Health care to be a central focus of busy Legislature

By Martin Taylor
CareOregon Health Policy Manager

Just when you thought it was safe to tune down the background cacophony of politics, the noise comes roaring back.

The Legislative session in Oregon starts in January. Before these significant health care-related events will have happened:

Oregon Health Fund Board Report: The final report has just been approved and will be drafted into legislation. On the whole, CareOregon will be very supportive of this work. We believe it offers Oregon the best chance to bring the cost of health care under control while expanding access and maintaining quality. It includes an expansion of the provider tax to commercial insurers that CareOregon already pays (and supports) and increases the tax on hospitals.
Economic Forecast: the recession and huge increase in unemployment already are hitting Oregon very hard. The state (which contributes to about 80% of CareOregon budget) is overwhelmingly based on the income tax. When the economy is down so are tax revenues. The last six months of the 2007-2009 budget will be down more than $300 million. That will trigger immediate cuts. The forecast for 2009-2011 will be down as much as $1 billion—that's billion with a “B”—.
The Governor’s Budget: The legislature will start its budgeting process based on the Governor’s recommended budget, which was released December 1. This budget partially reflects the massive budget downturns. It also reflects recommendations for new revenue, including the provider taxes.

The result is a budget proposal that brings huge cuts in human service that will have an impact on our members. It assumes an increase in Oregon Health Plan enrollment based on the new revenue. The new enrollment will be a mix of kids and adults (many with years of deferred health needs).

CareOregon is working on many issues in preparation for the legislative session. In addition to working actively on health care reform and budget issues, we are exploring a range of legislative proposals, including: support for School Based Health Centers and Primary Care Payment Reform. We are also following up on ideas that came to us from CareOregon employees, including improving access to medical information essential to coordinate all of the medical care for some CSD children and correcting a flawed medical record privacy bill from 2007.


State Rep. Mitch Greenlick, D-Portland, and Martin Taylor

Please let us know if you have suggestions for improving a state law or agency policy based on your experience working for CareOregon. We will take your recommendations seriously as we finalize our priorities for legislative attention.

Please call Melissa Criswell-Sircy with your suggestions, 503-416-1479, or send her an e-mail.

Oregon Health Forum

Legislators look ahead to “very interesting” health care discussion

Hundreds of volunteer hours and hundreds of Oregonians contributed to the development of the Oregon Health Fund Board’s (OHFB) report to the Governor and Legislature. Charged by the 2007 Legislature to take a thorough look at the health care system in the state and propose a clear path to fix it, the board’s report will be the basis for a robust discussion in the legislative session that begins January 2009.

Four legislators who will play key roles in the upcoming legislature spoke at the Oregon Health Forum, December 17, in Portland about what health care, and the OHFB proposal can expect in the upcoming session. The participants included:

Sen. Laurie Monnes Anderson, D- Gresham, chair of the Senate Health Policy and Veterans’ Affairs Committee, is a former public health nurse.

Rep. Mitch Greenlick, D-Portland, is former director of the Kaiser Permanente Center for Health Research and past chairman of public health and preventive medicine at Oregon Health and Science University.

Rep. Ron Maurer, R- Grants Pass, is owner of a rural health clinic and a former medical evacuation helicopter pilot with the U.S. Army.

Sen. Frank Morse, R- Albany, is formerly the chair of Samaritan Health Services Board.

“The economy is definitely going to dictate what we can do,” Sen. Monnes Anderson said. While health care reform starts its way through the legislative process in the House, her Senate committee will first take on improvement of the health care workforce, and then will address the reform package that the House sends over. She would also like to see telemedicine reimbursement, underage drinking and obesity (see related story) addressed in this session.

Rep. Greenlick said his committee has already started putting the OHFB work into legislative language.

“We’re pretty determined that the report is not just something to put on the shelf,” he said.

The OHFB proposal would begin the journey toward universal health care for all Oregonians by first covering 100,000 children and 100,000 adults who now are not covered. The two tiers of the Oregon Health Plan, Plus and Standard, would be merged into a single plan. Two aspects of the proposal are likely to generate the most heat.

The board proposed that a new health authority be established that would consolidate all health activities now a part of state government, including insurance regulation, under a single nine-person board. The board would have oversight duties, as well as some independent responsibility.
To fund the expansion, the OHFB plan would levy a tax on providers, including hospitals and insurers, and on tobacco.

The first hearing on this proposal will be January 16.

“We cannot afford not to have health care reform,” Rep. Maurer said. But the discussion of the scope of that effort “will be very interesting, to say the least,” he said.

There definitely will be work determining a funding source, and an amount, if a provider tax is adopted, Maurer said.

For many small providers operating on a slim margin, even a small tax is too draconian, “a huge problem,” he said.

Maurer also expressed concern about the scope of power to be granted to a statewide health authority and board.

“We are going to be in an environment of rationing care,” agreed Sen. Morse. “Who is going to ration that care?”

Morse said he would have liked to see cost containment strategies play a larger part in the OHFB report. Right now the state’s health care budget includes increasing expenditures by 3 percent. However, health care costs are on a 15 percent increase trajectory.

The OHFB addressed the medical liability issue—“a huge component” of overutilization—by authorizing a council to study it. Morse likened that to “saddling a dead horse.”

here was agreement by Republican and Democratic panelists that whatever final form the reform effort takes, it must be bipartisan. Monnes Anderson also urged her House counterparts to make the reform bicameral by letting her Senate committee consider any proposal before it is forwarded to the Ways and Means Committee for funding, the usual process for legislation.

With varying degrees of optimism—or pessimism—all agreed something must be done to address the conjoined issues of access, quality and cost.

The most expensive thing we could possibly do, the most destructive thing we could possibly do, is do nothing,” Greenlick said. “If we don’t do something now, the health care system in Oregon is in danger of collapsing.”

See the Oregon Health Forum’s Briefly News for more on this forum.

Diabetes, obesity plan to be considered

In 2007, the Oregon Legislature declared that obesity-linked diabetes constitutes a state emergency.

Consider these facts:

According to the Centers for Disease Control and Prevention (CDC), one third of children born in 2000 will develop diabetes under current conditions.
About 262,000 Oregon adults already have diabetes. That’s 62 percent more than in 1995.
Every year in Oregon, 6,900 adults develop diabetes.
About $1.4 billion is spent to treat Oregonians with diabetes each year.
Some 1.7 million Oregon adults are obese or overweight. That’s up 59 percent from 1995, and puts them at high risk of developing diabetes, or of developing severe complications if they already have the disease.
Every year, 37,000 Oregonians gain enough weight to be considered obese.
Oregonians most commonly affected by diabetes and obesity are those with low incomes and those who are African American, American Indian/Alaska Native, and Hispanic/Latino.

At the direction of the 2007 Legislature, an advisory committee of the Oregon Department or Human Services has prepared a strategic plan to address the issue, which will be debated by the 2009 Legislature.

Among the recommendations:

Funding should be dedicated to obesity prevention and education.
The underlying causes of health inequities should be seriously investigated.
Consumers should have easy access to information on healthy food choices.
A carefully planned health schools act should be enacted.
Health should be a priority consideration for land-use and transportation policy and funding.
Medical care quality should be improved through effective health care reform.

A full copy of the “Strategic Plan to Slow the Rate of Diabetes in Oregon” can be found on the web.

Can you help?

The 2009 Legislature will consider the Oregon Health Fund Board proposal to expand health care access and improve the health care delivery system.

Oregonians for Health Security is looking for people who can help tell the story of challenges with the delivery system as it is. They are seeking providers and patients who can share their own stories as legislative testimony or with reporters who cover health care for media outlets.

We would like to support them in their efforts.

If you or a member of your staff would be willing to help, or if you know of a patient who might help, please take a few minutes, follow this link, and respond to our survey.