Subject: Oregon Prioritizes Medical Operations In Care Program 
Date: Published: 2/22/91 (86 lines)
Source: Wall Street Journal. Copyright Dow Jones & Co. Inc.

    Oregon Prioritizes
    Medical Operations
    In Care Program
    ----
    By Hilary Stout
    Staff Reporter of The Wall Street Journal

    WASHINGTON -- Oregon has drawn up a list of health care
 priorities as part of a closely watched statewide experiment
 to provide health insurance to more people by rationing care.
    The list ranks more than 800 medical procedures and
 services from those deemed most essential to those considered
 least vital or cost-effective.  The Oregon state Legislature
 in the next few months will review cost estimates of the
 services and determine a cut-off point at which Medicaid, the
 public health insurance program for the poor, will no longer
 provide coverage.
    By refusing to pay for some high-cost, high-risk
 procedures, Medicaid plans to provide basic health benefits
 to 120,000 poor Oregonians who aren't currently covered by
 the program.  And Oregon businesses -- including those who
 don't now provide health insurance -- have agreed to
 guarantee the same package of benefits starting in 1994,
 drawing in most of the other 330,000 state residents who are
 uninsured.
    "We have publicly, honestly and explicitly defined what is
 most important to us as Oregonians for the health care and
 quality of our lives," said Bill Gregory, chairman of the
 state's Health Services Commission, which compiled the list
 of priorities.
    The trade-off is controversial, and before the Oregon plan
 can go into effect, the U. S. Congress must exempt the state
 from certain Medicaid rules.  It would mark the most radical
 health care reform effort in the U. S., where the cost of
 providing health services climbed above $650 billion last
 year and more than 30 million people lack health insurance.
    Age isn't a factor on the list, which gives priority to
 life-saving treatments likely to lead to full recovery, such
 as appendectomies and treatment of bronchopneumonia.  It also
 assigns high priorities to preventive care, such as childhood
 immunizations; to maternity care and birth control; and to
 treatment of chronic conditions that improves the quality of
 life.
    It makes hard choices on coverage of terminal illness.
 Treatment of the early stages of the AIDS virus ranks higher
 than for later stages.  Treatment of patients with acquired
 immune deficiency syndrome determined to have less than a 10%
 survival rate at five years, for example, ranks 801 out of
 the 802 services.  Local and regional cancers have higher
 priority than those that have spread.  While heart and liver
 transplants rank relatively high, certain types of bone
 marrow transplants are far down the list.
    The priority list has left some members of Congress deeply
 split.  Rep. Henry Waxman (D., Calif.), chairman of a House
 health subcommittee, worries that creating a package of core
 benefits for everyone could keep Medicare's most needy
 recipients -- poor woman and children -- from receiving vital
 health care services.
    But Rep. Ron Wyden (D., Ore.) said, "The current health
 care system for the poor is absolutely indefensible....  So
 many people are being missed that you can't defend the status
 quo."
    The experiment, he argued, would "allow us to serve more
 people in a more human, rational, cost-effective way."
    Currently in Oregon, Medicaid serves only 42% of residents
 living below the poverty line.  A family of four, with an
 annual income of $6,493 is considered too well-off to
 qualify.  About 18% of the state's population doesn't have
 health insurance.
    A study by a private health consulting firm estimates
 that, despite the rationing, providing basic health coverage
 to all Oregonians living below the poverty line would cost
 roughly $145 million annually.  Under a Medicaid formula, the
 federal government would provide about $91 million, with the
 state contributing about $54 million.  The Oregon state
 legislators have talked about a payroll tax or a hospital tax
 to help raise the state's share.

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