A Summary Of Oregon's Single Payer Health Insurance Bill

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An Act for Affordable Health Care for All Oregon 2011

A Summary

PURPOSE OF THE ACT
The purpose of the Act is to insure access to quality, patient-centered, and affordable health care for all Oregonians, to improve population health, and to control the cost of health care for the benefit of individuals, families, business, and society.

WHO IS COVERED
The Act covers all persons residing or working in Oregon.

CO-PAYMENTS AND DEDUCTIBLES
There will be no co-payments and no deductibles under the Act.

PAYMENT IN FULL
The provider must accept as payment in full amounts received from the Plan and not bill enrollees for those services.

FREE CHOICE OF PROVIDERS
Patients are free to choose any health care providers licensed in the state of Oregon and practicing within the scope of their license.

BENEFITS
Medically necessary benefits in each of the following categories:
Primary and preventive care, including health education; Specialty care other than elective cosmetic care; Inpatient care; Outpatient care; Emergency care; Home health; Prescription drugs (formulary); Durable medical equipment; Mental health services; Substance abuse treatment; Dental services other than elective cosmetic dentistry; Chiropractic services; Basic vision and vision correction;
Diagnostic imaging, laboratory services, and other diagnostic and evaluation services; Inpatient and outpatient rehabilitative services; Emergency transportation; Language interpretation and translation services; Hospice care; Podiatry; Acupuncture; and Dialysis.

Benefits shall also include long-term care, following completion of a plan by the Board to be submitted to the Legislature by 2016.

GOVERNANCE
The Board of Directors shall consist of nine voting members, appointed by the Governor, subject to confirmation by the Senate. One of the members shall be a licensed health care provider, one shall be a public health official, and one each shall be from labor and business.

RESPONSIBILITIES OF THE BOARD
The Board is responsible for the development of the Plan and the oversight of its implementation and management. The Board’s responsibilities in regard to the Plan include, but are not limited to:
Determining policies and adopting administrative rules; Establishing a balanced budget; Determining the specific benefits package; Overseeing management of the Affordable Health Care for All Oregon Fund; Ensuring that health services reimbursed by the Plan are evidence-based and cost-effective in promoting health; Ensuring access to quality health services; Emphasizing disease prevention and health promotion; Establishing a process by which proposed major capital expenditures will be evaluated for approval; Seeking all waivers, exemptions, and agreements from federal, state, and local government sources that are necessary to provide funding for the Plan; Partnering with public health agencies to improve population health; Submitting to the State Legislature the funding goal required from State taxes to adequately fund the Plan; Assuring that implementation of the Act shall affect all individuals equally, regardless of classifications such as health status, age, disability, employment status, and income; Developing a plan for long term care by 2016; Reporting, at least annually, to the Legislature and the public on the performance of the Plan and recommending needed amendments to this Act and related legislation.

DISTRICT ADVISORY COMMITTEES
District Advisory Committees will solicit input, receive complaints, conduct public hearings, facilitate accountability, and assist the Board with planning for health service needs. Board members elected to represent each region shall convene the committees.

OREGON HEALTH AUTHORITY
The Oregon Health Authority shall implement and administer the Affordable Health Care for All Oregon Plan under the general direction, policies, and oversight of the Board.

FUNDING THE PLAN
In lieu of premiums, co-payments, co-insurance, and deductibles, the Affordable Health Care for All Oregon Act will be funded by a system of dedicated taxes, progressive in nature, and based on ability to pay, which will be paid directly to “The Affordable Health Care for All Oregon Fund.” Following arrangements for necessary waivers, exemptions, and agreements, the Legislative Assembly shall enact legislation necessary to provide that all payments for health care services provided to participants from federal, state, county, and local government sources will also be paid directly to the “The Affordable Health Care for All Oregon Fund.” All money in the Fund shall be used only for payments to health care providers, for administrative overhead, and for temporary payments and retraining for workers displaced by the Plan.

CAPS ON ADMINISTRATIVE COSTS
Once the Plan is operational, there shall be a cap on administrative costs of 12% for the first two years of the Plan’s operation, 8% for the next two years, and 5% thereafter.