2009 Legislative Report
MONDAY UPDATE
April 20, 2009
HEALTH CARE REFORM
HB 2116 – Provider tax and OHP expansion
House leadership decided to peel the provider tax and OHP expansion out of HB 2009, the health care reform bill, and put them in a separate bill. That way, if the tax package runs into trouble, in the legislature or with voters, it doesn’t sink all of health care reform with it.
The tax package includes a premium tax on commercial insurers and a hospital tax, both at unspecified rates. The Revenue Committee will fill those in, hopefully after a negotiated agreement is reached.
OHP expansion includes both the Healthy Kids plan and an increase in the number served by OHP Standard.
Republicans on the House Health Care Committee moved to refer the tax plan to the ballot. Rep. Ron Maurer (R-Grants Pass) quoted committee chair Rep. Mitch Greenlick (D-Portland) from a floor speech last session when he said any major health care reform or tax to pay for it would have to go to the voters. Greenlink joked, “I can’t be both brilliant and consistent.” The committee rejected the referral to voters on a party-line vote.
HB 2116 now heads to the Revenue Committee, then to Ways and Means. In the meantime, legislators continue negotiating with hospitals and insurance carriers on details of the proposed taxes. Leadership says it wants this bill voted on in both chambers and on the Governor’s desk before May 15th.
PEBB to go self-insured
In March, the Public Employees Benefits Board (PEBB) unanimously voted to go self insured in 2010. They said Providence and Regence told them they could save 10 percent on their premium increase next year if they self-insure.
This step will move 120,000 state workers out of the commercial insurance market. That means PEBB would not contribute to the Governor’s proposed premium tax to pay for OHP expansion and will no longer pay the OMIP (high risk pool) assessment.
Insurance analysts say legislative decisions to exempt self-insured plans and union trusts from the premium tax the OMIP assessment will drive more and more large businesses to self insure, continually raising rates for individuals and businesses that still buy commercial insurance.
HB 2009 – Committee working its way through 50+ amendments
It’s been a full-time job for legislative counsel just drafting all the amendments requested for HB 2009, the omnibus health care reform bill. They are now up to at least 63.
The House Health Committee plans to add amendments with all seven of the Oregon Health Fund Board bills that were worked on and passed by the Senate Health Care Committee.
SB 856 – A new alternative to HB 2009
The Senate wants an opportunity to weigh in on the major elements of health care reform, so they are resurrecting a bill that was dormant, SB 856, and converting it into an alternative to HB 2009.
The original concept — developed by health plans, hospitals and AOI — uses the elements of HB 2009 but in a scaled-back, less-expensive process. Key among the changes is that the Health Authority would be created as a department within the Department of Human Services instead of as a new agency. The Oregon Health Plan and components of the Insurance Division would not be moved. “We didn’t think this was a very opportune time to undertake another reorganization of DHS,” said Tom Holt representing the Hospital Association. “I like the idea of not moving the Oregon Health Plan out of DHS,” Sen. Bill Morrisette said. “Splitting the agency I think is ridiculous.”
Holt said the Health Authority’s role would be to implement health care reform. “This is not another study group,” he said. “It’s designed to be an action agency.”
DCBS would analyze the individual and small group insurance markets to determine if an Insurance Exchange brings benefit to those markets. DCBS would bring the plan back to the 2011 session.
“We believe this is a practical, doable alternative,” Holt said.
The Senate Health Care Committee plans to work its way through this new alternative next week.
If approved, it would also health to Ways and Means where it would compete with HB 2009.
SB 453 – All payers, all claims database
One of the Oregon Health Fund Board’s more expensive proposals, for a statewide health claims database, would require all health care claims to be reported to the state.
The proposal would cost $3.7 million in the 2009-11 biennium. The state hopes to tap into some federal stimulus dollars to help pay for it. Sen. Frank Morse (R-Albany) said, “Building on an analogy from by previous business career, ‘I feel like we are bidding a job but we don’t have any money in the bank.’”
The Senate Health Care Committee approved the bill “without recommendation.” Sen. Jeff Kruse (R-Roseburg) said there will be other legislation that will give Ways and Means another opportunity to address this issue in a slightly different manner, “and I don’t want to prejudice that decision.”
SB 454 – Community reporting for hospital construction
The Oregon Health Fund Board wants hospitals to notify their community when they plan to undertake large capital improvement projects. Carol Robinson from the Oregon Health Fund Board said, “We want to make sure communities know what they are getting.”
Hospitals would have to report capital construction projects that exceed a percentage of gross patient revenues. Hospital reporting requirements would include posting notice of the project and its benefits on the hospital’s Web site, seeking community input, and sending notice to the Office of Health Policy and Research.
The Oregon Health Fund Board also recommends that individual medical equipment purchases of $1 million or more would also have to be reported. Equipment purchased with charitable dollars would not have to be reported. Freestanding diagnostic centers are exempted from this requirement. The Hospital Association objects to this portion of the bill.
Sen. Jeff Kruse (R-Roseburg) said, “This bill is total over kill.”
The committee delayed action on the bill until next week.
SB 456 – Integrated health home or patient-centered primary care home?
Health care groups agreed on a process to set standards for medical homes but argued about what they should be called. So the Senate Health Care Committee decided that medical homes in Oregon, or at least in this bill, will be called patient-centered primary care homes.
The committee is waiting to take action on the bill.
HB 3418 – OHP to pay for medical homes
In a hearing before the House Health Care Committee, Care Oregon and the Oregon Primary Care Association said HB 3418 would require the Department of Human Services to develop and implement a new system to reimburse for medical homes. It would be a voluntary system, for those providers who want to provide the array of services found in a medical home.
The original legislation was based on an FQHC model and required team based care, transportation, home visits for environmental health interventions, services to address homelessness and limited access to healthy food.
The Oregon Academy of Family Physicians and the Hospital Association supported the concept but raised concerns about the specifics in the bill.
Amendments are being drafted to open up the bill to a wider array of primary care practices.
OTHER HEALTH CARE ISSUES
HB 2067 – Sunset added to tax credit for rural health professionals
The House Revenue Committee wants all tax credits to have a sunset so they will be reviewed by the legislature every six years. Tax credits like the $5,000 per year credit for rural health professionals got roped in with the others. If HB 2067 passes, the rural health tax credit will expire in 2016 unless renewed by the legislature.
The Oregon Rural Health Association (ORHA) argued that this sunset creates uncertainty that defeats the purpose of the credit. “The ability to count on this tax credit is often the one thing that helps providers make that decision to make a long term commitment to rural Oregon,” Sandra Reese, president of the ORHA, wrote to the committee.
HB 2067 passed the Revenue Committee on a straight party-line vote and now heads to the House floor.
SB 355 – Electronic Rx database moves to Ways and Means
The Senate Human Services and Rural Health Committee unanimously approved SB 355 to establish an electronic database for prescription drugs. Sen. Alan Bates (D-Medford) says it’s an important tool to help stop drug shopping for painkillers.
The program will be funded with a $25 annual fee for each prescriber, collected by the licensing board. “Our solution to funding this program is absolutely golden,” said Sen. Jeff Kruse (R-Roseburg). Kruse says all the boards involved are supportive.
Bates says they worked with ACLU to protect patient rights and privacy, though he says ACLU continues to oppose the bill.
The bill now moves to Ways and Means.
HB 3022 – Antibiotics for sexual partners
OAFP’s Cat Livingston MD proposed HB 3022 that would allow physicians to prescribe and dispense antibiotics for the treatment of chlamydia or gonorrhea for a patient and the patient’s partner without an examination. The House Human Services Committee unanimously approved the bill. It now heads to the House floor.
HB 2702 – Psychologists prescribing privileges back before legislature
This is psychologists’ second run at legislation granting them the authority to write prescriptions. In an abbreviated hearing in the House Health Care Committee, psychologists talked about their training and made the case for why prescribing privileges could help them provide better mental health services, especially in underserved areas.
The hearing turned testy when opponents of the bill took the witness stand. One woman claimed that the psychologists’ board dismisses 95 percent of consumer complaints, “the worst record of protecting public safety of any health board.” To which the committee chair said, “Really?”
An OHSU psychiatrist was skewered for statements that psychologists did not receive adequate training – to which Rep. Bill Kennemer (R-Clackamas) a licensed psychologist said, “I received that training in 1973. You better check your facts.”
Another OHSU psychiatrist said there’s already a problem with over-medicating children. “There’s no shortage of prescribers.” To which Chair Mitch Greenlick (D-Portland) rhetorically asked, “Was it psychologists doing that over-prescribing?” Rep. Tina Kotek (D-Portland) chimed in, “Prescribing privileges would also allow psychologists to take people off medications.”
No action was taken on the bill.
SB 850 – Adds dentist to Health Services Commission
Deborah Loy from Capitol Dental told the Senate Health Care Committee, “Dental services improve not only the patient’s oral health but have also shown savings as a component of chronic care management.”
SB 850 would add a licensed dentist to the Health Services Commission. “Oral health services are integrated in the Oregon Health Plan’s prioritized list,” Loy said. “It’s important to have a dentist at the table.”
A representative for acupuncturists proposed an amendment that would a “complimentary medicine” practitioner to the Commission. He said that could include a naturopath, chiropractor or acupuncturist.
There are currently 11 members on the Commission. The Commission supports adding a dentist to the panel.
The committee took no action on the bill.
SB 734 – Tobacco cessation mandate moves forward
The Senate Health Care Committee approved SB 734 on a 3-1 vote. It would require health insurance to cover tobacco cessation programs. The mandate has a $500 lifetime limit. There was no opposition.
SB 381 – Traumatic brain injury insurance mandate
“This is another mandate,” said Sen. Jeff Kruse (R-Roseburg). He expressed concern about the cumulative effect of all the mandates in the insurance code.
“Oftentimes insurance companies stand in the way of health care,” said Sen. Bill Morrisette (D-Springfield). “It’s important to identify brain injury early and get it treated. I think this is a very important mandate.”
Insurers did not oppose this bill because it requires the procedure to be medically necessary.
Sometimes mandates level the playing field on insurance, so you know what you are buying,” said Sen. Alan Bates (D-Medford).
The Senate Health Care Committee unanimously approved the bill.
SB 804 – Patients have the right to lab results
“Patients have a right to this information,” said Sen. Alan Bates (D-Medford). “I’ve seen cases where results get lost and the patient is the only one who has the all the information.”
SB 804 would require a lab to release test results after receiving authorization from the physician or dentist.
Confusion about amendments led the Senate Health Care Committee to decide not to move SB 804 and instead wait for a House bill on the same issue to come to them.
HJR 18 – Health care is a right
Rep. Mitch Greenlick (D-Portland) is taking another run at his proposed constitutional amendment to make health care a right. “This is more important to me than any other bill I’ve carried,” he told the House Health Care Committee, which he chairs. Rep. Greenlick argued that it would not open up demands for coverage of everything under the sun. “It says medically appropriate, effective and affordable care,” he said.
Cat Livingston, MD, representing the Oregon Public Health Association, testified in strong support of HJR 18 saying it would improve equity and access to essential preventive health services.
Rep. Jim Thompson (R-Dallas) described the bill as “Blue sky.” He said, “Maybe we should also put in the Constitution that every have happy lives.”
The Health Care Committee moved the bill to the House Rules Committee where, Rep. Greenlick says, they are collecting bills that could be referred to the ballot.
SB 679 – Healthy lifestyles $ dividend
Sen. Frank Morse (R-Albany) told the Senate Health Care Committee that SB 679 would help connect insurance premiums to lifestyle choices. The Health Dividend plan is championed by John Lees, MD. Financial incentives could be used to encourage tobacco cessation, weight loss, fitness and nutrition he said.
Their plan suggests starting small, for example, with a one percent premium refund if people participate in healthy lifestyle programs. They said lifestyle choices are a major contributor to the cost of health care. This is an effort to begin addressing those costs.
The committee plans to move the bill next week.
SB 37 – OHP prompt pay for rural clinics passes committee
To avoid any fiscal impact this biennium, the Senate Human Services and Rural Health Committee changed the effective date of SB 37 until May 17, 2011, 45 days before the end of the biennium.
SB 37 requires DMAP to pay rural clinics within 45 days of receiving a bill. Sen. Laurie Monnes Anderson (D-Gresham) says this will set up a complicated program of estimated payments that would have to be reconciled after the state receives federal reimbursement. “It seems we are forming a real bureaucratic mess with this bill,” she said.
The bill was approved over Sen. Monnes Anderson’s objections and now heads to the Senate floor.
SB 39 – Cigarette tax for rural safety net passes Senate committee
Rural safety net, emergency medical services and health care providers would receive 3.5 percent of the existing cigarette tax if SB 39 becomes law. That’s $5.9 million in the 2009-11 biennium.
The Senate Human Services and Rural Health Committee approved the plan and sent it to Ways and Means.
Given the huge budget shortfall, Ways and Means would have to take the money away from other programs to give it to rural health care.
OTHER LEGISLATIVE ISSUES
Ways and Means hearings begin this week
Budget writers are seeking public input on the long list of potential budget cuts, up to 30 percent of existing budgets, which may be necessary to close the revenue shortfall now estimated at $4.4 billion.
These hearings are an important opportunity to highlight the impact these cuts would have on the Oregon Health Plan, addictions and mental health programs, Graduate Medical Education and others.
Monday, April 20 – Lincoln City
5:30 - 8 pm, Lincoln City Cultural Center, 540 NE Hwy 101, Lincoln City
Tuesday, April 21 – Portland
6 - 8:30 pm, Portland Community College -Cascade Campus, Auditorium, Moriority Building, 705 N. Killingsworth Street, Portland
Thursday, April 23 – Salem & Hood River
5:30 - 8 pm, Oregon State Capitol, Hearing Room F, 900 Court Street NE, Salem
Including Hood River via video link
Saturday, April 25 - Pendleton
10 am – noon, Pendleton Oregon National Guard Armory, 2100 N.W. 56th Drive, Pendleton
Saturday, April 25 - Ontario
3 - 5 pm (Mountain View or Ontario time), Ontario Treasure Valley Community College, 650 College Boulevard, Ontario
Wednesday, April 29 - Bend
5:30 - 8 pm, Central Oregon Community College, Cascades Hall Room 117, Bend
Thursday, April 30 - Ashland
5:30 - 8:00 pm, Southern Oregon University, Rogue River Room, Stevenson Union, 1250 Siskiyou Boulevard, Ashland
Friday, May 1 - Eugene
1 to 4 pm, University of Oregon, Prince Lucien Campbell Hall (PLC 180), 1415 Kincaid Street, Eugene
April 28 deadline for moving bills out of first committee
Friday, April 17 was the deadline for scheduling work sessions for bills in the chamber of origin. The next deadline is April 28. By then, committees must take action on those bills.
These internal deadlines help winnow the field of bills under consideration. Hundreds of bills will drop off the radar screen for lack of action, either on the 17th or by the 28th.
But it’s important to remember that no bill is really dead until the session gavels to an end. While it is unlikely that dead bills will be revived, it’s not impossible.
Policy committees will spend May considering bills that have passed the other chamber.
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.
