Oregon Universal Health Plan sounds too good to be true, which sadly is probably correct

In the 1970s and 80s, I was a health planner and policy analyst here in Oregon. Back then we were concerned that health care cost too much, lots of people lacked access to health care, and the quality of care wasn’t what it should be.

And now here we are in 2026, around fifty years later, and Oregon health care suffers from the same problems. As does the national health care system, using “system” in the broadest sense, given how fractured and nonsensical it is.

So I was enthused about attending last Thursday’s Salem City Club program, “A Health Plan for Every Oregonian: Promise or Pipe Dream?” The speaker was Dr. Miriam McDonell, a physician who serves as the Executive Director of the Universal Health Plan Governance Board. Here’s a description of what the Board has set out to do.

The Legislature created the Universal Health Plan Governance Board in 2023 (Senate Bill 1089) to design a publicly funded health care system for Oregon, building on the earlier Joint Task Force on Universal Health Care (Senate Bill 770, 2019). The board is charged with:

• Designing models for a publicly funded health plan covering everyone who lives in Oregon.
• Planning how the plan would be run, how to pay for it, and how it would work statewide.
• Getting input from people living in Oregon, such as health care users, providers, employers, insurers, tribes, and community leaders, as dictated by statute.
• Delivering final recommendations to the Legislature for consideration in 2027.

This work is guided by technical analysis, legal review, economic modeling, and broad public input.

The board has nine members, appointed by the governor and confirmed by the Oregon Senate. At least five bring expertise in health care delivery, finance, or administration, and four represent community perspectives. By law, at least one member must have personal experience with barriers to care, ensuring that lived experience informs decisions.

After hearing McDonell describe how Oregon’s Universal Health Plan would work, my emotional reaction was OMG, this sounds so great! But that was followed by the thought, And it probably won’t happen.

The plan would cover everybody who lives in Oregon, regardless of their employment or  immigration status. Those covered by the plan could see any licensed health care provider with no pre-approval restrictions. The plan benefits would be based on state employee health coverage, which covers almost everything. Vision, dental, and hearing benefits would be included.

Employers could continue offering private health insurance but would also have to contribute to the Universal Health Plan. The key principle would be: Preserve federal and state funding and redirect existing premium and out-of-pocket spending. Meaning, basically, that the money from various sources currently being spent in Oregon would be pooled to provide universal coverage with much lower administrative costs and no profit margin.

There would be a household health care contribution (fancy term for a tax) that replaces what households currently pay in premiums, cost-sharing, and out-of-pocket costs. Also, an employer payroll tax that replaces what employers currently spend to provide health care for their employees.

One of the 2032 cost estimates shared by McDonell showed the Oregon health care status quo as totaling $78.3 billion, with the universal health plan totaling $77.7 billion, a $600 million savings. Of course, this estimate probably is wildly incorrect, but at least it provides a basis for discussion. A public, nonprofit organization would administer the plan.

Like I said, it sounds great. However, plenty of hurdles stand in the way of the universal health plan becoming a reality.

One is obvious: the Trump administration would never approve the Medicare, Medicaid, and possibly VA waivers needed to pool federal health care funding into the plan. This would have to wait until a Democratic president is elected in 2028, and Democrats continue to control both the House and Senate.

There’s also the not-insignificant problem that comes with a single state pioneering universal health care: people in other states who can’t afford health care, or have expensive medical conditions, would flock to Oregon to take advantage of this plan, since it would be available to everybody who lives here.

And as I noted in a question I asked McDonell during the Q&A session, the universal health plan sounds like Medicare for All, except many of those who already are on Medicare would pay more for their health care than they are now, which I suggested could be a large political hurdle. McDonell showed a slide that lower-income households would generally pay little or nothing for health care; many medium income households would pay less than under the current system, and higher-income households often would pay more.

It’s wonderful that McDonell and her colleagues with the Universal Health Plan Governance Board are boldly trying to go where no other state has been able to reach: health care for all of its citizens. She said that California and Washington also are working on universal health plans. Hopefully the West Coast states can pool ideas and resources, perhaps even creating a three-state universal health care system that could be a model for the rest of the country.