-care system toward its final collapse."
Medicare is projected to run out of money by 2018, just a few years after the first of the post-World War II baby boomers start qualifying for coverage.
Kitzhaber was the chief author of the 1989 plan that transformed a traditional Medicaid program into a broader Oregon Health Plan offering basic services to all people under the federal poverty level.
While the priority-setting process for services worked, Kitzhaber said in his speech, the original plan itself was not broad enough to deal with rising costs.
During the speech, which largely focused on the need for change, Kitzhaber gave a personal example of how the system can save money without sacrificing essential services.
He said Medicare would have paid for lab tests and hospital stays for his mother in the final months of her life, when she was suffering from congestive heart failure and other complications. But Annabel Kitzhaber, a former state president of the League of Women Voters, chose to die in her Eugene home in 2005 rather than spend her remaining time in hospitals. She was 88.
"Medicare would not pay $18 an hour for a non-hospice care worker to help her stay in her home," Kitzhaber said. "My point is that the current reimbursement rate of Medicare encourages us to seek acute-care intervention that will not be a cure in these situations."
pwong@StatesmanJournal.com or (503) 399-6745