The 130th Annual Meeting of APHA

Abstract #40448

Susan L Prows, PhD, MPH and Jeanene Smith, MD MPH. Department of Administrative Services, Office for Oregon Health Policy & Research, 255 Capitol Street, NE, Salem, OR 97301, 503-378-2422, susan.prows@state.or.us

Oregon has acknowledged the limiting effect of fiscal realities in the State’s ability to provide publicly-funded health care benefits. As such, it is the only state to set health care priorities based on clinical effectiveness and it has used this priority setting mechanism to allocate public resources to expand Medicaid (Oregon Health Plan) coverage up to 100% of the federal poverty level (FPL). Oregonians wish to further expand Oregon Health Plan eligibility to 185% FPL with a budget-neutral strategy that includes reduction of health benefits to private-sector levels and significant cost-sharing through premiums and co-payments on office visits, hospital, and pharmacy. This presentation will detail how Oregon’s recent controversial bipartisan legislation (HB 2519) and the resulting federal waiver to CMS is the outcome of unique statewide traditions that include extensive open forum, exhaustive debate and discussion, original qualitative and quantitative research, methodical analysis and review, and eventual near-consensus by advocates, stakeholders, and program participants.

Learning Objectives: Attendees will learn about

• The Oregon Health Plan (OHP) and the prioritized list of benefits.
• Current state fiscal constraints facing Oregon and what has been done to significantly expand OHP coverage to 50,000 additional low income persons without additional funds.
• Role of the public in determining how Oregon should best prioritize trade-offs (e.g., benefits, cost-sharing, increased private sector control).
• Unique process of public debate, discussion, participation, and eventual consensus that leads to progressive health policies.

Keywords: Policy/Policy Development, Medicaid

Related Web page: www.ohpr.state.or.us/

Presenting author's disclosure statement:
Organization/institution whose products or services will be discussed: State of Oregon Office for Oregon Health Policy & Research
I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.