SALEM - When the Oregon Legislature adjourned two years ago, health care advocates could only stand back and count their losses.

They got nowhere with efforts to restore health coverage to some of the thousands of low-income people who'd been kicked off the Oregon Health Plan during the last recession.

Even a relatively modest plan to expand the state's prescription drug discount program was left in the dust, another victim of the gridlock that a Republican House and a Democratic Senate had brought upon the Legislature.

But two years and a pivotal 2006 election have made a big difference.

With Democrats running both the House and Senate for the first time in 16 years, health care measures are moving again, including a proposed cigarette tax increase to pay for children's health insurance.

Last week, Gov. Ted Kulongoski signed bills to make health care more affordable, including one to require insurers to let patients know in advance what their out-of-pocket costs will be.

And a sweeping overhaul of Oregon's health care system appears on track to pass and could eventually extend services to all 600,000 of Oregon's uninsured.

“It's certainly a new day in the Legislature,” said Maribeth Healey, head of Oregonians for Health Security, an advocacy group.

In 2005, House Republicans refused to allow a vote on a Senate-passed bill to expand Oregon's prescription drug discount program by easing age and income limits. House opponents said then that the bill went too far in enlarging a program meant for the poor.But a similar measure to extend state-discounted drugs to all Oregonians lacking prescription-drug coverage was one of the few ballot initiatives that passed in last November's election.

This session, there was nearly unanimous Republican support in the House for a bill that further expands the drug discount program by allowing small businesses and unions to use it to buy medicine for their employees.

Healey said she thinks the failure of the 2005 Senate bill may have helped cost the GOP control of the House in the 2006 election because Democrats used it as a campaign issue against Republicans in some House races.

The change in the political climate has opened the way for an ambitious “universal access” plan that won endorsement of the Legislature's budget-writing committee last week.

The long-range proposal will set up the machinery to determine how people enroll, what benefits they get, how services are delivered and how they will be paid for. A seven-member board and several groups under it will present a plan to the 2009 Legislature.

State Sen. Ben Westlund, co-sponsor of the bill, said the plan will emphasize cost containment while making coverage available for all of Oregon's uninsured.

“It's a big deal. We are creating a blueprint to get more primary, preventive care into the health care system,” the Bend Democrat said. “When we look back on this 10 or 15 years from now, this will be seen as the watershed event. That's because it will lead to higher quality, affordable health care that also will allow us to get to 100 percent access.”

As Westlund and other proponents envision the program, state and federal Medicaid money would be combined with contributions from employers and uninsured individuals to create a health fund to buy insurance for everyone.

In a separate move aimed at extending health care to all Oregonians, the House last week approved a proposed constitutional amendment to declare health care “an essential safeguard to human life and dignity” and a “fundamental right.”

The measure, if approved by the Senate, would be submitted to Oregon voters in the November 2008 general election.

Still, health care has touched off one of the biggest political battles of the year - the plan by Kulongoski and Democratic legislative leaders to raise the cigarette tax by 84.5 cents a pack to provide coverage to more than 100,000 uninsured children.

The proposal has failed three times in the House because of Republican opposition. The GOP says the tax is unfair, particularly to low-income smokers.

“We're just not there. It's a regressive tax on a limited number of people - those who smoke - to pay for a general insurance plan,” said House Minority Leader Wayne Scott, R-Canby.

Kulongoski and House and Senate Democrats say they are ready to take the issue to the voters if House Republicans won't provide the votes.

“It definitely isn't the end. We're going to go forward with this,” Kulongoski said last week after the third failure in the House.

The Senate approved a cigarette tax plan last Friday that would go to the voters as a proposed constitutional amendment in a special election this November. Now it's up to the House.

Besides offering coverage to uninsured children, the Senate plan would pay to restore coverage to about 10,000 of the state's “working poor” who were kicked off the Oregon Health Plan after the recession of 2001-03 crippled the state's finances.