MONDAY UPDATE
March 23, 2009

HB 2607 – Adds sunset to rural healthcare provider tax credit
As part of an effort to regularly review all of Oregon’s tax credits, the House Revenue Committee is considering adding a sunset to the $5,000 per year tax credit for rural health professionals. In written testimony to the committee, Sandra Reese, president of the Oregon Rural Health Association said, “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.”
The Oregon Rural Health Association’s was the only written testimony submitted and the timing was perfect. It became the example legislators used to talk about why this proposal may not work. “One size does not fit all,” said Rep. Vicki Berger (R-Salem). “There are many of these that don’t have a sunset for a reason. The rural health credit is a good example. A sunset works against the policy goals.”
A proposed amendment to HB 2607 would group tax credits into three broad categories and set up a sunset and review every six years.
Committee Chair Rep. Phil Barnhart (D-Eugene) said sunsets might not work for all of them. “The rural medical practitioner probably has some merit. We could take it off the list, grandfather in those who already receive the credit, or leave it in the rotation but double the sunset date (so it would expire every 12 years instead of every 6 years).
There was no agreement on the proposal. Committee members want time to think about how to standardize sunsets and tax credit reviews. They plan to schedule another discussion in two weeks.

HEALTH CARE REFORM

SB 452 - Information Exchange
SB 452, proposed by the Oregon Health Fund Board, is an outgrowth of the Health Information Infrastructure Advisory Committee (HIIAC) process. It would create a Health Information Technology (HIT) oversight council with 11 members appointed by the Governor. If SB 452 becomes law, this council would replace HIIAC and guide Oregon’s efforts to expand EMRs and develop interoperable EMR systems.
According to the Governor’s policy advisor Ree Sailors, the federal stimulus package includes three grant streams for HIT.
1. Loans – capital raised in Oregon would qualify for federal matching funds at an 80/20 split (80% federal) to help MDs purchase EMRs. This is particularly targeted at small clinics.
2. Planning – this funding qualifies for a 90/10 federal match and is to be used by states to develop a statewide plan for EMR adoption and EMR information exchange.
3. Implementation for the Exchange – The statewide plan is required and must be approved by the feds before state’s can receive these implementation grants. There’s “a lot” of money in this pot (amount unspecified). It’s weighted to early adopters. Those states that implement first receive larger grants.
Ree says it may be summer before the federal rules or guidelines for these programs are developed. She’s not waiting. She’s pulling HIIAC back together to begin the process of developing the statewide plan.
Among the decisions to be made are:
· Does Oregon create one statewide information exchange or regional exchanges? (She’s strongly leaning toward a regional model, possibly dividing the state into four regions.)
· Governance: Does the state run the exchange(s) or do they create 501(c)(3) utility-like organizations? (She’s leaning toward 501(c)(3).
Ree says it’s unclear whether the federal funding would be available before 2011.

HB 2009 – Basic benefits, Insurance Exchange and more
The House Health Committee is working its way through proposed amendments to the omnibus health care reform bill.
As so often happens in health care reform discussions, they got hung up on what benefits to include in the package. They couldn’t decide if they wanted to require a basic benefits package or an essential benefits package, or whether those are the same thing. Or is it a minimum benefit package they are really trying to define?
They discussed an Insurance Exchange for the first time, though it was rushed at the end of a long meeting. Chair Rep. Mitch Greenlick (D-Portland) makes it very clear in his statements that he wants the new Health Authority to develop a plan for an Insurance Exchange and bring it back to the Legislature in the 2011 session. But the proposed amendments don’t say that and in places contradict that idea. For example, an amendment to create a public health plan, approved by the committee, says that public plan must be based on the principles of the Exchange and implemented before the 2011 session begins.
Chair Greenlick also mentioned they may add a new section in the bill requiring hospitals to report their rates to the Authority on an annual basis.
The House Health Committee and Senate Health Care Committee are scheduled to hold joint evening meetings on March 25 and 30 to work together on the proposal.

HB 2009 – Provider tax
Behind-the-scenes discussions continue about proposed provider taxes to fund OHP expansion. The two plans are:
· A 4 percent hospital tax and 1.5 percent insurance tax proposed by the Governor. It would raise more money than the other plan, leverage more federal dollars and allow Oregon to add 180,000 children and adults to OHP.
· A 1 percent insurance claims tax and a continuation of the existing hospital tax proposed by a coalition of business, insurance and hospital groups. It’s a more broad-based tax, which spreads out the costs and keeps the tax rate, and the resulting cost shift, low. It would raise enough to cover about 105,000 more children and adults.
Unions launched a radio ad campaign this week against the broad-based claims tax (that they would have to pay) in favor of taxing “big hospitals and big insurance companies” (a tax many of them would not have to pay, except through additional cost shifts). You can hear their ad at http://www.saveourhealthplan.org/media/
There is also increased discussion about the wisdom of expanding OHP by a billion dollars or more at a time when it’s unclear whether Oregon will be able to maintain its existing commitment to the Oregon Health Plan given the current recession.

HB 2117 – Healthy Kids
The House Health Committee debated whether to fold the Healthy Kids proposal into HB 2009 or keep it as a separate bill. At this point it looks like it will continue as a separate bill.
The plan calls for three components:
1. 0 – 200 percent FPL – free access to OHP
2. 200-300 percent FPL – subsidized access to new private plans
3. More than 300 percent FPL – allow them to buy into the private plans with no subsidies
The goal is to have 95 percent of Oregon’s kids insured by the end of the 2009-11 biennium. The Healthy Kids expansion is contingent on funding from a new provider tax.

BUDGET

Budget fears worsen; even deeper cuts now on the table
The recent revenue forecast predicted a $3 billion hole in the 2009-11 budget, but the worsening economic picture has many at the Capitol predicting that hole could grow to as much as $5 billion by the time the May revenue forecast is released.
Those fears gained momentum this week when Ways and Means asked state agencies to submit plans for cuts of up to 30 percent. Plans for cuts up to 20 percent had already been submitted.

OTHER HEALTH CARE ISSUES

SB 272 – Informed consent bill dropped; DHS rulemaking will begin
Sen. Floyd Prozanski (D-Eugene) and DHS Public Health Division decided to drop SB 272 and instead use agency rulemaking to deal with the issue of informed consent for HIV testing in pregnant women.
According to DHS, the intent is to adopt a rule clarifying the combination of statutes related to this issue. In a statement, DHS said, “Any hospital, clinic, or doctor can of course choose to be more stringent than the law, but the rule will go a long way to assure consistency in the legal interpretation.”
DHS promised that a member of PeaceHealth, as well as other health care providers, would be invited to be on the Rule Advisory Committee that will be created to develop the new rule.

SB 327 – Naturopath Rx expansion
Naturopaths offered a compromise to help move their prescribing bill forward. The new amendment would require the Naturopathic Formulary Council to approve each drug that is added to their formulary; so new drugs would not automatically be included.
Currently, Naturopaths can only prescribe naturally derived drugs. This bill would allow them to prescribe synthetic drugs as well.
A number of clinics and family physicians have submitted written testimony in support of the bill.
The Senate Human Services and Rural Health Committee did not take final action on the bill.

SB 654 – Mandatory flu shots for health professionals
Health care facilities with more than 25 employees would be required to provide free annual flu shots for all its licensed health professionals. Employees could opt out by declining the vaccine in writing.
Sen. Bill Morrisette (D-Springfield) sees this as a “pandemic prevention bill.” He says hospitals offer flu shots as a matter of course, but many health care workers refuse. He says this requirement would be gentle persuasion to increase the number who will get vaccinated.
The Public Health Division says this is a significant public health concern.
The Hospital Association supports the goal but opposes the bill. They testified that hospitals already provide free flu shots but this bill just adds to required record keeping. They say vaccinating all health care professionals isn’t necessarily the best use of the vaccine when other hospital workers may have more direct patient contact. The association also says this mandate may increase the liability for a health care professional who refuses to get vaccinated and the facility where they work.
Long-Term Care Association says this bill mandates what’s already happening, but doesn’t solve the problem that up to half of those offered the vaccines decline. They testified that the bill isn’t necessary.
Sen. Morrisette says the Center for Disease Control says what’s going on now is not working.

UPCOMING

6-8 pm, Wednesday, March 25 – House and Senate Health Care Committees
Joint hearing on HB 2009, health care reform

8 am, Thursday, March 26 - Senate Health Care Committee
SB 24 – Telemedicine

3 pm, Friday, March 27 – House Health Committee
HB 2581 – Moves the Rural Health Services loan repayment program to the Office of Rural Health

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.