Latest / The Health Care for All Podcast / EP5: Deep Dive into the Draft Universal Health Plan || Part 1: Who’s Eligible & What’s Covered?
Transcript
- Rebecca Schoon: I think we're all so traumatized by living under a system that's run by people who prioritizing profits over our healthcare. In this instance, the people building this formulary want you to be healthy. That's the goal. They want you to access these prescription drugs. So don't think of this as a highly restricted or limited list of drugs. It'll be comprehensive. Hello and welcome to the Healthcare For All podcast. I'm Dr. Rebecca Schoon. Collin Stackhouse: And I am Collin Stackhouse. Oregon is on track to be the first state to move to a universal healthcare system. And we're so glad that you joined us to learn more about In this episode, Rebecca and I are going to do a deep dive into the Universal Health Plan Governance Board's proposal summary, which was released to the public in April of this year. It's an 18 page document that they used to pretty fully describe the plan during a series of focus groups that were conducted around the state of Oregon in the month of March. They shared it with us, ⁓ Health Care for All Oregon, to promote more widely at our series of town halls in the month of April. And also it's available publicly on both our website and also the state of Oregon's Universal health Plan Governance Board site. we did another episode where we hash out of the finer points of the last two or three pages, which are like the very broad overview summary, but we're gonna dive into the first. 16 pages talking about their work, the reason for the work, and the potential ramifications for Oregonians. Rebecca, what's a better way to describe what this document's all about? Rebecca Schoon: So this is the governance board's first proposal they're putting out to the of the most important ideas is that this is a draft. This is their first attempt at corralling all the data and research they've done ⁓ into a coherent cohesive plan to present to Oregonians to get your feedback. you still have several months to submit testimony to the governance board and they really want to hear what you think about this information that we're about to share. Do you like it? Do you not like it? What changes would you like to see? This is a draft, draft, draft. so let's let them know what you think. Collin Stackhouse: so we're going to get into it in just a minute, but Rebecca, you and I are sold. We're sold on the concept. I don't think we're necessarily sold on every aspect of this proposal. How do we begin to tear it apart? Pick it apart. Rebecca Schoon: I think before we dive into the details, we should start with the basic principles upon which this report has been built. grounding principles that this whole plan is rooted in. And It's worth thinking about those because it's what differentiates the governance board from, a for-profit health insurance company whose principles are really maximizing profits. The principles are health equity, maximizing health. ensuring a fair distribution of medical resources, minimizing financial hardship for both individuals and families, and ensuring a community sense of ownership and governance, meaning the community should feel like this is a health system built for them ⁓ and that Oregonians get to have a say in what that health system looks like. Those are the principles. And again, if we contrast that with how private health insurance companies are orienting their work, It couldn't be farther apart. Collin Stackhouse: Totally. The community sense of ownership and governance is one of the things that I'm personally most excited about. So in the rest of the packet, there's more background available on the history of universal healthcare in Oregon in a summary document that's also available at the Governance Board site and also in their 2025 report, which was delivered in December. The rest of the packet talks about four key parts about this proposal, who is gonna be covered, what specifically is going to be covered, like what care people will be able to get, how it will be financed and how it will be governed. Rebecca Schoon: Great. So who is eligible, Collin? Who's going to get health care under this proposed new plan? Collin Stackhouse: In short, all people who live in Oregon qualify for the plan. Rebecca Schoon: and that's regardless of housing status. It's regardless of immigration status. Out of state students who are in Oregon attending school, they get coverage under this health plan. Collin Stackhouse: also people who are in Oregon carceral settings like jails and prisons who is not going to be covered in this new system Rebecca Schoon: And that's really just people who work in Oregon, but they reside in, say, Vancouver, Washington. your residence is in a different state or a different country, you wouldn't be covered under this plan. but those employers will provide another way for those employees to get health coverage. Collin Stackhouse: Something that stands out in this proposal is the groups of Oregonians who would have the choice of opting into this system. present, that only extends to members of the nine federally recognized tribes, the Indian tribes that are here in our state. members of these nine federally recognized tribes have their own tribal sovereignty and so they would have the option to participate fully in this universal health plan but they would not be automatically enrolled in this. Rebecca Schoon: you know, something we've seen on social media quite a bit, people asking about is what if you travel to another state and need health care? don't worry, they've addressed this in the report. So if you are covered under this universal health plan, but you are visiting, say, a family member in Indiana, and you need urgent or emergency care, you are fine. This universal health plan will contract with a national carrier network. So your coverage extends even if you're traveling somewhere else in the United States. Collin Stackhouse: Sounds pretty good to me. So enrollment in this new system, the board is proposing to make enrollment accessible for individuals and more streamlined overall than today's current system. Rebecca, I don't think I've told you this, but I just personally reached a income tier. And so my insurance has now changed and I, some ways feel supported by the Oregon healthcare system and also very frustrated that I'm no longer eligible for the same coverage that I had been Rebecca Schoon: there's so much disruption and tumult if you change jobs or if let's say you go from OHP to now getting employer sponsored insurance you might have to change doctors. The universal health plan gets rid of all of those problems. So open enrollment periods is one of those difficult restrictions that we're used to in our system. I have to say, here I am, health policy professor, I know this system inside and out. I missed my open enrollment period this year. It was like six weeks, very busy time in the semester. I had it on my to-do list. I didn't get it done. So I now don't have dental insurance because I had to opt into that. This all goes away because under the universal health plan, you are automatically covered as long as you live in Oregon. as long as you can show residency, you are automatically covered. It's no longer this onerous process to sign up for health insurance. Collin Stackhouse: Right, so like we said, still everything's iterative, but in the current proposal, a new member can enroll in this system immediately after stating intent to reside in Oregon with verification required within 90 days. Rebecca Schoon: Right, and the documentation required is really simple. let's say you are eligible for Medicaid or Medicare, it'll be the same Collin Stackhouse: So it sounds great. We've put a shiny, happy sheen on enrollment. Wow, now it's easy. Easy for everyone. What do we get from this new universal healthcare system? What's covered? Rebecca Schoon: This is even shinier and happier. The benefits plan is pretty epic. Basically, it's the same plan that the governor gets right now. So it's an incredibly comprehensive plan. everyone gets physical and behavioral health benefits. Now, alert, when we say behavioral health, that means mental health. So physical health, mental health is covered, but also dental and vision. And that is something that this board is really committed to. They want to provide a comprehensive set of services But there is a caveat here. They've built a certain financing structure, assuming this really comprehensive set. This could change. If people, for example, want to see lower taxes than what they proposed, then they might have to pull back on dental or vision in some way. So all of this is in flux. But right now, the governance board wants to provide as comprehensive a plan as is necessary for people's health. Collin Stackhouse: healthcare for all Oregon did a series of town halls around the state and we survey people, which of these benefits were the most important for them to keep. And overwhelmingly from our survey of around 500 people that, that, you know, self-selected by choosing to come to these things. they overwhelmingly wanted to keep their dental benefits. And so that's gonna be something that we bring back to the board, which I think, bones. They're inside, they're in my body. I want them to be cared for. Rebecca Schoon: Absolutely. Anyone who works in health knows that it's such a bizarre part of our history that eyes and teeth were treated as not basic to our overall health. But yes, the Governance Board wants to fix that. Collin Stackhouse: The recommendations include this very comprehensive benefit package, Therapies like physical or speech therapies, diagnostic tests and treatments, specialty care, outpatient procedures, hospital care, disorder treatments including crisis care or peer support, some medical equipment, and a limited amount of fertility care. Rebecca Schoon: Right. And one of the big things that we don't want to gloss over is prescription drugs are covered under this plan. So when we get to the costs, when we get to individual costs you have to be thinking, wow, for X number of dollars paid a year, I'm getting comprehensive care. I'm getting almost all prescription drugs covered within that one payment I'm making a year. So this is a really comprehensive, high quality plan not many private health insurance companies can rival. Collin Stackhouse: What's the deal with a formulary? Can you talk about what that's going to look like? Rebecca Schoon: So a formulary is basically a list of prescription drug medications, and it says what will be covered under a plan So there is no plan in the world that covers every single prescription drug that exists, right? So that doesn't exist under private health insurance. It doesn't exist in any health system. so what this looks like is there's an independent board of pharmacists and doctors who work with groups like the Center for Evidence-Based Policy, and they develop a list of what are the prescription drugs that people need in this community. So our community is the state of Oregon, and they make that list of the most essential drugs. Those are covered under the plan. Again, the governance board's intention is that those are covered at no additional cost. Now, there are some exceptions. Let's say you want a specific brand name drug instead of the generic, there might be a small additional cost there. Or there might be special medications that aren't on the formulary is an additional cost. But remember, I've mentioned this before, I think we're all so traumatized by living under a system that's run by people who are prioritizing profits over our healthcare. In this instance, the people building this formulary want you to be healthy. That's the goal. They want you to access these prescription drugs. So don't think of this as a highly restricted or limited list of drugs. It'll be comprehensive. Collin Stackhouse: Sounds good to me. We touched on dental care and vision care being currently included with the caveat that there needs to be some considerations for financing and cost savings of this plan. So will tell what the governance board recommends to our legislature and time will tell what the Oregon legislature decides to move forward in the 2027 session. Regarding any changes to the current status quo for Medicaid, people who are eligible for Oregon Medicaid would receive any additional benefits that are covered for that population The best example is non-emergent medical transportation would be covered for those Oregon health plan Medicaid eligible participants. That same service would not be offered to all members of this new Oregon. health system. Rebecca Schoon: Yeah, and this is a question that we've seen. If someone's on OHP currently, they've asked, wait, is this different from OHP? Do I have to switch? Can I switch? OHP would effectively be going away. It would be rolled into this universal plan. But one area of health policy that Oregon's really been a leader on is providing non medical supports to people on OHP around things that support their health. Again, that's not medical. So transportation, like you just mentioned, air conditioner units, the governance board was really careful about this. They didn't want anyone currently on OHP to lose any of these benefits that, again, health policymakers had worked so hard to win for this population. So everything people on OHP currently get, they get under the new plan, though some of these benefits might be administered through different agencies. Collin Stackhouse: So one thing that's worth mentioning is who actually is going to be providing this care. So currently in the proposal, all licensed or credentialed providers in the state would be eligible to provide services covered by the universal health plan with no network restrictions. So the network would be expanded to include the entire state of Oregon, every provider in the state, and the board recommends dedicating 15 % of total healthcare expenditures to primary care services, which was one of the main things that they are highlighting as a focus of this new plan. Rebecca did mention that there are opportunities to talk to the Governance Board. Their main way that they prefer to receive input is in the form of written public comment, and we'll share links to that, but it's available at their website, which is oregon.gov slash UHPGB. They also have three different kinds of meetings. There's a regular Governance Board meeting, there's a new Transition Committee meeting, and there's also a Community Engagement and Communications Committee. I happen to be with other Oregonians on that communications committee and all of those meetings have opportunities for Oregonians to speak directly to the governance board, directly to the people who are making the plan. The governance board meetings are on the third Thursday of the month from 9 a.m. to 12 30 p.m. The community engagement meetings, we have shifted our time to allow for more working folks to come after normal working hours. So we meet on the fourth. Wednesday of the month with an hour dedicated from 5 p.m. To 6 p.m. Specifically to listen to as many Oregonians as as we can Rebecca Schoon: And we'll put all those times in the show notes so you can refer to them there.