With President Obama reforming the health insurance sector, many states in America are being left with the difficult task of asking how many people can they cover and how to pay.

Oregon is one of these states facing the complex dilemma. The state’s health-care debate so far has been dominated by just two questions: How many more people will get health insurance cover under state-supported schemes? And who will pay for it?

Such questions have not been met with a solid answer yet, but one thing is certain, the answer that lawmakers will give will shape how much all Oregonians pay for health cover in the future and how that care is delivered.

Last week, the Oregon Health Reform Collaborative held a meeting to discuss the prime problems with health care, and the consensus was that the status quo is no longer acceptable.

Employer based coverage, which has been the main outlet for health insurance in America for the past 60 years, is now decreasing due to continuing cost increases and employers then shifting this expense onto bosses. As a result, employers either reduce benefits or even completely drop health cover.

Workers who lose their jobs often cannot afford to continue the work health plan, although recent federal subsidies may help them.

Liz Baxter, executive director of the Archimedes Movement, founded by former Gov. John Kitzhaber in 2006 as a citizen voice for change said:  “People are more ready for change than we think. Even people who have good insurance today have no confidence they are going to have it tomorrow.”

Prime issues

There have been several proposals from the state government to help ease public worry over health issues.

Gov. Ted Kulongoski proposed an increase in provider taxes on hospitals and health plans, proceeds from which would recover more federal money under the joint Medicaid scheme.

State-supported programmes would expand to cover 80,000 more children and 75,000 more low-income adults — about a quarter of the estimated 600,000 uninsured Oregonians. The current provider tax, which is set to expire Sept. 30, supports only 28,000 low-income adults who would retain coverage under the new plan.

An alternative backed by the Oregon Association of Hospitals and Health Systems would keep the hospital tax at the same rate, but extend a provider tax to all health insurance claims. This would recoup less federal money, and would only extend coverage to around 60,000 children and between 31,000 and 49,500 low-income adults.

However, Kitzhaber said that if the lawmakers only focus on two main questions, they will be making a huge mistake.

"Without dealing with the underlying question of cost, these additional public subsidies that all these plans call for will increase the strain on public budgets being brought on by health care,” he said.

Kitzhaber believes that children should be given priority, improvements should be made to manage chronic diseases and more money should be put into into less costly prevention and screening measures, instead of the current procedure which simply pays for costly medical treatments when illnesses become acute.

What the public needs

However, many believe that the health care system should be governed by what the public thinks and needs.

“Oregon voters should decide whether raising taxes and creating more bureaucracy are the right solutions for our health-care system," said Rep. Ron Maurer, R-Grants Pass, who runs a community health clinic and is the top Republican on the House Health Care Committee.

Health insurance is vital to Americans, as health care consumes one of every six dollars in U.S. goods and services produced. Yet, shockingly more than 46 million Americans still lack coverage.

Oregon is one of about a dozen states considering their own proposals to extend coverage to more uninsured people. Of the three states that have approved such plans in recent years, Maine and Massachusetts have run into financial difficulties with soaring costs.

Therefore, House Speaker Dave Hunt, D-Gladstone, said Oregon should proceed with smaller steps. “I would love it if the federal government just did it. But I have somewhere between minimal to moderate confidence that they will do something this year.”