The Oregon Legislature will have a big task ahead as it considers how to implement a broad plan by Oregon's Health Fund Board to insure every resident of the state. The proposal is as ambitious in scope as Massachusetts' landmark reform, but comes at a time when state economies are more fragile. A draft proposal would pay for the program through provider taxes, a "pay or play" tax on employers and state and federal monies. In Washington, an effort to insure all children is bearing fruit with as many as 40,000 children getting on insurance rolls over the past year. In the commercial market, consumer-driven health plan designs have had a tepid response so far, but brokers predict more acceptance in a worsening economy as employers cope with runaway healthcare costs. There will be fewer private plans participating in the stand-alone Medicare Part D market in Oregon and Washington in 2009 as firms drop out of the segment of the program serving low-income seniors. Providence Health Plans, which has used a value-based insurance concept, is offering value-based benefit design options for prescription drugs and is targeting drugs for key chronic diseases. And research from Regence determined that health plan consumers know far less about their coverage than suspected – a development that may help insurers create products and benefits and communicate about them.