Oregon
Nation should take inspiration from Oregon’s reformed Medicaid system, former Gov. John Kitzhaber says
Former Democratic Gov. John Kitzhaber, who oversaw the creation of the Oregon Health Plan and the state’s Coordinated Care model, is among those Rep. Cliff Bentz is getting advice from as Republicans consider massive cuts to Medicaid and other programs. Kitzhaber is pictured on March 14, 2025 at OPB, before his appearance on “Think Out Loud.”
Allison Frost / OPB
In the late 1980s, former Governor John Kitzhaber was a chief architect of the Oregon Health Plan, the state’s reformulation of Medicaid. In 2012, he was the driving force behind another huge transformation: the creation of coordinated care organizations or CCOs, which became the way low-income Oregonians get their healthcare.
Kitzhaber has been out of office for 10 years now, but he has been paying a lot of attention in recent weeks to Congress, where Republicans are looking to trim upwards of $800 billion from Medicaid over the next ten years.
Kitzhaber spoke with OPB’s “Think Out Loud” about what Medicaid cuts or reform could look like for Oregon and the nation. Excerpts, edited for length and clarity, are below.
What an ideal healthcare system should look like
“The objective of the health care system ought to be health, right? And I think that, primarily, we view it as something to fund and deliver medical care, right? I think most of us would probably agree that we want a healthcare system that’s affordable, accessible and that actually improves health outcomes when people need it.
“You need to align the fiscal incentives with the outcomes that you want. So fee-for-service medicine, which is what most hospitals operate on, rewards you for doing more regardless of whether what you’re doing actually is connected to a health outcome. If you operate under a global budget that is a fixed amount of money that grows at a predictable rate each year, then you have an incentive to actually invest in, let’s say, childhood obesity, because you want to reduce the very costly consequences of diabetes downstream.”
How Oregon sets an example
“The Coordinated Care Organizations are essentially local organizations that operate on a global budget that can grow at about 3.4% per member, per year and are required to maintain enrollment and benefits and meet metrics around quality and outcomes. The idea originally was to prove that up in Medicaid and then move it into the private insurance market in the individual market and small group market, which I still think is a really important step because both Medicaid and Medicare and our employment-based system are simply unsustainable. They’re getting unaffordable for employers, for government and for individuals.
“We signed an agreement with the federal government that we would reduce the cost trend two percentage points from medical inflation by the second year of the waiver, but we had a period to phase that in and the feds gave us a $1.9 billion dollar one-time loan and that money went down over the five years as the cost savings came in.
“The classic block grant is they give you a fixed amount of money. And if the number of people in your Medicaid system goes up, then you’ve got to either drop some of them off or you have to cut benefits. The three classic ways to manage cost in any health care program is to reduce benefits, reduce enrollment or reduce what you pay providers. What we’re trying to do in Oregon is the fourth path, which is reduce the total cost of care itself, while maintaining access, while maintaining benefits, while maintaining quality.”
Former Democratic Gov. John Kitzhaber, who oversaw the creation of the Oregon Health Plan and the state’s Coordinated Care model, is among those Rep. Cliff Bentz is getting advice from as Republicans consider massive cuts to Medicaid and other programs. Kitzhaber is pictured in the “Think Out Loud” studio on March 14, 2025 at OPB, just before his interview with host Dave Miller.
Allison Frost / OPB
What cuts to Medicaid at the federal level could look like
“I think the Democratic response has been very loud and focused: ‘No cuts to Medicaid. Period.’ I think that’s not only the wrong response, but I think it misses a huge opportunity that’s presented at this moment in time.
“What I’ve been proposing and discussing with [Congressman Cliff Bentz] is using Oregon’s CCO model as a way to transform the Medicaid system nationally. We’ve saved the federal government almost $4 billion over the last ten years. Give other states the opportunity if they want to move down that path to adopt the key principles of our plan: a global budget that’s growing at a rate below medical inflation. Secondly, requirements: You can’t cut enrollment, you can’t cut benefits and you have to meet metrics around quality and outcomes.
“You can look at the $4 billion we saved as cutting Medicaid, or you could look at it as I do; as making the program more efficient and more responsive to the needs of people who depend on it. And actually ECOnorthwest did a study in 2018 on what would happen if the nation adopted a very similar program and received cost savings of the same magnitude as Oregon, and the 10-year budget reduction was about $700 billion.”
The potential political hurdles to get there
“One of them is on the Democratic side of the aisle. I think this attitude that [there should be] no cuts to Medicaid is politically not very smart. The last three election cycles, the Democrats have insisted that all our public institutions are working just fine, which doesn’t match up with the reality of millions of Americans who are working hard and can’t make ends meet, right? This is an opportunity for us to say, ‘Let’s defend the need for our public institutions – in this case, a healthcare program for vulnerable Americans – but let’s make it work. Let’s make it efficient. Let’s not continue to spend dollars on things that don’t produce health and simply line the pockets of big corporate interests.’
“On the Republican side, I question the motives of at least the president’s desire to cut these things. I don’t think there’s a lot of compassion there or understanding of the fact that these are hardworking people who are working one or two jobs and just can’t get by. And that healthcare to me, particularly in rural Oregon, is a key ladder to economic self-sufficiency. It’s part of the infrastructure of upward mobility. I’m not sure they understand that.
“I’ve been working closely with Congressman Bentz who has introduced this notion to the Committee on Energy and Commerce. Obviously, I don’t know what’s going to happen. But the question on the Republican side is whether they’re interested in just slashing and burning and cutting a program that is incredibly important to 80 million people, most of them kids in this country, or whether they’re actually interested in getting legitimate efficiencies without damaging this incredible infrastructure that’s so important to health.
“It doesn’t have to be an ugly partisan battle. We all need health care, no matter who we are, no matter where we live. Let’s work together to make it affordable and to make it effective.”
Former Oregon Gov. John Kitzhaber spoke with “Think Out Loud” host Dave Miller. Click play to listen to the full conversation:
Editor’s note: In 2016, WW expanded its Cheap Eats guide to include a road trip. We identified nine diners, food trucks and one boat worth a pit stop when journeying through Oregon. Since then, a few things have changed: Two of our picks have closed, as noted below, and you don’t need to travel to Medford to find an In-N-Out Burger. But maybe you should!
This list first appeared in the March 23, 1016, edition of WW.
TAQUERIA GUERRERO
508 E 1ST ST., NEWBERG.
Half tienda, half taco spot, Guerrero serves its street tacos and huge mojado burrito ($8.95) with handmade tortillas that shame almost anything in Portland.
JOE’S DONUT SHOP
39230 PIONEER BLVD., SANDY.
This 40-year-old candy-striped dough den offers a ridiculously rich cronut—that’s a fried croissant—fast service, and always-fresh doughnuts. It’s arguably the best doughnut shop in the state.
THE DINER
2580 SE STRATUS AVE., MCMINNVILLE.
The Diner makes one of the state’s greatest sandwiches—a fried-chicken club in which each layer is seasoned and housemade, and the middle slice of bread is replaced by the satisfying crunch of fried chicken.
EASTWIND DRIVE IN
395 WANAPA ST., CASCADE LOCKS.
The Eastwind is where Cheryl Strayed first tasted civilization after ending her long, long walk. The soft-serve ice cream is good enough for you, too, motherfucker.
BOWPICKER FISH & CHIPS
1634 DUANE ST., ASTORIA.
At this 28-foot converted gillnet boat, there are always 12 old men waiting in line for beautifully fresh-caught, hand-battered albacore tuna served with a raft of fries. Join them.
LOCAL BOYZ HAWAIIAN CAFE
1425 NW MONROE AVE., CORVALLIS.
A sweet shoyu chicken plate lunch will fill you up until dinner tomorrow. But broke high-school kids will buy rice for $1.50 just so they can douse it in the magical ginger-garlic-shoyu sauce.
IN-N-OUT
1970 CRATER LAKE HIGHWAY, MEDFORD.
With an address that already sounds like a road trip, the magnificent double-double has punctured the state line. Even from as far away as Portland, it beckons.
NOW CLOSED:
FAT FREDDY’S
6320 PACIFIC AVE., PACIFIC CITY.
After a brief hiatus best forgotten, Pacific City’s beachfront home of towering burgers and equally towering Tillamook ice-cream milkshakes returned two years ago to the sound of hardening arteries.
CORNBREAD CAFE
1290 W 7TH AVE., EUGENE.
It’s arguably Eugene’s best restaurant, and it’s also a perfect fit for the town—a vegan version of an old-school diner, complete with barbecued seitan and outrageously good greens.
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PORTLAND, Ore. (KATU) — Oregon officials asked the public to help find a two-year-old boy who went missing from Portland last Wednesday, June 17.
The Oregon Department of Human Services, Child Welfare Division, is asking the public to help find Armani Andrews and call 911 or local law enforcement if they believe they saw him.
Armani is believed to be in danger and is suspected to be in Portland, around any of the following areas: Rose Haven, Multnomah County Central Library, or Southeast Portland around 82nd-103rd.
Armani is a two-year-old Black/mixed race baby. He is about 24 inches tall, he has brown hair, brown eyes, and his weight is unknown.
If contacting Portland Police Bureau about Armani, reference the case number: #PP185430
The report number for Armani with the National Center for Missing and Exploited Children Report is: 2093182
ODHS said in a statement when a child is missing, they may be in significant danger and the department “may need to locate them to assess and support their safety.”
KATU News reached out to ODHS to clarify whether there is a custody aspect to the missing child’s case. The department said they are unable to provide that information.
Armani Andrews with Mother Rashonda Andrews/ODHS photos
You can report suspected child abuse to the Oregon Child Abuse Hotline by calling 1-855-503-SAFE (7233). The toll-free number allows anyone to report abuse of any child or adult to the Oregon Department of Human Services, 24 hours a day, seven days a week and every day of the year.
JOIN THE CONVERSATION (12)
KATU News included photographs of Armani to help the public identify and find him.
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