Los Angeles Times, March 10, 2008: In Oregon, healthcare for the lucky

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By Stuart Glascock
Los Angeles Times Staff Writer

March 10, 2008

SEATTLE Tens of thousands of Oregonians queued up quickly for a chance at the state’s latest lottery, but this one is no game.

Officials began drawing names last week for a chance at some rare openings in the state’s healthcare plan.

Announced in February, the lottery drew 91,675 hopefuls in 30 days. The winners will receive a postcard notifying them that they can apply for the Oregon Health Plan.

Like millions of people across the country, cash-strapped Oregonians bypass doctors, forgo prescription drugs and neglect basic healthcare when they can’t afford health insurance. The state’s Department of Human Services says at least 600,000 Oregonians live day to day without health insurance.

For some, life or death could hinge on the outcome of the unique insurance lottery.

Budget limitations capped the Oregon Health Plan standard benefit package in mid-2004. Now the plan has room for a few thousand people. The lottery winners will be the first new applicants since the cap was imposed.

Oregon’s standard plan covers physician services, prescription drugs, mental health and chemical dependency services, emergency medical services, and limited dental, hospital and vision benefits. Premiums range from zero to $20.

When it was fully funded, it was considered a trailblazing program. In 1996, the benefit package enrolled five times as many people as are enrolled today, and only 10.7% of Oregon’s population lacked insurance, compared with about 16% today.

Long odds of winning the healthcare lottery didn’t deter Judith Padgett, a 55-year-old resident of Keizer, a suburb of Salem, the capital. She can’t afford healthcare, avoids doctors, and goes without prescription drugs because they’re too expensive. She is banking on the state-sponsored insurance lottery.

“I’m just hoping that I’m lucky,” Padgett said. “I really do need it.”

Padgett has a rare blood disorder that has killed relatives, she said, but cannot afford healthcare on her $500 monthly stipend in an Easter Seals job retraining program.

Healthcare advocates and policymakers can recite story after story of low-income adults who don’t qualify for traditional Medicaid. Every day they see uninsured elderly, working-poor and young people trying to make ends meet with two or three low-wage jobs.

Oregon’s largest newspaper, the Oregonian, called the lottery a “jarring reminder of just how broken the U.S. healthcare system really is.”

A Department of Human Services computer in Salem is randomly picking about 3,000 people from among those who snagged reservations by the March 1 deadline.

The department will distribute more applications in coming months.

The exact enrollment figures for the program are determined by a monthly average during a two-year budget period.

Nearly 18,000 people are currently enrolled.

Anticipating demand, the department established 200 lottery sign-up sites. In February, people flocked to county health departments, hospitals, tribal health clinics and community health centers to register.

“To think that that many people signed up is unbelievable,” said Ellen Pinney, director of Oregon Health Action Campaign, a nonprofit consumer healthcare advocacy group.

The overwhelming response, she said, should “show our lawmakers the incredible need that is out there.”

Pinney acknowledged that some people considered a lottery an “absolutely ridiculous” way to make healthcare decisions. “But what is any other state doing to give access to at least some of the uninsured?” she asked.

Said Karen House, manager of self-sufficiency medical programs at the Department of Human Services: “We have a huge need.”

Oregon studied a variety of ways to allocate scarce insurance resources. It opted for random selection because that seemed the most fair, “particularly knowing we would not have funds to cover everyone,” House said.

The department secured federal approval to use the lottery process.

Federal law bans discrimination, and lotteries don’t discriminate, she said.

Meanwhile, elected officials in Oregon don’t intend to hold an annual lottery. In September, Democratic Gov. Theodore R. Kulongoski appointed the Oregon Health Fund Board to advise next year’s legislative session on better ways to address healthcare access and coverage.

“We are looking at a number of other reform approaches,” said Barney Speight, director of the board. “With so much uncertainty over what will happen at the federal level, the state is reviewing what choices we have.”

Oregon’s healthcare system will come under scrutiny again within days with the release of a report called “Dying for Coverage” by Families USA, a national nonprofit group for healthcare consumers. The report focuses on Oregon but also attempts to estimate on a state-by-state basis how many people die because they lack health insurance.

Families USA says its research builds on two previous studies on lack of insurance as a cause of death.

In 2000, an Institute of Medicine study said 18,000 adults nationwide died because they did not have health insurance.

A 2006 Urban Institute study put the number at 22,000 adults.

“It shows how dysfunctional our system is,” said Alwyn Cassil, director of public affairs for the Center for Studying Health System Change, a health policy research group. “To get healthcare coverage, you have to win the lottery.”

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