Lawmakers adjourn without containing
soaring costs or addressing the growing number of Oregonians without
insurance
Monday, August 15, 2005
BILL GRAVES
Health care costs have
threatened the middle-class security of Judy and Brian Crawford of Aloha
since their triplets were born more than two years ago.
Shortly after the births, Brian Crawford lost his job with a software
company. He has since moved through a series of temporary jobs. Sometimes
the jobs include health insurance. Sometimes the Crawfords shell out
hundreds of dollars a month to buy their own. And sometimes, such as now,
they live through worrisome spells without health insurance.
"We're right at the edge," says Judy Crawford, 43, who put aside her
fledgling landscaping business to take care of the triplets: Aimee, Edward
and Hope.
Though the Legislature tackled a few health care issues this session -- most
notably, passing a bill requiring insurance companies to cover mental
illness, and drug and alcohol dependence just as they do physical needs --
it did nothing to ease the plight of the Crawfords.
Lawmakers turned their backs on soaring health care costs and a growing tide
of the uninsured. The Legislature took no action to expand the Oregon Health
Plan, the federal-state Medicaid program for low-income residents, which has
dropped 63,000 people in the past two years. A variety of bills aimed at
curbing health care costs died in committees.
"We have made no headway and have everything left to do," said Sen. Ben
Westlund, R-Bend. "The Legislature's performance was dismal on health care.
We're just ostriches."
Health care advocacy groups say the state can expect to see health care
costs continue to climb unchecked.
At the same time, Oregon's effort to extend Medicaid insurance to the
working poor is running out of money. The number covered will continue to
shrink from 90,000 people two years ago to about 24,000. Right now, that
part of the Health Plan serves 27,000.
Health care costs also are eating away the security and standard of living
for middle-class families such as the Crawfords. Even when they are insured,
the Crawfords must pay big premiums and high deductibles.
Their triplets were born full-term by Caesarean delivery, but even so, the
Crawfords had to pay 20 percent of the hospital bill, forcing them to take
out a second mortgage.
So far, they've been lucky during their spells without insurance, and only
once has Judy Crawford been forced to take an injured child to a hospital
emergency room. They expect to get insurance this month when Brian Crawford
takes another job.
The Crawfords are among 609,000 Oregonians -- 17 percent of the population
-- without health insurance, up from 14 percent in 2002.
Some of the newly uninsured lost their jobs. Some work for employers that
cut their health insurance. Others were kicked off the shrinking Oregon
Health Plan.
As more Oregonians lose insurance, they must turn to safety-net clinics or
emergency rooms for health care. And because they often cannot pay for those
services, the costs are shifted to those who do pay, including employers.
About 10 percent of the health insurance premiums paid by employers and
workers goes to cover the cost of the uninsured who visit hospitals and
clinics, said Dr. Bruce Goldberg, administrator for the Office for Oregon
Health Policy and Research, a state agency that advises the governor and
Legislature. High health care costs are a leading cause of bankruptcy, even
in some cases for people with health insurance, he said.
Since 2000, premiums for employer-sponsored family health insurance
increased by 59 percent to an average $9,950 in 2004, more than one-fourth
of which was paid by workers, according to the Kaiser Family Foundation and
the Health Research and Educational Trust.
Workers are paying more and more for health insurance, while a growing
number are losing insurance altogether. The number of workers receiving
health insurance nationwide dropped from 65 percent in 2001 to 61 percent in
2004.
"We have a health system in crisis and, frankly, no answers at the state
level or the national level," said Tina Kotek, policy director of Children
First for Oregon, a nonprofit, nonpartisan advocacy group.
Legislators tried in the recent session to tackle health care costs and
access in a variety of ways.
One bill proposed restoring a 10 cent-per-pack cigarette tax to provide
health insurance for 16,000 more Oregonians. Another sought to insure all
Oregon children and to add more adults to the Oregon Health Plan with a 60
cent-per-pack tax. There was a proposal to lower prescription drug costs by
adding more Oregonians to a bulk purchasing plan, and a bill to require
hospitals to show costs so consumers could compare.
One bill would have required the state to report on the number of people
working for large companies who earned so little that they could qualify for
the Oregon Health Plan. Other pieces of legislation would have created a
health insurance pool for teachers in an effort to lower premiums; would
have required hospitals to get a certificate of need, a process to curb
unnecessary or ill-planned services or construction; would have fought
childhood obesity.
But all the bills died.
"These were all steps that would have helped us," Goldberg said, "Every
single one. There just wasn't the political will."
The Oregon Medical Association was disappointed by the Legislature's failure
to pass a bill that would have reduced doctors' liability and lowered
malpractice insurance. The bill would have limited attorney fees in civil
actions and would have required claims to be approved by a medical legal
panel.
Without the legislation, Oregon doctors will continue to face rising
malpractice costs, said Joanne Bryson, OMA director.
Nevertheless, there were small victories for health care. In addition to the
mental health parity bill, which Gov. Ted Kulongoski will sign today in
Portland, the Legislature provided $500,000 to add a health clinic in one
public school in each of five counties, bringing the total number of
school-based clinics in Oregon to 48.
"These centers serve the uninsured and underinsured," Kotek said. "It is
part of the safety net."
The Legislature also eliminated a $6 monthly premium for the poorest 10
percent of people on the Oregon Health Plan, expanded adult foster care,
extended the summer free lunch program for low-income children and added $4
million to a program that helps subsidize health premiums for low-income
residents.
The Legislature also passed bills to increase insurance companies'
accountability and to require them to cover colorectal and prostate
screening, and more women's health needs, including mammograms.
Some leaders say they will keep working to curb costs and broaden health
care access for Oregonians. Kulongoski is exploring a plan to help small
employers offer health insurance to their employees' children, said Anna
Richter Taylor, his spokeswoman.
Westlund, the senator from Bend, Sen. Alan Bates, D-Ashland, and Rep. Mitch
Greenlick, D-Portland, are pushing an initiative for a constitutional
amendment that would declare health care a fundamental right and require the
Legislature to expand it.
Goldberg and Westlund predict the growing health care crisis will compel
leaders to take action.
"If nothing is done," Westlund said, "it is guaranteed to engulf us all."
Bill Graves: 503-221-8549; billgraves@news.oregonian.com
©2005 The Oregonian