plan called Coordinated Care Organizations, which included some of the preexisting organizations such as CareOregon, PacificSource, and FamilyCare as well as independent practice associations. In 2017, the second-largest Medicaid insurer, FamilyCare, shut down; its 100k Portland-area will largely be absorbed by another Medicaid insurer, Health Share. Health Share is related to CareOregon, which absorbed 80k members. From 2016 to 2018, CareOregon, which was founded in 1994 by providers with the Oregon Primary Care Association, Oregon Health Sciences University, and Multnomah County Health Department, lost about $96m. Various other plans showed losses as well. Controversy The Oregon Health Plan became the focus of national scrutiny in 2003, after deep budget cuts led to 100,000 people in mental health and/or substance abuse treatment losing prescription coverage under the program. During 2008 and 2009, the Oregon Health Plan stirred up controversy when enforcing 1994 guidelines to only cover comfort care, and not to cover cancer treatment such as chemotherapy, surgery and radiotherapy for patients with less than a 5% chance of survival over five years. Springfield resident Barbara Wagner said her oncologist prescribed the chemotherapy drug Tarceva for her lung cancer, but that Oregon Health Plan officials sent her a letter declining coverage for the drug, and informing her that they will only pay for palliative care and physician-assisted dying. She appealed the denial twice, but lost both times. Tarceva drugmaker Genentech agreed to supply her the $4,000-a-month drug free of charge. Wagner's plight garnered a flurry of attention from the media, the internet, and triggered protest from religious groups. On August 26, 2008, former Oregon Governor John Kitzhaber and Somnath Saha, a Portland physician and then-chairwoman of the Oregon Health Services Commission, issued an op-ed in The Oregonian newspaper in response to the twisting of Wagner's story in the media. According to Kitzhaber and Saha, the Oregon Health Plan covers nearly all chemotherapy prescribed for cancer patients, including the multiple rounds of chemotherapy that Wagner received; Wagner's request for second-line treatment was denied because of the drug's limited benefit and very high cost, which would have led to the denial of access to well-established, first-line treatments for other cancer patients. Kitzhaber and Saha stated that "the idea that treatment has ever been denied because death would be more 'cost effective'...is both abhorrent and a blatant distortion of the facts. [T]he fact that [physician aid in dying] is covered by the health plan