Ore. Uses Lottery Approach for Health Program

Oregon officials knew demand for new slots in a state-funded health-insurance program would far exceed supply, so they decided to randomly pull names from the nearly 100,000 people who applied. Meet a winner and a loser in Oregon's health-insurance "lottery."

Copyright © 2008 NPR. For personal, noncommercial use only. See Terms of Use. For other uses, prior permission required.

MICHELE NORRIS, host:

This is ALL THINGS CONSIDERED from NPR News. I'm Michele Norris.

ROBERT SIEGEL, host:

And I'm Robert Siegel.

This spring, thousands of Oregonians are checking their mailboxes for the equivalent of a winning lottery ticket. This ticket will not win them money. Instead, it could open the door to the doctor's office.

Chris Lehman of the Northwest News Network explains.

CHRIS LEHMAN: For Sharon Doyle(ph) of Salem, the golden ticket she was looking for came in a big, white envelope in the mail. When it came, she broke the news to her daughter over the phone.

Ms. SHARON DOYLE (Resident, Salem, Oregon): I mean, I told her, I got the package. She says, Mom, do you realize what you're holding in your hand? I said, do you think I don't know? I just can't talk.

(Soundbite of laughter)

LEHMAN: Ninety-two thousand Oregonians put their name on a list requesting state-funded health insurance. That's out of an estimated 600,000 in the state who lack coverage but don't qualify for Medicaid. Doyle was one of the 3,000 people whose name was pulled.

Ms. DOYLE: My neighbors come over and they asked me, what's going on? What's wrong? And I said, well, I got something and that's like - almost like you win in the lottery.

LEHMAN: Just don't call it a lottery when you're talking to the state agency that oversees the program.

Ms. JEAN PHILLIPS (Deputy Assistant Director, Oregon Department of Human Services): We use the terminology random selection rather than lottery.

LEHMAN: Jean Phillips of the Oregon Department of Human Services says the state consulted health care advocates and determined this would be the fairest way to enroll more people in the Oregon health plan, specifically the section of the program that covers poor adults who don't qualify for Medicaid. Phillips says the plan hit its high watermark about five years ago.

Ms. PHILLIPS: When it was at its peak, we covered approximately 132,000 people under that program. Today, we cover less than 18,000 people, so it's quite a reduction.

LEHMAN: That reduction came during a long-term economic downturn in Oregon. In 2003, the state introduced premiums ranging from $9 to $20 a month, which forced some people off the plan. Then a year later, the state stopped letting new people sign up altogether. So, it was big news when the announcement came earlier this year that the Oregon Health Plan would be enrolling new clients. The fact that slots in the program would be given away at random took some people by surprise.

Judith Paget(ph) works half time as a receptionist and has a blood disorder that sometimes causes severe allergic reactions. She put her name into the drawing but so far, she hasn't been a winner.

Ms. JUDITH PAGET (Receptionist): I don't know if it would be fair or not. I just really believe that they should go by need. It should be, you know, written down and they should evaluate it. And really give it to the people that really need it.

LEHMAN: But University of Oregon ethics professor Courtney Campbell says the problem with using need as a measuring stick is that medical conditions change over time.

Professor COURTNEY CAMPBELL (Ethics, Oregon State University): You know, some individuals are going to have very pressing, acute care needs right now, and some individuals are not going to have needs that may show up for five years because of some genetic predisposition.

LEHMAN: Golden-ticket winner Sharon Doyle says her medical needs are not off in the future.

Ms. DOYLE: I'm a diabetic, asthmatic, high-blood pressure with a peptic ulcer that's non-curable.

LEHMAN: Despite her health problems, Doyle works as an in-home caregiver for senior citizens. She says getting the application package from the Oregon Health Plan was a godsend.

Ms. DOYLE: It means everything to me. It means not to be afraid no more because I can't afford my medicines.

LEHMAN: For people who signed up for the lottery but didn't get picked, there is still hope. State officials plan to draw more names each month until the plan is maxed out. That means several thousand more Oregonians will get their own golden ticket in the mail sometime soon.

For NPR News, I'm Chris Lehman in Salem, Oregon.

Copyright © 2008 NPR. All rights reserved. No quotes from the materials contained herein may be used in any media without attribution to NPR. This transcript is provided for personal, noncommercial use only, pursuant to our Terms of Use. Any other use requires NPR's prior permission. Visit our permissions page for further information.

NPR transcripts are created on a rush deadline by a contractor for NPR, and accuracy and availability may vary. This text may not be in its final form and may be updated or revised in the future. Please be aware that the authoritative record of NPR's programming is the audio.

Comments

 

Please keep your community civil. All comments must follow the NPR.org Community rules and terms of use, and will be moderated prior to posting. NPR reserves the right to use the comments we receive, in whole or in part, and to use the commenter's name and location, in any medium. See also the Terms of Use, Privacy Policy and Community FAQ.