Health Care for All Oregon Act Being Considered by Legislators

Legislators in Oregon and Washington are considering bills that would provide every resident with comprehensive health care. In Oregon, Senator Laurie Monnes Anderson, chair of the Health Care Committee of the Oregon Senate, has scheduled a hearing for a bill titled the Health Care for All Oregon Act, for Monday, May 4, at 3pm in Hearing Room A in the Capitol in Salem.

This bill, SB 631, outlines a plan to provide publicly funded universal health care for all Oregon residents. Washington’s legislature had a hearing on a similar bill on Feb. 20, 2015. When enacted, it (HB 1025) would create the Washington Health Security Trust and establish universal health care for all Washington residents.

These two northwest states are not alone in considering universal health care. Across the country, activists in 17 states are working with state legislators to introduce bills that will provide publicly funded, universal health care to residents. This type of health care financing is often called single-payer because all of the funds to pay health care providers and cover related medical costs are deposited in a central institution created to manage the funds. These may be called a “trust” (Washington) or “fund” (Oregon) or “trust fund” (New York).

States with active universal health care committees represent all regions of the country. Illinois, Massachusetts, New York, Ohio, Pennsylvania, Rhode Island, South Carolina, Vermont, and Washington, like Oregon, have universal health care bills in current legislative sessions, while California, Maine, Minnesota, Missouri, New Hampshire, New Mexico and North Carolina have committees pursuing proposals.

Benefits offered in the state proposals are similar, but because the states differ greatly in their current tax structures, their funding mechanisms probably will differ. Most bills suggest types of public funding but leave to their legislatures the final decision as to which taxes will be enacted. For example, the New York state bill, A05062, suggests a progressive payroll assessment and a progressive assessment on taxable income that is not subject to payroll assessment. Washington and Oregon fund state expenses with opposite types of taxation, Washington on a sales tax and no income tax, while Oregon has an income tax but no sales tax. Washington state’s bill, HB 1025, suggests payroll assessments coupled with an individual premium to be paid by individuals whose income is more than 200 per cent of the federal poverty line. Oregon’s SB 631 suggests a progressive employer payroll assessment supplemented by a progressive tax on some types of income, but in each state, the exact financing method and the amount of money to be collected are not specified.

Speaking at the Salem hearing will be: Senator Michael Dembrow, chief sponsor of SB 631. Following him will be a Power Point presentation narrated by Charlie Swanson of Eugene. Other speakers include Penny York, chair of the Corvallis City Council; Tim Roach, a retired minister who serves as Vice-President for Mid-Valley Health Care Advocates and works with the Inter-Faith committee for health care; Jason Freilinger, president of Freilinger Electronics of Silverton; Dr. Paul Hochfield, a member of Physicians for a National Health Program; Prof. Chunhuei Chi, a Public Health professor who has advised Taiwan on its National Health Program; Jo Ann Hardesty, principal partner of Consult Hardesty and former state legislator; and Rob Sisk of SEIU 503.

In addition to obvious humanitarian impulses, the motivations of health care activists who are developing the state plans include substantial cost savings and improved population health. Gerald Friedman, chair of the Economics Department of the University of Massachusetts at Amherst, did a study of New York’s health proposal showing that its plan would cut overall costs by “reducing administrative bloat and monopolistic pricing.” He concluded that the plan would reduce “the cost of health care to New Yorkers even while extending and improving the provision of care” (“Economic Analysis of the New York Health Act”, executive summary, p. 2). Providing quality care to all residents also conforms with policies and goals developed by the World Health Organization.

Not in conflict with the Patient Protection and Accountable Care Act (ACA), known popularly as Obamacare, proposals in the state bills rely on one of its 90-plus provisions, including section 1332, which describes a “Waiver for State Innovation.” By using this provision, plus two other required waivers, states would qualify for funds equal to the tax credits and cost-sharing benefits provided in the ACA. A primary requirement is that the state systems provide equal or greater care than that offered through the ACA. Just as other requirements of the ACA have been phased in on a pre-determined timetable, this waiver cannot be utilized until January of 2017, but can be developed before that time.

The hearing on May 4 is after the April 21 deadline a bill must have met to be considered for a vote during the legislative session. These “courtesy” hearings are given to bills that have many supporters and co-sponsors (SB 631 has almost 30) or for other reasons are considered significant for legislators to learn about. Earlier versions of SB631 have had hearings in the House Health Care Committee in 2011 and 2013; similarly, the Washington bill has had three hearings. Typically, bills are heard in the legislature for several sessions before being brought to the floor for a vote. They are re-shaped in intervening years in response to legislative input, and then approved.

More than 30 other countries have systems similar to those being proposed by the 10 states, though countries differ in types of public financing and in some benefits. A few countries, such as Great Britain, hire and manage health care providers and are called socialized systems. In many others, such as in Canada and those proposed in the 10 states, health care providers are in the private sector.