AS Congress and the Clinton administration continue to wrestle with health care, Oregon's controversial plan is about to get its first real test.
The results could sway the direction of national health care, particularly if Hillary Rodham Clinton's earlier opposition is reversed. How well the plan succeeds could also determine Oregon's next governor.
The Oregon Health Plan, which goes into effect Feb. 1 for a five-year trial run, is distinctly different from Medicaid, health care for the poor jointly funded by state and federal governments. Currently, states budget as much as they can and then allocate health-care services to those below a certain income level. This means that many families below the federal poverty level remain ineligible.
The Oregon plan will provide Medicaid to all those financially qualified, but it limits the kinds of medical procedures available. In essence, it draws the line on procedures instead of individuals. In practice, it means that 120,000 previously unqualified recipients (mostly poor women and children) now come under Medicaid here.
Critics call this ``rationing'' - lower-quality health care for those of lesser means.
Supporters say virtually all the most important medical treatments (including preventative ones) are included.
In a process that took several years, health-care providers, social workers, and consumers developed a list of 696 conditions and treatments ranked in order of importance based on effectiveness, cost, and societal values. For the current year, state lawmakers budgeted enough money to cover the first 565 of those medical procedures.
Plan widely supported
The plan has widespread political support here, but it took considerable lobbying to get the federal government to grant the necessary waiver to change Medicaid in Oregon.
As he promised in the presidential campaign, Bill Clinton granted that waiver. But Mrs. Clinton, who has taken the lead in developing the administration's health-care proposals, was very active with the Children's Defense Fund, which strongly opposed the plan. Others in the administration have spoken out against priority lists for medical procedures as well.
``We got the waiver because of Bill Clinton and not because of Hillary Clinton,'' concedes John Kitzhaber, the small-town physician and former Oregon Senate president who led the long fight for the state's health plan. An additional federal waiver is needed to require that all employers provide medical insurance or pay into a state insurance pool - another element of the Oregon plan yet to go into effect.
As a recently announced candidate for governor, Mr. Kitzhaber is counting on his success as a state lawmaker for 14 years, and in particular his effectiveness in pushing through the Oregon Health Plan, to defeat incumbent Barbara Roberts in this May's Democratic primary election.
Governor race at stake
If that election were held today, Kitzhaber would be a shoo-in. A recent poll of Oregon Democrats showed him favored over Governor Roberts by a wide margin (52 percent to 28 percent). Among Republicans, particularly lawmakers with whom he worked, Kitzhaber enjoys considerable respect as well. Although he represented a conservative timber town, he had no trouble getting reelected to the state senate despite his progressive image.
Philosophically, there is little difference between Roberts and Kitzhaber. Both are social liberals. Both are known as pro-environment and pro-gay rights and both favor a sales tax in a state that has none and is in serious budgetary difficulties.
But many Oregonians, according to polls and political observers, think Roberts has failed to deal with the state's problems - particularly the need to find new sources of revenue and reorder spending in light of recent ballot initiatives that cut property taxes and rejected a sales tax.
Kitzhaber's main pitch is that his success in bringing together many different interests on health care (whether or not the Clintons make room for it in their proposal) qualifies him to unite Oregonians on other difficult issues. ``The Oregon Health Plan is a model for finding consensus,'' he told a League of Women Voters meeting this week.
But nobody is ruling out Roberts at this early date. An up-from-the-grass-roots politician, she came from behind to beat a popular Republican state attorney general for the governor's post four years ago.