Commissioner seeks elusive magic bullet
Walt Ponsford wants the county to tackle the rising cost of health care no matter how unconventional his ideas sound
March 12, 2003 — Call it wishful thinking, but don't blame him for trying.
Jefferson County Commission Chairman Walt Ponsford has shown he's not afraid to think outside the box.
So last week, he organized a brainstorming session that evolved equally into a venting session regarding one the nation's nagging problems: the rising costs of health care.
Ponsford wants local health-care experts to combine forces to come up with an innovative way to slash health insurance premiums and keep more dollars in the county.
"You know what scares me? Maybe we can't do anything about it," Ponsford admitted. "But I'd sure like to try."
The newly elected commissioner kept his ideas close to him during last fall's campaign, but now he's brought them into the open.
He convinced representatives from a wide spectrum of county-based entities -- including Mountain View Hospital, local insurance agents, doctors, the 509-J School District, Bright Wood, county government, Crooked River Ranch and natural health providers -- to hear out his bold ideas last week during an hourlong discussion in the basement of the Library Annex.
Ponsford pitched his ideas, then opened them to criticism They included:
- Creating a universal, county-based insurance pool for any and all willing participants.
- Instituting a countywide self-insurance plan.
- Creating a modified HMO-like entity integrated with local health-care providers.
His ideas were predicated on transcending the boundaries between the private and public sector to give county residents health insurance purchasing power -- a concept that many local health-care experts suggested was nearly, if not completely, impossible.
But out of the meeting came a tentative plan to meet again in two months to discuss one idea that seemed more feasible than the rest: health-care reimbursement accounts, known as HRAs.
HRAs combine high deductible health insurance with a cash reimbursement for employees who incur smaller expenses. HRAs have been touted with saving employers money while providing 100 percent coverage to employees. Higher deductibles allow employers to allocate the savings to future employee-directed health care.
The U.S. Treasury Department authorized their use last June.
County Administrator Mike Morgan said his staff would research the feasibility of HRAs and report back to the other groups.
With a hint of humor, Morgan also likened the concept of Jefferson County entities tackling the health-care system to "a grain of sand trying to influence a beach."
"We're going to discuss things we can do and things we can't do, and we'll find the answer somewhere," he said.
While health-care representatives will sleep on the idea of HRAs for the next two months, they mulled several other scenarios during their discussion, including Ponsford's ideas to pool public and private employees in a single countywide plan.
They also did a lot of venting.
Mike McGowan, owner of The Insurance Mart, discussed the pros and cons of the Crook County School District's decision to be self-insured. He said self-insurance requires strength in numbers, and Crook County School District had remained ahead of its costs, with about $300,000 to spare.
"Where they projected to be and where they are, are different numbers," McGowan said. "But they're still ahead of the game."
However, McGowan cautioned: "One or two strokes will eat it up."
Mike Throop, a Bright Wood employee who was invited because the wood-products company operates a successful self-insured health program, said the company chose that route 10 to 15 years ago as an employee benefit that encourages retention.
Paul Hathaway, Jefferson County's attorney, expressed skepticism about Ponsford's various concepts of a countywide insurance program that would mix private and taxpayer-funded employees.
"I doubt very much it would be lawful to combine the two groups," Hathaway said.
Ponsford emphasized that another reason he called for the round-table discussion was to explore ideas of keeping money in the county.
"The bleeding we have at the hospital is not just at the hospital," he said, referring to the economic impact of residents who seek health-care services in Deschutes County.
Mountain View Hospital Administrator Susan McGough said 43 percent of county residents who seek inpatient care go out of county. Of those, 25 percent seek services they can't find locally while the remainder do it by choice.
"That would be another million or two that could go into our local economy," McGough said.
McGough appeared lukewarm toward the ideas being discussed, but admitted health insurance costs for hospital employees are burdensome. Insurance premiums, in a twist of irony, are the hospital's fourth largest expense.
"We've explored many options, but none are perfect," McGough said.
Dr. Bud Beamer echoed similar comments. He said one of his biggest challenges is the number of patients he sees that are on the Oregon Health Plan and Medicare.
"It's upwards of 82 percent," Beamer said. "We don't get a reasonable blend here to offset those things."
Those attending the meeting also bemoaned the price of health insurance premiums in Central Oregon, which Morgan said he was told are the highest in the country.
Said Ponsford: "What's maddening to me is we're paying the highest premiums in the country and we're not paying our local health-care providers. It's maddening.
"I hope people will get a heads up on this thing and start doing something about it."
Although combining the public entities' insurance purchasing power to save taxpayers and employees didn't appear likely by the end of the meeting, representatives walked away seemingly willing to listen to what Jefferson County pencils out in regards to a possible HRA plan.
Morgan suggested public entities would be remiss not to address rising health-care costs.
"I think everybody at this table knows you can't ignore this subject," he said.
Ponsford said the public sector faces additional insurance premium increases upward of 15 percent to 20 percent -- just one of many reasons he chose to pitch his ideas without regard to how well they'd be received.
"If we can find the magic bullet, we can literally keep our work forces employed without even any new taxes," he said.