Eight years after Oregon voters crushed a proposal for universal health care at the polls, reformers are quietly preparing for another run at the issue in Salem.
A coalition of major reform groups has drafted new legislation that would create a single-payer health care system for the state, essentially taking private insurers out of the picture and creating a taxpayer-funded system to cover a broad spectrum of health services for all Oregonians.
It's an updated version of Measure 23, a 2002 referendum that went down in flames, losing by more than 700,000 votes.
"We were quite conscious it was a bit premature," said Mark Lindgren, chairman of M23 proponent Health Care for All-Oregon.
"We need it now because more people don't have health insurance and more employers are finding it difficult to provide health insurance for their employees."
This time around, Lindgren's organization has teamed up with the Oregon chapters of Jobs With Justice and Physicians for a National Health Program. The League of Women Voters of Oregon also is considering throwing its weight behind the measure, though it hasn't done so yet.
Dubbed the Affordable Health Care for All Oregon Act, the bill would incorporate some of the main features of previous state reforms. For instance, it would have a menu of defined benefits a la the Oregon Health Plan and would be administered by the Oregon Health Authority, the fledgling health care agency created by the 2009 Legislature.
Some aspects of the 2009 reforms that would go away are the public option plan and the insurance exchange - because the bill would create a single public plan to cover everyone in the state, eliminating the need for private insurance except supplemental coverage for things such as cosmetic surgery.
Backers would seek waivers to use Medicaid, Medicare and other federal funds to cover about half the cost of running the plan. The rest of the money would come from a system of progressive payroll and income taxes.
The idea is to capture the money now spent by individuals and businesses on insurance premiums to fund the plan, said Physicians for a National Health Program member Mike Huntington, a retired Corvallis radiologist.
"This should end up costing Oregonians less for health care, or the same, but cover everybody," Huntington said.
"We would get rid of the overhead of private insurance, which accounts for at least 20 percent of where our health care dollars go."
Michael Dembrow, a Democratic state representative from Portland, has agreed to carry the bill in the House and said several other lawmakers are prepared to sign on as co-sponsors. He acknowledges the measure could be a tough sell, especially with the gains made by Republicans in the last election.
"Obviously, the political landscape has changed," Dembrow said. "It's going to be tough to get it passed this session. Obviously, we'll push, push, push, but this is a long-term commitment."
His hope is to get a hearing for the bill so the pros and cons can be debated and so proponents will have a chance to build support for their cause among legislators and the public.
"There are still many people out there who don't understand single-payer," Dembrow said. "People have to become educated."
It's not clear at this point where the medical community will come down on the issue. While many physicians are vocal supporters of a single-payer system, others strongly resist the idea.
"Generally speaking, our membership is pretty divided," said Betsy Boyd-Flynn, a spokeswoman for the Oregon Medical Association.
"We have some members who love the federal health reform plan, some who hate it because they think it doesn't go far enough, and some who haven't made up their minds. We're a lot like the state of Oregon in that regard."
Larry Mullins, the president and CEO of Samaritan Health Services, said the mid-valley hospital operator still is working through the implications of the current state and federal reform initiatives.
While he doesn't necessarily oppose the single-payer approach, he thinks the Affordable Health Care for All Oregon Act would have to be thoroughly evaluated to make sure it gets all the details right.
"Whenever you go through a major change process, you have the intended consequences and the unintended consequences. That's why health reform is so complicated," Mullins said. "My hope is we'll continue to have incremental improvement, but I'm not sure we have a consensus yet on what right is."
The bill is certain to face strong opposition from major health insurers, which are already facing potentially costly new mandates under the federal Patient Protection and Affordable Care Act of 2010.
Samantha Meese, a spokeswoman for Regence Blue Cross Blue Shield of Oregon, said she hasn't had time to study the measure but said her company tends to be dubious of single-payer plans.
"Simply changing the mechanics of how we pay," she noted in an e-mail, "doesn't increase affordability or improve quality."
Lobbyist Roger Beyer represents both the Independent Insurance Agents and Brokers of Oregon and the National Association of Insurance and Financial Advisors in Salem. He's dubious as well but not too worried.
"It's a concern to the insurance agents, obviously, but I don't think the chances of it moving forward are very good," said Beyer, a former state lawmaker himself.
"You would be taking a group of people who are basically private business people ... and you'd be replacing them with people who are paid by the taxpayers," he added. "The people I represent don't think that's a good solution for anything."
If the Affordable Health Care for All Oregon Act doesn't pass in the 2011 Legislature, its backers say they're quite prepared to keep trying - and might even push to put the proposal before the voters as a ballot measure yet again, perhaps in 2013.
Lindgren says he has no objections to that approach, despite Measure 23's lopsided loss in 2002.
He thinks people are more willing to discuss the idea of single-payer insurance now, especially given the large number of Oregonians who have lost jobs - and employer-sponsored health insurance - in the Great Recession.
Besides, he's not ready to concede that the bill won't pass the Legislature.
"You never know what's going to happen," Lindgren said.
"In politics, you're trying to catch a wave, and you never know when that wave is going to come along."