Oregon Seeks OK on Medicaid Rationing

Oregon’s controversial plan to ration services in the state’s Medicaid program was resubmitted Friday for federal approval by Democratic Gov. Barbara Roberts.

Roberts said the plan has been altered to eliminate alleged bias against the disabled that was cited by Health and Human Services Secretary Louis W. Sullivan when he refused to approve the plan in August.

The Oregon plan is the largest experiment in explicit rationing of medical services ever proposed in the United States. It would eliminate some treatments to low-income Medicaid patients that are viewed by the state as marginal or of low medical effectiveness.

The money saved would help Oregon expand the joint federal-state medical program for the poor to everyone living below the poverty line ($13,924 in 1991 for a family of four), adding 120,000 people to the Medicaid program. Now, the cutoff for Medicaid eligibility in Oregon is half the poverty line.

The plan also would trigger a state mandate that employers provide health insurance to an additional 400,000 workers and their dependents who lack health insurance.

Sullivan said the version he rejected appeared to violate the Americans With Disabilities Act by giving low priority to some services for the disabled--such as liver transplants for alcoholic cirrhosis--because their “quality of life” was assumed to be lower than those without impairment.

Before the election, Bill Clinton indicated that he favored the Oregon experiment, but Sen. Al Gore opposed it. Health and Human Services Department approval is needed because Medicaid gets more than half of its funds from the department.

“Although we still believe our original process did not violate the ADA,” Roberts wrote Sullivan on Friday, “we acknowledge that the perception of discrimination could stand in the way of implementing our plan for near-universal access to health care.”

Under Oregon’s original rationing plan, the state drew up and ranked in order 709 categories of treatment. The rankings were based on judgments by professionals of medical effectiveness and on a telephone survey in which Oregonians were asked, in effect, how much they valued the results of these treatments. The state decided it could pay for the first 587 of these treatment groups.

Roberts said Friday that new rankings, reduced to 688 treatment groups, reflect “only the degree to which a particular treatment saved life or returned a person to his or her original health status without placing a value on that status.”

Treatments for low birth weight babies and those with liver disease caused by alcohol have been moved up in the rankings, as was treatment for most advanced cases of AIDS.