Oregon's Legislature took a step Tuesday toward enshrining the right to healthcare in the state Constitution, a move that would be unprecedented in the United States but raises serious funding questions.
The House of Representatives' 35-25 endorsement of the bill sends it to the state Senate, whose approval would put the proposed constitutional amendment on the ballot for Oregon voters in the November election. The move comes as the Trump administration has tried to dismantle former President Barack Obama's healthcare law.
If the Senate passes the bill, voters would be asked to consider amending the state's 160-year-old Constitution to declare: "It is the obligation of the state to ensure that every resident of Oregon has access to cost-effective, medically appropriate and affordable healthcare as a fundamental right."
Oregon is one of the most liberal U.S. states and was the first sanctuary state protecting immigrants in the country illegally and the first to legalize suicide for the terminally ill. The state also expanded coverage on abortions and other reproductive services regardless of income, citizenship status or gender identity. Both chambers of the Oregon Legislature are controlled by Democrats.
Amending the constitution to establish healthcare as a right would also be a first, according to Richard Cauchi of the National Conference of State Legislatures, who specializes in health and related issues.
"Some states have an extensive history of considering universal health coverage, going back 15 to 20 or more years," Cauchi said. "However, no such binding ballot question language has been passed and added to a state constitution."
A measure has been introduced in both houses of the Maryland General Assembly that would establish "Healthy Maryland" as a public corporation and state government unit "to provide comprehensive universal health coverage for every Maryland resident." A hearing is scheduled for March 7 on the Senate bill.
In 2014, then Vermont Gov. Peter Shumlin, a Democrat, ended an initiative to develop a single-payer healthcare system in his state. An analysis had predicted new taxes of 11.5% for employers and up to 9.5% for individuals, according to the National Conference of State Legislatures.
In California, a single-payer plan supported by some Democrats was spiked last year by other Democrats because the cost would have been astronomical.
Those who spoke out in favor of the Oregon bill on the House floor Tuesday said no Oregonian should lack access to medical care, but opponents said there is no plan to fund making healthcare access a right and warned that doing so would make the state vulnerable to lawsuits.
His voice frail, Rep. Mitch Greenlick described how he was diagnosed with lymphoma in 2005, and relied on insurance to pay huge treatment costs.
"If I didn't have insurance, I wouldn't be here," the Democrat from Portland said. "I would be dead."
He urged lawmakers to pass the bill as "a moral decision."
Rep. Paul Evans, a Democrat, said "if the people decide they want it, it's our responsibility to try come together and make it happen."
Rep. Mike McLane, the House Republican leader, highlighted the uncertainties about how healthcare would be funded in Oregon.
"What's been said today is there is no plan. We have no idea how much it will cost," McLane said.
House Speaker Tina Kotek, a Democrat, told reporters Monday that putting the Hope Amendment, as it is nicknamed, before Oregon voters in November would "send an important value statement about the importance of healthcare, particularly as you see at the federal level there are a lot of efforts to scale back Medicaid and Medicare."
Kotek said the goal of the legislation is "primarily aspirational" and that if the ballot measure passes, details would still need to be worked out about the state's health care commitments.
Asked if a person could sue the state if the constitutional amendment passes and they are denied seeing a medical specialist, Kotek said that is unclear.
"Somewhere down the line that will be someone else's conversation," she said. "I think whenever you put anything into the Oregon Constitution, it sets a framework of future effort."
The bill is scheduled for a first reading in the Senate on Wednesday. A spokesman for Senate President Peter Courtney, a Democrat, declined to comment when asked if Courtney has a position on the bill.