Universal Health Plan Governance Board July 2026 Meeting Summary

Big Picture

The July meeting focused on three major areas:

1. Impacts of recent federal Medicaid changes on Oregon

2. Updated revenue modeling 

3. Decisions regarding whether and how to include a revenue strategy in the final report

The Board also discussed next steps leading to final approval of the report in August, including continued work on legislative concepts and economic analysis.

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The Draft Universal Health Plan is Posted Publicly

Board will make final revisions during the August meeting.

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Changing Board Membership

Board member updates included:

• Recommendations for new board appointments were submitted to the Governor's Office to replace expiring members later this year.

• Bruce Goldberg returned to the Board after several months assisting the state with implementation planning related to recent federal HR1 health care legislation.

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Federal Medicaid Changes

Bruce Goldberg provided a summary of the state's response to the recently enacted federal HR1 legislation. Highlights included:

• Approximately 1.4 million Oregonians currently receive Oregon Health Plan coverage..

• State estimates suggest roughly 200,000 adults could lose Medicaid eligibility.

• Oregon projects losing approximately $9.4 billion in combined state and federal Medicaid funding by 2031.

• The Governor's Medicaid Advisory Group has developed dozens of policy options to address the resulting budget shortfall while preserving coverage and access where possible.

Board discussion emphasized that declining federal support creates additional challenges for implementation of a universal health plan. 

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Updated Revenue Modeling

EcoNorthwest presented updated financial modeling incorporating feedback from the Legislative and Policy Research Office (LPRO). Updated estimates included:

• $85.5 billion projected total Universal Health Plan expenditures in 2032 (unchanged from the Milliman report).

• Approximately $35.5 billion in revenue replacement needed after accounting for public funding.

• Preliminary tax rates were increased based on updated LPRO modeling.

Board members raised several significant concerns regarding the current revenue proposal, including:

• How employer tax levels compare to current employer health care spending.

• The complexity of the proposed tax structure and associated tax credit.

• The importance of presenting costs in terms of what households and businesses would pay compared to today's insurance costs rather than focusing solely on headline tax rates.

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Revenue Strategy Decision

The Board considered three options for how to address financing in the final report:

1. Include the current preliminary revenue proposal with significant caveats.

2. Revise the revenue proposal before report adoption.

3. Exclude a specific financing recommendation and instead describe potential revenue mechanisms that were considered and principles for future legislative consideration.

Following discussion, the Board voted 6–3 to adopt the third option. 

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Other  - The Board also received presentations on: 1) opportunities to integrate Oregon programs into a Universal Health Plan without requiring additional federal approvals, and 2) long-term information technology infrastructure needed to support an integrated statewide health system.

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August Meeting - Will include final report approval, discussion of legislative concepts, review of universal health plan economic impact analysis, and planning for the Board's work through June 2027.

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Public comment:

Public testimony included recommendations to:

• Consider additional revenue options, including a sales tax.

• Ensure provider reimbursement remains competitive.

• Revisit Milliman expenditure estimates.

• Delay release of the final report to allow for additional refinement of the financing proposal.

Universal Health Plan Governance Board June 2026 Meeting Summary

Executive Director's Report

The Board received updates on preparation of the final report and future legislative planning.

• Special Board meeting scheduled for July 9 to continue revenue discussions.

• Legislative Decision Package was not accepted by the agency; Senators Patterson and Manning are pursuing legislative funding and a potential 2028 legislative concept.

• Milliman budget analysis completed; Artemis contract concluded.

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Expenditure Analysis

Staff presented updated expenditure projections and revenue targets.

• Status quo health spending estimated at $82 billion, excluding dental, vision, and fertility benefits while leaving many Oregonians uninsured.

• Estimated UHP spending would increase to approximately $85.5 billion while covering all residents and adding those benefits.

• Administrative savings and elimination of uncompensated care are expected to make provider revenue more consistent.

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Community Engagement: Deaf and hard-of-hearing focus group met and recommended communication access standards, interpreter workforce development, and hearing-related benefits.

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Reserve Funding Strategy

The Board reviewed recommendations for startup financing and reserve requirements.

• Reserve strategy includes startup, ramp-up, and ongoing operational funding.

• Potential funding sources include bonds, state appropriations, and federal funding.

• Finance & Revenue Committee recommended:

  • Three-month operating reserve target

  • One-month trigger for additional recapitalization

• No specific recapitalization mechanism was selected.

• Board discussion focused on balancing financial stability, liquidity, and long-term flexibility.

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Revenue Plan

The Board continued refining its revenue proposal.

• Approved adding a 0.2% increase to the state lodging tax, increasing the total state lodging tax from 2.5% to 2.7% beginning in 2026. Vote was 7 - 1. 

• Estimated annual revenue: approximately $5 million.

• Legislative Revenue Office will model additional revenue scenarios and recommend tax percentages needed to meet revenue targets.

• Board discussion included whether employers should contribute a greater share of funding.

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Implementation Sequencing

The Board discussed three options for transitioning the state to a universal health plan from the status quo: 1) population-phase in, 2) hybrid, and 3) simultaneous transition approaches.

Key discussion points included:

• Lessons from Vermont suggested a phased implementation is politically practical.

• OR could consider exempting certain populations that would not initially benefit from UHP from paying UHP taxes.

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Public comment:

• Pursue legislation to negotiate prescription drug purchasing and pricing.

• Launch a legislative and public information campaign to build support for UHP.

Universal Health Plan Governance Board May 2026 Meeting Summary

May 21, 2026 

Big Picture

The Board focused on:

1. Community engagement and public feedback

2. Administrative savings assumptions and revenue modeling

3. Revenue policy decisions and final report development

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Community Engagement & Communication

• Continued outreach to disability-affected communities.

• Town hall survey results to be presented at the next meeting.

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Administrative Savings & Revenue Modeling

• Dr. William Hsiao (Harvard) presented on how a unified health system could reduce administrative costs, billing fraud, and duplicative spending.

• Board reviewed Billing and Insurance Related (BIR) cost savings assumptions:

  • Conservative: 7–9%, Moderate: 9–11%, Ambitious: 15–17%

  • Board adopted a 12% administrative savings assumption.

  • Milliman expenditure estimates will be revised accordingly.

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Revenue Plan

• Board reviewed the final draft of the Revenue Plan from ECOnorthwest.

• The Finance & Revenue Committee considered the work unfinished.

• The Revenue Plan includes:

  • Universal Health Plan expenditure targets

  • Proposed revenue mechanisms

  • Household and business impact analysis

  • Reserve recommendation (3-month target, 1-month trigger)

• The Legislative Revenue Office is helping convert the proposal into a legislative-ready package.

• Tax calculator under development to compare current health care costs with projected Universal Health Plan contributions.

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Revenue Plan Votes

Household Size Rate Readjustment (HSRR)

• Would have required larger, higher-income households (>200% of the Federal Poverly Level) to contribute more.

• Concerns included increased costs for families and added complexity for voters.

• Board voted to remove the HSRR.

Medicare Part B Premiums

• Discussion on whether Universal Health Plan should cover premiums for Medicare enrollees, or reimburse enrollees via a tax credit.

• Motion passed (7–1) to have Universal Health Plan cover Medicare premiums and eliminate the proposed tax credit.

Vote on the broader revenue strategy was postponed.

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Final Report Development

• Work continues on: administrative structure, financing structure, supporting materials (history, public comments, consultant reports)

• Updated drafts will continue to be released for Board review.

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Public Comment

• Recommendation for a multi-year startup plan.

• Concerns that financing proposals could increase costs for families with children.

• Concerns that larger families should not pay more simply because they use more health care.

Next Steps

• Revise expenditure estimates using the new administrative savings assumption.

• Continue public engagement.

• Finalize financing recommendations and September report.

Universal Health Plan Governance Board April 2026 Meeting Summary

Big Picture

In April, the Board focused on three primary areas:

1. Discussion of revenue recommendations

2. Ongoing debate about adequacy and completeness of Milliman savings estimates 

3. Board operations, recruitment, and future leadership transitions

Discussions reflected growing tension between the desire to move financing recommendations forward and concerns that incomplete proposals could undermine confidence in the Board’s final report.

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Revenue Proposal Review

The Board reviewed a high-level summary of draft revenue proposals and discussed a minority report released by several Finance & Revenue Committee members asserting that some revenue and expenditure assumptions may be inaccurate. Further discussion will continue at the next meeting. Planned votes on components of the revenue package were postponed.

Board members raised several concerns about moving forward before the package is complete, including:

• Whether the Board should vote on isolated revenue elements without understanding the full financing framework

• Whether partial recommendations could be misinterpreted by the Legislature as a finalized plan

• Whether unresolved policy questions should first return to a committee for further refinement 

• Administrative complexity created by certain payroll tax approaches

Michelle Glass emphasized the need for any interim recommendation to clearly state that it is not a complete revenue plan.

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Milliman Expenditure Discussion

In response to ongoing concerns about cost assumptions understating potential savings, Milliman reviewed several areas where savings may be possible, including via reimbursement levels, provider payment collectibility, simplified eligibility and billing systems, and health plan staffing.

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Executive Director Report

The Executive Director reported on several organizational matters:

• Board Outreach - Continued public outreach activities statewide, including HCAO-hosted town halls 

• Budget Funding Request - The Board’s biennium funding request continues moving through the legislative process

• Upcoming Board Transitions - Several board terms are ending over the next year:

• Michelle Glass is anticipated to depart in September 2026

• Amy Fellows is expected to complete her term in December 2026

The Board expects to open recruitment processes in October and January 2027, with an emphasis on candidates experienced in public engagement.

Leadership succession will also require selection of a new Vice Chair and future Chair.

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Committee Updates

• Community Engagement & Communications Committee - Completed 11 focus groups. 

• Transition Committee - Ongoing discussion of role and scope.

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Oregon Health Authority (OHA) System Readiness Report

The OHA readiness report was approved as part of the consent agenda, without presentation.

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Public Comment

Public comment focused heavily on financing issues. Major themes included:

• Concerns about the accuracy of Milliman expenditure forecasts

• Questions about whether proposed taxes are sufficiently progressive

• Skepticism regarding the effectiveness and fairness of the household size rate readjustment

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Looking Ahead

May is likely to focus on:

• Continued debate and possible votes on revenue proposals

• Reserve strategy discussion

• Release of the community engagement focus group summary

• Increasing pressure to reconcile incomplete financing work ahead of the September final report deadline