Legislative Update
April 27, 2009

HEALTH CARE REFORM
HB 2009 – Health care reform headed to Ways and Means
On a 7-3 vote, the House Health Committee finally wrapped up work on its major
health care reform package. They were up to the -75 amendment by the time they
finished.
Some of the last amendments added are duplicates of the Oregon Health Fund
Board bills passed by the Senate Heath Care Committee. There was also an
amendment from the insurance carriers making it absolutely clear that plans for a
public health insurance plan and an Insurance Exchange must come back to the
2011 session of the legislature for approval.
Sometimes the most interesting debates are over what does not get included.
Here are two:
1. Referral to the ballot – Rep. Ron Maurer (R-Grants Pass) wanted to send the
entire package to the ballot. He tried and lost on a similar amendment to HB 2116,
the provider tax and OHP expansion. The result to this amendment was the same –
a party-line vote and his amendment was defeated.
2. Tax deduction for individual health insurance premiums – Rep. Scott Bruun
(R-West Linn) said, “This will do more than anything else we can do to lead us to
universal coverage.” Businesses and self-employed can deduct the cost of health
insurance, but individuals cannot. This would have the effect of lowering the cost of
individual health insurance and lowering revenues to the state. Rep. Mitch Greenlick
said, “This is not a bad idea but I don’t want to add something with a $3+ million
fiscal. Let’s talk about it next session. The amendment was defeated.
The bill now moves to Ways and Means where it will compete with the Senate’s
health care reform bill, SB 856.
At its core, HB 2009 creates a new Health Authority agency to coordinate all of
the state’s health policies. The Department of Medical Assistance Programs
(DMAP) that administers the Oregon Health Plan (OHP) would move from the
Department of Human Services (DHS) to the Health Authority in July 2011.
The biggest unknown about HB 2009 is how much it would cost. So many
components were added to the bill in the last week that Legislative Fiscal could not
keep up. The fiscal will be prepared now for Ways and Means. The Governor
included $5 million in his budget for health care reform. The challenge for Ways and
Means will be how to pay for these new programs at the same time it is cutting
services for a long list of social service programs.

SB 856 – Alternative to HB 2009 moving forward
The Senate Health Care Committee is trying to decide between two slightly different
versions of a scaled-back health care reform bill. The Senate is not comfortable
leaving health care reform to the House. “I think it’s a tragedy that we aren’t
involved in HB 2009,” said committee chair Sen. Laurie Monnes Anderson (DGresham).
One version, sponsored by Sen. Jeff Kruse (R-Roseburg) does not actually
create the Health Authority but it does include a series of technical committees
under DHS to implement the work of the Oregon Health Fund Board. “It gives us
more flexibility and, hopefully, no fiscal,” Kruse said.
The other version was put forward by the hospitals, insurance carriers and AOI.
It creates the Health Authority within DHS and also has the technical committees.
“The key question at the end will be, ‘What does the Authority look like?’” Sen. Alan
Bates (D-Medford) said. Bates co-chairs the Ways and Means subcommittee where
all of the health care reform bills are headed. Bates said, “At the end, there may be
some mixing and matching to get the job done.”
New versions of an alternative proposal continue coming forward. The Senate
committee plans to move something on Tuesday.

HB 2116 – Provider tax negotiations continue
The Gang of Four (Senators Bates and Johnson, and Representatives Nolan and
Greenlick) continues negotiating with hospitals and insurers on new taxes to fund
the Oregon Health Plan (OHP) expansion.
A health insurance premium tax is being linked to Healthy Kids, to make sure all
Oregon children have coverage. The proposed hospital tax would be used to
expand the OHP Standard program.
How many children and adults can be covered depends on the tax rate and how
many pay the tax.
Those details are not finalized but as currently proposed only individuals and
groups that purchase commercial insurance would pay the premium tax. The
700,000+ covered by union trusts and self-insured plans would be exempt.
As proposed, only the 25 large hospitals would pay the new hospital tax. Small
Type A and Type B hospitals would be exempt.
Legislators continue saying they want both houses to pass and the Governor to
sign the provider tax bill before the new revenue forecast is released on May 15.
SB 454 – Insurance reporting and hospital construction notification
Health analysts at the state want more information about insurance trends. SB 454
would require insurance companies to report on the number of covered lives by type
of insurance (individual, small group, large group) and zip code.
The bill also requires insurers to develop uniform administrative standards for
eligibility verification, claims and payment.
Hospital capital construction reporting was agreed to. Hospitals would post
information about major capital construction projects on their Web sites and notify
the state. The debate in the Senate Health Care Committee was about notification
requirements for major equipment purchases. The committee settled on a $1 million
threshold. So hospitals and ambulatory surgery centers would have to use the same
notification process for equipment purchases, e.g. MRI’s, which exceed $1 million.
Sen. Alan Bates (D-Medford) said, “I know this is controversial. I think we should
send it to Ways and Means but I don’t know if it will leave there.”
This is the last of the Oregon Health Fund Board bills and it’s now on its way to
Ways and Means.

OTHER HEALTH CARE ISSUES
HB 2067 – House adds sunset to rural health tax credit
In a straight party-line vote, House Democrats added a sunset to the rural health
professional tax credit. They didn’t single out rural health. The point of HB 2067
was to add a sunset to all tax credits. If HB 2067 becomes law, the rural health tax
credit would sunset in 2016.
During debate on the House floor, Rep. Jules Bailey (D-Portland) said, “This is
about efficiency, good government and an orderly review of tax breaks.” Opponents
of the bill used the rural health tax credit as the poster child for why HB 2067 was
bad public policy. “When we take certainty away, doctors will think twice about
relocating to central or eastern Oregon,” said Scott Bruun (R-West Linn).
Rep. Debbie Boone (D-Cannon Beach) spoke against the bill saying, “This is not
an incentive to bring more doctors to our rural counties,” but ended up voting for it.
Rep. Phil Barnhart (D-Eugene), who chairs the House Revenue Committee, said,
“If rural areas have been looking for physicians for four or five years, that says to me
we don’t have the right mix of financial incentives to encourage physicians in our
rural settings.” Rep. Bailey added, “Perhaps we should continue the rural health tax
credit. Perhaps we should increase it. Perhaps we can find a way to make it more
effective. Without review, we won’t know.”
Critics argued that the bill does not call for review. It calls for sunsets. But
Democrats have the votes and passed their bill 36-24. It now heads to the House.

HB 3258 – Primary care loan program
Third year medical student Patrick Kinney told the House Health Care Committee, “I
am the doctor you are aiming to recruit.” He grew up in a town of 5,000 in Alaska,
wants to work in a rural hospital providing primary care and delivering babies, and
expects to graduate from medical school with $200,000 in debt. “Medical students
are like stem cells,” he said. “They can be developed into all kinds of doctors.” But
he told the committee their money would be better spent in a loan repayment
program.
Dennis Johnson from the Oregon Student Assistance Commission said a loan
forgiveness program does not give the state as much bang for its buck as a loan
repayment program.
The House Health Care Committee sent the bill to the Ways and Means
Committee, “with enthusiasm but not much hope,” in the words of committee chair
Rep. Mitch Greenlick.

HB 3257 – State GME funding for primary care residents
OHSU testified that it’s already meeting the intent of HB 3257. All of its state
Graduate Medical Education (GME) funding and more is used for primary care
residents.
The state gives OHSU $2 million each year for GME. It spends $50 million on
primary care GME. So the state pays for about 12 of the 100 new primary care
residency positions at OHSU each year.
Another part of HB 3257 would require hospitals to pay primary care residents
150 percent of the average resident’s salary. “Increasing salaries of primary care
residents would not attract more residents to Oregon because there are no unfilled
spots to accommodate additional trainees,” OHSU said.
OHSU said additional money would be better spent adding additional GME slots
which it has been trying to do through its regional GME programs in Eugene and
Bend.
The committee said it will probably send HB 3257 to the House Rules Committee
as a way to keep it alive, allowing supporters of the bill to work on amendments.

SB 862 – Multi-share model passes Senate
The Senate unanimously passed SB 862, which dovetails with a new federal State
Health Access Program announced last week. The federal program offers grants of
up to $10 million a year to help states that are ready to implement innovative
programs designed to provide the uninsured with access to affordable health care
coverage. Eligible states must demonstrate that they have achieved the statutory
and regulatory changes to implement the new program, such as the multi-share
model of SB 862.
Multi-share programs allow communities to craft low-cost health benefit packages
targeting individuals and small businesses that cannot afford insurance. The plans
emphasize prevention and primary care but are not traditional insurance. They only
cover services in the local community. The plans are called multi-share because
they combine contributions from the individual, employer and community to cover
the cost.
At least four communities covering eight counties are developing multi-share
plans.

SB 701 – Nurse faculty loan repayment
The Senate Health Care Committee supports the concept of increasing nurse faculty
by helping to repay their graduate school loan. But they aren’t thrilled with the idea
of sending the bill to Ways and Means when they have no idea how it will be funded.
A spokesperson for the Northwest Health Foundation said this bill will create the
funding mechanism and they hope federal grants may be available to fill the fund.
The committee gave the bill its reluctant approval. It now goes to Ways and
Means.

HB 3204 – Compromise moves dental hygienist bill forward
The Oregon Dental Hygienist Association (ODHA) and Oregon Dental Association
(ODA) struck a deal on expanding the scope of practice for limited access permit
(LAP) hygienists and creating a new pathway for licensure.
Hygienists could now qualify for an LAP license by doing 500 hours of clinical
work with an LAP hygienist. In addition, the bill would allow LAP hygienists to serve
patients in hospitals, medical offices or clinics including those staffed by nurse
practitioners, physician assistants or midwives.
The ODHA and ODA agree to work during the interim on the use of anesthesia
and temporary restorations by LAP hygienists.
“You guys are my heroes in the scope of practice battles,” Rep. Mitch Greenlick
(D-Portland) said. “Two years in a row you’ve worked out a compromise.”
The bill now heads to the House floor.

HB 3261 – Certificate of Need for hospital construction
Every session, unions and advocates introduce enhanced Certificate of Need (CON)
legislation. They argue it’s a way to control health care costs by limiting hospital
construction. HB 3261 is this session’s version and it received a brief public hearing
in the House Health Care Committee.
Providence testified that the national trend is toward less CON, not more. “Our
research indicates that more CON does not equal less health care costs,” they said
in written testimony.
A number of contractors and building union representatives oppose the bill saying
it will delay projects and increase cost when we need jobs most.
The committee sent the bill to the House Rules Committee to keep it alive.

HB 2056 – Increases public members on health boards
Health care boards must all have two public members under amendments approved
by the House Health Care Committee.
Committee chair Rep. Mitch Greenlick (D-Portland) began pushing more than a
year ago for more public participation on the health boards. Initially he wanted a
majority of public members. Then he agreed to 50 percent minus one public
members. But there was resistance from the board that did not want to lose
professional expertise.
The Oregon Nursing Association introduced the amendment to standardize the
board with two public members each. That means no change for some board,
including Nursing. Some boards, such as Dental, will need to add one public
member. At least one board, Direct Entry Midwives, has no public members now
and will need to add two.
The ONA’s amendment also replaces an LPN with a CNA on the Nursing board.
The bill now heads to the House floor.

HB 3236 – Pharmacists immunizing children more than 11 years old
The Oregon Medical Association and the Pharmacy Association came to an
agreement on allowing pharmacists to administer vaccines and immunizations to
children who are at least 11 years old. “We realize there are areas of the state
where children don’t have access to primary care,” said Jim Lace MD from the OMA.
“So if we can improve the vaccination rate for these children, we support that.”
Physicians just want to make sure that whoever administers vaccines reports that
information to the vaccine registry system.
The Pharmacy Association agreed to delay implementation of the bill until
January 1, 2011 to give them time to further develop the reporting system.

HB 2925 - 90 day Rx supply bill dropped for lack of interest
The House Health Care Committee scheduled, then dropped, proposed legislation to
require health plans to pay for 90-day prescriptions filled at a pharmacy as well as
through mail order. Chair Rep. Mitch Greenlick (D-Portland) said committee
members were lukewarm at best about the idea, so he decided to not pursue the bill.

SB 845 – Rx marketing limitations
This has become known as the “it’s just lunch” bill. Sen. Alan Bates (D-Medford)
proposed an amendment that prohibits pharmaceutical reps from providing gourmet
lunches for medical offices. “These expensive lunches are inappropriate,” Bates
says. But the bill would still allow dinners.
A spokesman for Pharma said there is a simple solution to Sen. Bates’s problem,
“Post a sign that says, ‘No free lunch,’” he said.
In a hearing before the Senate Human Services and Rural Health Committee,
Sen. Jeff Kruse (R-Roseburg) said the pharmaceutical company is doing a
remarkable job of self-policing with its new code of conduct. “If folks are moving in
the right direction on their own, we shouldn’t get in their way,” he said
An alternative bill, SB 649, that requires pharmaceutical companies to sign on to
and abide by the Pharma code of conduct, is also before this committee. The chair
says they will make a decision on Monday.


The first deadline of the session comes up Tuesday. Bills must move out of the
committee of origin by the end of the day April 28. A few bills that leadership wants
to keep alive will be moved to the Rules Committees. Others will die.
For the next month, policy committees will work on those bills that have already
passed the other chamber. Policy committees are scheduled to close May 28.

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.