Oregon Health Plan (OHP) – A Peek Into The Future Of Obamacare – UPDATED

I’m not sure why we are hearing so little about the Oregon Health Plan (OHP). The similarities to the Obama Plan do draw a strong parallel. The OHP is a state funded/administered program that was established in 1994. Logically speaking we have in place a system now that we can use to measure where Obama’s Healthcare Plan will likely take us within 15 years. 

According to Oregon.gov.

The Oregon Health Plan (OHP) provides health care coverage to low-income Oregonians through programs administered by the Division of Medical Assistance Programs (DMAP). Currently, more than 380,000 people each month receive health care coverage through the Oregon Health Plan.

Goals:

  • Increase access to health care for low-income Oregonians.
  • Improve the quality of health care and receipt of preventive services by low-income Oregonians, thereby improving their health.
  • Contain health care costs.

Sounds good right? and familiar. Unfortunately, Oregon does not seem to be meeting it’s goals – or maybe it is? The main difference between Oregon and Obamacare is the addition of the “Death With Dignity Law” which Oregon passed in 1997, which has been upheld by the courts. Since this law has been upheld, what would stop the Federal Government from implementing the same guidelines? Not much – this type of legislation is already making it’s way through the States. The 2008 passage of the Washington Death with Dignity Act not only marked a great victory for Death with Dignity supporters, it also inspired legislators in other states to begin working on this important issue. Since the win in Washington, bills that seek to improve end-of-life care have been introduced in nine different state legislatures around the country.

Normally, I would say that the Healthcare and Assisted Suicide are two separate debates. Until you do a little research into what is happening in Oregon.

According to ABC News the Death With Dignity Law is being used in conjunction with the OHP.

The news from Barbara Wagner’s doctor was bad, but the rejection letter from her insurance company was crushing.

The 64-year-old Oregon woman, whose lung cancer had been in remission, learned the disease had returned and would likely kill her. Her last hope was a $4,000-a-month drug that her doctor prescribed for her, but the insurance company refused to pay.

What the Oregon Health Plan did agree to cover, however, were drugs for a physician-assisted death. Those drugs would cost about $50.

Unfortunely Ms. Wagner fell into the 5%-5years group. If the medication does not give you better than 5% chance of surviving for more than 5 years – sorry, no can do. I wonder, can you think of anything in the past five years that has brought meaning to your life? A birth, a wedding, a cure…………..

This is not an isolated case. Randy in the video was given the same option and he had prostate cancer. We’ve all been hearing alot about prostate cancer lately due to the fact that Chris Dodd is fighting this cancer. I haven’t heard anything saying that Mr. Dodd was turned down by his Government Plan?? For all men with prostate cancer, the relative 5-year survival rate is 100%, and the relative 10-year survival rate is 91%. So, why was Randy turned down? It seems the Oregon Health Plan is not consistent with it’s 5%-5year plan.

 How is this explained by OHP?

“It’s their duty to inform patients of all of their legal options.”

Just like “Advanced Care Planning” – they’re just trying to help.

In 1994, the plan’s first year of operation, nearly 120,000 new members signed up, and bad debts at Portland hospitals dropped 16%. Sounds good so far.

The plan’s costs increased from $1.33 billion in 1993-1995 to $2.36 billion in 1999-2001. Wait – the hospital bad debts dropped by 16% at a cost to the taxpayers of $1.33 billion. Must be politician math.

New enrollment in the program was closed from mid-2004 until early 2008, when a lottery-based system was introduced. Tens of thousands of Oregonians signed up, competing for 3,000 new spots in the plan.

Significant cuts were made to the Oregon Health Plan’s budget in 2003. The following are highlights of reductions to the OHP for 2009-2011:

Only drugs on their pre-approved list with pre-approval will be paid for;

The most effective way to produce prescription drug cost savings is to allow DMAP to enforce its preferred Prescription Drug List (PDL) through the use of prior authorization (PA).

This pre-approved list will now include mental illness medication. Note: 13,000 mental health patients already lost their coverage with budget cuts in 2007;

This reduction would add mental health drugs to the preferred Prescription Drug List (PDL) and eliminate co pays for preferred mental health drugs.

Elimination of vision services;

This reduction option would eliminate routine vision coverage for all OHP Plus non-pregnant adults, age 21 and older (about 125,000 people).

Elimination of dental services;

This reduction option would eliminate all dental services for non-pregnant adults, age 21 and older, who are covered under the OHP Plus benefit package (about 125,000 people).

Elimination of Medicare ‘optional’ items;

This reduction option would eliminate certain services currently provided in Oregon that are considered optional under federal Medicaid regulations: Private Duty Nursing, prosthetic devices, hearing aids, chiropractic services and podiatrist services.

The rest of the reductions will be accomplished by cutting payments to providers and decreasing amount of money you can make to be eligible for the program;

Of 28,000 individuals currently served, about 4,000 exceed the 150 percent FPL requirement and will lose both their long-term care services and eligibility for the Oregon Health Plan.

What items will they be increasing the budget on?

  • ITsupport for desktops and operating systems, e-mail, and file and print services
  • 16 additional administrative staff positions
  • Software upgrade to properly withhold union due for the long-term Community Based Care (CBC) system
  • Certificates of Participation (COP) funding request and date conversion for the OR-Kids (not healthcare – software)
  • Software upgrade to develop and deploy a single data information system

There will not be one increase in health care services – only cuts.

So, we have a working model of what we can expect if this healthcare reform passes and no one is talking about it.

 Was Palin right?

An enlightening video posted on Hot Air:

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8 Comments

Filed under Healthcare

8 responses to “Oregon Health Plan (OHP) – A Peek Into The Future Of Obamacare – UPDATED

  1. Pingback: More about ObamaCare — an example from Oregon « Greene Fields

  2. jsterling500

    I think one important point you’re missing, or at least neglecting to mention, is that these individuals would never be offered coverage by a private insurer at ANY price. It’s quite likely they were on the Oregon Health Plan in the first place because they couldn’t get private insurance.

  3. speakmymindblog

    I didn’t mention because I don’t know what their previous insurance situation was – I wasn’t trying to mislead or leave out anything.

    Assumption – Ms. Wagner is of an age that she should qualify for Medicare – however in Oregon you cannot have both.

    As far as private insurance – if these people were able to work or be covered under a ‘group’ plan as a family member – they CANNOT be denied health coverage under our current HIPAA laws. The insurance companies can delay coverage for 9 months if you have not had medical coverage for a period of more than 63 days.

    • jsterling500

      Thanks for your response.

      I believe you’re correct regarding “group” plans and coverage denial. As far as Medicare I don’t think Ms. Wagner would be eligible until 65 (I think you apply three months before).

      My assumption was that if they had better options available to them through the private sector they would take them, hence my reasoning as to why they were on the OHP in the first place.

      For many, private sector health insurance simply isn’t available and due to far less dire preexisting conditions than cancer. Health care in the U.S. is already being rationed by insurance companies and HMOs. The only people who in a de facto sense don’t have their health care rationed are members of congress.

  4. speakmymindblog

    I absolutely agree. I just cannot get behind any plan that puts Congress in charge of my decisions and ultimately the plan that they are pushing will. There are reforms that should be undertaken; however no one asked them to re-write the healthcare system. To accomplish the main points that cause people pain all they need to do is amend our current HIPAA laws (pre-existing conditions, caps, etc.) and allow competition between State lines which would increase competition and decrease costs. But none of this matters – until they do Tort reform – nothing else they do will work. And of course our government of lawyers and lobbyists are not touching this.

    By the way, one of the big lies I keep hearing is how insurance companies drop your coverage when you become ill. This is just untrue and illegal (again covered under HIPAA). The only way an insurance company can drop your coverage is if you commit fraud (lie) – nothing else. If you pay your premiums and tell the truth, they cannot drop you.

  5. Pingback: The Blog of Record » Blog Archive » This Will Give You an Idea How Obamacare Will Work

  6. jsterling500

    Some tort reform would be useful in lowering costs however it is but one piece of a big puzzle.

    Regarding the big lie you mentioned, you are technically correct. A health insurance company may only rescind (cancel) coverage if they find any inaccuracy or omission on the original application. Simple? Well, yes and no.

    The thing is they don’t investigate applications until they start having to pay claims, in other words when you get sick. The applications are long and detailed and any omission or inaccuracy, intentional or not, is legal grounds for rescission. It’s in the company’s financial interest to find a reason to get out of having to pay. It’s simple economics. If a claim is expensive they will scour all available records in search of any excuse to rescind the policy, knowing that most people don’t have the knowledge and/or resources to take them on in court (they have top notch lawyers).

    That is the origin of the big lie. The law should require insurance companies to show proof of intentional misrepresentation in order to rescind a policy. As it stands right now, you can pay your premiums on time every month for decades and then find out you have cancer and um, oh yeah, you don’t have insurance because you didn’t check a box on a form next to a 5 syllable word you’d never heard of 20 years ago.

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