Editorial: Shaving down the cost of health care
Published 9:21 am Wednesday, July 16, 2025
- Oregon is looking at a new way to hold down the cost of health care. (123RF)
Expensive health care can be a powerful incentive to eat your vegetables and exercise. People can’t afford to get sick.
And some people say the health care industry isn’t looking out for us.
If you think that is a terrible way to incentivize a healthy lifestyle, we are right there with you.
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Oregon state officials have been working on ways to control health care costs. The state already has a soft cap on increasing costs of health care at 3.4%, which is going to be revisited this year.
Health care insurers and providers have to stay under that cap. If they exceed it and don’t have a reasonable excuse, the Oregon Health Authority will work with them on how to do better. If they consistently blow past the limit they may face financial penalties.
What’s new is that the state may cap commercial health insurance payments. We stumbled across that Tuesday morning. Then we found that The Oregonian had published an article about it that appeared – Tuesday morning. Good job, Oregonian. You can read that that story here: tinyurl.com/Oregoniancap.
The state caps such payments for two Oregon health plans for public employees – the Public Employees Benefit Board and Oregon Educators Benefit Board. The top limit of payments is not supposed to exceed 200% of Medicare rates for some hospitals. The state is considering a broader statewide cap.
“Commercial insurance paid an average of 1.85 times the amount that Medicare paid and 2.68 times what Medicaid insurers paid Oregon hospitals for inpatient procedures in 2023,” the state says. “If commercial insurance payments in Oregon were capped at 200% of Medicare reimbursement rates, OHA estimates more than $500 million could have been saved across all of the inpatient and outpatient hospital procedures tracked in the 2023 Hospital Payment Report.”
Too many Oregonians forego health care because of its cost, so we are eager to see how this might work. The challenge with any cap or target is ensuring it is reasonable. And then there is the problem of figuring out what sort of distortions the policy will create. Will health care access or quality decline?
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Somewhere, something will get squeezed. We don’t want it to be patient care.