Legislative Update
February 16, 2009

Provider tax negotiations beginning
Four legislative leaders — Sen. Betsy Johnson (D-Tillamook), Sen. Alan Bates (D-Medford), Rep. Mitch Greenlick (D-Portland) and Rep. Mary Nolan (D-Portland) — have been assigned to begin negotiating the details of a provider tax with the hospital association.
The logistics of expected negotiations with the insurance industry are not as simple. The hospital association represents all 57 hospitals in Oregon and can negotiate on their behalf. There is no association that represents the eight Oregon-based health insurance companies.

Federal SCHIP a “down payment” on Healthy Kids for Oregon
Oregon expects to receive an additional $22.1 million in SCHIP (State Children’s Health Insurance Program) funds to provide insurance coverage to low-income children. The new law, signed by President Obama, allows states to provide coverage to children above 200 percent of the federal poverty level.
Sen. Ron Wyden (D-Oregon) said, “SCHIP is a down payment on health care reform.” The SCHIP expansion is being funded with an increase in the federal cigarette tax from 39 cents to $1.01 per pack.
As of November 2008, 45,729 Oregon children were covered by SCHIP. That number is expected to grow to 56,079 during the 2009-11 biennium.

HB 2009 – Insurance Exchange proposal changing
Rep. Mitch Greenlick (D-Portland) and Rep. Ron Maurer (R-Grants Pass) submitted 50 pages of amendments to HB 2009 to Legislative Counsel including an amendment on the Insurance Exchange (Section 18).
The new proposal has a new Health Authority developing a plan for an Insurance Exchange and bringing it back to the 2011 legislative session for review. The new amendments tell the Authority to consider combining the individual and small group markets, community rating and guaranteed issue, but it stops short of requiring these elements.

Senate Heath Committee hears report on hospital cost shift
The Oregon Healthcare Leadership Task Force report on the Oregon physician and hospital cost shift, prepared by Milliman at the request of major Oregon health care purchasers, was presented to the Senate Health Committee last week. Among the findings:
· The total 2007 cost shift to commercial payers was $1.6 billion
· 19¢ of every dollar paid by commercial payers for hospital and physician services subsidizes Medicare and Mediciad
· The cost shift represents 13.6 percent of the annual premium for a family of four (approximately $2,209)
· The average operating margin of Oregon hospitals, considering all payers, is 3.9 percent
· Proposals to add 60,000 children to SCHIP or 100,000 adults to OHP would have little impact on the cost shift, but a loss of 10 percent of the lives in commercial insurance would drive premiums up 3.6 percent in addition to the generally increasing cost of insurance

HB 2132 - POLST end-of-life registry
While there is widespread support for the idea of health care reform, finding agreement on the details can be extraordinarily difficult. The one exception to that is the proposal to create a physician orders for life sustaining treatment (POLST) registry.
Unlike an Advance Directive, a POLST is a physician order that EMTs can use to determine if a patient should receive life-sustaining treatments. Patients who have less than a year to live commonly use POLSTs.
The House Health Committee heard universal support for the idea at it’s hearing.
The Senate Health Care Committee is scheduled to hear testimony on SB 451, a mirror image of HB 2132, on Thursday, February 19.

SB 355 – Electronic Rx Registry debated
Pain specialists, emergency room physicians, nurse practitioners, dentists and pharmacists make a compelling case for how a Prescription Monitoring Program (PMP) for controlled substances would help improve patient care and help stop the growing problem of prescription pain drug shopping. Oregon is one of only 12 states that do not have some form of prescription drug registry.
The Senate Health Care Committee also heard from those who don’t think the risks outweigh the benefits, or that the database won’t be secure. Portland physician Jody Pettit said patients should be able to see their own records, correct mistakes and find out who has accessed their data and when.
Doctors testified that a Web-based system would be more secure than what they do now, which is calling all the pharmacies in the area asking about a patient they suspect of drug shopping and waiting for information to be faxed back to them.
Federal grants are available to develop the system. On-going funding for the registry would come from a $25 per year fee on those who can prescribe or dispense controlled substances.

other health care legislation

SB 311 – Oregon state tort cap moves out of committee
The Senate Judiciary Committee sent the bill to increase Oregon’s state tort cap to the Senate floor on a bi-partisan vote last week. Sen. Brian Boquist (R-Dallas) joined three Democrats in approving the bill. Sen. Doug Whitsett (R-Klamath Falls) voted no.
Sen. Alan Bates (D-Medford), a family physician, has long advocated a larger solution to medical malpractice issues. Many believed that Bates was willing the “blow up” the state tort cap deal unless physicians who practice in non-governmental settings received some relief, but Bates pledged to support SB 311 on the Senate floor.
Bates testifies that medical malpractice premiums, while annoying, constitute only 5/8ths of 1 percent of health care costs. The bigger problem, in Bates mind, is defensive medicine caused by the fear of lawsuits that constitutes 15 percent of health care costs. He calls SB 311 a “missed opportunity” because legislative leadership limited the bill to simply determining the "right number" for the state tort cap.
Bates practices in Medford and says SB 311 will present a difficult choice: should he refer patients to OHSU, where OHSU’s liability is capped, or should he instead refer them to another tertiary care center with no caps? And can a patient sue a physician like him, who has no cap, if the patient fails to collect all they want from OHSU?
SB 311 combines economic and non-economic damages under one cap. Legislators differ on whether that’s wise. Sen. Suzanne Bonamici (D-Beaverton) says it helps level the playing field for those who don’t work. Sen. Whitsett says combining the damages would drive up the cost for taxpayers. Sen. Bates says he thinks it harms patients – that patients should recover all of their non-economic damages but the government’s interest should be in limiting punitive damages.
Committee chair Sen. Floyd Prozanski (D-Eugene) says he is willing to have a broader discussion in the future, and that the bill provides for direct consideration of the new caps by the Oregon Supreme Court.

SB 272 – Exactly what consent is needed for HIV testing in pregnant women?
In 2006, a baby in Eugene was born with HIV when the mother, who did not know she was HIV-positive, would not give written consent to an HIV test. In written testimony, Robert Pelz, M.D., said the “vertical transmission” of HIV from mother to child could be nearly eliminated by treating the pregnant woman with HIV medications.
Dr. Pelz asked Sen Floyd Prozanski (D-Eugene) to introduce SB 272 so physicians can test pregnant women for HIV without consent in the same way they test for hepatitis B, syphilis, gonorrhea and chlamydia.
The Department of Human Services’ Public Health Division says no HIV positive babies have been born in Oregon in more than two years. But they recognize that the laws and administrative rules governing consent are confusing and contradictory.
DHS says it will work with Sen. Prozanski, ACLU and other interested groups to clarify the consent requirements for testing pregnant women.

HB 2435 – OMA opposes limited licenses for rural MD’s
Staff at Holy Rosary Medical Center in Ontario says it takes up to six months to get an out-of-state physician licensed in Oregon. They say that long drawn-out process puts them at a competitive disadvantage.
Rep. Arnie Roblan (D- Coos Bay) says rural hospitals keep telling him how difficult it is to get physicians from other states licensed to practice in Oregon. So he wants the Oregon Medical Board to provide temporary limited licenses to speed up the process.
The Oregon Medical Board opposes HB 2435. They say the median time it now takes for the Board to process an application and issue a license is 75 days. The Board is already taking a series of steps to help including:
· Moving rural applicants to the top of the pile
· Allowing the director to waive some requirements
· Applicants can track their application process and status online.
The Board says no other state has this type of license and they don’t want Oregon to become a magnet for physicians with licensing problems.
The House Health Committee created a work group to explore ways to improve the bill.

budget

Federal stimulus includes more $ for Medicaid
The new federal stimulus package that passed Congress this week includes higher Medicaid payments to Oregon of more than $800 million over the next two years. More than $200 million of that will be available over the next few months to help close the state’s budget gap this biennium.

SEIU agrees to wage freeze and furloughs
The largest state employee union agreed to forego negotiations on a new contract and cost of living increases for the next two years. They also accepted the Governor’s proposal to take eight unpaid days off during the next biennium.
AFSCME is also reportedly preparing to accept the wage freeze and furloughs.
But, so far, neither union has agreed to give up the 4.8 percent step increases they are scheduled to get each year.
State budget analysts say if all of the state’s 50,000 employees take eight furlough days over the next two years, the state’s general fund would save $35 million. If all state workers forego the annual 2 percent cost-of-living increases, it would save an additional $79 million.
Republican legislators say they appreciate the union’s step but they called on the Governor to rollback $358 million in pay increases given to agency heads and state workers over the past year. Those increases will cost taxpayers $650 million over the next two years.

Revenue forecast coming Friday
There is plenty of speculation about how bad the next Revenue Forecast will be when it’s released February 20. The budget hole for the remaining four months of this biennium is expected to be at least $800 million.
Revenues during 2009-11 are expected to be down as much as $2.5 billion. It could put the next biennium’s budget below this biennium’s in actual dollars, necessitating program cuts as high as 20 percent in many areas.

Upcoming

Friday, February 20
8 am - Revenue Forecast released

11:30 am - School-Based Health Centers’ Rally, on the Capitol steps.

Monday, February 23
8am – noon - OAFP’s Day at the Legislature. Speakers include Sen. Alan Bates, Bruce Goldberg MD and Chuck Hoffman MD.

Wednesday, February 25
8 am – SB 12, rural physician loan tax credit in Senate Rural Health Policy Committee

OAFP’s bill tracking Website: http://www.capitolonramp.com/lts/guests/1477220/
For more information contact Doug Barber at doug@lobbyoregon.com or 541-221-3072.