Jodi L. Liu

A Comprehensive Assessment of Four Options for Financing Health Care Delivery in Oregon

This article 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.

MACRA's Effects on Medicare Payment Policy and Spending

The Medicare Access and CHIP Reauthorization Act (MACRA), enacted by Congress in 2015, was intended to eliminate a long-standing conundrum about how to determine Medicare reimbursement rates for physician services. MACRA also represents an aggressive expansion of the value-based payment model in Medicare, consistent with the ambitious goals set by former U.S. Department of Health and Human Services Secretary Sylvia Mathews Burwell.