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Health reform is under way in Oregon

 Posted: 2:00 AM April 29, 2013

Time Magazine ran an amazing issue telling us all about what is wrong with health care in the United States. Paul Ryan still wants to repeal the Patient Protection and Affordable Care Act, or PPACA, ("Obamacare") — somehow, I thought he was on the losing ticket in last November's election. States with Republican governors are now joining those with Democratic governors in expanding access to Medicaid in 2014. Many states are working hard on setting up health insurance exchanges.

But what does all this mean to us as residents of Southern Oregon? Are there really any signs we are moving in the right direction?

I'm glad you asked. Here is what is happening locally.

First, we are anticipating the including of many more people whose personal/family income is below 138 percent of the federal poverty line starting in January 2014. This is a good thing for people who will now be able to access the coverage, and for the people of Oregon, the expansion comes at no additional cost for medical care because the federal government will be covering the bill for the first three years.

Second, the move to establish a health insurance exchange in Oregon is moving forward apace. The organization to be responsible is Care Oregon, and the rules by which it will gain the participation of health insurance companies and judge the appropriateness of what they offer are being solidified right now.

The exchange will provide two services: First, it will help shoppers to compare insurance offerings to select the one most appropriate for them; second, it will help arrange a federal subsidy for people who qualify. This financial assistance in purchasing health insurance is part of the PPACA and is to help people who cannot afford the high cost of premiums to obtain coverage.

Third, Oregon is assisting in the formation of Coordinated Care Organizations, or CCOs, which are our home-grown version of the PPACA's Accountable Care Organizations. The idea is that the Oregon Health Plan will contract with selected organizations that will be charged with providing coordinated services from physicians, mental health workers, dentists and hospitals. These organizations will share information internally to avoid costly repetition of tests and to be sure each new person or organization providing care knows what the others are doing.

It is widely estimated that there are substantial monetary savings to be gained by eliminating the waste of repetition and the consequences of poor communication. It seems that these same organizations will be in a position to do some really creative things to improve quality of care and access to care for their enrollees. In Oregon, the CCOs will be leading the health care reform transition in many important ways.

All of this sounds so wonderful, it seems sad that initially it will only involve enrollees in the Oregon Health Plan. However, the CCOs are new, so it is a good idea to let them start small and grow into their jobs, and let the number of enrollees increase over time.

It may well be that Oregon state employees will be the next group enrolled in CCOs. If the experiment proves to be very successful, we may see CCOs contracting with Medicare and with private insurance companies, so that we can all experience the benefits they provide.

Who are the CCOs? Currently, there are two CCO organizations serving Jackson County. They are called Jackson Care Connect and All Care Health Plan. The Oregon Health Plan population in Jackson County will be divided between the two, but we understand that individual enrollees will be allowed to change plans if they wish to do so. It seems pretty clear that all Jackson County hospitals and most Jackson County physicians will be available in both plans.

What can you do? Let your legislators know how much you support this effort to improve health care services in Oregon. Look for the organizations mentioned in this article online and find out what they are doing. The CCOs need to have Oregon Health Plan members sitting on their Citizens Advisory Committees — call them and volunteer to help out. Oregon Action will be focusing on health care issues in our community. For information on how to be involved, call Oregon Action at 541-772-4029. And keep your eyes and ears open. There will be more news coming.

Roger Howe, M.D., MMM, is the author of "Healing Healthcare: How to Fix Our Broken Healthcare System." He lives in Medford.

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