A state task force has published a proposal for how single-payer universal health coverage could be rolled out in Oregon. Oregon lawmakers in 2019 passed Senate Bill 770, setting up a Joint Task Force on Universal Health Care with the goal of establishing the first state single-payer system in the country. The task force included health care providers, local government officials and others. It published its final report and recommendations in September.
“Oregon’s current health care is inefficient, expensive, and complex,” the report declares. “It relies on multiple private, public, and taxpayer-subsidized insurance plans. It relies primarily on employment for health care insurance and access.”
Instead, the task force proposes a single public health insurer. Known as the Universal Health Plan, it would offer a universal set of health care benefits to anyone who lives in Oregon. Benefits would include medical, vision, hearing, dental, and mental health. Oregonians could seek services from any provider in the state, and would pay no premiums or out-of-pocket costs such as deductibles and co-pays. Establishing a single-payment system would put an end to health providers’ practice of charging different amounts depending on who’s paying. Because providers would bill only one entity, administrative costs would be dramatically reduced. And the total cost of the plan would be less than paid under the current structure—$980 million a year less—according to an estimate from an independent actuarial firm.
The Universal Health Plan would be funded by an employer payroll tax and income tax, and by redirecting existing state and federal government funding for Medicare, Medicaid, and Affordable Care Act programs. Private insurance would remain available for people who want more coverage.
But the report acknowledges that significant challenges remain, including securing waivers to allow the state to redirect federal funds. Another hurdle may be the Employee Retirement Income Security Act of 1974 (ERISA), which preempts state regulation of employer benefits.
Eleven union representatives weighed in during development of the recommendations, supporting the goals behind universal health care but raising logistical questions. In comments that are summarized in the report, union representatives pointed out that health benefits dominate union negotiations and that union members have foregone wage increases to ensure robust health benefits.
“Union representatives expressed concern that benefits under the proposal could be less, in both quantity and quality, than the benefits many unions have negotiated,” the report said.
Another unknown is how the universal system would impact workers whose health benefits are provided by union-sponsored multi-employer “Taft-Hartley” funds that may operate in multiple states, or workers covered by multi-state collective bargaining agreements that obligate employers to make specific contributions to health coverage. The committee left those points unresolved, writing: “Further study of this issue is needed to determine policy implications for certain employees who are represented by unions.”
The recommendations come as Oregon voters consider Measure 111, which would amend Oregon’s constitution to establish health care as a fundamental right, and obligate the state to provide Oregon residents access to cost-effective, clinically appropriate and affordable health care.
