A Tale of Two Behavioral Health Systems

How the State Border Determines Who Gets Access to Mental Healthcare

Members of Health Care for All Oregon were featured in this article by The Daily Yonder, an online periodical that provides news, commentary, and analysis about and for rural America.

Thanks you Astra Lincoln for the feature. Read the full article at dailyyonder.com

The article highlighted HCAO's perspective on what Oregon's potential transition to universal healthcare could mean for people who receive mental health services in and around Ontario Oregon.

Even before the changes that are coming due to the One Big Beautiful Bill, the care that residents in that area can receive already is differentiated by which side of the Snake River people live on. Below is a section of the article that highlights HCAO Leadership’s perspective.

Oregon’s Radical Plan Years in the Making

What are residents of these rural regions of Idaho and Oregon to do, in the face of dwindling insurance options and closing clinics and hospitals? In Idaho, social worker April Browne said, “There will just be people that fall through the gaps. We all have community connection. But that’s the only thing here that can close those gaps.”

In Oregon, there might be another option: the state is currently considering a universal health care plan. Since 2023, a governance board has been developing a policy proposal that could fully fund and implement a single-payer health care option that would cover every resident in the state. It’s the first serious effort to establish a single-payer health care system since 2002, when voters overwhelmingly rejected a plan proposed via ballot measure.

For Oregon’s rural clinics, which have historically been less likely to withstand unstable funding environments, the plan could have a “stabilizing effect,” said the advocacy nonprofit Health Care for All Oregon (HCAO) President Valdez Bravo, who works in health care administration. “The Baker City Birthing Center closed a few years ago, right on the eastern edge of the state. That wouldn’t have happened if we had a universal health care system providing stability and predictability to funding,” Bravo thinks. 

One of the Universal Health Plan Governance Board’s (UHPGB) nine members, Chunhuei Chi, helped design Taiwan’s first universal health plan in 1995. He’s been working on health care finance ever since, and has been involved in Oregon’s efforts to implement a universal health plan ever since the last ballot initiative in 2002. In an interview for Willamette Week in May 2026, Chi said the current UHPGB effort is “the closest [to success]. This is probably the closest ever.”

If enacted, the plan put forward by the UHPGB could resolve many of the health care funding gaps created by OBBBA. While the draft plan is not set to be released until September 2026, early summary documents released by the UHPGB suggest that the final version will include provisions to provide full insurance coverage to every resident, regardless of income, for all medically necessary services. There would be no premiums, no co-pays, no out-of-network providers, and no Coordinated Care Organizations.

According to a 19-page summary of preliminary recommendations released in April 2026, the plan would cover all necessary physical and behavioral health services, as well as routine vision and dental care and some fertility services, with minimal to zero cost-sharing for patients at the point of service. For patients, there would be no insurance premiums, no deductibles, and no co-pays. And insurance would no longer be tied to a person’s job — which could have a huge impact for the 40% of Oregonians who currently do not have coverage through their employer.

The plan would be funded through a combination of federal funding, business contributions, and a progressive income tax. (The income tax would only be on income over 200% of the FPL, or $31,500,) Preliminary analysis shows most Oregon residents would pay less for their care under the proposed plan, and most businesses would pay less in health care costs for their employees. 

The UHPGB is due to submit its final recommendations to the state legislature in September of 2026. But whether or not the legislature acts on the plan depends on whether or not it is written into a bill that is then introduced to the 2027 legislative session. In July, a petition circulated by HCAO and the Portland chapter of the Democratic Socialists of America encouraging legislatures to do so had collected more than 4,000 signatures.

If the UHPGB’s plan is brought to the session, the legislature  could then either vote to pass the recommendations into law as-is — though the HCAO leadership team does not expect that it will — or refer the plan to a ballot measure, which could go before voters in 2028.

If a bill or ballot measure is eventually passed, the new plan would not fully cure Oregon’s health care landscape overnight. “There will still be challenges for rural communities that lack services,” said Colin Stackhouse, who serves as HCAO’s Communications Coordinator and also volunteers on the UHPGB Community Engagement and Communications Committee. 

“Rural clinics are closing. This plan won’t directly address that,” Stackhouse said. “But it will solve the problem for the people in these rural communities who can’t see available providers because their local providers don’t take coverage. It would solve the insurance coverage access question.”

Bravo is optimistic about the plan’s potential trickle-down effects. “Right now, we’re heading in a direction where there’s just not going to be any care offered [to rural residents]. We’re going to be like five hours away from what you need.” But if more robust insurance infrastructure existed, Bravo is confident that “it will promulgate more care being offered out there in Eastern Oregon.”