Still Learning from Oregonians About Medicaid

In this issue, Muruganand et al. report the work of the Oregon Health Services Commission, a group tasked by Governor Kitzhaber with prioritizing coverage for health services in Medicaid so that all people living under the poverty level could be included. Federal and state policy makers continue to search for ways to constrain Medicaid spending. The problem of how to fairly allocate limited resources for healthcare (and other determinants of health) is both urgent and enduring. Allocating limited state and federal funds for Medicaid challenges us to consider equal opportunity, keeping in mind that opportunity benefits not merely from healthcare coverage but from other safety net programs that support housing, education, childcare, nutrition and more. The Oregon Health Services Commission, like other entities then and since, learned that a purely formulaic approach to costs and benefits can create results that fly in the face of moral reason. Participatory budgeting and public deliberations about spending priorities for health, informed by and in conjunction with high quality evidence about costs and outcomes, could inform and perhaps make "just enough" decisions about allocating scarce resources that affect health.