Words Matter as Much as Policies

Will Oregon Governor John Kitzhaber convince the federal government to give money back to the state because of progress here on health care reform?As a person who likes and uses words, I have noticed that the health care debate — both heading toward the U.S. Supreme Court and the 2012 Oregon Legislative session — has been marked by words apparently designed to get the attention of those involved.

Consider these examples:


  • Regarding the "you-have-to-buy-health-insurance mandate" that is heading to the U.S. Supreme Court, a health economist at the Massachusetts Institute of Technology, put it this way:  "Health reform without an individual requirement is the spinach you need to get the chocolate you want."
  • On the same issue, a former health care policy advisor to President Bill Clinton was quoted last week as saying that "health reform without an individual mandate is like driving a train without tracks; you can still move, but you can't get to your destination and it will be a tougher and far more costly trip."
  • Or, consider this quote used last week in an update for Oregon legislators on the Health Insurance Exchange: "Our assumption is that the exchange is being born in a political battlefield. Half of Oregon never wanted you to exist and other half wanted much more than what you are. It seems your biggest challenge will be to gain the trust from both sides that you are an honest broker of information and opportunity — not the purveyor of a political agenda."
  • And, finally, in a another report to legislators on the new, magic answer to health care reform in Oregon, Coordinated Care Organizations (CCOs): "...(there is) general consensus that the two most telling factors in gauging CCO financial solvency will be its risk reserves and the type of reinsurance."


For the Supreme Court, many words are being written about the decision, expected next spring or summer, on the future of "ObamaCare."  If the individual mandate does not survive, it does not require a leap of logic to believe that the entire ObamaCare proposal comes tumbling down at the very time the President is running for re-election.

Think of it this way. If states can require automobile insurance for the privilege of driving to protect public safety, why can't Congress require everyone to buy health insurance for the privilege of...well, living?

In Oregon, the focus of the health care debate has been on new ways to deliver health insurance. A business plan for the new Health Insurance Exchange, essentially a shopping center for health insurance, must be reviewed and approved by legislators in the February annual session before the Exchange can launch. At the same time, a business plan for the CCO approach to organizing health care — and perhaps a host of other social services—- also must survive the February legislative review. If terms and conditions for CCO formation, including the necessity to bear the financial risk for the health and other services to be provided, then the CCOs will be formed around the state in time to begin organizing services by July 1, 2012.

No one knows how many will be formed, what services they will cover or what clients will be affected, but one thing is clear:  The stakes are very high.  The legislatively approved budget for the second year of the biennium, 2012-13, includes an assumed "savings" of $239 million in general funds based on the claim that CCOs will operate more efficiently. Most observers believe the $239 million will be achieved by cuts to health and other services, not efficiencies, in the short run. 

There is almost no chance the governor or legislators will restore the $239 million in the February session. In fact, the Kitzhaber Administration is asking the Obama Administration to consider giving back to Oregon a portion of the resulting savings in federal Medicaid match dollars that would accrue with the $239 million state general fund cut.  

Kitzhaber officials contend because Oregon is making progress on reform as a national leader on a new way of doing business, the federal government should help with the effort and give money back to the state. No one is taking bets on whether the Kitzhaber entreaty will succeed, though his status as a national health care expert could give him more traction than anyone else.

CFM partner Dave Fiskum has represented health care clients before the Oregon Legislature for more than 20 years.