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Eurrmn nl the Unllrh imlu

l TECNNOLOG, ASSESSMEM

NOTF This repnrl was released en April 1/l, l991 in page proul lin-mal. Prinrcd cnpies Mrhe summary as

wcll as rlre full repnrr are nam available.

Thc cnngressienal Ullicc nlTechnnlogy Asessmcnr (OTA) rnday released ils analysis era prnpnsal hy

rhe srale nl' Drcgnn rn dramalically change rhe slale 030s


Medicaid pregram,

Many srales as well as rhe lcderalgnyernrucnl arc srruggling wir.h rhe severe cnsr and access prnhlems

nlrhe eurrenl heallh care svsrem. (rregnn is cme nl lhe lirsl srales ro prnpuse cnmprehansrve reforms lu

oregon': Medicaid prnprml, wlneh nails {ur a S-year demnnsrrarinn prcigrarn, is parr ala srare

lcgixlarive inilialiyu ln address rhe needs nl resldenrs uilhnul hnallh insurance, ln addilinn ln alrenrpring ru

make prrvale healrh insurance mnre avaliable, lhe srale is seeking federal apprnval ln ll) expand Medicaid

vnnsr Medicaid beneliciaries in snnlc fern-. nlmanagcd care such as a heallh mainlcnance urganizarinn nr a

"galekeepef primary carc physician; and (3; Iimir Medicaid acule and primary healrh care henelils based an a

ranked lisr ol wi heallh cnnduinns leg. appendnlrls) paired with lrcalmenls leg. appenllecxnmics) Al rlle

nurse: dlrhe inilialive, rhe srale prnpuses lhar SK7 nl lh: 709 pairs be paid hir.

Amnhizr unique aspecr nflhe prnpnsal is ils waiver nf legal liahilily nl prnwders [nr den)-lug Medicaid

palierrrs medically necexary lrcalmenrs rhar {all hclnw lhe cumll puinl uu lhe pr-inrilived Lisr,

currcnl lederal rcquiremenrs hir lhis lederallyeluncled, sraleradminisrered heallh program lur rhe pnnr. lflhe

be newly ellgihle under rhc waiver ~ lhnsq whn canmir qualify lnr Medicaid heuelils under currenl rules · 024
lhc

implicariirns nrrhe new cliglbilily and cnvcrage rules are unamhignusly grind,

0regun's prnpnsal cannnr be leglrrmarely crrlrcizcd on grnumls rhere is a clcar ner Inss ln currenl

lwcneuciaries Ar a benenl lcacl ser ar line 587 nn lhn prlmirized lisr, lh: nyerall ner elrecls nl cnlcrage changes

en currenr Medicaid parlinpanrs is nnl clearly eilher holler nr wnrse rhau cnyurag; undcr rlle currvur program;

lhc ner ellerl cannnl be preclicred sl-llh cnnlidence lmpnrranr services arc hell: lnsl and gained ar lhl: currcnr

whe wnuld be eligible mr Mcilicard under lhe currenl prngram would nnl be eligible under rhe dernnnsrrariun

UTA alsn lnund lnal desprle lhe slalc's bear ellnrrs, lhe ranking ulrhe 709 enndilinnrrrearenenr pairs

was ullimarely dcpendenl nn lhe lurlgmenls nfrhe rnemhers nl`lh¤ cunrmlxlun rhnl produced rlre lisr because

erisring healrh nulrnmes inlrrrmarinn is cnrirrly madequalc ln scierlrmrally rank all hcalrh services by

decisinnmakulg in heallh care Furrher, OTA cnnrludes lhal ralsen as a uhnle, and, wilh lln: llne drawn ar W7,

lhe lisl ix nnr irrarnlnal nr discriminarnry and appears acccplahle rn rhe cirizens nf Orcgnn

Accnrding lu OTA. rhe main prnhlern nllhe prinriliwed lisr relares rn ils use by clinicians ln mnlc

dccislnns al·nur care lnr individual palrerrrs. lr is fundamentally prublemaxic rhar Oregen's ranking prnces:

mixed pallenrs sx-nh hnlh lerygcmd and very l-anu prngnnses in rhe samc heallli mndirinn and rrealrncnl parr nn

rhe lisr. This slurrlcnmrng cannnr be remedied willleur making a signilicarnly mere cumpliulcd ranking rhar

may he impnsxihle ru implemenr. Also, lhe Iisr shuuld nnl be cnunled nn as a cusl cunlainnrerrl mul hcuusc il

nlferr many npparlunilics lnr 'gaming lhe sv<lc·rn and


034 is nur mlcnded lo ldenuf; and limir unnecessary servlccs
The lack nin guaranmed minimum ser nfhenelixs, bclnw which cnvrragc would nur be allowed In fall.

is wnnisnme Ku OTA, especially hccausc OTA believes that the stun may luv: underestimated lhe costs of lh:

dcmnnsuzulun. ll costs are signmcnntly higher than expected, cmd lfhiedlmld banzllls were reduced ln rh: V

luune ru cumpenszr: (as rh; prupnsnh design requires in cas: ol ¤ funding shnnfzll). bcuzlicizxies would stand

.1 grezner likelihlwd al harm, Hnwcvu, even in the abszncz ul me proposed demonstration, il is yxxslble that

hencms tu current henellcnznes would be reduzed ln Lb: hnure due In underlying unda in the economy and ln

publxc funding [ur Llregmfs Medncard program In Unis Inner use, unrrenl beneficiaries could also be placed at

greater likelilmnd nl` harm due m fewer bench.: nr loss cl elijhllky.

According lu the slate, the 5-yen dcmcnslrzlinn prngam would require an nddjdunal $143 mlllinn

(mm the Federal government. with n potential 10 recnup SIW millinn in saving; tu the lxledlcnm program, [nr n

ncl Fcdcml ws! uf X109&> mlllian.

As n msuxch demcnsrnrlun pmjecx, OTA says, the pmgam wnuld have grur. difliexnlly determining

the dlllzxennal eI`l'::d.s nl managed ure expansions and szrvicc pdoddudon nn pmgnm costs and pavjenr

untcames. However. sum: policymakers view the proposal as nu experiment designed in nnswex the qucsrlans

ulwhether in ls passable 7- using the cnmblnzuun uf mednamkms Drcgmx propose: ~ xc pmvid: acceptable

health me coverage In rh: poor uninsured pcpulaxlou wuhuul sigmllunlly raising ncsu. Viewed in this light,

lhe pmgam, if successlnl could he an lnlnrmzdve demunszraxion for otherstale: In examine, unly if Ihnw suits

were cmuidenng implrmennng lh: tnul ccmbxnatlnn nl rnechznisms. OTA alsu mnclmles rlul because nil';

great interest in managed car: coupled with past experience, Oregon wnuld be .1 gmd sum I0 les! the vlnbxlily ul

expxnding managed car: in Medicaid Lu evaluate whuhu ir can cnnlain health we costs and impmvc quality al

Tlus report was prepared in mspnnse In an rcqucsr [mm Rep. lulm Dingell, Clminnnn ul due House

Cummine: un Energy and Commerce, uml Rep. Henry Wvunan. Chmrmrm ahh: Subcommittee un Health

null the Envlrunmem. The request hr this study was endorsed by Scnalnr AI Gore, Cluinunn ul rh: Sennlc

Subcommittee un Science, Technulngy, and Spas: and the Oregon delegaunn, lnduding Senators Hah

Pnckwnod and Mark Hzmeld, Reps. Mike Kupctslri, Les AuC¤m, Peter D¤Fazi¤, Ran Wydeu, and Ruben F,

(Hum Smith.

Copies ofthe 32 0317 024pag:


repnn Ewzlummn lg/the Oregon Mcdicmd Proposal nr its 21 024pag:
summary lor

cnngressiuna] use Are Avanlnhle by culling 443241. Copxes ul me xepnn for nnueouyealonal use may he

nblained from the Superintendent uf Dnnnnenu, U5. Government Prixmng Gmc: (GPO}; Wzulningmn, D.C.

20402.03D; phnne (EEZ] The stock number is ¤5Z-003-012979; rh: pnce is UTA!). Snmmarles ue

available nr nn clung: hy calling (IUI) 214-8990.

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