Subject: Oregon's Revised Medicaid Proposal Is Expected to Win Clinton's Approval 
Date: Published: 3/19/93 (112 lines)
Source: Wall Street Journal. Copyright Dow Jones & Co. Inc.

    Politics & Policy:
    Oregon's Revised Medicaid Proposal
    Is Expected to Win Clinton's Approval
    ----
    By Hilary Stout
    Staff Reporter of The Wall Street Journal

    WASHINGTON -- President Clinton today is expected to announce
 approval of Oregon's plan to extend Medicaid benefits to all the
 state's poor people by denying coverage for some costly and
 less-effective medical services.
    The Bush administration rejected the plan last summer, saying
 that it violated a new federal law protecting people with
 disabilities.  Oregon subsequently revised its application to address
 those concerns, and Clinton administration officials say the new
 president is likely to approve it.
    The Oregon plan has been closely watched around the country as an
 unprecedented way to expand basic medical coverage to all people
 living in poverty.  Critics denounce it as medical "rationing."  But
 supporters contend it is far more humane to provide some benefits
 for all, rather than a vast range for some.
    Oregon's Medicaid program now covers only two-thirds of the
 people actually eligible for benefits under the state-federal health
 program.  "We should concentrate the resources on those services that
 do the greatest good," said Jean Thorne, Oregon's Medicaid director.
 "Now we have people getting a full range of services ...some of
 which do little good," while others get nothing.
    The proposed Medicaid plan ranks 688 medical procedures and
 services from the most cost-beneficial to the least.  Based on
 projections of the money they would have available to spend, Oregon
 officials decided they wouldn't pay for any service ranked below
 568.  In return, the state would bring into the program the 120,000
 Oregonians below the federal poverty line who now don't receive any
 Medicaid benefits.
    A spokeswoman for Secretary of Health and Human Services Donna
 Shalala said yesterday that a final decision on the Oregon plan
 hadn't been made.  She said Ms. Shalala, who is legally responsible
 for ruling on the application for a waiver from federal Medicaid
 rules, was reviewing the "pros and cons" of approving the program
 and would make a recommendation to President Clinton.  But a White
 House official said the president was planning to approve the plan.
 Several officials said the decision would be announced today.  The
 likely approval was first reported yesterday by the Oregonian and
 the New York Times.
    Ms. Thorne, who met last week in Oregon with four HHS officials,
 said she had been given encouraging signals.  But she cautioned,
 "After last summer, I'm not making any predictions."
    Bush administration officials had said for months last year that
 they were likely to approve the Oregon experimentation, even though
 they had reservations about it.  Then, in the 11th hour of the
 application review, groups representing the disabled complained that
 it would deny medically necessary services to people with
 disabilities.  The administration denied the application but
 suggested the state submit a new one addressing the concerns about
 the disabled.
    Ms. Thorne said the state had removed the objectionable elements
 of the plan.  For example, she said, in the first application the
 state would have denied coverage of liver transplants for cirrhosis
 of the liver caused by alcoholism.  The Bush administrion charged
 that this discriminated against alcoholics, and the revised plan
 will cover liver transplants due to cirrhosis, even if it was caused
 by alcoholism.
    But many organizations representing people with disabilities
 weren't convinced.  In a letter to Mr. Clinton, dated March 17,
 groups including the United Cerebral Palsy Association, the American
 Amputee Foundation, the AIDS Action Council and the American
 Association of Mental Retardation charged that approving the Oregon
 plan will create "dangerous precedents" for "private health
 insurance and for national health care reform."
    During the presidential campaign, Mr. Clinton, a strong advocate
 of state experimentation, said he would have approved the Oregon
 plan.  However Vice President Al Gore expressed strong reservations
 about it when he was a senator.
    ---
    Some services the proposed Oregon Medicaid plan won't pay for:
    Medical therapy for disorders of sweat glands.  (No. 569)
    Repair, reconstruction and medical therapy for spine deformities
 and scoliosis.  (588)
    Liver transplants for liver cancer and intrahepatic bile ducts.
 (619)
    Medical therapy for hypotension.  (622)
    Medical therapy for herpes simplex without complications.  (633)
    Medical therapy for the common cold.  (636)
    Therapy for minor head injuries.  (660)
    Surgery for chronic pancreatitis.  (665)
    Therapy for infertility.  (671)
    Restorative dental services.  (680)
    Some services the plan will pay for:
    Medical and surgical treatment of severe or moderate head
 injuries.  (No. 1)
    Medical therapy for tuberculosis.  (22)
    Obstetric care.  (27)
    Therapy for low-birthweight babies (under 2,500 grams).  (40)
    Medical and surgical treatment of treatable breast cancer.  (77)
    Medical therapy for HIV and AIDS.  (82)
    Liver transplants for biliary atresia.  (92)
    Renal transplants for end-stage renal disease.  (93)
    Bone-marrow transplants for lymphoid leukemias other than acute
 lymphocytic leukemia.  (233)
    Medical and surgical treatment for spina bifida.  (234)
    Medical therapy for chronic bronchitis.  (549)
    Neuroplasty for peripheral nerve disorders.  (568)
    Source:  Oregon Health Services Commission.

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