Latest / The Health Care for All Podcast / EP4: What's in the Draft Universal Health Plan? (Short Synopsis)
Transcript
- Rebecca Schoon: no deductible, no copay, no premiums, no coinsurance, no surprise billing. That even covers your prescription drugs, or at least most of them. So you are getting comprehensive care. in this current draft plan, that's even including vision, dental, mental health. Collin Stackhouse: Welcome to the Health Care for All Podcast. I'm Collin Stackhouse. Rebecca Schoon: and I'm Dr. Rebecca Schoon. And you may have heard, Oregon is on track to become the first state to win universal healthcare. Collin Stackhouse: No big deal, that's why we're starting a podcast. That's why you're here. We gotta talk about it. Rebecca, a few days ago, something was posted on a Reddit thread that took a pretty deep dive into this new UHP, Universal Health Plan, proposal summary that was published by the Universal Health Plan Governance Board on April 8th. basically an outline of what the potential universal health plan summary is gonna look like and what the plan is gonna entail. And it was pretty spicy in the Reddit thread. Rebecca, what happened? Rebecca Schoon: You know, we love it. Someone out in the community got a hold of the summary. Maybe they attended a town hall. I'm not sure. So they summarized the main points of the plan and put it on Reddit, which is great. We want this information out in the public. ⁓ Or I should say the Universal Health Plan Governance Board. wants this spread far and wide, they want to get feedback on it. So they made this summary, this draft of the plan available ahead of the December deadline because they want to hear what people's reactions are. And the reactions were, yeah, pretty spicy. I will say there were a couple points, this is no diss to the person who posted the thread, but there were a couple points that were not quite accurately framed. And so that caused a lot of misunderstandings, particularly about the tax structure. And therefore the response was, I think, a little extra spicy. Collin Stackhouse: Yeah, I think people are pretty frustrated with how everything's going and with our taxes in Oregon and in Portland, we have some of the highest taxes in the country. ⁓ And what do we get from it, we still are suffering in this broken healthcare system. And so this ⁓ proposal will change ⁓ how taxes work in the state of Oregon. And the wealthiest Oregonians, pay more in this new proposed tax structure. But most of the 4.2 million Oregonians will be paying much less and have the burden of coinsurance, deductibles, copayments, the you know, knot of our healthcare system removed entirely so that it's simpler, easier to navigate, easier to be enrolled just by virtue of being an Oregonian. So yeah, but I think the main problem with any sort of discussion about it is it talks about a potential 10.1 % increase in your taxes and that is just like, whoa. but we Rebecca Schoon: Yeah, people hear that and nothing else gets through. So we're going to talk a bit about that today. when you hear the word 10.1, please don't turn your brain off. Listen to this next sentence. No one really has a 10.1 % increase in their taxes. There'll be a lower effective tax rate. We're going to walk through what that structure looks like, but it actually is not the reality that anyone will experience 10.1 % income taxes. Collin Stackhouse: And again, this is a summary of a proposal of a plan in development anything we talk about right now is totally iterative. we can make comments to the governance board, just like any resident of Oregon, but we're not in charge of this. So you can get mad at us, but we're just excited to see this development, we don't have any final say in the plan. But we're gonna do all we can to affect the change as well as we can and try to, foster a system that's going to work for us. Another caveat with that 10.1 % is that most people when they were reading this Reddit thread that got spicy, were not thinking about or did not understand that it's 10.1 % potentially after you have reached the 200 % of the federal poverty level threshold, right? So for a single person, that's around $31,000, that % increase in taxes would be after that threshold, which is 200 % of the federal poverty level. Rebecca Schoon: Yeah, and that's the mechanism that makes it a lower, what we call effective tax rate, like the reality of what the impact is. But we're kind of getting ahead of ourselves, right? Collin Stackhouse: always. Rebecca Schoon: ⁓ Today, we want to give you a little brief summary overview of what this draft plan is. We're going to have a longer episode where we really go into the details to accompany this. But if you don't want to wait for that, if you just want the top 10 most important things to know about the draft plan, that's what we'll talk about. right now. Collin Stackhouse: yeah, today we're going to jump into ⁓ the final pages of the document, which was shared in the April meeting of the Universal Health Plan Governance Board. ⁓ It's available for everyone to see at oregon.gov/UHPGB and you can check the documents in their April meeting. We've also featured it on the front page of our website, is hcao.org. There are lots of details in the beginning, but at the very end, pages 15 to 18, they do this pretty easy comparison comparing broadly what is it like in our healthcare system today to what it could be like in this new universal health plan. Rebecca Schoon: so should we dig in? Collin Stackhouse: Let's do it. Rebecca Schoon: ⁓ So the first thing they talk about is cost. they describe how today the healthcare costs that you have to cover are totally disconnected from your income. ⁓ So you might have really high costs and really low income. There's no correlation there. People suffer from a lot of unpredictable costs, not knowing how their premiums are going to rise, what co-pay they have for certain services, what's the co-insurance they to pay after they get a treatment. And a lot of people are even shocked by learning what a deductible is. They buy health insurance, and then it turns out that when they submit their first claim, they find out that, well, you haven't met your $2,000 deductible, which you have to pay out of pocket before insurance kicks in even a dime. So Colin, how does the summary report describe how it'll change under a universal health plan? Collin Stackhouse: So instead of all of those different ways to pay for your healthcare, there would be one progressive income tax, below 200 % of the federal poverty level, there'd be no charge, and then above that 200%, there would be a progressive income tax based on the income level of the individual or the family. Rebecca Schoon: Actually, I think you mentioned that the threshold for an individual, so that means you have no kids, it's actually closer to 32,000. It's like 31,900 So what that means is that let's say you make $70,000 a year, you would subtract 32,000 from that 70,000. and you're left with $38,000, that's the amount that is subject to the 10.1 % income tax. So it's much lower than if you're just thinking 10 % of your $70,000 salary would be going to taxes. Collin Stackhouse: And I just did a little calculator thing and 10 % of that 38,000 is around $3,800. Most people, the average cost of healthcare in the United States is around $12,000 per person per year. So even at a low-ish. middle income of $70,000 per year, 3,800 to have everything covered sounds better to me than our current system, which is really hard to navigate and clearly leaves so many people behind. Rebecca Schoon: Yes, and for that $3,800 for this hypothetical $70,000 salaried person, that means that's all they pay. They have no deductible, no copay, no premiums, no coinsurance, no surprise billing. That even covers your prescription drugs, or at least most of them. So you are getting comprehensive care. Again, in this current draft plan, that's even including vision, dental, mental health. Be sure to check the summary report out. There's even more extensive tables that look at different size households, different income levels, so you can see the projected costs. And also, again, that amazing benefit package you get for it. Collin Stackhouse: So, okay, this potential amazing benefit package, what do they say about the differences with our experience of care? Rebecca Schoon: Right, well right now, so many people know that getting healthcare is really difficult. even if they have health insurance. people are restricted to really narrow networks of doctors. They can only go to certain physicians who have joined their insurance plan. ⁓ And people are delaying or deferring care because the associated costs, those co-pays, that co-insurance is just too expensive. Collin Stackhouse: Under the universal health plan, people will get the care that they need when they need it. ⁓ And the costs will not be a factor into the decision of whether to access needed care because it's a shift to care as a public good and not this endless billing ⁓ opportunity, right? Less, less opportunities to pay and more opportunities to get the care that you need. Rebecca Schoon: Another point about provider access under the Universal Health Plan, ⁓ all licensed clinicians who are in good standing in the state of Oregon who offer the services covered under the plan will be included in the quote unquote network. But really, there is no network. The idea is that people can go see any doctor in the state of Oregon. Collin Stackhouse: Right, so that's a broader integration of all of the services that right now are very fragmented and siloed. So, the current status quo, which is this network limitations and these providers that you may want to see, and you may even be in a clinic where you do see them, but you find out later they were never in the network to begin with. And so the billing process is different for those providers. That would not apply in this new system because every provider in Oregon would be included and every resident would be covered. Rebecca Schoon: Another really important component of this plan is about coverage access. So right now, your coverage, your costs are based on so many different factors. Your ability to pay, your job status, how you're using health services, A lot of people get health insurance through employer plans. But typically, you only have maybe choices of two types of plans at any given workspace. So right now, the type of health insurance coverage you have, the costs associated with it, are contingent upon all these different variables. Who's your employer? What are the plans they offer? How much can you pay for? What health services you need to use versus what's offered under your plan, whether that's employer, Medicare or Medicaid, or if you're just paying out of pocket for health care or buying health insurance on the exchange. So it's really this complicated patchwork that is not covering everyone sufficiently. But under the universal health plan, what's it gonna look like, Collin? Collin Stackhouse: Under the universal health plan in Oregon, everyone, no matter how much they earn or how much healthcare they use, would have comprehensive healthcare coverage. And everyone, no matter their job status or their income level, they would have this comprehensive healthcare available to them at any point in their life. Rebecca Schoon: That's a huge shift. There are so many people who are staying in certain jobs that might be toxic or just not where they want to be just to maintain their health care. There are people who are not starting their own businesses or engaging in entrepreneurial things because of the connection between employment status and health insurance. So this is a really liberating aspect of their plan where people are free to pursue the work and the careers that they want without feeling the yoke of needing to stay somewhere just to keep health insurance. Collin Stackhouse: Yoked, we want to remove the burdens and remove the So that is the very brief comparison that the governance board shared with us. next page of their summary talks about the different experiences that employers could see from this transition to a universal health plan for all of their employees and for themselves compared to this current status quo, which is kind of burdensome for most employers. Rebecca Schoon: I love talking about this part. This is something that came up on the Reddit thread. A lot of people raised the concern that businesses would leave Oregon. This would drive businesses out of the state. When in fact, businesses right now are under this massive bureaucratic, expensive burden to either provide healthcare if they're a business above 50 employees, or if they're a small business, they're having to see all this turnover from employees leaving their company because they have to go get a job that offers healthcare at a certain I can't wait for us to do a fuller episode on the real business case for universal healthcare. But again, for those larger companies, health care costs account for a significant part of their budget and staff time in having to compare and negotiate with different potential plans. It's a huge cost in contract negotiations and having to get into the weeds of planned administration and employee benefits. Collin Stackhouse: So that's the burden that employers experience today. Under this universal health plan, there would be no costs for the planned administration or for the expanding workforce that these businesses need to hire to... fulfill this need or to contract out with different insurance brokers. There would be predictable costs for every business because it'd be the same for every single business in the state. Employers will be able to draw workers to Oregon with this offer of universal healthcare. there's no way to not have it be conjecture, but just by doing a temperature check on everybody that I've ever spoken to about our broken health care system, I think most people would be interested in moving to Oregon to experience a functional system compared to our current broken one. Potentially employers could experience this draw of having their quality candidates want to move to somewhere with a universal healthcare system. ⁓ Businesses will also be incentivized to locate to Oregon with those lower healthcare costs because our current status quo is the most expensive option on the planet. And so if we have one little ⁓ sanctuary state where somehow these businesses are able to come and have a functional healthcare system without the burden of the administration that they currently are experiencing, could be good. And then smaller businesses can afford to be more competitive to hire their talent into the state. Rebecca Schoon: Right. You know, there's a documentary I show in my class that really lays out the business case and it interviews business owners in Canada. There was one company in particular where he wanted to open a branch in the United States. A lot of the customer base was in the U.S. So he wanted to expand into the United States and it was healthcare costs that kept him from doing so. He crunched the numbers and it would have been impossible to run the business with ⁓ the financial burden on businesses that currently exists. So it's kind of funny that so many people think this would be a negative for businesses So instead of all that staff time and spiraling costs, 9.6 businesses would just pay 9.6% payroll tax on any part of their salaries above $500,000 annually. So if you're a business where the total of your salaries that you pay every year is $330,000, you pay nothing and all your employees have comprehensive benefits. If you are a business that has about in annual salaries, you would pay 9.6 % of $100,000 and all of your employees have health security. Collin Stackhouse: That sounds good to me, I'm sold. So I hope that any business owner listening to this podcast would want to learn more. In this moment we are really just offering a summary of a summary which is publicly available for, any business owner to take a look at available again on our website. So we've talked about individuals, we've talked about employers, what about the providers? What's happening right now with providers in our state? Rebecca Schoon: So I was just part of a research project where Health Care for All Oregon partnered with physicians for a national health Program We surveyed over 1200 physicians nationwide with some focus groups as well. And it's ugly out there. what we are hearing is burnout, something called moral injury, which is this tension that can arise when the ethical requirements of the job to provide healthcare conflict with the structural constraints of the work environment, which is again, private health insurance intervening and blocking that care that physicians want to give to their patients. So we're seeing a shortage of clinicians. People are retiring early, getting out of the practice because they're so frustrated with a system that is not meeting their patients' needs or their needs for a reasonable workload, for ⁓ finding meaning and satisfaction in their profession. ⁓ The system is built around financial incentives and profit instead of caring for the community, ⁓ for their patients. ⁓ Collin Stackhouse: All of that is related to our current poor outcomes in clinician recruitment, retention, and wellbeing. And in this potential new universal health plan, we see that it's a transition to a rational, simpler, less frustrating plan that ensures everyone can get the care that they need. It's an environment that lets the clinicians do the clinical work instead of this huge current burden of different. goalposts and different guidelines for the different insurance companies And it's finally a return to medical care as a service provided to the people in your community and a return to medical care as a public good. Rebecca Schoon: Instead of a product, a commodity, which is how the system currently treats it. Collin Stackhouse: That also hopefully speaks to this terrible language of us as patients being consumers. We are consuming this healthcare when it's really just a necessity of our day-to-day life. We're not consumers. We are people. Rebecca Schoon: Absolutely. ⁓ So on other episodes, we've talked about the huge administrative costs for the system overall. But let's talk about this impacts providers. So these high administrative costs, again, all the paperwork, all the overhead it takes to file pre-authorizations, to fight denials, to negotiate contracts with multiple payers, all with different billing codes, billing systems, ⁓ different reimbursement rates. ⁓ it's an administrative nightmare. And I think this should be the rallying cry because I've never heard someone say, ⁓ I love inefficient bureaucracies. Well, this is the worst. ⁓ You always hear me describe it as a Frankenstein system. This was never built to go together. It's so inefficient. And clinicians and hospitals need to hire massive staff just to wade through all the different billing, the coding, contract management, prior authorizations, and appealing denials. It's a problem that is created by the system. It's not inevitable. Collin Stackhouse: This is not an inevitability. It's a system that's built by many, many choices by many, many people over many, many decades. And we can actually choose to do something that's more effective. So Under this new universal health plan, there would be reduced administrative burden due to one single payer for all covered people, ⁓ one unified payment system with standardized rules, benefits, billing processes, and coverage policies and a potential reallocation of staffing towards care coordination, patient engagement, and clinical services instead of the kind of waste of staff time trying to make sense of a nonsensical insurance administration process. Rebecca Schoon: There's also mention of coverage churn. So right now, patients are ping-ponging between OHP, marketplace coverage, jobs, where they suddenly get employer coverage and through each of these changes, their benefits change, their coverage changes, whereas under the universal health plan, ⁓ everyone has the same plan from the moment they are born in Oregon or the moment they become a resident of till the day they leave Oregon. ⁓ So it's one plan, one system, which also supports really stable long-term patient-provider relationships, which is absolutely the goal for quality of care. Collin Stackhouse: And there's still gonna be an obligation to measure the quality, right? All of the burden of that admin won't totally go out the window, but it will be reduced. Currently different insurance companies require numerous and various reporting metrics there's also Medicaid and Medicare. Like those things, those federal and state requirements will continue to exist, but there won't be also the added burden of these insurance companies' hoops that you have to through. Under a universal health plan, there will be aligned quality measures, performance expectations and payment models across. every provider in the system and across every person in the system. Rebecca Schoon: Again, just streamlining efficiency. That's what we're trying to get to. So that is really the quick summary, the little sampler platter of what is in the summary report. you can find it on hcao.org, our website, and watch for a longer episode where we really go deep into some of these details. If you want a closer look at what this draft plan is. But the most important ideas are, again, ⁓ this is a draft. The Governance Board wants your input on it. If there are parts you like, if there are parts you don't like, they want to hear from you. So check out the summary report, submit your testimony to the Governance Board, and let's help shape this into the plan that all Oregonians can get behind Collin Stackhouse: Like we said, it's still a draft plan and this podcast episode is the summary of a summary of a draft plan which is being delivered in December There are plenty of opportunities for you to speak directly to members of the Governance Board about what you need in a new universal healthcare system. The Governance Board meets on the third Thursday of the month at 9 a.m., 9 a.m. to 12 30 p.m. and you can join those meetings in person in Salem or you can do that remotely. And there's also an opportunity that we're very excited about which is a. a whole hour that is dedicated to listening to public input from the public to members of the Community Engagement Committee of the Governance Board. So those times have shifted to be from 5 p.m. to 6 p.m., on the fourth Wednesday of the month. So the upcoming hour-long sessions that you as an Oregonian, as a community member, can speak directly to the Governance Board for five minutes at a time are August 26th, September 23rd, and October 28th. So there are plenty of opportunities for you to speak directly to the people making the plan, There's a lot more information about your options available at oregon.gov/UHPGB. ⁓ Thanks so much for listening. Universal healthcare begins in Oregon. See you next time. ⁓ Rebecca Schoon: Next time, see you.