A state task force is meeting regularly, charged by the Oregon Legislature to figure out how a single-payer health care plan might work in Oregon. It’s a big deal.
Single payer is often called “Medicare for all.” It would be a lot like Medicare in that everyone would have the same health insurance plan, though people get to choose where they get care.
Could it be an improvement? Yes. There’s sure room for improvement. But there are also complicated problems to sort out, and others that such a program could create.
The first obstacle is public opinion. Try telling people: Your health plan is going away. And we have some new taxes. The new system will be better. Your state government will get it right just like always!
Oregon’s Joint Task Force on Universal Health Care is looking at the big questions. How would Oregon pay for it? How much care is the “right” amount? How would eligibility work if people come to the state? Would it be allowed under federal law?
This week the task force takes on the issue of the federal ERISA law. The Employee Retirement Income Security Act of 1974 sets standards for retirement and health plans in private industry. ERISA also sort of creates a roadblock, stopping states from experimenting with health care reform.
If a single-payer option was created in Oregon, it might be challenged under ERISA. Employers that are self-insured might argue that a state, single-payer plan funded by a payroll tax would put pressure on employers to drop their coverage for their employees or they would be effectively paying twice. That happened in Maryland and the plan was struck down, according to documents for this week’s meeting.
It’s not clear that Oregon would stick to that script. What Oregon would likely do is seek a waiver from the federal government from certain requirements of ERISA. If that was granted, one problem could be solved.
As problems go with creating a single-payer system, dealing with ERISA may be one of the easier ones. It would be a mistake for legislators to assume that because there are clear Democratic majorities in both houses of the Legislature and in Oregon’s top elected offices that Oregonians are ready for a state takeover of health care. That’s still a tough sell.
Smaller steps would probably be smarter than one big swooping change, to build trust and to build government competency. We’re not saying that’s what the state should do. Just that it would be smarter.