Gathering Signatures

According to the Virginia-based American Medical Student Association (AMSA), nearly 10 million Americans age 18 and under lack health insurance, and more than 9,000 uninsured students attend Portland public schools.

Dr. Gregg Coodley, a Portland internist, initiated a signature campaign late last year aimed at prompting the Portland City Council to appropriate $3 million to $4 million in taxpayer funds each of the next two years to finance a health insurance program for all Portland students. After two years of City Council funding, the responsibility for insuring students would be shouldered by the Portland School District.

If the City Council finds the 38,500 signatures gathered are legitimate, the measure will be placed on the city’s ballot in November as a referendum item.

Taking a Political Stance

“One of the objectives was to try to give some basic health insurance to all students in our schools,” said Coodley, “and try to figure out how they are tracked in their health care, and also to attract more families to the city and keep our kids in public schools.

“We are losing kids to the suburbs because the core of the city is a very expensive place to live,” Coodley added.

“At the height of our enrollment in Portland Public Schools in the early ’70s we were at about 85,000 students,” noted Matt Shelby, Portland Public Schools’ information officer. “Now we are holding steady at 46,000 students.

“Dr. Coodley is trying to address two issues,” Shelby said, “obtaining health care coverage for uninsured students, and attracting families back into the city by offering taxpayer-funded health coverage to Portland residents.”

Crowding Out Private Health Insurance Coverage

Devon Herrick, Ph.D., a senior fellow with the National Center for Policy Analysis, says such a program can drive up health insurance costs as parents who have already been providing health insurance for their children opt out for the free plan.

“Proponents often tout these types of programs as a low-cost way to cover students, who are generally healthy with few medical needs,” said Herrick. “But if students have access to free care, many parents will drop their private family coverage. Over time this crowding out by public insurance will drive the costs well above early estimates.”

Mary Katherine Stout, director of the Center for Health Care Policy at the Texas Public Policy Foundation, called the Oregon initiative another “bad idea by well-intentioned people.”

“This is outside the scope of public education,” said Stout.

Contemplating Options

“We are not quite sure yet how we feel about it,” said Shelby, citing the long-term effect the measure will have on the district’s budget. “We believe healthy kids are good for the schools and the community, but how we provide that is still up for discussion.

“After two years it becomes the school district’s liability. Coodley’s logic is that more students will come to the district, which in turn will bring more revenue and money to the district,” Shelby said.

“The majority of our funding comes from the State of Oregon, and his thinking is the more students, the more money,” Shelby continued. “That’s true, but what isn’t being talked about in this campaign is all of those new students will need to be educated–which means more teachers, books, etc. So it is going to increase our costs for new kids coming in.

“In addition, there are a lot of questions, including what will the proposed health insurance plan look like? What happens when parents take the free coverage as opposed to covering their child under their own insurance plan? How does that work? There is just a lot of analysis that needs to happen on our end,” Shelby added.

Coodley said the City of Portland currently has a $38 million surplus, and “They should be able to put $3 to $4 million aside to pay for health insurance for all the kids.”

Affordable Health Insurance Coverage Available

“I don’t think this is the greatest thing since sliced bread,” said Coodley, “but it is more than nothing.”

Policy experts disagreed.

“‘Do it for the children’ is a powerful campaign,” said Stout. “But there is a mistaken belief that health insurance is unaffordable for children.”

John R. Graham, director of health care studies at the Pacific Research Institute, concurred, pointing out children’s health insurance plans are available in Oregon beginning at $88 per month–an affordable plan, he said, for almost any budget.

A state’s top objective should be “removing barriers for its citizens to purchase insurance in a competitive health care marketplace,” Stout concluded. “When insurance plans are competitive and companies are delivering a product of value, consumers will have more choice when it comes to health insurance.”

J.E. Loomis (creawricon@verizon.net) writes from Indiana. Ingrid Jacques (ijacques@hillsdale.edu) writes from Michigan.

By: Heartland.org – Mon, 07/28/2008 – 01:57

The taxes would generate an estimated $700 million over the next two years, which would be used to draw down more than $1 billion in federal matching funds.

The plan also would regulate hospital prices and insurance company administrative costs and would increase taxes on alcohol and cigarettes to fund mental health services and public education programs about chronic disease prevention. State and local governments and eventually private insurers would consolidate to create purchasing to negotiate better prices for prescription drugs, insurance and other services. The state also would help doctors and hospitals convert paper records to electronic systems to improve efficiency and reduce costs. Eventually, all state residents would be required to have health insurance and insurers would be required to cover individuals regardless of pre-existing health conditions.

The plan calls for the creation of a nine-member Oregon Health Authority Board, appointed by the governor, that would encourage health care professionals to establish “integrated health homes” and develop new pay structures and reward programs. The state also would establish measures and standards for health care and provide consumers with information about the cost and quality of care.

Barney Speight, executive director of the Oregon Health Fund Board, said most of the recommendations by the board would cost about $5 million to $7 million and generate up to $10 billion in savings over the next 10 years. The board is expected to deliver the plan to Gov. Ted Kulongoski (D) and legislative leaders on Nov. 25 (Rainey, Oregonian, 11/15).

Reprinted with permission from kaisernetwork.org. You can view the entire Kaiser Daily Health Policy Report, search the archives, and sign up for email delivery at kaisernetwork.org/email . The Kaiser Daily Health Policy Report is published for kaisernetwork.org, a free service of The Henry J. Kaiser Family Foundation. © 2007 Advisory Board Company and Kaiser Family Foundation. All rights reserved.

By: kaisernetwork.org – Wed, 11/19/2008 – 19:26

The ballot measure would amend the state constitution to increase cigarette taxes by 84.5 cents per pack. The measure would generate an estimated $153 million from 2007 to 2009 and $233 million from 2009 to 2011. Democratic lawmakers this year were unable to secure a three-fifths majority in the state Legislature, which was needed to pass legislation to raise the tax, but there were enough votes to put it on the ballot as a constitutional measure.

Lobbyist Mark Nelson, whose clients include the tobacco industry, said if cigarette makers "decide to oppose [the measure], they’ll form a political action committee and file with the secretary of the state." He added that the tobacco industry objects to how the funds would be used, as well as the constitutional amendment. "I don’t know of any time in the country we’ve had a tax on a single product and put it in the constitution," Nelson said.

Coalition members include the American Cancer Society; the American Heart Association; the American Lung Association; Oregon PTA; Children First for Oregon; several unions; and physicians, nurses and other health care advocates (Graves, Oregonian, 8/10).

Reprinted with permission from kaisernetwork.org. You can view the entire Kaiser Daily Health Policy Report, search the archives, and sign up for email delivery at kaisernetwork.org/email . The Kaiser Daily Health Policy Report is published for kaisernetwork.org, a free service of The Henry J. Kaiser Family Foundation. 2007 Advisory Board Company and Kaiser Family Foundation. All rights reserved.

By: Kaisernetwork.org – Wed, 08/15/2007 – 12:50

Forty-five percent of clients had no health insurance, compared with 41 percent in FY 2005. One-half of all clients were children ages 18 and under.

Lillian Shirley, Multnomah County Health Department Director states, ” As part of it’s public health function, the health department continues the difficult task of assuring access to care for as many people as it can within its clinical capacity. Providing the highest quality service and maximum access to healthcare while facing increasingly limited resources remains a community-wide challenge.

Multnomah County Health Department provides communicable disease prevention and monitoring, food service inspections, immunizations, maternal and child health care, environmental health, adolescent health services, tobacco prevention, and chronic disease prevention in addition to providing medical and dental care to uninsured and Medicaid-insured patients .

By: Multnomah County Health Department – Thu, 08/23/2007 – 09:42

• New York Times:The defeat of the Oregon children’s health measure %26quot;is a testament …to the shamelessness of the nation’s big tobacco companies,%26quot; which%26quot;spent an obscene amount of money on deceptive television ads designedto protect their profits, even at the expense of poor children,%26quot;according to a Times editorial. Tobacco companies %26quot;didnot win by disputing the urgent health care needs the initiative wasmeant to address or the benefits higher cigarette taxes would bring bydeterring smoking,%26quot; the editorial continues. Instead, they %26quot;sought tohide behind a benign-sounding front group called Oregonians Against the Blank Check%26quot; and encouraged %26quot;doubts that the funds raised would actually be used for children’s health care,%26quot; the Times writes. According to the Times,%26quot;The referendum said a lot about the power of money in any election andnot much about what the public thinks about the issue if given accurateand balanced information.%26quot; The editorial concludes, %26quot;The vote shouldneither deter Congressional Democrats from continuing to confrontPresident Bush on expanding children’s health care under the SCHIPprogram nor discourage other states from trying to do more to take careof the health of their children%26quot; (New York Times, 11/8).

• Wall Street Journal:%26quot;Oregon reproduced the current SCHIP fracas in [Washington, D.C.,] onthe state level,%26quot; and the %26quot;referendum took a major shellacking%26quot; fromvoters, the Journal writes in an editorial. %26quot;There arepolitical lessons here, in case anyone in Washington is payingattention,%26quot; the editorial states, adding, %26quot;Voters are rightly concernedabout health care and would like everyone to have insurance, but theyrealize that government programs are very expensive,%26quot; and they %26quot;don’tseem to want to pay for health care reforms directly through highertaxes.%26quot; This sentiment %26quot;accounts for the reliance by politicians on theeasier sell of tobacco taxes, and it also explains why Congress hasdisguised the real cost of its SCHIP contraption with a $30 billionbudget gimmick,%26quot; according to the editorial. It concludes, %26quot;most of thenational press corps has already assumed ‘universal’ coverage will bothcarry [Sen. Hillary Rodham Clinton(D-N.Y.)] to the White House and march easily into law,%26quot; but the%26quot;message from the Oregon trail is — not so fast, especially if herRepublican opponent advances a credible free-market alternative%26quot; (Wall Street Journal, 11/8).

Reprinted with permission from kaisernetwork.org. Youcan view the entire Kaiser DailyHealth Policy Report, search the archives, and sign up for email deliveryat kaisernetwork.org/email. The Kaiser Daily HealthPolicy Report is published for kaisernetwork.org, a free service of The HenryJ. Kaiser Family Foundation. 2007 Advisory Board Company and KaiserFamily Foundation. All rights reserved.

By: Kaisernetwork.org – Thu, 11/08/2007 – 18:24

According to the Oregonian,legislators had no back-up plan for the measure, which failed by a59%-41% vote. However, a seven-member panel is drafting legislation for2009 that would expand coverage for the uninsured. According to the Oregonian,Gov. Ted Kulongoski (D) and legislative leaders said there is notenough time to address the issue in February 2008 during a four-weeklegislative session.

State lawmakers this fiscal year allocated enough funds to expand coverage in the Oregon Health Planto about 9,000 additional state residents, and Jean Phillips, deputyadministrator for the state division of medical assistance programs,said the state will focus its efforts on covering adults with children.State Rep. Gene Whisnant (R) said the state Legislature should focus onenrolling uninsured children who already qualify for health careprograms.

According to Phillips, the state was planning to usefunds from Measure 50 to launch media and informational campaigns aimedat an estimated 60,000 uninsured, eligible children in state healthprograms, but now the state does not have enough money to conduct such"aggressive outreach" (Har/Cole, Oregonian, 11/8).

Reprinted with permission from kaisernetwork.org. Youcan view the entire Kaiser DailyHealth Policy Report, search the archives, and sign up for email deliveryat kaisernetwork.org/email. The Kaiser Daily HealthPolicy Report is published for kaisernetwork.org, a free service of The HenryJ. Kaiser Family Foundation. 2007 Advisory Board Company and KaiserFamily Foundation. All rights reserved.

By: kaisernetwork.org – Mon, 11/12/2007 – 19:22

When asked about raising state cigarette taxes to add more children to publicly funded health coverage, Oregon voters rejected the plan by an 18-point margin, 59 percent to 41 percent.

Before the Oregon vote, Congress passed a bill that would increase federal cigarette taxes by 61 cents a pack to pay for an expansion of the State Children’s Health Insurance Program (SCHIP) to cover more children, including many in middle-income families. The bill was vetoed by President George W. Bush.

No Help

Oregon’s ballot results are an important signal.

Measure 50 would have increased Oregon’s cigarette tax by 85 cents a pack. The measure went to the voters for a referendum after Democratic state legislative leaders failed to get enough support to pass the measure outright. They didn’t have the three-fifths vote needed to pass revenue-raising bills in the legislature, but they did have the simple majority needed to ask voters to amend the constitution and add the cigarette tax. All they needed was a simple majority of the voters to say yes.

The measure failed in every county but one.

Bush has said he wants Congress to focus on devising an SCHIP bill that would concentrate on enrolling lower-income children who already are eligible for Medicaid and SCHIP, before expanding coverage to kids in higher-income families.

That is what Oregon’s fallback plan will be. Oregon state Rep. Gene Whisnant (R-Sunriver) said after the defeat of Measure 50, lawmakers should focus on finding ways to enroll the children who already qualify for aid but aren’t signed up.

The ballot initiative was the most expensive campaign in Oregon history, with strong support for the measure from the governor, the majority in the legislature, labor unions, hospitals, and citizens’ groups who said the tax increase would insure nearly 100,000 children and would discourage more Oregonians from smoking.

Media-Voter Disconnect

Supporters of Measure 50 blamed a huge advertising campaign financed by tobacco companies for its defeat. But the opponents’ message must have resonated.

Opponents zeroed in on four basic arguments against the tax, according to The Oregonian: They argued there was no way to account for how the money would be spent; it was inappropriate to stick a product tax in the constitution; it was unfair to smokers; and the program was fiscally unsustainable as costs eventually would outstrip revenue.

A November 8 New York Times editorial was predictably scathing: "Big tobacco defeats sick kids." The Oregonian offered a similar indictment.

But it is always a mistake to tell voters they are stupid, which is what these editorials did.

The direction Congress is taking with its SCHIP legislation is fundamentally flawed. Voters need to have real options. Oregon voters, like those who faced similar referenda in California and Missouri before, said this wasn’t it.

By: Grace-Marie Turner – Heartland.org – Wed, 12/26/2007 – 18:22

Karen House, a medical director with the state Department of Human Services, said that about 19,000 people currently areenrolled in the program and that the program can enroll up to 32,000beneficiaries and still maintain budget solvency. House said more than 100,000uninsured Oregonresidents are eligible for the program. Eligibility is restricted to stateresidents ages 19 to 65 who do not qualify for Medicaid and have incomes lessthan the federal poverty level (Graves, Oregonian,1/8).

Reprintedwith permission from kaisernetwork.org. You can view the entire Kaiser Daily Health Policy Report, search the archives, and sign upfor email delivery at kaisernetwork.org/email . The Kaiser Daily Health PolicyReport is published for kaisernetwork.org, a free service of The Henry J.Kaiser Family Foundation. 2007 Advisory Board Company and Kaiser FamilyFoundation. All rights reserved.

By: kaisernetwork.org – Thu, 01/10/2008 – 17:28