Finding work that provides health insurance—or pays enough for them to afford an individual plan—isn’t withint the grasp of the 373,197 uninsured folks in the Portland-Vancouver area.

JEALOUS YET? I AM. The more I read about Massachusetts’s far-reaching health care overhaul, which passed in 2006 under then-Governor Mitt Romney, the more I wondered why Oregon—a similarly educated, liberal, creative state—hasn’t yet implemented such reforms. After all, our new-old Governor John Kitzhaber fathered the Oregon Health Plan (OHP) in the early ’90s, when he was the president of the Oregon Senate. By prioritizing certain medical procedures (like checkups), Kitzhaber significantly expanded Medicaid coverage and earned a national profile for doing so. His reforms, which slashed the uninsured rate from 18 percent in 1992 to 11 percent in 1996, made Oregon a beacon of American health policy. But during his last term as governor, Kitzhaber’s attempt to expand the health plan to residents at 185 percent of the poverty level ran head-on into the state’s 2003 budget crisis. The result became the current “OHP Standard Plan” which shrunk benefits and lowered enrollment caps. The number of people covered sharply declined. In short, the once-vaunted Oregon Health Plan completely unraveled. By 2009, the portion of Oregon’s population that is uninsured was back at 18 percent.

Since then, Oregon’s health reformers have hatched a new plan for a health care overhaul. In 2009, the Legislature passed a bill that set up the Oregon Health Authority and the Oregon Health Policy Board—a nine-member citizen board charged with improving quality of and access to health care. The bill also called for creating an insurance exchange similar to Massachusetts’s Health Connector.

Over the past two years, the health policy board has been diligently devising this exchange, drawing from Massachusetts’s experience but putting Oregon’s own unique stamp on it. After holding a series of meetings across the state, the board is focusing on controlling costs and increasing quality, “delivery system reform” (improving health at a lower cost without sacrificing quality of care), and workforce development—that is, making sure Oregon has enough doctors, nurses, and physicians’ assistants to meet what will surely be a skyrocketing number of insured Oregonians. (An estimated 150,000 previously uninsured Oregonians are expected to buy insurance through the exchange by 2019.) At press time, the board was expecting to hand over its action plan to the Legislature as early as late December.

The state received $1 million from the feds this fall to set up the exchange, and Sean Kolmer, deputy administrator for the office of health policy research at the Oregon Health Authority, says the exchanges will be ready to enroll Oregonians by early 2013 to meet the federal deadline of January 1, 2014. (This is the magic date when federal tax credits for buying insurance through a health exchange will go into effect, in addition to being the date when insurance companies across the land will be required to cover everyone with pre-existing medical conditions.)

This all sounds tremendously exciting, but many of us with chronic conditions can’t wait years for health insurance. Is there any chance Oregon’s exchange can be up and running any sooner?

As it happens, the Affordable Care Act includes funding for states that come up with innovative pilot projects—particularly those that save money. Governor-elect John Kitzhaber intimated that he is on the case at an Oregon Health Policy Board meeting in mid-November. Describing all the political sniping over the act as merely a debate over how to pay for the existing health system rather than on how to “improve the health of Americans,” Kitzhaber predicted “system failure” if the focus remains on “acute care” rather than “prevention, wellness, and the appropriate home and community-based management of people with chronic conditions.”

“This provides a great opportunity for Oregon,” he added, “to provide the bold innovation needed to meet this challenge and bring our health care system back under control.” 

FOR NOW, MY ONLY OREGON insurance option is the state administered Oregon Medical Insurance Pool for “high-risk” people. The cost: $465/month. A friend who lives in LA and has several chronic medical conditions says that it’s a deal. Others tell me to be grateful that there’s a plan that will cover my pre-existing condition at all. On a good day, I trust that Oregon legislators and health care advocates will craft a superior health insurance exchange, but I can’t help but feel jilted: why not an affordable exchange now?

I’m not going to move to Massachusetts. Nor do I want to find a “real” job—I’m happy with the one I have. I’m lucky: my career as a freelance journalist is a choice—and I’ve got family who will help me if I’m unable to pay for the medical care I need. Finding work that provides health insurance—or pays enough for them to afford an individual plan—isn’t within the grasp of the 373,197 uninsured folks in the Portland-Vancouver area.

In the meantime, I’ll frequent Mercy & Wisdom (see “The Last Safety Net,” below), a low-cost integrative medicine clinic I discovered on W Burnside Street and Third Avenue. Or maybe I’ll face up to the fact that while Stumptown is a fabulous place for cultural creatives of all stripes, the Big Apple trumps this fine city when it comes to offering affordable health plans. At least until 2014.