Pressadvisory9213-ocr

Eurrmn l

nl the

Unllrh imlu

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

rhe srale nl' Drcgnn rn dramalically change rhe slale

Many srales as well as rhe lcderalgnyernrucnl

nlrhe eurrenl heallh care svsrem.

analysis era prnpnsal hy

030s Medicaid pregram,

arc srruggling wir.h rhe severe cnsr and access prnhlems

(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

make prrvale healrh insurance mnre avaliable, lhe srale is seeking federal apprnval ln

vnnsr Medicaid beneliciaries in snnlc

"galekeepef primary

alrenrpring ru

expand Medicaid

care such as a heallh mainlcnance urganizarinn

nr

a

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

ranked lisr ol wi heallh cnnduinns

nurse: dlrhe

fern-. nlmanagcd

ll)

leg. appendnlrls) paired with lrcalmenls

inilialive, rhe srale prnpuses lhar SK7 nl lh:

leg. appenllecxnmics)

Al rlle

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

currcnl

Lisr,

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

be newly ellgihle under rhc waiver ~

implicariirns nrrhe new cliglbilily

en currenr

Ar a benenl lcacl

be leglrrmarely crrlrcizcd on grnumls rhere is

ser ar line 587 nn

Medicaid parlinpanrs is nnl

lhn prlmirized

UTA

lmpnrranr

Mcilicard under lhe currenl

alsn lnund lnal

was ullimarely dcpendenl

lisr, lh:

024 lhc

a clcar ner Inss ln currenl

nyerall ner elrecls nl cnlcrage changes

clearly eilher holler nr wnrse rhau cnyurag; undcr rlle currvur

lhc ner ellerl cannnl be preclicred sl-llh cnnlidence

whe wnuld be eligible mr

lnr Medicaid heuelils under currenl rules ·

and cnvcrage rules are unamhignusly grind,

0regun's prnpnsal cannnr

lwcneuciaries

lhnsq whn canmir qualify

lflhe

program;

services arc hell: lnsl and gained ar lhl: currcnr

prngram

would nnl be eligible under rhe dernnnsrrariun

desprle lhe slalc's bear ellnrrs, lhe ranking ulrhe

709 enndilinnrrrearenenr pairs

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

lhe lisl ix nnr

heallh care

irrarnlnal

nr

Furrher, OTA cnnrludes lhal ralsen as a uhnle,

discriminarnry

Accnrding lu OTA. rhe main prnhlern nllhe prinriliwed

dccislnns al·nur care lnr individual palrerrrs.

mixed pallenrs sx-nh hnlh

rhe lisr.

This

and, wilh lln:

llne drawn ar W7,

and appears acccplahle rn rhe cirizens nf Orcgnn

lr is fundamentally

lisr

relares rn ils

use by clinicians ln

mnlc

prublemaxic rhar Oregen's ranking prnces:

lerygcmd and very l-anu prngnnses in rhe samc heallli mndirinn and rrealrncnl parr nn

slurrlcnmrng cannnr be remedied willleur

may he impnsxihle ru implemenr.

nlferr many npparlunilics

lnr

making a signilicarnly mere cumpliulcd

Also, lhe Iisr shuuld nnl

'gaming lhe sv
ranking rhar

be cnunled nn as a cusl cunlainnrerrl mul hcuusc il

and 034 is nur

mlcnded lo ldenuf;

and limir

unnecessary servlccs

The lack nin guaranmed minimum ser nfhenelixs, bclnw which

is wnnisnme Ku OTA, especially hccausc OTA believes that the stun

dcmnnsuzulun.

ll costs are signmcnntly higher than expected,

cnvrragc would nur be allowed In fall.

may luv:

underestimated lhe costs of lh:

cmd lfhiedlmld banzllls were reduced ln rh:

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

publxc funding [ur Llregmfs Medncard program

the economy and ln

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

(mm

mlllinn

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

ulwhether in ls

nnswex the qucsrlans

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.

great interest in

OTA alsu mnclmles

managed car: coupled with past experience, Oregon wnuld be .1 gmd sum

expxnding managed car: in Medicaid Lu evaluate whuhu ir can cnnlain

Tlus

Cummine:

null

report was prepared in

un

mspnnse In an rcqucsr

rlul because nil';

I0 les!

the vlnbxlily ul

health we costs and impmvc quality al

[mm Rep. lulm Dingell,

Clminnnn ul due House

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

the Envlrunmem.

The

request hr

this

study was endorsed by Scnalnr AI Gore, Cluinunn

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

Pnckwnod and Mark Hzmeld,

Reps. Mike Kupctslri,

ul rh: Sennlc

Senators Hah

Les AuC¤m, Peter D¤Fazi¤, Ran Wydeu,

and Ruben F,

(Hum Smith. Copies ofthe 32

0317

024pag: repnn Ewzlummn

cnngressiuna] use Are Avanlnhle by culling 443241.

lg/the Oregon Mcdicmd Proposal nr its 21

024pag: summary lor

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!).

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

37*

Snmmarles ue

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