(1)As used in this section, “single payer health care financing system” means a universal system used by the state to pay the cost of health care services and goods in which:
(a)Institutional providers are paid directly for health care services or goods by the state or paid by an administrator that does not bear risk in contracting with the state;
(b)Institutional providers are paid with global budgets that separate capital budgets, established through regional planning, and operational budgets;
(c)Group practices are paid directly for health care services or goods by the state, by an administrator that does not bear risk in contracting with the state, by the employer of the group practice or by an institutional provider; and
(d)Individual health care providers are paid directly for h
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(1) As used in this section, “single payer health care financing system” means a universal system used by the state to pay the cost of health care services and goods in which:
(a) Institutional providers are paid directly for health care services or goods by the state or paid by an administrator that does not bear risk in contracting with the state;
(b) Institutional providers are paid with global budgets that separate capital budgets, established through regional planning, and operational budgets;
(c) Group practices are paid directly for health care services or goods by the state, by an administrator that does not bear risk in contracting with the state, by the employer of the group practice or by an institutional provider; and
(d) Individual health care providers are paid directly for health care services or goods by the state, by their employers, by an administrator that does not bear risk in contracting with the state, by an institutional provider or by a group practice.
(2) The Universal Health Plan Governance Board established in ORS 751.001 shall create a comprehensive plan to finance and administer a Universal Health Plan that is responsive to the needs and expectations of the residents of this state by:
(a) Improving the health status of individuals, families and communities;
(b) Defending against threats to the health of the residents of this state;
(c) Protecting individuals from the financial consequences of ill health;
(d) Providing equitable access to person-centered care;
(e) Removing cost as a barrier to accessing health care;
(f) Removing any financial incentive for a health care practitioner to provide care to one patient rather than another;
(g) Making it possible for individuals to participate in decisions affecting their health and the health system;
(h) Establishing measurable health care goals and guidelines that align with other state and federal health standards;
(i) Promoting continuous quality improvement and fostering interorganizational collaboration; and
(j) Focusing on coverage of evidence-based health care and services.
(3) In developing the comprehensive plan and the recommendations to the Legislative Assembly under subsection (4) of this section, the board shall:
(a) Consider, at a minimum, the following values:
(A) Health care, as a fundamental element of a just society, must be secured for all individuals on an equitable basis by public means, similar to public education, public safety and public infrastructure;
(B) Race, color, national origin, age, disability, wealth, income, citizenship status, primary language, genetic conditions, previous or existing medical conditions, religion or sex, including sex stereotyping, gender identity, sexual orientation and pregnancy and pregnancy-related medical conditions may not create barriers to health care nor result in disparities in health outcomes due to the lack of access to care;
(C) The components of the Universal Health Plan must be accountable and fully transparent to the public regarding information, decision-making and management through meaningful public participation; and
(D) Funding for the Universal Health Plan is a public trust and any savings or excess revenue must be returned to the public trust;
(b) Consider, at a minimum, the following principles:
(A) A participant in the Universal Health Plan may choose any individual provider who is licensed, certified or registered in this state or may choose any group practice;
(B) The plan may not discriminate against any individual health care provider who is licensed, certified or registered in this state to provide services covered by the plan and who is acting within the provider’s scope of practice;
(C) A participant in the plan and the participant’s health care provider shall determine, within the scope of services covered within each category of care and within the plan’s parameters for standards of care and requirements for prior authorization, whether a service or good is medically necessary or medically appropriate for the participant; and
(D) The plan shall cover health care services and goods from birth to death, based on evidence-informed decisions as determined by the board;
(c) Assess the readiness of key health care and public institutions to carry out the plan and collaborate with state agencies, including the Oregon Health Authority and the Department of Human Services, to determine how the agencies’ existing systems will integrate with the Universal Health Plan;
(d) Consider the recommendations of the Joint Task Force on Universal Health Care in the report approved by the task force on September 29, 2022, including the recommendations to establish a single payer health care financing system that are consistent with subsection (1) of this section;
(e) Identify statutory authorities and information technology infrastructure needed for overall plan operations;
(f) Evaluate how to work with the nine federally recognized Indian tribes in Oregon and existing boards, commissions and councils concerned with health care and health insurance;
(g) Work collaboratively with partners across the complexities of the health care system, including hospitals, health care providers, insurers and coordinated care organizations, to build a sustainable health care financing system that delivers care equitably;
(h) Engage with regional organizations to identify strategies to reduce the complexities and administrative burdens on participants in the health care workforce and to otherwise address workforce challenges;
(i) Study and address the impacts of the Universal Health Plan with respect to specific types of employers;
(j) Design the administrative and financing structure for the Universal Health Plan;
(k) Engage with the Governor’s office, the Oregon Health Authority and federal authorities to ascertain and describe, if not yet in federal or state law, necessary federal waivers or other options to secure federal and state funding and to implement the Universal Health Plan;
(L) Include a plan to create a Universal Health Plan Trust Fund in the State Treasury, separate and distinct from the General Fund, consisting of moneys from all sources, public and private, that are allocated to or deposited to the Universal Health Plan Trust Fund for the purpose of financing the planning for and the administration and operation of the Universal Health Plan by the Universal Health Plan Governance Board, with any moneys in the Universal Health Plan Trust Fund at the end of the biennium being retained in the Universal Health Plan Trust Fund;
(m) Include a plan to create an independent public corporation that shall exercise and carry out all powers, rights and privileges that are:
(A) Expressly conferred upon the board;
(B) Incident to such powers, rights and privileges; or
(C) Implied by law; and
(n) Ensure that the proposed plan will include all Oregon residents equitably.
(4) No later than September 15, 2026, the Universal Health Plan Governance Board shall present to the interim committees of the Legislative Assembly related to health, in the manner provided in ORS 192.245, and to the Governor, a comprehensive plan for the implementation of the Universal Health Plan.