Oregon Health Plan’s Prognosis Uncertain

As he pulls himself along the edge of a coffee table and munches on a handful of Goldfish crackers, Korben Baker looks like any rambunctious toddler.

But the surgical scars that crisscross his belly and the feeding tube that sticks out of his stomach tell another story--of a little boy born with a heart defect who’s already endured three major operations in less than two years.

Korben’s mother, Debbie Jensen, is convinced that her son is alive today because of the Oregon Health Plan, the state insurance program that allowed her to take Korben to a specialist in San Francisco.

“It saved his life. He’s now a healthy, happy baby boy,” said Jensen, who worked in a furniture refinishing shop before she quit to spend more time with her son.

They are the beneficiaries of Oregon’s nationally touted experiment that has extended insurance to thousands of low-income residents by rationing health care to recipients.

But spiraling costs will put it under intense scrutiny in the Oregon Legislature this year. Even the plan’s author--Democratic Gov. John Kitzhaber--is proposing cutting services and imposing tougher screening to make certain applicants are truly eligible.

Still, Kitzhaber is asking the Legislature to provide $764 million in state support--a 28% increase over current spending--to cover the plan’s rising costs.

Republicans might seek deep cuts, however, which could trigger a battle over whether the state can continue to afford the program.

“I understand the need for health care, but you can’t have a program that’s growing in the 20% range year after year,” said Senate President Brady Adams. “The taxpayers’ pockets are only so deep.”

Launched in 1994, the Oregon Health Plan provides coverage to more than 300,000 poor and working poor Oregonians--those who have jobs but who can’t afford health insurance and whose employers don’t offer insurance.

To help keep the program’s costs down, the health plan “rations” services through a prioritized list of medical conditions and treatments, with the state paying only for those treatments deemed the most important and most likely to be effective.

The program has meant peace of mind for people such as Ronald Wisler, who works as a carpenter in Bend.

Wisler, 42, a divorced father of four who has taken the responsibility to rear his children, said his job is seasonal and he often finds himself out of work.

“I don’t know where I would get health care for me and my kids if it weren’t for the health plan,” Wisler said.

The issue recently hit home for Wisler when it appeared that his 6-year-old daughter, Bonnie Rose, might have a crippling spinal disorder.

“As it turned out, one of her legs is shorter than the other,” he said. “But it could have cost me hundreds of dollars just to find out she’s OK. I had to take her to a bone specialist, and those guys aren’t cheap.”

To help curb the program’s costs, Kitzhaber is proposing tougher screening to make sure all health plan applicants are eligible.

The governor’s plan is expected to trim the number of health plan participants by 6,000.

Kitzhaber, a former emergency room physician, also wants to limit costs of the program by deleting some of the medical services now covered on the prioritized list of services.

Over the last year, the Oregon Health Plan has expanded to include such services as doctor-assisted suicide. Officials are seriously studying the idea of adding sex-change operations.

Kitzhaber’s budget would eliminate coverage for treatment of such maladies as skin irritations that often go away on their own. Knee ligament damage also would no longer be covered, on the theory that ligaments often grow back.

Further, Kitzhaber would require hospitals to cover an additional $10.4 million in patients’ health care costs by changing the timelines governing when people become eligible for the health plan.

Adams said he and other Senate Republicans might want to look for other savings, such as cutting more deeply into the benefits package so that fewer medical services and treatments on the prioritized list are covered.

The whole idea behind the “rationing” concept was that the state would decide what services it could afford to cover and draw the line there, Adams said.

“Why can’t we go back to the original premise and talk about adjusting the line?” he said.

The governor said he’s open to other proposals by the Republican-led Legislature--as long as they don’t have the effect of gutting Oregon’s nationally touted plan.

“I’m not going to sign up for that,” Kitzhaber said. “At some point, you really wouldn’t have a benefits package.”

Jensen said she hopes that lawmakers will keep people such as her son in mind when they make decisions about the health plan.

“Just take a look at him,” she said, gesturing toward the smiling, curly-haired Korben. “That’s what I’d say to the Legislature. The health plan is a great thing for people who have a job like I did with no health insurance.”