Writings and observations

Health care now

jorgensen

A few hundred people braved freezing winter weather Friday, January 6 to hear former Oregon Governor John Kitzhaber and former Maryland Governor Martin O’Malley discuss the future of health care policy under the Trump administration.

The early morning breakfast forum was held at the Multnomah Athletic Club in Portland. It was billed as an overview of how the incoming Republican president-elect’s policies will affect the health care reforms that have been initiated in “blue states” such as Oregon and Maryland.

O’Malley, who served two terms as that state’s 61st governor, ran for president in last year’s Democratic primary election. He was also chairman of the Democratic Governors Association from 2011 to 2013. Under his leadership, Maryland became the first state to adopt an all-payer system that included all of the hospitals within its borders.

Kitzhaber said that in the 30 years since the creation of the Oregon Health Plan (OHP), millions of the state’s residents have benefited from expanded insurance coverage. Access was expanded to 400,000 Oregonians, Kitzhaber said, with subsidies provided to 95,000 of them.

However, he added that the program did not connect with outcomes or address costs within the health care system.

O’Malley said that many states, including Washington and Maryland, had commissions as far back as 1978 that set insurance rates. But many of those states abandoned that approach over time.

Health insurance reforms implemented in Maryland saved the federal Medicare program $116 million in their first year, O’Malley said. Those reforms involved a process that begins with rate setting and utilizes a global budgeting system.

Rates are set for hospitals by the rate commission, O’Malley said. Those entities agree on a budget and prices. Volumes are monitored, prices are adjusted and hospitals get to keep the savings that result from improved patient wellness, he said.

O’Malley said that hospital revenues are estimated in advance and an emphasis is placed on preventing unnecessary patient admissions. Some Maryland hospitals began changing their inpatient centers into wellness centers to achieve those aims.

“I believe we have found a better way to move forward in Maryland,” O’Malley said.

Following his presentation, entitled “Paying for Wellness—Maryland’s Story,” O’Malley took a seat besides Kitzhaber and a few others for a panel discussion.

Kitzhaber said that prior to the passage of the federal Affordable Care Act (ACA) in 2010, insurance premiums went up 75 percent between the years 2001 and 2008. Out-of-pocket expenses went up over 100 percent, Kitzhaber added, and 44 million Americans lacked coverage.

Like previous efforts, Kitzhaber said the ACA was insurance reform, but did not address the underlying inflation in the system.

O’Malley and Kitzhaber both said they felt that progress on health care reform has been made in their respective states, and it is worth fighting to protect. They agreed that states like Oregon and Maryland can reframe the debate on the issue.

“I think we should step into this thing boldly,” Kitzhaber said.

Kitzhaber did caution, though, that trying to obstruct the incoming Trump administration will not help Oregonians. He concluded that “blue state” leaders like himself and O’Malley need to offer rational solutions as part of the process.

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