Experiment in Oregon Gives Medicaid Very Local Roots

Gov. John Kitzhaber, a former emergency room doctor, said, “We’re building something that’s never been built before.”

Some say America has been homogenized, a chain-store nation bereft of regional distinction in dialect or dinner. But now this state, at the pioneer’s end of the road, is testing the idea that local community difference is alive and well, and that grass-roots leadership holds the key to fixing health care in America.

Under an agreement signed with the Obama administration last year, and just now taking shape, Oregon and the federal government have wagered $1.9 billion that — through a hyper-local focus on Medicaid — the state can show both improved health outcomes for low-income Medicaid populations and a lower rate of spending growth than the rest of the nation. If Oregon fails on either front, the consequences are grave, potentially tens of millions of dollars in penalties a year, bleeding a state budget still wounded from recession.