White House expected to OK Oregon health plan Services would be rationed to cover poor

March 18, 1993|By Robert Pear | Robert Pear,New York Times News Service

WASHINGTON -- The Clinton administration is expected to approve Oregon's novel proposal to ration health care for poor people in the state, federal officials said yesterday. The proposal would expand eligibility for Medicaid there while eliminating coverage for some treatments.

But President Clinton and Health and Human Services Secretary Donna E. Shalala will impose stringent conditions on Oregon to try to limit federal costs and to prevent sharp reductions in services for poor people and those with disabilities, the officials said.

Under the plan, which needs federal approval because it is partly financed with federal Medicaid money, the number of Medicaid recipients in Oregon would rise to 360,000 from 240,000 now.

The plan, which was revised after a similar proposal was rejected by the Bush administration last year, ranks 688 medical procedures according to their costs and benefits.

The Oregon Medicaid program would pay for services ranked 1 through 568. It would not pay for the remaining procedures, which the state considers too costly or beneficial to relatively few patients.

Among the excluded services are liver transplants for people with liver cancer, nutritional counseling for obese people, fertility services and medical treatments for the common cold, chronic back pain, infectious mononucleosis, phlebitis and acute viral hepatitis.

In general, Oregon officials said, they would not pay for treatment of medical conditions that clear up on their own or for procedures judged to be ineffective.

Oregon officials defend rationing as a corollary to their effort to guarantee access to health care for all poor people in the state. Under the proposal, Medicaid would be available to all Oregon residents with incomes less than the federal poverty level ($11,187 for a family of three in 1992).

In Oregon, as in most states, fewer than half of the poor people get Medicaid because various income limits for the programs are below poverty level.

In rejecting the Oregon proposal last year, the Bush administration said it was biased against disabled people and therefore violated a new federal law. Some spokesmen for the disabled maintained then that the disabled might be denied medically necessary services under the plan.

Oregon revised its proposal to take the federal objections into account. In ranking medical services for coverage under Medicaid, the original proposal weighed the contribution of the services, if any, to a patient's quality of life. State officials say they eliminated the use of that measurement because federal officials objected to it.

Despite such changes, said Roger Auerbach, senior policy adviser to Oregon Gov. Barbara Roberts, critics of the state plan, including advocates of disability rights, are likely to file a lawsuit aimed at blocking it.

During the 1992 presidential campaign, Mr. Clinton said Oregon should have been allowed to go ahead with its proposal, which has drawn attention from people all over the country as a systematic attempt to expand health care by rationing services.

White House communications director George Stephanopoulos said yesterday that a decision on whether to approve the plan probably will be announced tomorrow. He did not say which way the administration would decide. That information was provided by other officials, who spoke on condition of anonymity.

Ms. Shalala is legally responsible for ruling on the Oregon proposal. Avis LaVelle, a spokeswoman for the secretary, said yesterday that Ms. Shalala had not made her decision and would consult the president before doing so.

Oregon has often been a pioneer in social policy, from its efforts to regulate workers' hours early in this century to its recent attempts to protect the environment and guarantee access to health care for state residents.

In many ways, the Oregon health plan resembles proposals being drafted by the Clinton administration for the nation as a whole. It encourages Medicaid recipients to use health maintenance organizations and other forms of managed care.

It would require employers to buy or provide health insurance for their employees. It defines basic health benefits to which state residents will be entitled. And it probably will reduce access to services beyond the standard package.

In a letter delivered yesterday to the White House, 70 national advocacy groups urged Mr. Clinton to reject the Oregon proposal. They said it would set dangerous precedents and would violate the Americans with Disabilities Act of 1990, which generally prohibits discrimination against disabled people.

Administration officials said Mr. Clinton was willing to let Oregon go ahead with its plan. As governor of Arkansas, he often complained that the federal government gave states too little leeway to design and manage their Medicaid programs.

Medicaid, financed jointly by the federal government and the states, provides care for more than 35 million people nationwide.

Mr. Clinton told governors several times last month that he would give them more flexibility in running Medicaid. He promised that his administration would act swiftly and sympathetically on state requests for federal approval of experimental health programs.

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