A Tale of Two States

What a difference 290 miles can make in how one State Governor’s administration and legislature can view health care rights of a population. Is health care a right?

A Tale of Two States: Idaho, Limiting Health Plan Benefits; and Oregon, Moving Toward Universal Health Care


The United States don’t feel very united these days on a whole range of issues. But today, I’m struck by a 180-degree-apart chasm between Idaho and Oregon. While these two states only lie 290 miles from each other, they are worlds apart when it comes to their views on their residents as health citizens.

Idaho. First, let’s travel to Idaho, aka the Gem State due to its rich endowment of natural resources. Health insurers in the state are now allowed to offer plans with limited benefits, escaping the rules for plans in the Affordable Care Act that provided for a list of covered benefits.

Idaho’s new health insurance rules compel new plans to cover emergency care, hospital admissions, outpatient services, mental health and substance abuse, prescription drugs, rehab, lab and preventive care. But the plans could limit coverage to $1 million for the year, and charge older people five times more than younger people, compared with the ACA limits of 3:1. There are other allowed exclusions, limits, and pricing differentials, as well.

David Cameron, the state’s Director of Insurance, called this strategy, “pushing the envelope” in an interview with NPR last month.

Oregon. Now let’s drive on to Oregon, the Beaver State, nicknamed for the region’s association with beavers known for qualities of industry, ingenuity and industriousness. In popular culture today, this state may be better known with its persona of Portlandia, but it is, indeed, a more progressive U.S. state than most of the other 49.

So perhaps it’s not surprising that on Valentine’s Day Eve 2018, Oregon’s House of Representatives voted to ask Oregonians to amend the State’s Constitution to make health care the right of all health citizens. The vote passed along party lines, with 35 Democrats in the House voting “ay,” and 25 Republicans, “nay.” This proposal now moves to the Oregon State Senate for their consideration. Note that the Senate includes 17 Democrats and 13 Republicans; if the Senate vote behaves like the House’s, then this amendment will move on to the State election ballot on November 7, 2018, for all Oregonians to consider.

The Oregon universal healthcare amendment would state: “It is the obligation of the state to ensure that every resident of Oregon has access to cost-effective, medically appropriate and affordable health care as a fundamental right.”

Health Populi’s Hot Points:  What a difference 290 miles can make in how one State Governor’s administration and legislature can view health care rights of a population. Is health care a right? A nice-to-have, but not necessary, benefit?

And what of these “United” States? Should healthcare rights be fragmented at the State level? Or should an American who lives in, say, Miami, have the same healthcare assurance as a person in Seattle or Boise or Omaha or Kennebunkport?

As I reflect on this tale of two States as I’m composing, for another publication, a treatise on what the U.S. is facing with the erosion of the Affordable Care Act in 2018. I welcome Health Populi readers to comment on the 290-mile health policy chasm I’ve identified here. I’m keen to know what you see now, and for the future of U.S. healthcare.


Brian Klepper, PhD

Principal, Worksite Health Advisors

904.343.2921, bklepper@worksitehealthadvisors.com

Care & Cost

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