Legislative updateThe 2009 Oregon Legislature: An historic session for health care reform |
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By Martin Taylor The 2009 Legislature made the most significant strides in health care since the creation of the Oregon Health Plan in 1989. But any celebration must also be tempered by recognition that more lives are being affected by poverty and more people are needing help dealing with health issues. The work of many lawmakers, state agency experts and health care advocates resulted in two landmark pieces of health care legislation. House Bill 2116 expands the tax on hospitals and health insurance companies (including CareOregon). This expanded tax base will be matched approximately 2 to 1 with federal funds and generate almost $2 billion in new revenue to fund health care for low-income Oregonians, including ALL children under age 19. Its companion bill, HB 2009, includes a half dozen cost-containment strategies including: spreading primary care renewal, expanding electronic medical records, a POLST registry, investing in the health care workforce, shifting state purchasing to evidence-based treatments, consolidating Oregon’s buying power and adopting common state contracting expectations. This legislation also directs the State to develop a plan for establishing a new statewide health insurance exchange and a public health insurance option. Last November, when the stock market crash exposed the full extent of recession in Oregon’s economy, it seemed improbable that we would pass major health care reform. In January, when the legislature convened and concluded that the state budget would fall short $4 billion, or almost 1/4 of the total budget, passing health care reform legislation of this magnitude seemed impossible. And yet it happened. The 2009-2011 Oregon State Budget: For CareOregon, stability and growth within a climate of financial constraints and austerity.Because Oregon has committed to expanding health care to approximately 115,000 uninsured people through Medicaid plans, lawmakers had to be careful how deep they cut the budgets of Fully Capitated Health Plans, such as CareOregon. The legislature imposed a rate cut of 5 percent: that is, the state will set our budgets at 5 percent less than what it has determined to be an “actuarially sound rate.” In any normal time this would be an appalling development. The tools health plans such as CareOregon have to manage a rate cut are more limited than those of a commercial plan. The state determines which members we serve. The state determines the benefit package our members receive. CareOregon’s primary tool for managing a 5 percent cut is to reduce our costs. From CareOregon’s perspective, we can report tremendous success in a legislative session that faced huge challenges. We achieved stability and growth, albeit with additional budget constraints. Keeping it real: Temper celebration of accomplishments with sobering view of poverty in OregonThe overall report from the CareOregon membership perspective is still very bleak. The number of Oregonians facing poverty is increasing. Many human service programs for the poor face dramatic cuts from state and county budgets. Medicaid dental and vision benefits were reduced. CareOregon members still have serious challenges and very difficult times ahead. The forces our members encounter will influence their physical health and their overall well-being. (See related story.) From a time of crisis, the state and CareOregon have emerged stable. The overall health care system in which we operate will be much improved. It would be easy to feel successful. But Medicaid, the Oregon Health Plan, CareOregon and our network of providers are charged with the care of people in poverty. Those people are still in crisis, and more are joining them as the economy continues to sputter. So our sense of accomplishment must be tempered with a sobering look at our mission. We must consider that the work is still incomplete. |
“An incredible accomplishment” I think it was incredible what we in Salem were able to accomplish. But until there is more oversight, cost containment will be difficult. —Sen. Laurie Monnes Anderson, “I’m not optimistic, but I hope I’m wrong.” The state’s health care legislation did not incorporate enough cost-control measures. We would be unique if we were able to even reduce the rate of increase. —Rep. Scott Bruun “There is still work to be done.” As long as we are paying more for doing more, as long as we’re not focusing on primary care, as long as we’re not focusing on chronic conditions, we’re going to be in trouble. Oregon has the potential for doing that, but the Legislature did not take on that challenge itself, instead assigning the chore as a task for the new health policy board to complete by the 2011 legislative session. —Rep. Mitch Greenlick, |
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