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The Oregon Health Plan is Oregon's state Medicaid program.
[edit] HistoryThe Oregon Health Plan was conceived and realized by emergency room doctor John Kitzhaber, then a state senator,[1] and Dr. Ralph Crawshaw, a Portland activist.[2] It was intended to make health care more available to the working poor, while rationing benefits.[1] At the time, Oregon was considered a national leader in health care reform.[3] The law passed in Oregon was not initially compatible with federal law, so a waiver was needed. President Bill Clinton approved the plan on March 20, 1993, though he required a revision to the plan due to a concern about whether disabled people would have equal access.[4] At the time, Medicaid covered 240,000 Oregonians.[4] In 1994, the plan's first year of operation, nearly 120,000 new members signed up, and bad debts at Portland hospitals dropped 16%.[1] The plan's costs increased from $1.33 billion in 1993-1995 to $2.36 billion in 1999-2001.[1] Significant cuts were made to the Oregon Health Plan's budget in 2003.[5] New enrollment in the program were closed from mid-2004[6] 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.[7][8] The legal foundation for the OHP is generally spelled out in Chapter 414 of the Oregon Revised Statutes.[9] [edit] EligibilityBasic eligibility requires that the applicant be a resident of Oregon, as a citizen or otherwise. The level of coverage is based on income, age, mental and physical condition. [edit] CoverageSince a February 2003 adjustment to the Oregon Health Plan,[6] it consists of two main plans, OHP Plus and OHP Standard. [edit] OHP PlusOHP Plus is a full benefit package offered to children and adults who are eligible for Medicaid or for the Children's Health Insurance Program. The OHP Plus package has no premiums, but some adults may be required to pay small copayments for outpatient services and some prescription drugs. [edit] OHP StandardOHP Standard is a limited benefit package covering a limited number of uninsured adults who are not eligible for Medicaid. In 2003, when OHP Standard began requiring small premiums of most adult participants, around 40,000 Oregonians (many homeless, destitute or mentally ill) were unable to pay the premium and were disenrolled from the program[10]. Significant cuts were made to the Oregon Health Plan's budget in 2003. Today, the monthly premiums are still required, but there are no copayments. [11] [edit] ControversyThe Oregon Health Plan became the focus of national scrutiny in 2003, after deep budget cuts led to 100,000 people in mental health and/or substance abuse treatment losing prescription coverage under the program.[12] This year and last, the Oregon Health Plan stirred up controversy when enforcing 1994 guidelines[13] to only cover comfort care, and not to cover cancer treatment such as chemotherapy, surgery and radiotherapy for patients with less than a 5% chance of survival over five years.[14] Springfield resident Barbara Wagner said her oncologist prescribed the chemotherapy drug Tarceva for her lung cancer, but that Oregon Health Plan officials sent her a letter declining coverage for the drug, and informing her that they will only pay for palliative care and physician-assisted suicide. She appealed the denial twice, but lost both times.[15] Tarceva drugmaker Genentech agreed to supply her the $4000-a-month[16] drug for free.[17] Wagner's plight garnered a flurry of attention from the media,[18] the blogosphere,[19][20][21][22] and triggered protest from religious groups.[23][24][25] Wagner died in October 2008.[26] [edit] Ongoing legislative effortsFollowing the end of two terms as Governor of Oregon, Kitzhaber established the Archimedes Movement, which aims to be a grassroots effort toward crafting legislation and solving Oregon's health care problems. The Archimedes Movement also has a close relationship with the Foundation for Medical Excellence.[27][28] The 2007 Oregon legislative session passed the Healthy Oregon Act (Senate Bill 329), which established the Oregon Health Fund Board.[29] This seven member advisory panel is working with Governor Ted Kulongoski to propose legislation for the 2009 session. Among other challenges, the board has been advised that changes in federal requirements will affect funds that currently support 24,000 Oregonians on the OHP Standard plan.[30] [edit] References
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