Health Co-Ops Pave the Way for Change in Oregon

By Chris Thomas

(08/22/13) PORTLAND, OR – In less than two months, Oregonians who need to shop for health coverage will be able to find and compare plans in the new health insurance marketplace, called Cover Oregon.

And they’ll find some of the plans will look very different than any insurance they’ve seen before.

Dr. Ralph Prows describes the Oregon Health CO-OP as “a movement, not an insurance company.” He’s the CEO.

The organization asked people around the state what they want – and they said coverage should be simpler, with predictable out-of-pocket costs. So, Prows says, Oregon Health CO-OP members will notice a difference when they pay for medical services.

“What you have are just a simple series of co-payments,” he explains. “And you know exactly what it’s going to be – and the doctor also knows what he needs to collect from you. And he doesn’t have to then bill the insurance company, wait for them to pay, and then bill you again for whatever they didn’t pay.”

Other features include a flat $15 price for a phone call with the doctor when a medical question doesn’t warrant an office visit – and coverage for seeing naturopaths as well as MDs.

The co-op had to get what is called an innovative designation – special permission from the state – for its new approach. More traditional policies also will be available.

More than half of the people on the Oregon Health CO-OP board will be members. That alone is a big departure from typical insurance companies, which Prows says have highly paid boards and executives and focus on making a profit for shareholders. Co-ops, on the other hand, are nonprofit.

“The point is that any excess money beyond paying medical expenses that we have, will be turned back into either lower premiums or to health benefit programs for our membership,” he says. “Those are legally the only uses of our funds, aside from paying back our loans.”

There are only 24 health insurance co-ops in the nation, and Oregon will have two of them. The Cover Oregon insurance marketplace opens on October 1. Individuals and small businesses can compare plans and sign up for coverage that begins on January 1, 2014.Φ

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Chris Thomas has been a writer for more than 30 years, in television, radio and print. Her work experience includes stints as a reporter, producer and anchor for TV stations in Boise, Idaho (KBOI), Portland, Oregon (KATU), and Dallas, Texas (WFAA). For three years, she taught news writing and presentation skills as an adjunct professor at Southern Methodist University in Dallas. She is the co-author of 15 college textbooks for publisher John Wiley & Sons. Chris also has written countless speeches, newsletters, articles, and technical manuals since starting her own business, Chris Thomas Company, in 1986. She is currently a producer, editor and Regional Manager for Public News Service (PNS).

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