Oregon: A Prescription Plan Hailed as a Model Is a Budget Casualty

By TIMOTHY EGAN
New York Times

PORTLAND, Ore., March 3, 2003— In a state that says it is already so short of public money it does not have enough to keep all the schools open and prosecute many criminals, Oregon took another drastic step this week to cover budget shortfalls: it cut off medications to thousands of schizophrenics, manic-depressives, drug addicts and others who are poor and have no health care.

A decade ago, Oregon was widely hailed as a pioneer in providing health insurance, including prescription drug coverage, not only to the poor but also to people who make just enough money that they do not qualify for most federal Medicaid programs.

Now, in a reversal that has stripped a once ambitious program to its core, Oregon has pared back the insurance, and removed prescription drug coverage for things like mental illness and drug addiction. Most of the cuts went into effect March 1, but others started Feb. 1, just days after Oregonians voted in a referendum against a tax increase to balance their budget.

And while state officials are looking for some way to restore some of the health program, they admit that they will not be able to offer anything like the expansive benefits of the past.

So throughout Oregon this week, about 100,000 poor people are suddenly scrambling for the basic medications that allow them to function.

For Dave Cesario, 45, who is H.I.V. positive, diabetic and on methadone to stave off addiction to heroin, it meant going cold turkey Saturday.

"I'm just numb; I don't know what to do," said Mr. Cesario, who lives with his disabled wife and 12-year-old son. "My only hope is that the drug companies will have mercy and I'll be able to get some free samples."

For Karen Hansen, 50, who has prescriptions for everything from anxiety disorder to high blood pressure, the cutoff means taking only the few drugs that will keep her alive. She lives on $689 a month in Social Security disability payments, and her monthly prescription bill, without assistance, is $615.

"I don't buy the newspaper, I eat hot dogs that they give out free and get other meals from the food bank," Ms. Hansen said. "But that only saves about $200."

The step is the latest response to a budget crisis that led state officials to make nearly $600 million in cuts in the last two years, and will require another $2 billion in reductions, according to projections, in the new budget cycle that begins this June.

Hit by a harsh recession after a series of tax-cutting measures pared the budget to the bone, Oregon, which has no statewide sales tax, now lacks enough money for health care, schools, prisons and criminal prosecution.

Portland schools had planned to cut nearly five weeks off the school calendar this year. But teachers agreed on Monday to work two weeks without pay, and that offer — together with a plan for a temporary business tax — looks as if it will now save the school year. But the state has announced plans to close a number of schools.

Prisons have let out some criminals early. And starting today, prosecutions of people arrested for theft and drug crimes are being delayed because there is not enough money for prosecution or legal defense. Officials say those arrested are being released and may be tried later, in the summer, if the legislature can come up with new funds.

The latest round of cuts came after Oregonians considered a referendum in January on whether to raise taxes temporarily. The measure was narrowly defeated, after opponents of the tax increase said the state could find ways to cut without major consequences.

Unable to raise taxes, and having cut financing for police, prosecutors and schools, state officials turned to the Oregon Health Plan. They ordered the board that governs the plan to decide how and where to cut. It chose to revert to more basic coverage, stop paying for many prescription drugs and charge higher premiums and co-payments.

Dr. Patricia Kullberg, medical director of the health department of Multnomah County, which covers Portland, said she just did something she had never done in 21 years as a family physician: she advised a patient which medications he could stop taking and suffer the least. The patient lost his prescription drug benefit for arthritis, depression, high cholesterol and hypertension.

"I feel like I'm living in some foreign country where suffering is routine," she said. "It's scary. What we're doing is condemning people to the long-term consequences of their diseases."