History

The Oregon Health Plan was conceived and realized by emergency room doctor

Physician

A physician is a health care provider who practices the profession of medicine, which is concerned with promoting, maintaining or restoring human health through the study, diagnosis, and treatment of disease, injury and other physical and mental impairments...

 (and current Oregon governor) John Kitzhaber

John Kitzhaber

John Albert Kitzhaber is the 37th Governor of Oregon. He served as the 35th Governor of Oregon from 1995 to 2003 and became the first person to be elected to the office three times when he was re-elected to a non-consecutive third term in 2010...

, then a state senator

Oregon State Senate

The Oregon State Senate is the upper house of the state-wide legislature for the U.S. state of Oregon. Along with the lower chamber Oregon House of Representatives it makes up the Oregon Legislative Assembly. There are 30 members of the State Senate, representing 30 districts across the state,...

, and Dr. Ralph Crawshaw, a Portland activist.

It was intended to make health care more available to the working poor, while rationing benefits. At the time, Oregon was considered a national leader in health care reform

Health care reform

Health care reform is a general rubric used for discussing major health policy creation or changes—for the most part, governmental policy that affects health care delivery in a given place...

. The law passed in Oregon was not initially compatible with federal law, so a waiver was needed. President Bill Clinton

Bill Clinton

William Jefferson "Bill" Clinton is an American politician who served as the 42nd President of the United States from 1993 to 2001. Inaugurated at age 46, he was the third-youngest president. He took office at the end of the Cold War, and was the first president of the baby boomer generation...

 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. At the time, Medicaid covered 240,000 Oregonians.

In 1994, the plan's first year of operation, nearly 120,000 new members signed up, and bad debts at Portland hospitals dropped 16%.

The plan's costs increased from $1.33 billion in 1993-1995 to $2.36 billion in 1999-2001. Significant cuts were made to the Oregon Health Plan's budget in 2003.

New enrollment in the program were closed from mid-2004 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.

The Oregon Health Plan was expanded to cover 80,000 uninsured children through legislation that passed in 2009.
The program has enrolled 38,000 additional children through February, 2010.
The legal foundation for the OHP is generally spelled out in Chapter 414 of the Oregon Revised Statutes

Oregon Revised Statutes

The Oregon Revised Statutes is the codified body of statutory law governing the U.S. state of Oregon, as enacted by the Oregon Legislative Assembly, and occasionally by citizen initiative...

.

Eligibility

Basic eligibility requires that the applicant be a resident of Oregon

Oregon

Oregon is a state in the Pacific Northwest region of the United States. It is located on the Pacific coast, with Washington to the north, California to the south, Nevada on the southeast and Idaho to the east. The Columbia and Snake rivers delineate much of Oregon's northern and eastern...

, as a citizen or otherwise. The level of coverage is based on income, age, mental and physical condition.

Coverage

Since a February 2003 adjustment to the Oregon Health Plan, it consists of two main plans, OHP Plus and OHP Standard.

OHP Plus

OHP Plus is a full benefit package offered to children and adults who are eligible for Medicaid

Medicaid

Medicaid is the United States health program for certain people and families with low incomes and resources. It is a means-tested program that is jointly funded by the state and federal governments, and is managed by the states. People served by Medicaid are U.S. citizens or legal permanent...

 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.

In January 2010, most vision and some dental benefits were cut from OHP Plus due to budget deficits. In January 2011, John Kitzhaber again took office for a third term as governor, and has proposed new reforms and cuts to OHP Plus.

OHP Standard

OHP 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. 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.

Controversy

The 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.

During 2008 and 2009, the Oregon Health Plan stirred up controversy when enforcing 1994 guidelines to only cover comfort care, and not to cover cancer treatment such as chemotherapy

Chemotherapy

Chemotherapy is the treatment of cancer with an antineoplastic drug or with a combination of such drugs into a standardized treatment regimen....

, surgery and radiotherapy for patients with less than a 5% chance of survival over five years.

Springfield

Springfield, Oregon

Springfield is a city in Lane County, Oregon, United States. Located in the Southern Willamette Valley, it is within the Eugene-Springfield Metropolitan Statistical Area. Separated from Eugene to the west, mainly by Interstate 5, Springfield is the second-most populous city in the metropolitan area...

 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

Palliative care

Palliative care is a specialized area of healthcare that focuses on relieving and preventing the suffering of patients...

 and physician-assisted suicide

Assisted suicide

Assisted suicide is the common term for actions by which an individual helps another person voluntarily bring about his or her own death. "Assistance" may mean providing one with the means to end one's own life, but may extend to other actions. It differs to euthanasia where another person ends...

. She appealed the denial twice, but lost both times. Tarceva drugmaker Genentech

Genentech

Genentech Inc., or Genetic Engineering Technology, Inc., is a biotechnology corporation, founded in 1976 by venture capitalist Robert A. Swanson and biochemist Dr. Herbert Boyer. Trailing the founding of Cetus by five years, it was an important step in the evolution of the biotechnology industry...

 agreed to supply her the $4000-a-month drug free of charge. Wagner's plight garnered a flurry of attention from the media, the blogosphere, and triggered protest from religious groups. Wagner died in October 2008.

Ongoing legislative efforts

Following the end of two terms as Governor of Oregon

Governor of Oregon

The Governor of Oregon is the top executive of the government of the U.S. state of Oregon. The title of governor was also applied to the office of Oregon's chief executive during the provisional and U.S. territorial governments....

, Kitzhaber established the Archimedes Movement

Archimedes Movement

The mission of the Archimedes Movement is to create a new space for civic engagement outside our traditional legislative and governance structures to advance solutions to the common problems we face – starting with the crisis in the U.S. health care system....

, which aims to be a grassroots

Grassroots

A grassroots movement is one driven by the politics of a community. The term implies that the creation of the movement and the group supporting it are natural and spontaneous, highlighting the differences between this and a movement that is orchestrated by traditional power structures...

 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.

The 2007 Oregon legislative session passed the Healthy Oregon Act (Senate Bill 329), which established the Oregon Health Fund Board. This seven member advisory panel worked with former Governor Ted Kulongoski

Ted Kulongoski

Theodore R. "Ted" Kulongoski is an American politician, who served as the 36th Governor of Oregon. A Democrat, he has served in both houses of the Oregon Legislative Assembly, as the state Insurance Commissioner, the Attorney General, and an Associate Justice on the Oregon Supreme Court.-Early...

 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.