For a summary of the 2017 RAND report to the Oregon Legislature, scroll to the end of this page.
Most important committee for most bills – Joint Ways and Means. Member list at https://olis.leg.state.or.us/liz/2017R1/Committees/JWM/Overview. Click on member name to find contact information.
The human services subcommittee of Joint Ways and Means is especially important. See https://olis.leg.state.or.us/liz/2017R1/Committees/JWMHS/Overview
In general, if you are talking with a Republican legislator, the most important thing to lobby for is increased revenue. Of the revenue issues, the highest priority is the healthcare industry tax increase, which is necessary to get federal matching money. If you know your legislator supports a bill of interest, thank them for doing so.
Info for Legislative Constituent Contact Teams: 2018 Update
The most important item for HCAO-Action in the 2018 session is Mitch Greenlick’s proposed constitutional amendment, HJR 203. Prior to the session, a “yes” vote on Ballot Measure 101 on the January 23 special election is critical – see Health Care Industry Assessment Increase below. Get Out The Vote!
2018 will provide a marvelous opportunity for Oregon to create a universal healthcare plan. There are two convergent legislative efforts underway that could result in the legislature presenting a plan to the voters.
1. Rep. Greenlick’s proposed HOPE amendment. See Affordable Health Care as a Fundamental Right below.
2. Rep. Greenlick organized a Universal Access to Health Care work group being chaired by Rep. Andrea Salinas (see https://www.oregonlegislature.gov/salinas/Pages/healthcare.aspx). This work group had its first meeting on January 9 and will submit a report to the legislature no later than November 2018. This report should provide the legislature with “an incremental road map to creating a system of universal and affordable health coverage for all Oregon residents”.
Bills and Measures of interest to HCAO-Action in the 2018 session
Affordable Health Care as a Fundamental Right – Rep. Mitch Greenlick has proposed the HOPE amendment, HJR 203, which reads –“It is the obligation of the state to ensure that every resident of Oregon has access to effective, medically appropriate and affordable health care as a fundamental right.” Tentative plans are for a public hearing on Wednesday, February 7, probably late afternoon. Please save the date!
Message: This is the most important bill for us. Polling suggests that a strong majority of Oregonians think health care should be affordably accessible to all. This will obligate the legislature to do something about it. They have already made steps in that direction, with strong support of the Medicaid expansion, and with passage of Cover All Kids and the Reproductive Health Equity Act in 2017. The legislature has already put into law the intent to do more, with Oregon Revised Statute 414.018 stating, “It is the intention of the Legislative Assembly to achieve the goals of universal access to an adequate level of high quality health care at an affordable cost." This bill should be passed so that Oregon voters have the opportunity to weigh in on this important matter, and to add this to our constitution if they so choose.
As of 1/12/18, most Democratic legislators are sponsors (11 in the senate, 30 in the house), including all Democratic members of both the Senate and House Health Care committees. All SB 1046 sponsors are known sponsors of LC 46 except possibly Reps. Barker, Doherty, Helm, Piluso, Rayfield, and Witt (5 representatives signed on 1/12, and we don’t know which ones). Those who sponsored Cover All Kids but are not yet sponsors of LC 46 (as of 1/11/18) include Sens. Roblan & Boquist and Rep. A. Olson. Try to find out if your legislator supports this. If they do, urge them to become a co-sponsor and talk with Rep. Greenlick about that – though new Senators cannot join in until it gets to their chamber.
If your legislator seems potentially supportive but reluctant perhaps because of cost – point out that the legislature funded a study by the RAND Corporation that showed Oregon could create a universal, comprehensive healthcare program without increasing costs. Other studies have reported that costs would be less.
CCO reform –Rep. Mitch Greenlick will introduce CCO reform again as HB 4018.
The reforms are intended to make CCOs more transparent and accountable. The bill will probably not be as strong as what Rep. Greenlick first introduced in the 2016 session. It may include only the requirement for the governing board to follow open meeting laws – but even just that is useful. There will be a push to have the OHA request for proposals (RFPs) and contracting to include transparency and accountability recommendations made by the Oregon Health Policy Board (OHPB) following the fall 2016 listening sessions around the state – at least those that can be done without new legislation. See OHPB’s recommendations at https://tinyurl.com/y9kv59kh.
Message: CCOs currently serve 25% of Oregonians and will need to be effective community organizations for there to be any reason to continue in a universal system. We cannot allow CCOs to misuse public money as profligately as some already have. The most important help would be to meet with your senator before the legislative session begins in February or within the first two weeks of the session (before February 16). Meeting with your representative is also important.
Prescription Drug Pricing Transparency – Rep. Rob Nosse will introduce a prescription drug pricing transparency bill – HB 4005.
The bill will either be very much like sections 6 & 7 of the A-engrossed version of HB 2387 in the 2017 session, or like California’s SB 17, signed into law on October 10, 2017. More information about California’s bill can be found here.
Message: Prescription drug pricing transparency is useful in figuring out what a state can do to help mitigate high costs of prescription drugs. Opaque pricing is antithetical to well-functioning markets and to transparent and accountable government programs.
The following will be decided before the 2018 session begins, and does not need to be discussed with legislators, though if “no” wins, much of the 2018 session will be devoted to figuring out what to do about it.
Health Care Industry Assessment Increase – this will be on the ballot as Measure 101 on the ballot in a January 23 special election.
A “yes’ vote will affirm what the legislature passed, and will protect healthcare for hundreds of thousands of Oregonians. This was put on the ballot by Referendum 301 as an attempt to reverse a carefully crafted bipartisan assessment increase on the healthcare industry. The revenue raised from the healthcare industry provides funds to preserve the Medicaid expansion in Oregon, to fund Cover All Kids, to fund the Reproductive Health Equity Act, and to provide some reinsurance intended to help stabilize insurance rates in the Oregon individual health insurance market.
Message: HCAO-Action has strongly endorsed a “yes” vote. This is the most important happening in the next few months that can affect equitable access to health care in Oregon. A “yes” vote will preserve the funding for the Medicaid expansion, Cover All Kids, the Reproductive Health Equity Act, and insurance premium rate stabilization. A “no” vote will jeopardize all of these programs. A further result of a “no” vote is to likely cause a long, drawn out, and extremely contentious re-budgeting process, where legislators will be forced to reduce funding in other areas to preserve at least some of the generous federal matching funds (as much as $5 billion) that will otherwise be unavailable for healthcare in Oregon. If the measure fails, it is unlikely that the 2018 session will have time for any other measures that may be slightly controversial. This includes all three of the bills mentioned above.
The proposed ballot title, containing further explanations, can be viewed on pages 3 & 4 of the document http://oregonvotes.org/irr/2018/301cbt.pdf. An article from the Oregon Center for Public Policy (OCPP) outlines why a “yes” vote makes sense. An article by the Cascade Policy Institute (which “promotes property rights, incentives, markets and decentralized decision making”) argues, in essence, for a “no” vote.
Advocates for a “no” vote will try to mislead voters by claiming the health care industry assessment increase (or tax – “no” advocates call it a sales tax) will cause insurance rates to rise. But because of the $5 billion in federal matching money and other state revenue at stake, the exact opposite is true – a “no” vote will lead to increased rates.
Steps to following a bill
Go to the Oregon State Legislature website: https://www.oregonlegislature.gov/
On the main page, click on “Find Bills,” an icon of a magnifying glass on the upper right-hand side. Clicking on the magnifying class will take you to the “How to Find a Bill” page.
On the “How to Find a Bill” page, look for the box on the right-hand side of the page with a magnifying glass icon, titled: Search Bills. Type in the number of the bill or key words for it (ex: “2122” and/or “coordinated care”).
For “HB 2122,” search for “2122” and “coordinated care”. Then, when the results populate, on the left-hand margin, select “2017 Regular Session” in the “Filter Your Search” box.
In the results, select “HB 2122 Introduced” to proceed to the bill’s summary page.
To subscribe to follow the bill, go to the HB 2122 summary page.
On the top of the page, there is text for “Follow this Bill” with a hyperlink for “e-Subscribe Email.” Clicking on “e-subscribe Email” will take you to a page for you to input your email address and submit.
You can click on various committees and bills to add to your e-subscription. I recommend selecting Senate Health Care Committee, House Health Care Committee, Joint Committee on Ways and Means (which is where HB 2122 is headed after House Health Care Committee), then scroll down to select other bills like HB 2115, or any others to follow. Click “Submit.” Click “Finish.”
Back to the HB 2122 page. This page will show the measure’s history and the current committee the measure is assigned to, which is currently the House Committee on Health Care. You can select the “House Committee on Health Care” hyperlink on the page to see all the members of the committee. You can click to read each member’s biography and contact information to determine whom to approach in the committee.
Also, as the measure moves or is revised, these movements/changes can be seen by perusing the tabs on the measure’s page: “Overview,” “Analysis,” and “Meeting Material/Exhibits.” (These will also be emailed through the e-subscription.”
You can save the HB 2122 page to your bookmarks to make finding the page easier.
To view the “HB 2115” summary page, go back to the search page, and type “2115” and “nonprofit.” Select “HB 2115 Introduced” to go to the bill’s main page.
You can review the measure history on the overview page as well as the current committee.
You can click on the committee hyperlink to review the members and click on their bios.
You can save this page as a bookmark on your internet browser to save for later viewings.
You do not need to e-subscribe through this page if you already clicked on “HB 2115” when you subscribed to the other bill and committees. If you didn’t click on HB 2115 when you e-subscribed to HB 2122, then you can click on the e-subscribe link at the top of the page and add it to your subscription.
Summary of the RAND study on health care financing in Oregon
--by Charlie Swanson, HCAO Legislative committee chair
The RAND study found that
- “Should Oregon want to achieve universal coverage, Single Payer and Health Care Ingenuity Plan (HCIP) are the most promising options.”
- Single Payer (SP) would cost roughly the same as the status quo, whereas HCIP would be significantly more expensive.
- SP is the only option that significantly reduces financial barriers to care.
- SP is the only option for which the % of household income going to health care decreases as income decreases - all of the other options are significantly regressive.
- With SP, all income groups except those above 400% of poverty level would have lower health care costs than any other option.
RAND recommends that Oregon “seek legal counsel to determine whether an ERISA challenge is likely and to assess possible steps to minimize the possibility of a successful challenge.” ERISA is a federal law protecting employee retirement and health benefits which prohibits states from interfering with health care provided by self-insured employers or multi-employer multi-state plans. Such plans cover 25% of Oregon’s population.
RAND did not appropriately examine how SP reduces administrative costs, primarily because RAND completely ignored the effect of administrative simplicity in provider offices under SP.
- RAND referenced appropriate studies finding SP would lead to average administrative savings of 11% of total health care costs, but then claimed Oregon administrative savings would be only 1.7% ($600 million annually).
- 11% savings in Oregon would be $4 billion annually, or $3.4 billion greater than what RAND reported.
- RAND assumes provider reimbursement is 10% lower with SP than the status quo, which amounts to $3.1 billion.
- The extra $3.4 billion in administrative savings is greater than the $3.1 billion decrease in reimbursement, leading to a likely increase in provider net compensation on average.
- Billing and insurance related activities (BIR), a significant part of administrative activity in the U.S., consume substantially more time in provider offices in the U.S. than in countries with SP.
- SP administrative simplicity would allow providers either to see more patients (and thus increase compensation), spend more time with patients (thus increasing the quality of care), or spend less time in the office (leading to less burnout). All of these factors would help mitigate the expected increase in congestion due to increased demand.
Some of RAND’s financial details seem questionable, so the study does not provide us with the sound quantitative data we need to design an appropriate tax structure to finance a single payer system in Oregon. RAND also did not respond to a request to explore the possibility of the state becoming a Medicare Advantage plan provider.
A work group formed by legislators following the 2017 session could address outstanding issues regarding how best to implement an affordable, publicly funded universal healthcare system in Oregon.
Health Care for All Oregon • http://hcao.org/
+1 503 206 6709 • 1443 SE 122nd Ave, Portland, OR 97233 • email@example.com