A Comprehensive Assessment of Four Options for Financing Health Care Delivery in Oregon.

This article describes four options for financing health care for residents of the state of Oregon and compares the projected impacts and feasibility of each option. The Single Payer option and the Health Care Ingenuity Plan would achieve universal coverage, while the Public Option would add a state-sponsored plan to the Affordable Care Act (ACA) Marketplace. Under the Status Quo option, Oregon would maintain its expansion of Medicaid and subsidies for nongroup coverage through the ACA Marketplace.

Oregon's Medicaid Transformation: An Innovative Approach To Holding A Health System Accountable For Spending Growth.

In 2012, Oregon initiated a significant transformation of its Medicaid program, catalyzed in part through an innovative arrangement with the Centers for Medicare and Medicaid Services (CMS), which provided an upfront investment of $1.9 billion to the state. In exchange, Oregon agreed to reduce the rate of Medicaid spending by 2 percentage points without degrading quality.

Greatest impact of safe harbor rule may be to improve patient safety, not reduce liability claims paid by physicians.

"Safe harbor" legislation that provides liability protection to physicians when they follow designated guidelines is often proposed as a way to reform the malpractice system while improving patient safety. However, published evidence provides little policy guidance on implementing safe harbors. With the support of an Agency for Healthcare Research and Quality planning grant, we conducted an empirical analysis of closed liability claims in Oregon to determine the potential effects of hypothetical safe harbor legislation.

Defining the medical home: the Oregon experience.

Objective: The patient-centered medical home (PCMH) is emerging as a key strategy to improve health outcomes, reduce total costs, and strengthen primary care, but a myriad of operational measures of the PCMH have emerged. In 2009, the state of Oregon convened a public, legislatively mandated committee charged with developing PCMH measures. We report on the process of, outcomes of, and lessons learned by this committee.

Impact of Medicaid cutbacks on emergency department use: the Oregon experience.

Study Objective: Federal policy changes and tightened state budgets may reduce Medicaid enrollment in many states. In March 2003, the Oregon Health Plan (Oregon's Medicaid expansion program) made substantial changes in its benefit package that resulted in the disenrollment of more than 50,000 beneficiaries. We sought to study the impact of these Oregon Health Plan policy changes on statewide emergency department (ED) use.

Effect of eliminating behavioral health benefits for selected medicaid enrollees.

Objective: To determine the extent to which the elimination of behavioral health benefits for selected beneficiaries of Oregon's Medicaid program affected general medical expenditures among enrollees using outpatient mental health and substance abuse treatment services.

Data Source/study Setting: Twelve months of claims before and 12 months following a 2003 policy change, which included the elimination of the behavioral health benefit for selected Oregon Medicaid enrollees.

Study Design: We use a difference-in-differences approach to estimate the change in general medical expenditures following the 2003 policy change.

"Mind the Gap" in children's health insurance coverage: does the length of a child's coverage gap matter?

Objective: Gaps in health insurance coverage compromise access to health care services, but it is unclear whether the length of time without coverage is an important factor. This article examines how coverage gaps of different lengths affect access to health care among low-income children.

Methods: We conducted a multivariable, cross-sectional analysis of statewide primary data from families in Oregon's food stamp population with children presumed eligible for publicly funded health insurance.

How effective are copayments in reducing expenditures for low-income adult Medicaid beneficiaries? Experience from the Oregon health plan.

Objectives: To determine the impact of introducing copayments on medical care use and expenditures for low-income, adult Medicaid beneficiaries.

Data Sources/study Setting: The Oregon Health Plan (OHP) implemented copayments and other benefit changes for some adult beneficiaries in February 2003.

Study Design: Copayment effects were measured as the "difference-in-difference" in average monthly service use and expenditures among cohorts of OHP Standard (intervention) and Plus (comparison) beneficiaries.

Uninsurance among children whose parents are losing Medicaid coverage: Results from a statewide survey of Oregon families.

Context: Thousands of adults lost coverage after Oregon's Medicaid program implemented cost containment policies in March 2003. Despite the continuation of comprehensive public health coverage for children, the percentage of uninsured children in the state rose from 10.1 percent in 2002 to 12.

Uninsured but eligible children: are their parents insured? Recent findings from Oregon.

Background: Despite expansions in public health insurance programs, millions of US children lack coverage. Nearly two-thirds of Oregon's uninsured children seem to be eligible for public insurance.

Objectives: We sought to identify uninsured but eligible children and to examine how parental coverage affects children's insurance status.

The demise of Oregon's Medically Needy program: effects of losing prescription drug coverage.

Background: In January 2003, people covered by Oregon's Medically Needy program lost benefits owing to state budget shortfalls. The Medically Needy program is a federally matched optional Medicaid program. In Oregon, this program mainly provided prescription drug benefits.

Health policy roundtable: how are Medicaid and SCHIP weathering the storm?

States recently went through a period of rising Medicaid costs and declining revenue, creating pressure to cut the program, while economic hardships, population expansion, and changes in the private sector created counter pressures to swell its ranks. This roundtable, organized and moderated by Alan Weil, presents a variety of perspectives on recent events, including a national overview of how Medicaid and SCHIP fared relative to other state priorities, one state's experience with significant cuts and the research questions that arose from them, and another state's use of research and evidence to prevent having to make drastic reductions to its programs.

The impact of increased cost sharing on Medicaid enrollees.

Many state Medicaid programs are implementing cost-saving mechanisms, but little is known about the impact of those strategies on low-income people. Recent increases in cost sharing for Oregon Health Plan (OHP, Oregon's Medicaid program) members have created a natural experiment that is ideal for examining such impacts. Early results from an ongoing cohort study suggest that cost-sharing increases led to a large reduction in OHP membership.