2024-2025 Updates
April/May 2024
The Universal Health Plan Governance Board was launched in April 2024, with the goal of creating a plan to deliver a simplified, equitable, publicly funded health plan that will cover all Oregonians. The board began by establishing structures, procedures and a work plan for the next two and a half years.
Senate Bill (SB) 1089, which created UHPGB, provided financing for three full-time staff members within the Department of Consumer and Business Services (DCBS) to support the board. Additionally, funding was provided for two limited-duration staff members at the Oregon Health Authority to support the board.
- Morgan Cowling was hired as executive director and has been on board since mid-February. She is the administrative focal point for board activity, including compliance guidelines.
In mid-April, Director Cowling hired two staff members who will report to her in supporting the board:
- Jenny Donovan, senior policy advisor
- Katy Deluca, coordinator
At its first meeting in April, UHPGB elected board members Helen Bellanca and Warren George to serve as the board chairperson and vice chairperson, respectively. In November, Warren George stepped down from the board due to family considerations and the board elected Judy Richardson to take the vice-chair seat.
At the May meeting, the board heard a presentation on the work of the Joint Task Force on Universal Health Care, which led to legislative creation of UHPGB, and began discussing strategic values and principles that the board will use to guide its policy objectives.
Two short-term board member work groups were formed at the May meeting.
- Values and Principles to be adopted by the board.
- Work Plan Development – This group discussed and created the workplan draft. The resulting plan will help direct staff and outline needs for additional expertise and contractors going forward.
June 2024
The Universal Health Plan Governance Board (UHPGB) continued the work of grounding the Board with a basic overview of single-payer health care structure and the work that has been and is currently being done to advance universal health care in other states.
Substantial progress was made in creating a work plan for the next two years. Included in that work plan are committees focused on specific work streams necessary to the creation of the universal health plan required in SB 1089.
Here is a summary of items completed or now being launched:
- Two short-term board member work groups formed at the May meeting reported back at the June board meeting.
- The Values and Principles work group returned four overarching principles to the board for consideration. The board agreed with the direction of the work group and requested that the group accomplish additional work to define the terms of the principles. The overarching principles recommended are:
- Maximize Health
- Fair Distribution of Medical Resources
- Minimize Financial Hardship on Individuals and Families from Medical Costs
- Community Ownership and Governance
- The Work Plan Development work group provided a timeline for the work of the board and a recommendation of committees and committee charters to identify individual committee tasks, deliverables and required expertise.
- At the June meeting of the UHPGB, the board agreed on the work plan to be used as a foundational and iterative document for the organization of the board’s work. The charters will be used to begin committee recruitment and identification of expertise for which the board will need contract with outside parties.
- The board agreed to move forward with the creation of four committees to manage six identified work streams:
- Community Engagement
- Community Engagement
- Communications
- Finance
- Plan Design and Expenditures
- Operations
- Operations
- Transitions and Implementation
- Recruitment for the committees will begin in July
July 2024
The Universal Health Plan Governance Board (UHPGB) is continuing to concentrate on two major priorities, board foundational grounding, and planning for the work which will ultimately lead to a comprehensive financial and operating plan for the implementation of a Universal Health Plan.
Under board foundational grounding, the board drew from board member expertise for presentations on two topics.
- Cherryl Ramirez reported on the board the Behavioral Health System and its funding mechanisms.
- Michelle Glass reported on general strategies and tools for Community Engagement.
As a major step in planning, the board adopted a work plan which will help guide the board through September of 2026 when the final report is due.
To support the work plan, four committees were approved by the board, with board members assigned as follows.
Community Engagement and Communications
Michelle Glass and Amy Fellows - Co-Chairs
Plan Design and Expenditures
Debra Diaz – Chair
Helen Bellanca, Chunhuei Chi
Finance and Revenue
Cherryl Ramirez – Chair
Chunhuei Chi
Operations
Bruce Goldberg – Chair
Judy Richardson
A fifth committee, Transition, will be formed once a plan has been further developed.
The board recruited for volunteers to apply to serve on these committees in addition to the assigned board members.
In the next month, work will continue on adopting a framework for Values and Principles, and on reviewing the SB 770 Task Force recommendations as a means to help guide next steps.
August 2024
This month the Universal Health Plan Governance Board continued to expand its knowledge of health systems and their financing structures, moved forward with the adoption of the Board’s guiding values and principles, agreed upon a preliminary structure with which committees can begin to build their work once they are seated, and heard an update on committee recruitment.
UHPGB staff presented an overview of four primary health plan systems, with their supporting financing structures, and information for discussion of how the definition of single payer has evolved over time. This information was provided to give the board a foundational jumping off point from which to begin discussion of the interplay between plan design and financing structure by exploring the structures commonly used around the world.
The Values and Principles workgroup met for a final time in August. The members discussed public comment received in July that incorporated the values and principles laid out in SB 1089 into the overarching principles created by the workgroup. After discussion of this approach to structuring, the workgroup agreed to incorporate the Health Equity Commission’s statement into the overarching principles, placing it in the number one position, and to accept the guidance of the public comment and integrate the SB 1089 values and principles while retaining the workgroups carefully crafted language supporting and defining the overarching principles.
The UHPGB voted unanimously to adopt the recommendations of the workgroup. The values and principles document will be posted on the UHPGB website as a permanent foundational document of the board.
Following the adoption of the values and principles, the board engaged in robust discussion reviewing the recommendations from the Universal Health Plan Task Force, and using them as the basis for the board to develop a preliminary structure to further guide the work of the committees. Committees already have charters for their work from the board approved work plan, and this preliminary structure will further support committee work by providing more focused guidance.
Executive Director Cowling provided the board with an update on committee recruiting. The application period for the recruitment closed on August 12, 2024, with 166 applications received. The applicant pool included representation from across the state, from multiple health care and business entities, and interest spread throughout the four committees, with plan design receiving the largest amount of interest.
UHPGB staff will be reviewing each of the 166 applications and bringing recommendations to committee chairs to assist in their decisions on which applicants to bring forward for full board approval. The board will vote on committee applicants at the September board meeting and chosen applicants will be onboarded shortly thereafter. Committee meetings will begin as soon as possible after the membership has been approved, according to each committee’s charter under the work plan.
September 2024
The September 2024 meeting of the Universal Health Plan Governance Board included the selection of members for each of the four committees established by the board. Discussion of the report due to the legislature in December and a presentation to the board by the Oregon Health Authority’s (OHA) Cost Growth Target team followed by a robust board discussion.
- After review and consideration by UHPGB staff and committee chairs, the board appointed 47 committee members from the 166 applications received.
- 12 members were appointed for the Community Engagement and Communications committee
- 7 members were appointed for the Finance and Revenue committee
- 18 members were appointed for the Plan Design and Expenditures committee
- 10 members were appointed for the Operations committee
- Committee meetings will begin the first week of October, with the Finance committee.
- SB 1089, the legislation that created the UHPGB, requires the board to submit a progress report to the legislature annually beginning in 2024. A draft outline of the report was provided for discussion. Board members recommended highlighting the values work that has been accomplished and noted the importance of emphasizing the need for ongoing support and partnership from the legislature. The board wants to communicate that their work is both resource and time intensive and will require an iterative relationship with the legislature and the community. The board will receive a draft report for discussion at the October meeting.
- The board heard a presentation from the OHA Cost Growth Target (CGT) team. The CGT presented a history of the program and a report on how the program works. The board followed the presentation with a robust discussion about how the board can address cost and cost drivers. A point of discussion was cost growth associated with increased utilization. Board members discussed that Medicaid has a cost growth cap that should be reviewed, especially considering its expansion in the state and increased utilization. It was noted that other countries have included cost-sharing to reduce cost and provide a mechanism to track utilization. The board discussed how cost containment will be an important consideration because without cost control measures the universal health plan will become unaffordable.
October 2024
The UHPGB elected a new board vice-chair, and chair for the Finance and Revenue committee at their October meeting. Board member Judy Richardson has been elected as the new board vice-chair beginning November 1, 2024, and board member Cheryl Ramirez was elected as the new chair for the Finance and Revenue committee. Cheryl will begin her work as committee chair immediately.
The board reviewed the draft status report to the legislature. The board is required by SB 1089 to submit a status report to the legislature by December 1st of each year. The draft reviewed by the board included recent past work on a universal healthcare proposal by the Joint Task Force, a summary of work completed by the board to date and the short-term work of the board moving forward. Board members discussed challenges and opportunities they foresee and what possible additional resources the board may require. Staff will incorporate board feedback and provide a complete draft to the board in November for their final input and approval.
The Legislative Revenue Office provided a presentation on Oregon revenue. This presentation covered state revenue, tax system details, health related tax expenditures, and a brief look at the Oregon Kicker. The board followed this presentation with a discussion led by Vice-Chair George on the guiding revenue principles recommended by the joint task force and additional principles the board may want to include to provide further direction to the Finance and Revenue committee.
The board also discussed the decision making process the board will undertake to review committee proposals, when to solicit community feedback and engage deeper policy analysis, and how to reconcile proposals among committees to come to final recommendations.
*Board meetings and established work group meetings are open to the public. The board encourages people to attend and take advantage of the opportunity to provide written and oral comments to the board. Meeting information and materials are available at the Universal Health Plan Governance Board
website. The board will continue working on strategies to encourage and include greater public engagement.
November/December 2024
The November-December meeting of the UHPGB included the following:
- A presentation from Professors Elizabeth Y. McCuskey and Erin C. Fuse Brown about the Employment Retirement Income Security Act (ERISA).
- A discussion and update of the board policies and procedures regarding compliance with Oregon public meetings law.
- Approval of the status reported required by SB 1089, which was submitted to the legislature on December 1, 2024.
- A discussion on committee communications and coordination.
ERISA Presentation
The presentation on ERISA provided information about what ERISA is, and provided considerations for the board in designing the financing system for the universal health plan to ensure the plan reduces the risk of a successful ERISA challenge and does not violate federal law.
The Employment Retirement Income Security Act is a federal law which preempts states from directly regulating employers choice in providing benefits and employers benefit plans. States may regulate insurance providers. However, if an employer is self-insured (bears the risk and pays out claims itself) the state has no role in regulating those benefits.
In this presentation Professors McCuskey and Fuse Brown discussed the joint task force’s considerations of a payroll tax levied on employers, explaining that it could likely survive an ERISA challenge. According to current case law, such a tax may affect an employer’s decision to provide benefits, but does not constitute a direct limitation or prohibition on an employer’s right to provide benefits. The amount of the payroll tax would also be a factor in determining if the plan could withstand an ERISA challenge. While the courts have not provided a limitation, case law does provide that an exorbitant tax rate may violate ERISA.
Update to Board Policies and Procedures
After discussion at the October and November board meetings, the UHPGB made the decision to amend the language of item number 11 in their General Policies and Procedures, “State Email Accounts and Member Communications” to clarify how board members may communicate with one another outside of publicly noticed meetings to ensure the board can complete their work by their deadline and comply with Oregon public meetings law (ORS 192.610 - ORS 192.705).
The original policy stated (in relevant part):
“To prevent any inadvertent nonpublic convening of a quorum of the board and avoid any appearance of board business being discussed or conducted other than in a properly noticed public meeting, members should avoid communicating with other members of the board on any matter relating to the board, board business, or the members’ work and participation as members of the board matter.”
The updated policy language adopted by the board in November states:
”The board and its committees hold a firm commitment to transparency and the preservation of public trust. The board also recognizes that it is important to have some limited communication among members to facilitate the work of the board and accomplish its deliverables laid out in Senate Bill 1089. Communications among less than a quorum of the board is permitted, so long as it does not create a serial communication creating a quorum. A quorum of the members of the board shall not, outside of meetings conducted in compliance with the Public Meetings Law, use a series of communications of any kind, directly or through intermediaries, for the purpose of deliberating, making recommendations, or deciding on any matter that is within the jurisdiction of the board. All board and committee members are encouraged to take the training offered by the Oregon Government Ethics Commission (OGEC) and to submit inquires to OGEC if unsure about compliance.”
Status Report to the Legislature
The legislation that created the UHPGB, SB 1089 (2023), requires the board to a submit an annual status report to the legislature on December 1st of each year. Staff submitted the status report to legislation on the board’s behalf. Chair Bellanca and Vice-chair Richardson presented to the house interim committee on behavioral health and healthcare.
Committee Communications and Coordination
The board discussed the decision path for committees to bring proposals before the board and how committees will communicate among each other.
Bringing Proposals to the Board
- Committees will bring straw proposals before the board which provide an overview or outline of a course of action the committee would like to take on a task or deliverable.
- The board may approve the direction for the committee to move forward with collecting more detailed information and analysis of the idea, and community input or the board may reject the proposal and ask the committee to come back with changes or a different proposal.
- Once the board has approved a straw proposal and the committee has collected additional information, analysis and community input, the committee may amend the proposal into a final proposal and bring it before the board.
- The board may again approve or deny the proposal.
- If the proposal is approved it is tracked as a board decision and considered for inclusion in the board’s final Universal Health Plan.
Committee to Committee Communications
Much of the work of the UHPGB’s committees require collaboration and information sharing among one another. The board and staff are working to find effective and efficient ways to facilitate committee to committee communication.
The board reviewed and discussed a draft UHPGB Committee Meeting Summary document that may be used to capture information from each committee’s meeting. Committee chairs may then review these documents to determine if a committee will require information from their committee or to communicate information they need from another committee.
The board will look at this document again in December after chairs have had an opportunity to use the document to determine if it a useful tool.
January 2025
Director Cowling announced her resignation to pursue another career opportunity, effective January 23. The board appointed senior policy analyst, Jennifer Donovan, as interim executive director. The board also agreed upon a hiring process for the new executive director and created an executive hiring director hiring committee with the authority to review and screen candidates and complete first round interviews. The board will have a special meeting in early March to extend the offer of the position to one of the candidates.
The board heard updates from each committee chair and their current work: Finance and Revenue – Cherryl Ramirez, chair
- Committee approved a guiding document of revenue principles and attributes of a sound financial plan.
- Committee agreed on a hybrid approach of gathering data for health expenditures using the National Health Expenditure Accounts as a framework, with data pulled form other sources as needed.
- Committee is proposing using the year 2030 to project revenue needs.
Plan Design & Expenditures – Debbie Diaz, chair
- Committee is grounding themselves in current benefits and differences between Public Employee Benefits Board (PEBB) and Oregon Health Plan (OHP) and discussing how to handle benefits such as Long Term Services and Supports, Health Related Social Needs, etc.
Operations Committee – Bruce Goldberg, chair
- Committee has met once for their introductory meeting.
- Next meeting is focused on public corporations.
Community Engagement and Communications – Co-chairs Michelle Glass and Amy Fellows
- Committee has contracted with Diana Bianco from Artemis Consulting for community engagement support; however, since there is no plan yet to engage with the community on, Diana Bianco has proposed that her contract be paused until she is needed.
- Committee is working on making current UHPGB communications more accessible to the community: i.e. plain language, tips and tricks on how to submit public comment, 1 pager of values and principles, etc.
- The committee will begin looking into travel options for the board to have their board meetings in a few different locations across the state and create opportunities for the board to engage with targeted parties.
February 2025
Interim executive director, Jenny Donovan, shared the following updates with the board:
- DCBS has brought on a limited duration, operations and policy analyst, Kim Yee, to support staff while the board hires a new executive director. Kim has extensive background in health policy.
- The Finance and Revenue RFP is close to being finalized and the goal is for that contract to begin supporting the work of the F&R committee in early March.
- The larger, formal RFP, which will be for a consult to also support the work of the Plan Design; Operations; and Transition committee has closed and the board received one bid. Contract negotiations will begin next and this contractor should be on board soon.
The board received a presentation from fellow member, Chunhuei Chi, regarding an introduction to health systems financing. The presentation covered important aspects to be considered and evaluated when designing a financial plan for universal health care.
The board heard updates from each committee chair and their current work:
Finance and Revenue – Cherryl Ramirez, chair
- Committee presented a straw proposal to the board to use the National Health Expenditures Accounts as framework and 2030 as the year to project revenue needs. The board approved.
- The committee will begin researching/reviewing administrative costs.
Plan Design & Expenditures – Debbie Diaz, chair
- Committee is currently working on straw proposals related to Long-Term Services and Supports; Behavioral Health; and Eligibility. The goal is to present these to the board in March’s meeting.
Operations Committee – Bruce Goldberg, chair
- Committee discussed public corporations and is working on a straw proposal to present to the board in March.
- The committee will begin discussing waivers in their next meeting.
Community Engagement and Communications – Co-chairs Michelle Glass and Amy Fellows
- Committee has paused their contract with Diana Bianco.
- Committee has shifted their focus to communication – until committees or the board have items to engage with the community about.
- Committee is working on making current UHPGB communications more accessible to the community: i.e. plain language, tips and tricks on how to submit public comment, 1 pager of values and principles, etc.
The board discussed the budget for the UHPGB and current resources available to complete the board approved workplan. The board will be having a discussion in March about the budget and what additional funds may be needed as the work moves forward.