In 2022, Oregonians narrowly passed Measure 111, amending their constitution and guaranteeing affordable health care as a fundamental right to every resident of the state. Through years of organizing, coalition building and planning, Oregon may enact its Universal Health Plan as early as fall 2027.
In the face of extreme Medicaid cuts from the Trump administration, which will leave roughly 16 million people without health coverage by 2034, a state-level universal plan could mean the difference between cared-for, insured patients and thousands of preventable deaths.
Oregon’s single-payer health care dream still has hurdles to overcome, but with a constitutional amendment voted in by the people, it may have a leg up over previous state-level campaigns, such as Vermont’s Green Mountain Care in the early 2010s. Even so, a clear understanding of what went wrong in previous campaigns — as well as continued organizing in Oregon — is needed to push it through.
If successful, Oregon could lead by example and set the stage for a better, more efficient health care system in other states. While a national campaign isn’t on the table, organizers can look to Oregon for how to push a bold health agenda in their state.
What happened in Vermont?
In 2011, Vermont’s state government set in motion the steps to enact a publicly-funded, universal health care program across the state.
For over a decade, organizers in Vermont fought for a single-payer health care system. Through forums, rallies and public education campaigns, groups like Vermont Health Care for All, the Vermont Workers’ Center and Vermont Businesses for Social Responsibility built a broad coalition to push for universal coverage.
The program, referred to as Green Mountain Care, came very close to implementation, but it was shot down in 2014. It did not have the buy-in from then-Gov. Peter Shumlin, who cited significant tax increases as his primary issue.
Dr. Deborah Richter, a physician and president of Vermont Health Care for All, spoke at over 500 events in the lead-up to Green Mountain Care in 2011. Richter agreed that taxes were the greatest barrier in Vermont’s state-level campaign, but highlighted a key flaw with this logic.
Under a publicly-funded system, the taxes are all out in the open, making it easier to criticize. Under the private insurance system, health care costs are generally hidden — often in the prices of goods — with the financial burden falling on individuals with medical needs.
“We do a lot of cost shifting,” Richter said. “You don’t realize that when you go into a store, and they’re paying for health insurance, that you’re paying higher prices for that [through] the goods that are in that store. You’re paying higher property taxes to pay for public employees’ health insurance. You’re paying a lot of other hidden taxes to pay for health care for other people.”
For Vermont, this meant people saw a scary price tag and may not have understood the tangible benefits. According to Richter, what a publicly-funded system really does is shift the cost-burden onto the wealthy, creating a fairer, more efficient and more complete system. Getting that message across, however, is its own challenge.
Organizing against a behemoth
A number of less-comprehensive plans would later be proposed in Vermont, such as universal primary care, but the single-payer system drifted into the background. Oregon will likely face many of the same challenges, but with the distinct advantage of a constitutional amendment on the books.
According to Collin Stackhouse, communications coordinator for Health Care for All Oregon, or HCAO, Oregon’s Universal Health Plan Governance Board aims to propose the next draft of the health care plan in fall 2025. Stackhouse and multiple other HCAO members and affiliates serve on the Universal Health Plan Governance Board and its four committees.
Over the past three years, HCAO has built a multifaceted organizing apparatus. With an emphasis on community outreach and voter education, they’ve conducted crowd canvassing, tabling at events and given presentations with a wide variety of community organizations, such as faith groups, Rotary clubs and neighborhood associations.
Robyn Gottlieb, an organizer with HCAO, emphasized a few key elements in their strategy. Throughout the process, HCAO asks people to sign up for their mailing list to further help mobilize volunteers and also informs people about the Governance Board.
“We have folks writing testimony to the Governance Board advocating for the strongest health plan possible with the most coverage,” Gottlieb said. “We want dental, we want vision, we want all the things.”
These efforts aim to create a strong network of advocates that can push a comprehensive health plan over the line without backstepping. With the final draft of the health plan due from the Governance Board by September 2026, engaging as many people as possible will be crucial over the next year.
Even with this push from HCAO, the general lack of knowledge about universal health care still presents a challenge.
“I answer the comments [on our organization’s social media] and there’s a lot of misinformed people,” Stackhouse said. “There’s no way to give any detail or nuance in a 90-second clip.”
Disinformation from opponents of Oregon’s universal health plan is expected, and Stackhouse emphasized the need to connect with people in their communities in order to overcome this — especially given how complicated the current health system is.
“Part of our hope as an organization is that we can reach everybody, every person in every corner of the state in some capacity,” Stackhouse said. “It’s becoming a pretty central part of our next year, these things called community conversations: actually having local people … go speak publicly in these different communities with their neighbors about the plan.”
What this really boils down to is recognizing the lack of information around health care, then finding a way to pull back the veil on the health care system with people across the state.
“One of the main key points that I think everybody [needs to know] is that universal health care is cheaper,” Stackhouse said. “Our taxes probably will change, but we have the most expensive health care system in the whole world. Everybody [else] is spending less money, and they have universal health care. All of the countries that have the best health care have universal health care.”
For some, the buy-in may come from learning about universal health care itself, but others may need a more personal understanding. Getting individuals to consider the reality of never needing to pay another copay or deductible can make the difference. If there’s time, Gottlieb emphasized the power of telling a personal story as well.
There are still some details to iron out in Oregon’s plan, such as residency requirements and how the system would work for Oregonians traveling in other states. However, if Oregon is able to overcome the many challenges, it could clear a path for the United States to join all other high-income countries in providing affordable health care to its people.
The small origin of Canadian universal health care
Universal health care in Canada began with the founding of the Co-operative Commonwealth Federation, or CCF, in 1932, one of the earliest democratic socialist parties in North America. In the early 1940s, the party’s grassroots engagement and political education efforts dramatically boosted party membership and led to a sweeping victory in Saskatchewan, where they won 47 out of 52 seats in 1944.
Following through on one of its many political aims, in 1947, CCF introduced the Saskatchewan Hospital Services Plan, the first universal hospital insurance program in North America. By 1962, the Saskatchewan Medical Care Insurance Act took effect, bringing publicly-funded health insurance to the entire province.
While the process wasn’t without pushback, including a failed doctors’ strike, Saskatchewan’s Medicare system would pave the way for Canada’s nationwide universal health plan, culminating in the Canada Health Act of 1984.
Through effective organizing based on working-class values and affordability, the CCF was able to kickstart dramatic change. The first domino that fell in favor of national universal health care in Canada came from a rural province with only around five percent of the population at the time.
In the U.S., Oregon is not the only state working on a single-payer plan. The nonprofit One Payer States lists 22 states across the country with active movements or infrastructure for universal health care plans, but Oregon is closest to the finish line.
Even with cross-state support, significant resistance is expected in Oregon and nationally.
Philip Verhoef, the immediate past president of Physicians for a National Health Plan, emphasized the need for administrative simplicity to build a viable health care system in Oregon, especially when facing down the private insurance industry.
“I assume the various private insurance companies that do business in Oregon are going to fight this tooth and nail because it’s going to effectively take them out of the game,” Verhoef said. “You almost need to make the argument impervious to money. The people fighting for single-payer are never going to outspend the insurance company, so instead they simply have to get everyone on their side.”
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DonateThe reality facing advocacy groups like HCAO is a U.S. private health insurance industry worth over a trillion dollars. Getting everyone on your side is far from a simple task, but that’s where the on-the-ground organizing comes in.
HCAO’s community conversations, health care education efforts and volunteer mobilizing could make the difference in passing a universal health care plan that is both comprehensive and affordable.
Oregon could be the domino that universal health care needs to spread across the country. It will require community effort, cultivating a deeper understanding of the vast inefficiencies in American health care and ultimately realizing a dream of something better.
As we careen toward significantly more health care-related deaths due to the Trump administration’s cuts, the situation may be bleak. However, Richter suggests universal coverage could be a light at the end of the tunnel.
“You hope [that people] at least wake up and realize you can’t just keep kicking the can down the road, that this is not going to get better,” Richter said. “I’m optimistic because things are so bad. There is no other way to solve this problem.”
I am wondering if more could be added to this conversation by bringing up how Medicaid cuts are already happening and harming Oregonians. In particular Oregon’s largest Medicaid “avenue” (I am not sure what to call it) CareOregon which is under the CCO of Health Share of Oregon will no longer allow us to see behavioral and mental health services that are “out-of-network.” This includes therapists and psychiatric physicians who prescribe medication. I believe there is a huge gray area that should be covered as much as possible in the media. Cuts to Medicaid and Medicare obviously harm people, right now in Oregon this is happening to the most vulnerable and/or marginalized group of people. I know that the board cannot do anything about that obviously, but the more people that cannot get the help they need and deserve can equate to less people being able to even advocate for this, especially the ones who want to advocate for this. No one is prepared for 15k people to be dropped from behavioral health services. It will also continue to perpetuate the “bad rap” Portland has regarding drug usage and homelessness. I am curious as these major cuts begin, how this will affect their proposal in a year, and if HCAO will make statements in response to this. While private insurance is going to be one of the biggest fighters, depending on the type and time between cuts, Medicaid/Medicare can and will defeat some civilian advocates for HCAO and that could very well make or break it. Oregon is trying to be first and am scared about the damage that could be done in a year and ultimately lead less civilian report, and not out of opponent, but because health dictates life. Your health dictates your life. I hope to see another article or two from you regarding healthcare in Oregon. I also hope this was on-topic enough.
Oregon can’t even fund the Dept of Transportation without more massive tax and fee increases, and you expect them to do this?
They can’t manage our highways infrastructure and much anything else for that matter, I sure don’t want them managing my healthcare!
Thank you for this detailed article on this vital subject. I will share widely in my networks.
There is an error in the paragraph: According to Collin Stackhouse, communications coordinator for Health Care for All Oregon, or HCAO, Oregon’s Universal Health Plan Governance Board aims to propose the next draft of the health care plan in fall 2025.
The draft of the plan will be presented at town halls around the state in the summer of 2026. Here input will be sought from we ordinary people. The the final draft is due to the legislature, as correctly stated later in the article, fall 2026.
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