ABSTRACT
In 1989 Oregon became the first state in the nation to adopt legislation that explicitly rations or prioritizes health care for the poor. The Oregon Health Plan, originally called the Oregon Basic Health Services Act, guarantees health care to all those whose incomes fall below the federal poverty level, but limits that care to what expert opinion, community sentiment, legislative judgment, and fiscal reality deem a "basic level of services." This chapter focuses on the most publicized and controversial aspect of the Oregon plan, namely, the prioritizing of health services for the Medicaid population. At the heart of the Oregon reform is Senate Bill 27, which explicitly confronts the most critical challenges facing the nation's health care system. Oregon's road to prioritizing and rationing health services began in the 1987 legislative session, when the state decided to eliminate funding of organ transplants for Medicaid recipients.
