The Oregon Health Plan

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Table of Contents

Overview
Evaluation
Analysis
References

Overview

The Oregon Health Plan (OHP) is a Medicaid program that was initiated in 1993 (Oregon Health Authority, 2015). The minimum eligibility requirement for enrollment in OHP is to be an Oregon resident. Its coverage level is contingent on a set of conditions, such as applicant’s age, state of mental and physical health, and income. OHP is comprised of two packages: OHP Standard and OHP Plus (Oregon Health Authority, 2015).

OHP Standard is a benefits package offered to those adults who do not have medical insurance and do not meet eligibility requirements for Medicaid. Even though it requires monthly premiums, co-payments were eliminated (Oregon Health Authority, 2015). Unlike OHP, Standard OHP Plus offers full benefits for those adults who are eligible for Medicaid and children eligible for the Children’s Health Insurance Program (Oregon Health Authority, 2015).

SustiNet is an affordable healthcare plan that became available for Connecticut residents in 2014 (Manthous & Sofair, 2014). It covers the healthcare needs of “existing state-sponsored populations, state employees and retirees as well as Medicaid and HUSKY beneficiaries.” (SustiNet Health Partnership, 2011). It also offers insurance for private employers, with a focus on small businesses and non-profit organizations. Connecticut municipalities and private individuals are also eligible for SustiNet (Connecticut General Assembly, 2009). The healthcare plan does not require co-payments for preventive healthcare services. Dental coverage that is offered by SustiNet can be compared in its scope to that of large employers (Connecticut General Assembly, 2009).

Healthcare reform in Massachusetts was initiated in 2006 and was designed to ensure that almost all of the state’s residents would be offered a minimum level of insurance coverage (Commonwealth Health Insurance Connector, n.d.). This reform helped to establish the Commonwealth Health Insurance Connector Authority that provides insurance plans for the people whose income does not exceed 150% of the Federal Poverty Level (FPL) (Commonwealth Health Insurance Connector, n.d.).

Evaluation

One significant strength of OHP was its ability to expand insurance coverage to those residents of the state who did not have the financial ability to purchase any level of healthcare insurance. However, the program’s success in providing insurance coverage by rationing medical services was not sustainable. The enrollment in OHP dropped by 53%, from 104,000 at the beginning of 2003 to 49,000 at the end of 2003 (Oberlander, 2007).

SustiNet was designed to provide healthcare insurance to those who cannot purchase it on their own, in a similar vein to OHP. One of the strengths of the plan is the provision of independent information about health outcomes, costs, and other pertinent information about both state-sponsored and private insurance coverage plans in Connecticut (SustiNet, 2010). However, even though the implementation of the plan was meant to “slow the growth in health care costs while simultaneously expanding coverage dramatically,” the report… shows that SustiNet costs will rise by $77 million in 2017 (SustiNet, 2010; HayGroup, 2011).

Notwithstanding the fact that the enrollment in the program did not fall precipitously as it did in the case of OHP, it is projected that benefits costs for all current enrollees would be paid by the state. Taking into consideration that even a 1% error in the estimation of premiums can result in a significant impact on spending, this could be a major problem for the State of Connecticut (HayGroup, 2011).

Just like OHP, Massachusetts’ healthcare reform was meant to expand insurance coverage to those residents of the state who did not have the financial ability to buy healthcare insurance coverage. After its enactment in 2006, more than 400,000 people living in Massachusetts received insurance (Commonwealth Health Insurance Connector, n.d.).

Taking into consideration that the outcome of legislation was the provision of healthcare coverage to almost 98% of the state’s residents, it can be argued that the reform delivered on its promise. However, in a similar vein to SustiNet, it led to a massive increase in state spending on healthcare services (McAdoo, Irving, Deslich, & Coustasse, 2013). According to a recent report, Massachusetts spent $2.42 billion dollars on Medicaid and SustiNet (McAdoo et al., 2013).

Analysis

According to the World Health Organization (WHO), the idea of universal health coverage (UHC) is associated with “equity in access to health care services,” meaning that everyone in need of those services can receive them regardless of whether they have the financial wherewithal to afford them (WHO, 2016). Considering that Massachusetts’ healthcare reform was designed to ensure that almost all of the state’s residents would be offered a minimum level of insurance coverage, which is consistent with WHO’s definition of UHC, it can be argued that the state came close to providing the people living within the state’s boundaries with affordable healthcare services.

OHP, on the other hand, did not succeed in meeting the objective of expanding insurance coverage to those residents of the state who did not have the ability to purchase an insurance (Oberlander, 2007). Taking into account that its enrollment rates significantly dropped, it cannot be considered a UHC (Oberlander, 2007). Unlike OHP, SustiNet provides insurance for “existing state-sponsored populations, state employees and retirees as well as Medicaid and HUSKY beneficiaries”; therefore, it can be called a UHC (SustiNet Health Partnership, 2011).

References

Commonwealth Health Insurance Connector Authority and Executive Office of Health and Human Services. (n.d.). The top ten facts about Massachusetts health care reform. Web.

Connecticut General Assembly. (2009). An act concerning the establishment of the SustiNet plan. Web.

HayGroup. (2011). An assessment of the SustiNet Health Partnership Report to the Connecticut General Assembly.

Manthous, C. A., & Sofair, A. N. (2014). On Medicaid and the Affordable Care Act in Connecticut. Yale Journal of Biology and Medicine, 87(4), 583-591.

McAdoo, J., Irving, J., Deslich, S., & Coustasse, A. (2013). Massachusetts health care reform: is it working? The Health Care Manager, 32(4), 314-320.

Oberlander, J. (2007). Health reform interrupted: the unraveling of the Oregon health plan. Health Affairs, 26(1), 96-105.

Oregon Health Authority. (2015). Oregon Health Plan (OHP) handbook.

SustiNet. (2010). SustiNet by the numbers: projections of cost, coverage, and economic impact.

SustiNet Health Partnership. (2011). Report to the Connecticut General Assembly from the SustiNet Health Partnership Board of Directors. Web.

WHO. (2016). Health financing for universal coverage. Web.

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The Oregon Health Plan

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