VOICES FROM THE COMMUNITY:
The visionPDX Input Report

HEALTH:
Health Insurance

  


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Insurance is a major obstacle preventing many from receiving the care they need.

Section Summary

Portlanders are concerned about high insurance rates and the ever-growing number of people that lack health insurance because they cannot afford it. Many Portlanders see lack of insurance as the primary barrier preventing people from receiving the medical care that they need. Even those with insurance want their premiums, co-pays and deductibles to be more affordable and provide a greater range of benefits. When it comes to obtaining insurance, many Portlanders look to their employers—they want more employers to offer insurance and they want company-sponsored insurance plans to provide better coverage. Other Portlanders look to the Oregon Health Plan, believing that this plan should cover many more people than it currently does.

Still others favor alternate insurance arrangements, including a local single payer system or group insurance pools, which could lower the costs of premiums and offer coverage to a much larger number of people. Many people envision a future in which all Portlanders have the insurance they need to access whatever medical services they find necessary. However, disagreements emerge over whether insurance should be free for all or only for those who cannot afford to purchase it on the private market. It is also unclear whether Portlanders want to improve the current employer-based model or move towards a universal or single-payer model that shifts the burden away from businesses and onto the local or state government.

Summary of Main Ideas

  1. The cost of health insurance is a barrier preventing many from receiving the medical care they need.
  2. More employers should offer health insurance to their employees.
  3. The Oregon Health Plan no longer meets the needs of low-income families.
  4. Portland should find a way to insure all people in the community.

Summary of Tensions and Disagreements

  1. How should we expand insurance to cover all those who need it?
  2. Should everyone be eligible for free health insurance?

MAIN IDEAS

  1. The cost of health insurance is a barrier preventing many from receiving the medical care they need.
  • Too many Portlanders lack insurance, either because their employer cannot afford to offer it as a benefit or because they cannot afford to purchase it for themselves.
  • Many Portlanders believe that if health insurance were more affordable, many more people would purchase it, reducing the current over-reliance on emergency room care and bringing down costs across the system (see Health: Cost of Healthcare).
  • Portlanders who do not have insurance speak of foregoing the medications, doctor’s visits and preventative care they need to stay healthy.
  • Those who are forced to seek medical care without insurance speak of enduring crippling debt to pay for their healthcare expenses.
  • Some with insurance can no longer afford it because it becomes more expensive as they get older and as they develop certain medical conditions.
“They need to make medical coverage affordable for families, like medical and dental, prescription and emergency care. This really needs to happen for low-income families. I want my kids to have insurance, it’s important, but I can’t afford it.”

“Better medical care. I don’t have insurance, so I do without the medication I need."

“[In the future] insurance companies are banned from charging outrageous deductibles and co-pays - sometimes people who have health insurance come to the MCHD immunization clinic where I work because their co-pays are incredible.”

Sample Strategies:

  1. Develop a city-wide small business health plan, so that more individuals can afford insurance and medical care.
  1. More employers should offer health insurance to their employees.
  • Many, many Portlanders want their employers to offer health insurance or offer better quality health insurance to employees.
  • Time and again, community members call for businesses to contribute their part to the community by providing their employees with access to healthcare.
  • When discussing job creation, Portlanders consistently say they want more jobs created that offer living wages and full benefits, including health insurance (see Economy: Employment).
  • At the same time, respondents acknowledge that many businesses, especially small businesses, cannot afford healthcare for their employees.
  • People would like to see the following in terms of employer-based insurance:
    • Insurance coverage for all full-time workers;
    • More affordable insurance for family members, especially children;
    • Insurance coverage for part-time workers; and
    • Assistance to small businesses so that they can afford the costs of insurance.
"They need to make medical coverage affordable for families, like medical, dental, prescription, and emergency care. This really needs to happen for low income families. I want my kids to have insurance, it’s important, but I can’t afford it.”

“Portland is struggling to bring up wages and provide social services to the most needy. The Oregon health system has unraveled and needs to be looked at again from between a partnership between state and business to provide cost contained health care for all. Businesses and public services are bleeding because of health care costs in this state and all over the country.”

“[In 2030] every worker in the city would be earning a living wage and be provided with health insurance. We will have invested in the lower income neighborhoods and made them safer and cleaner. Schools will have all the money they need because corporations will be paying their share of taxes.”

Sample Strategies:

  1. Give businesses a tax break if they provide benefits to employees.
  2. Attract businesses to Portland that will pay living wage jobs with better benefits.
  3. Regulate businesses so that they are required to provide insurance to all workers.
  4. Assist small businesses so that they can provide health coverage to their employees.
  5. “Create incentives so that smaller businesses buy group insurance for their employees. I just read that Burgerville now gives its employees health insurance - what motivated them to do that? Can we similarly motivate other companies to do the same?”
  1. The Oregon Health Plan no longer meets the needs of low-income families.
  • Significant concern is expressed over the perceived deterioration of the Oregon Health Plan (OHP) both in terms of the number of people it covers and the quality of coverage it provides.
  • Many low-income families and children are not covered by the OHP, yet they cannot afford to purchase their own health insurance.
  • Some would like to see OHP expanded to serve many more people, while others feel that the plan needs to be overhauled or eliminated in favor of universal coverage for everyone.
"The politicians overspend our money, leaving the poor to get poorer and the rich to become richer. They cut OHP for a lot of people, causing people to either suffer with illness, or go into extreme debt to get help.”

“More accessible health services. Our program has deteriorated. OHP is so limited. It has fallen apart/expensive. I was in the health field and it was so discouraging to me that I wouldn’t practice anymore. The treatment was being compromised.”

  1. Portland should find a way to insure all people in the community.
  • Many Portlanders are disillusioned with the employer-based healthcare model and want to see some form of universal health coverage through which all people can be insured.
  • Portlanders discuss different types of insurance systems, including:
    • Pooled insurance programs (small businesses, nonprofits, etc…) to bring down premium costs and ensure more employees;
    • A single payer system run at the city, county or state level;
    • Free insurance for all children, presumably supplied through the state (although this isn’t specified);
    • Drastically expanding the Oregon Health Plan (OHP) to cover many more people than it currently does;
    • Tiered systems that would provide free insurance to children and the needy and more affordable insurance to everyone else.
  • Regardless of which system they prefer, respondents want the City to take bold action to guarantee that all Portlanders have access to the healthcare they need.
“I would like to see health insurance for all of us! National health care isn’t happening. Lets do something locally.”

"[I would like to see] single-payer health care (get employers/healthcare providers/citizens to the table and get creative) more prevention/health initiatives. More rapid transit-MAX, more bike lanes, consumer owned PGE, more solar production, more hybrid cars.”

“[In the future] I would not longer need to own a car. I would have a decent paying job with publicly funded health benefits so I would not have to constantly worry about medical expenses as I age. I would not have a garbage bill—I would recycle everything.”

“20 years later: everybody has free medical insurance or people pay for a medical service only when it is necessary and it is quite affordable.”

Sample Strategies:

  1. Raise taxes. Many Portlanders say they are willing to pay higher taxes for quality health insurance if they can be assured that their money won’t be wasted.
  2. Create an unprecedented state health program that eliminates the need for insurance and provides excellent care for all residents.

TENSIONS AND DISAGREEMENTS

  1. How should we expand insurance to cover all those who need it?

    The vast majority of respondents agree that all Oregonians should have access to health insurance; however disagreements emerge over how to accomplish this goal. Many people speak of the importance of expanding the current employer-based system so that all those people who have steady jobs receive adequate insurance through their workplace. Throughout this report, Portlanders speak of their desire to have “living wages with full benefits,” including health insurance for themselves and their family members.

    On the other hand, an equally large number of people think that the current employer-based model is incapable of fully insuring all those who need it. These people would prefer to move towards a system in which the government (either local or state) offers insurance that will cover all people, so that health insurance is not tied to employment. Proponents of various single-payer systems feel that these systems will cover more people and will also reduce the burden on businesses (especially small businesses), which will be able to compete more effectively once they are no longer saddled with soaring insurance premiums.

  2. Should everyone be eligible for free health insurance?

    Many Portlanders have a vision of the future in which no community member lacks health insurance. These Portlanders believe that health insurance should be provided free of cost for everyone, funded by tax dollars. Others would prefer a system in which only those who cannot afford health insurance receive free insurance through the government. Under this scenario, those who can afford to would continue to purchase their own private insurance or obtain insurance through their workplace. Individuals who are children, elders, homeless or have low-incomes would be eligible to receive publicly-funded insurance.