Guest Column: Oregon is on an alarming health care trajectory

Many years ago, the company I was working for announced it was cancelling its health insurance. It couldn't afford to keep it. The company was self-insured. Some people in the company needed catastrophic levels of care. If that happened again, it would threaten the financial survival of the business. So, health care was gone. For employees and their families, it was sailing in uncharted waters on a leaky boat.

Today, most Oregonians have health insurance. One way or another, though, we are all in a leaky boat. Health care costs are rising faster than inflation. Health care costs takes up more and more of the budgets of Oregon households and businesses. It leaves many people with piles of medical debt. People don't get care, because they worry about their ability to pay those bills.

Universal health care

Some in Oregon are serious about moving the state to universal health care. The goal is to cover everyone, equitably and affordably. The state would be the insurer. Legislators launched a state board to come up with options for the Legislature to consider in the 2027 session.

I went back and listened to meetings of the board. The goal of a healthier Oregon is unquestionably right, but I don't see how Oregon gets there from here.

Oregon is going to need permissions from the federal government. The state needs to be granted waivers for Medicaid (called 1115) and more. Can you see that happening in President Trump's administration?

"The current federal administration has announced that they do not intend to approve any new state proposals or extend existing 1115 waivers," Jessica Merino of the Oregon Health Authority recently told Oregon's board. "That's something that's really, really critical to keep in mind."

President Trump won't be president forever. Maybe the next will be more amenable to the idea. Maybe the next Congress will grant Oregon permission to try a state-run system. It's not guaranteed. It's uncertainty.

An Oregon switch to a state-run system will also likely face lawsuits. One may come related to what is called ERISA. The Employment Retirement Income Security Act is a federal law that stops states from interfering in employer choices in providing benefits. Basically, when an employer is self-insured, the state can't meddle.

The Oregon plan for universal care has been to raise revenue for the system, in part, through a payroll tax on employers. The line of argument from the health care board is that a new state payroll tax for health care would not directly limit an employer's rights to offer health insurance to its employees. An employer could choose to continue its health plan or it could stop it and let employees take advantage of the state plan. That might work.

The impact of such a new payroll tax sure looks like interfering. Isn't it just a maneuver to elude the law? I don't know how courts would rule.

Congress could change ERISA to allow Oregon to try its plan. Would Congress do that?

Then there's cost

One of the promises embedded in the idea of universal health care in Oregon is that it would cost less than the status quo. The state board has been presented with projections to the contrary, at least in the short run. Cost estimates show the state's health care costs would be billions more under a universal health care system in its early years than if Oregon proceeded under the status quo. It's almost inevitable. The estimate is that there would be more spending because Oregonians have pent up demand for health care. Some people would also move to Oregon to seek care, because the state would have one of the best opportunities for health care in the country.

There are more uncertainties that I have not mentioned than those I have. But don't get me wrong. I think it would be wrong to give up on the Oregon effort. Disease and injuries ruin lives. And the health care system we have now, as excellent as it in providing care, ruins finances and has an alarming cost trajectory.

I want to see the health care board keep trying. It might not find the solutions Oregonians want, but it does create pressure to find solutions.