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Projected Effects of Single Payer Option in 2020

• Enrollment would increase.
• Financial barriers to accessing care would be significantly reduced for low- and middle-income individuals.
• Total health system costs in Oregon would not change much.
• Aggregate provider reimbursement would decrease.
• System congestion would increase.
• There are major hurdles to federal approval that might require federal legislation.
• Implementation would require significant changes to state administration and roles.

Projected Effects of Health Care Ingenuity Plan in 2020

• Enrollment would increase.
• Financial barriers to accessing care would be reduced for low-income individuals.
• Total health system costs in Oregon would increase.
• Aggregate provider reimbursement would increase.
• System congestion would decrease.
• There are major hurdles to federal approval.
• Implementation would require potentially significant changes to state administration.

Projected Effects of Public Option in 2020

• Enrollment would increase modestly.
• Financial barriers to accessing care would be slightly reduced.
• Total health system costs in Oregon would decrease.
• Aggregate provider reimbursement would decrease.
• System congestion would increase slightly.
• Federal approval would not face major hurdles.
• Implementation would be feasible.

This report describes four options for financing health care for residents of the state of Oregon and compares the projected impacts and feasibility of each option. The Single Payer option and the Health Care Ingenuity Plan would achieve universal coverage, while the Public Option would add a state-sponsored plan to the Affordable Care Act (ACA) Marketplace. Under the Status Quo option, Oregon would maintain its expansion of Medicaid and subsidies for nongroup coverage through the ACA Marketplace.

The state could cover all residents under the Single Payer option with little change in overall health care costs, but doing so would require cuts to provider payment rates that could worsen access to care, and implementation hurdles may be insurmountable. The Health Care Ingenuity Plan, a state-managed plan featuring competition among private plans, would also achieve universal coverage and would sever the employer–health insurance link, but the provider payment rates would likely be set too high, so health care costs would increase. The Public Option would be the easiest of the three options to implement, but because it would not affect many people, it would be an incremental improvement to the Status Quo. Policymakers will need to weigh these options against their desire for change to balance the benefits with the trade-offs.

• Chapter One

  Background and Context

• Chapter Two

  The Four Options

• Chapter Three

  Evaluation Criteria

• Chapter Four

  Overview of Methods and Assumptions

• Chapter Five

  Comparisons of the Options

• Chapter Six

  Implementation and Administrative Considerations

• Chapter Seven

  Alternative Specifications for the Options and Other Considerations

• Chapter Eight

  Assessment of the Options

• Chapter Nine

  Recommended Next Steps

• Appendix

  Methods, Data Sources, and Detailed Results