"Health-care amBush" was the headline of the Portland Oregonian's lead editorial last Wednesday. The Bush administration had just torpedoed the most far-reaching plan any state has yet fashioned to extend health care to thousands of the medically imperiled poor, and at the same time start reining in spiraling costs for medically unproductive procedures.
The White House denied the Medicaid waiver that Oregon needed to go forward with its plan. So much for the agenda of states' rights and responsibilities that Ronald Reagan trumpeted the Republicans came to power in 1981.
The administration said it was rejecting Oregon's waiver because the state's health-care rationing plan was "tainted with discrimination" against people with disabilities and thus violated the 1990 Americans with Disabilities Act.
It was alleged that in ranking 709 medical procedures by their costs and benefits, and announcing it wouldn't pay for items far down the list -- liver transplants for alcoholics, or heroic )( measures to save extremely low-birthweight babies, for example Oregon might undervalue the lives of persons with disabilities.
The action pleased national advocacy groups that had lined up against the plan -- 20 groups representing the disabled, the National Right to Life Committee, and the Children's Defense Fund (which faulted the plan as a mean-spirited public experiment that might harm some children).
The advocacy groups' tunnel vision misses the big picture. State Senate President John Kitzhaber, chief architect of the Oregon plan, notes that Oregon is a leader among the states in assisting the disabled, including such optional Medicaid services as durable medical equipment and physical therapy.
The plan would have expanded Medicaid benefits to 120,000 poor Oregonians, 65,000 of them impoverished women and children. President Bush's move means "all health services will now be rationed to that population," says Mr. Kitzhaber. "Some of these people will die, some will give birth to infants with profound mental and physical disabilities which could be prevented with adequate medical care. The ADA legislation was created to help people with disabilities, not to create people with disabilities."
What's more, says Oregon's Medicaid director, Jean Thorne, Oregon's law would leave intact existing Medicaid benefits for presently covered disabled people until 1993, and then change them only with further legislation requiring yet another federal waiver.
The 120,000 new Medicaid recipients the state wanted to cover include many disabled people. The administration, Mr. Kitzhaber says, is effectively denying all treatment to those disabled in order to "protect" them from hypothetical future discrimination.
Ms. Thorne put her finger on the dirty little secret of advocacy-group politics: "They apparently don't care about those without, only those within. I'd like the advocacy groups for the disabled to look uninsured people in the eye and say 'We did it for your own good.' "
Another irony of the White House decision is that it quashes one of the most thoughtful, democratic policy-making exercises of our time. The plan passed the Oregon Legislature with overwhelming bipartisan support. A broadly based commission of physicians, nurses, hospital administrators and ordinary citizens went to work sorting out hundreds of medical procedures. Forty-seven community forums were held to gauge Oregonians' community values on critical medical-care questions.
Now, by rejecting a painstakingly conceived plan, Mr. Bush casts a chill over state health-care reform efforts coast to coast. "You just can't grapple with health-care reform without making hard choices," says Ms. Thorne. "We only wanted the administration to condone our making hard choices. And they wouldn't even do that."
Leaving the National Governors' Association meeting in Princeton, New Jersey, Gov. Booth Gardner, D-Wash., a leading health-care reform advocate, noted that "the people of Oregon struggled with the toughest issues inherent in expanding access to affordable health care. Their efforts should be respected and encouraged, not thwarted."
Gov. Arne Carlson, R-Minn., said, "It sounds like the feds are continuing to admire the health-care problem. If they aren't sending cash any more, they should at least send permission."
The Bush camp, Republican Sen. Bob Packwood told the Oregonian, is using the disabilities act as a sham to avoid making a decision -- that Health and Human Services Secretary Louis Sullivan wanted to approve the waiver, but was overruled by the White House for political reasons.
One is left wondering if things would be better under a Clinton-Gore administration. Senator Gore last spring opposed Oregon's plan for allegedly "leaving poor women and children at risk."
But Governor Clinton said in May, "If I were president, I would give Oregon permission to move forward." In late July -- after Mr. Gore joined the ticket -- Mr. Clinton specifically reiterated his support, saying Oregon would "get more health care for more people and be a healthier state."
Would Mr. Clinton, in the White House, stick by his word and continue to espouse creative federalist experimentation as he has as a governor and chair of the National Governors' Association -- even under political heat? One can't say for sure.
But there's no doubt what we have now. "This president," the Oregonian editorialized, "is an invertebrate when dealing with controversy."
Neal R. Peirce writes a column on state and urban affairs.