Abstract
ON AUGUST 19, 1991, the Oregon Department of Human Resources submitted to the Health Care Financing Administration (HCFA) a proposal to conduct its new Medicaid program as a 5-year demonstration project. If approved, the most visible and controversial plan to reform health care coverage for the poor and uninsured will be set in motion. If denied, the results of 2 years of hard planning and negotiations will disappear, and 2 years of debate will become moot. Frustrated by uncontrollable increases in Medicaid costs, a large population of uninsured, and a nagging sense that resources were being misallocated, the Oregon state legislature passed the Oregon Basic Health Services Act in July 1989.1The act had three parts designed to ensure that every citizen was covered for at least basic health care. One part would expand Medicaid to cover all people with incomes less than the federal poverty level; the second
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