Editorial: Oregon’s plan for universal health care taking shape – bendbulletin.com

Oregon’s Universal Health Plan Initiative: A Report on Progress and Alignment with Sustainable Development Goals

Advancing SDG 3: Good Health and Well-being

A state committee in Oregon is developing a universal health care plan aimed at achieving key targets within Sustainable Development Goal 3, which seeks to ensure healthy lives and promote well-being for all at all ages. The primary objectives of the proposed plan include:

• Providing universal access to a high level of health care for all residents.
• Decoupling health care coverage from employment status, promoting equitable access.
• Allowing individuals to see any authorized provider, enhancing patient choice.
• Creating a simpler, more affordable, and sustainable health care system for the long term.

The committee is scheduled to submit a report with options for the plan to the state Legislature within the next year, with an interim report due on December 1.

Governance and Implementation Framework (SDG 16)

The proposed model aligns with SDG 16 (Peace, Justice and Strong Institutions) by aiming to create a more effective and accountable public institution for health care management. The core concept involves replacing the current system of private health insurance with a public corporation. Under this framework, the state government would assume the primary role of administering health care insurance for Oregonians.

Economic Strategy for Sustainable Financing (SDG 8 & SDG 10)

A central challenge is the development of a sustainable financing model. The committee is operating on the premise that sufficient funds already exist within the current health care system and that these funds can be redirected more efficiently. This approach supports SDG 8 (Decent Work and Economic Growth) by seeking to reduce the economic burden of health care on businesses and individuals.

A financing recommendation memo from October outlines several potential revenue-raising measures designed to be progressive and broad-based, directly addressing SDG 10 (Reduced Inequalities). The proposed options are:

1. Corporate Taxation: An increase in Oregon’s corporate income tax by 3% and the corporate activity tax by 0.1%.
2. Employer Payroll Tax: A statewide payroll tax, estimated at an 11% increase, which would replace what employers currently pay for employee insurance plans.
3. Personal Income Tax: A new personal income tax, estimated at a 9% increase, for individuals earning above 200% of the federal poverty level.
4. Income-Sensitive Premiums: A per-person premium with a maximum cap of $4,000 per adult and $2,000 per dependent.

The stated goals of this financing strategy are to:

• Redirect existing employer contributions into a universal health plan trust fund.
• Protect low and middle-income households through progressive tax policies and credits.
• Ensure broad-based, predictable contributions to maintain system stability.

Addressing Current Barriers to Health and Well-being

The universal health care initiative is a response to significant challenges within the current system that impede progress toward SDG 3. These challenges include:

• Health care costs rising faster than average incomes.
• Individuals putting off necessary medical care due to cost.
• The growth of medical debt among the population.
• The struggle for businesses to provide affordable health coverage for employees.
• Operational and financial strains on health care providers.

Analysis of Sustainable Development Goals in the Article

1. Which SDGs are addressed or connected to the issues highlighted in the article?

• SDG 3: Good Health and Well-being: The entire article is centered on creating a “universal health care plan” for Oregon. It directly addresses the goal of ensuring healthy lives and promoting well-being for all by discussing access to a “high level of health care,” affordability, and sustainability of the health system.
• SDG 1: No Poverty: The article connects health care costs to financial hardship by mentioning that “Medical debt grows” and that the proposed financing plan is designed to “protect low and middle-income households.” This relates to SDG 1, as high out-of-pocket health expenses are a major driver of poverty. The plan’s structure, which considers income levels (e.g., a new tax for those “making above 200% of the federal poverty level”), is a social protection measure aimed at preventing people from falling into poverty due to health care costs.
• SDG 10: Reduced Inequalities: The proposed plan aims to decouple health care from employment (“it wasn’t connected to their employer”), which is a significant source of inequality in health coverage. By creating a universal system where everyone is “eligible to see any authorized provider,” the plan seeks to reduce disparities in access to care. The financing mechanism is described as having “progressive policies,” further supporting the goal of reducing income-based inequalities.
• SDG 8: Decent Work and Economic Growth: The article highlights that “Businesses struggle to provide coverage for employees.” A universal health plan funded by a statewide payroll tax would replace the current employer-based insurance system. This could alleviate a significant financial and administrative burden on businesses, potentially fostering a more stable economic environment and allowing companies to invest in growth and job creation.

2. What specific targets under those SDGs can be identified based on the article’s content?

1. Target 3.8: Achieve universal health coverage, including financial risk protection, access to quality essential health-care services and access to safe, effective, quality and affordable essential medicines and vaccines for all.
   • The article’s central theme is the development of an “Oregon universal health care plan.” The text explicitly states the objectives are to make the health care system “simpler, more affordable and more sustainable” and to ensure “everyone in Oregon got a high level of health care.” This directly aligns with the goal of achieving universal health coverage and access to quality services. The mention of growing “medical debt” and the plan’s aim to “protect low and middle-income households” speaks directly to the financial risk protection component of this target.
2. Target 1.3: Implement nationally appropriate social protection systems and measures for all, including floors, and by 2030 achieve substantial coverage of the poor and the vulnerable.
   • A government-run universal health care system is a form of social protection. The article describes a financing model that is sensitive to income, specifically mentioning that individuals “making above 200% of the federal poverty level would pay a new personal income tax.” This implies the creation of a social protection floor to shield lower-income individuals from prohibitive costs, directly contributing to this target.
3. Target 10.4: Adopt policies, especially fiscal, wage and social protection policies, and progressively achieve greater equality.
   • The article details the proposed fiscal policies to fund the plan, including increases in corporate taxes, a statewide payroll tax, and a new personal income tax. The memo cited in the article explicitly states the financing recommendation includes “progressive policies.” This tax-based, government-run system is a fiscal and social protection policy designed to achieve greater equality in health care access, a key aspect of this target.

3. Are there any indicators mentioned or implied in the article that can be used to measure progress towards the identified targets?

• For Target 3.8 (Universal Health Coverage):
  • Proportion of population covered by the health plan: The goal is a “universal” plan, implying an indicator would be the percentage of Oregon’s population enrolled and covered.
  • Proportion of households with large health expenditures: The article’s concern with rising costs, “medical debt,” and the need for an “affordable” system implies that a key measure of success would be a reduction in the number of families facing catastrophic health care costs.
• For Target 1.3 (Social Protection):
  • Proportion of the population below the federal poverty level covered by the health plan: The article specifically mentions the “200% of the federal poverty level” threshold. An indicator would be the percentage of people below this line who are effectively covered and protected from health-related financial shocks by the new system.
• For Target 10.4 (Reduced Inequalities):
  • Impact of health-related taxes and transfers on income distribution: The plan’s use of “progressive policies,” including income-based taxes and premiums, implies that an indicator would be how the new fiscal structure affects income inequality. Progress would be measured by a system where the financial contribution is equitably distributed according to ability to pay.

SDGs, Targets, and Indicators Table

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