By Christine Vestal, Stateline Staff Writer
Pew Center on the States
Long before the national health law was enacted last year, a handful of states started work on their own health care overhauls. Massachusetts became the first state to require health coverage for all; it was the model for President Obama’s Affordable Care Act. Vermont has enacted a unique, state-based method of financing health care.
Oregon may soon become the next national model — for seeking to control costs and improve the public’s health at the same time. Setting up so-called “coordinated care organizations” as the front door for patients, the state aims to abandon the impersonal and fragmented way most people receive health services today. In its place, the state hopes, will be community-based systems that resemble the way medicine was practiced a century ago, when local doctors visited families in their living rooms.
Governor John Kitzhaber, a Democrat and former emergency room physician, signed legislation in June to launch Oregon’s first-of-its-kind health plan. It was not the only time the governor had been involved in a health policy change that would be both groundbreaking and controversial. In the 1980s, while he was state Senate president, and then during a first stint as governor, Kitzhaber promoted a re-ordering of state health care spending that critics derided as “rationing.” But a version of that system is still intact.
Today, the 64-year-old Kitzhaber is in a hurry to get the state’s new health care practices up and running before the national health law’s scheduled Medicaid expansion in 2014. Though he supports the Obama administration’s law, Kitzhaber says it did not go far enough.
“Expanding coverage to give more people access (which is the main thrust of the Affordable Care Act) — without changing the system people have access to — will only serve to increase cost and expand the national debt,” he told a crowd of health policy experts in Washington on October 4.
Coordinated care
Oregon’s new health care scheme aims to do what Massachusetts failed to do and the national health law seems unlikely to do — get a handle on costs. The coordinated care organizations — which are scheduled to be in operation sometime next year — are charged with doing most of the work.
In broad terms, the new law calls for creating local health care teams that would provide something new in the field. Instead of providing only medical services, the new organizations would combine comprehensive medical and dental care with behavioral health and substance abuse services.
The organizations would also offer preventive care, help Medicaid beneficiaries navigate the system and ensure that patients have access to any other local support services they need — all under one fixed fee per customer.
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