SALEM — Two proposals that would kick-start a move for universal health care coverage at both the state and national level are awaiting action by the budget-writing Ways and Means Committee.
One is the so-called Bates-Westlund reform. The second is being offered up by former Gov. John Kitzhaber and his Archimedes Movement.
While there are similarities, there also are some major differences — not the least of them being the scope of each plan.
Sens. Alan Bates, D-Ashland, and Ben Westlund, D-Tumalo, limit their coverage to eligible Oregonians. Kitzhaber says the only way to avert a looming crisis in health care is to go national.
The framework, however, would be developed in Oregon, which is why Kitzhaber has come to the Legislature seeking state dollars to develop a blueprint for national reform.
The Ways and Means co-chairs have reserved $1 million and many in Salem believe Bates and Westlund have the inside track in securing the funding.
But the former governor is not giving up, and recently proponents met in the Capitol, then listened to a passionate pep talk from their leader before fanning out to lobby individual legislators.
Kitzhaber believes the nation's health care crisis cannot be solved on a state-by-state basis.
He wants to put together a proposal, utilizing existing resources, to force federal action for true universal coverage and cost containment.
"It's a big bill, but as I told the folks in here, there is no risk to passing the bill (Senate Bill 23) unless you're afraid to talk about the issues we have to take on to maintain the health care system," Kitzhaber said.
He said the Archimedes Movement will produce a detailed blueprint by July 1, 2009, on what a national model would look like. "It will be based on a clear set of assumptions concerning the objective of the health care system ... and how health care should be financed and delivered," Kitzhaber said in an interview.
There have been suggestions that the plans are in competition for the high ground in health care reform. But Kitzhaber rejects that notion.
"I strongly support Bates-Westlund and Gov. Ted Kulongoski's Healthy Kids initiative to extend coverage to all children through an increase in cigarette taxes," Kitzhaber said.
He said ideally the Legislature in 2009 would vote to implement the provisions of Bates-Westlund and at the same the Oregon congressional delegation could introduce the national reform package. "They're very complimentary," Kitzhaber said.
The Archimedes Movement was created in January 2006. There are 39 chapters around the state, Kitzhaber said. Most of the major insurance carriers are involved, along with 13 hospital chief executive officers and 50 to 60 employers, doctors and union representatives.
"They basically wrote Senate Bill 27, it didn't just come out of my head," Kitzhaber said.
The former emergency room physician recognizes the enormous challenges ahead. "One of the biggest problems in changing the health care system is fear of the unknown," he said.
He said people will hold on to what they have, even though it isn't serving their needs.
"In order to move the agenda," Kitzhaber said, "you have got to be able to ... demonstrate that there is a better way to do this."
The framework for Senate Bill 329 — the Bates-Westlund plan — was developed after intense work prior to the session, then hearings both in Salem and around Oregon by a special committee created to fill in the details.
The bill authorizes hiring a director and four or five staffers over the next two years to flesh out the plan, including federal waivers for Medicaid dollars (Medicare is not part of the financing) and a system in which employers could buy in with employees picking up a share of the costs.
"One of the reasons I think this is going to work is that medium and small employers simply can't afford to cover their workers," said Bates. Larger employers such as big box stores who do not provide insurance for their workers could wind up paying a payroll tax, he said.
Every eligible Oregon resident would receive a health card, and the plan includes a strong preventative care component. Bates estimates some 615,000 people, or 18 percent of the population, are uninsured. Illegal immigrants would be ineligible, but Bates, a family practitioner, said they can continue to use state clinics and hospital services.
"They're here, they pay taxes, they are part of our economy. We need to take care of them," Bates said.
The biggest roadblock? "Fear of change," said Bates, echoing Kitzhaber.
"Most people in Oregon have health care coverage," he said. "Most people are fearful they are going to lose it. They're fearful that when they are 65 Medicare isn't going to be there."
Bates is confident the bill will get through the Legislature, and he said he has assurances from the governor that he will sign it.
Watching the process unfold are business groups, including the Oregon Business Council, comprised of the CEOs of the 50 largest corporations in Oregon. Bill Kramer, a health care and health policy consultant, is the point man for OBC.
The council has not endorsed either proposal but it recognizes the urgent need for health care reform, he said.
"We are trapped in a system that simply does not work," he said. "It's unsustainable."
This is particularly true for companies such as Intel and Nike, who compete internationally against companies whose health care costs are lower, Kramer said.
At the same time, he said business would like it made clear that employers can continue to have flexibility to design plans that meet the needs of their employees. A problematic issue with the Kitzhaber plan is that it ends the tax exemption for benefit plans, using those savings to provide coverage.
But overall, OBC recognizes the need for both short-term solutions — the Healthy Kids Initiative and the Bates-Westlund reform — as well and the Kitzhaber approach and efforts by U.S. Sen. Ron Wyden, D-Ore., for reform.
"The devil, however, is in the details," Kramer said.
Don Jepsen is a freelance writer living in Salem. Reach him at email@example.com.