General Notes

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

1/5/2019 version

If you have not done so since the November election, it is best to meet with legislators to renew relationships and make contact with new legislators before the session begins on January 22. The most important, simplest, and most time sensitive request of your legislature is to join in sponsoring LC 1927 (see the first section below). This should be done before January 22 – by email or phone if you are unable to arrange an in-person meeting. Please help Increase the number of co-sponsors!

We don’t have copies of many of the bills in which we have interest, so many of the recommendations below are tentative. We will send out updates to this information as we learn more. If you come across healthcare bills on which you think HCAO should take a stand, please send information to legislative@hcao.org

The Universal Access to Healthcare Workgroup (UAHW) has released its final report – see here, and an op-ed about the report by Sam Metz is here. The report suggests several incremental steps that deserve further exploration – the most useful for us are likely to be exploring a universal primary care (see below under “Other bills of interest”), and perhaps a single common billing form and plan uniformity.

LC 1927 (was SB 1046 in the 2017 session)
Status
: SB 1046 has been pre-session filed with Sens. James Manning and Michael Dembrow as chief sponsors. Sen. Manning is the main contact on the bill. We did not submit any revisions yet, but legislative counsel updated it appropriately. Getting more co-sponsors before January 22 is our primary immediate effort.

Explanation: This bill describes how a single-payer health care system could be implemented for the state, but funding details are not yet determined. We intend to aim for more than a courtesy hearing on the bill during this session. It is not yet clear whether that is more likely in the House or the Senate.

Message: Our intent is to have all returning co-sponsors of SB 1046 sign on to the bill and to add more co-sponsors. Ask your legislator to be a co-sponsor – they can talk with Sen. Manning to sign on. Seven returning senators sponsored SB 1046 - Dembrow, Frederick, Manning, Prozanski, Riley, Steiner Hayward, and Taylor. 21 returning representatives were sponsors – Barker, Doherty, Fahey, Gomberg, Gorsek, Helm, Hernandez, Holvey, Keny-Guyer, Lively, Malstrom, Marsh, Nosse, Piluso, Power, Rayfield, Reardon, Sanchez, Smith Warner, Williamson, and Witt. From campaign information, new legislators that are most likely to become co-sponsors are Sen. Jeff Golden and Reps. Wilde, Mitchell, Neron, Prusak, and Salinas.

For any Democratic legislator, it is worth pointing out that the number one legislative action item of the Democratic Party of Oregon is

As health care is a human right, adopt an equitable, high-quality, comprehensive, universal, publicly-funded healthcare system including general, preventative, and emergency care, plus vision, dental, hearing, prescription drugs, long-term care, substance abuse, hospice care, and mental health services at the state or federal level.

For any legislator who is at all reluctant to become a co-sponsor, please let them know that the RAND study which the legislature funded projected that a single payer system in Oregon, as described in our bill, could cover every Oregon resident with no out of pocket costs for essentially what Oregon society would pay for health care with the current system. Please ask them what reservations they have about sponsoring LC 1927.

Please send meeting information to legislative@hcao.org – who & when you met, that your legislator is already or will be a sponsor of LC 1927, and if not, reasons they give for not being a sponsor. Thank you!

Other bills for which HCAO is the major advocate

We do not have legislative concept numbers or a firm commitment from any legislator for introducing any of our other bills. The information below is a brief description of what we want.

Oregon health care expenditure transparency – We have talked with Sens. Manning and Beyer about sponsoring a bill to make information about health care expenditures in Oregon publicly available. We should be telling supportive legislators that people need to become much more cognizant of what is being spent in our current system so that most can see the new taxes necessary to fund our system as merely a shift of resources, not as new spending. Credible expenditure information is critically important for both designing details of the tax structure necessary to finance a single payer system and for acceptance of such a tax structure. Please urge your legislator to support this concept, and if they do, urge them to talk with Sen. Beyer or Sen. Manning about their support.

Joint Memorial urging Congress to pass HR 6097 — Rep. Jayapal’s State-Based Universal Health Care Act – We have talked with Sen. Manning and Rep. Andrea Salinas about introducing this memorial. Please urge your legislator to support this memorial, and if supportive, urge them to talk with Sen. Manning or Rep. Salinas about their support.

Codifying the criteria of the best system for the delivery and financing of health care that was the basis of what became the RAND study – HB 3260 in 2013 listed 19 criteria that became Chapter 712, Oregon Laws 2013. But these criteria had a sunset date of January 2, 2016. HB 2828 in 2015 funded the study, and extended the sunset to January 2, 2018. There is no good reason that there was a sunset date on these criteria. We have talked with Sen. Manning about putting them in Oregon Revised Statutes. Please urge your legislator to support this, and if supportive, urge them to talk with Sen. Manning about their support.

Other bills of interest

Universal Primary Care – Rep. Andrea Salinas has indicated she will be introducing a bill relating to universal primary care, but we have not yet seen a legislative concept for this. We expect that we will support it. Let your legislator know that we expect this could be a good incremental step towards an equitable and affordable universal system in Oregon. Of all of the incremental steps considered by the UAHW, this was the most positively received and is likely to have the greatest positive effect.

Bills relating to prescription drugs – HCAO is part of the Oregon Coalition for Affordable Prescriptions. The coalition has proposed a number of bills which we expect to support, though we have not seen the language. (1) Importation from Canada: Require Oregon Health Authority to design and, with federal approval, implement a state program to import and distribute wholesale prescription drugs from Canada; (2) Require drug manufacturers to provide at least 60-day advance notice of any intent to raise prices beyond a certain threshold; (3) Advertising Price Disclosure: Require manufacturers to disclose the wholesale drug price in Oregon in any prescription drug advertisement; (4) Substitution of Generics: Amend ORS 689.515 to require (rather than simply allow) a pharmacist to substitute a generic drug for a brand drug if the substitution will result in cost savings/no cost increase to the purchaser, while maintaining other consumer protections in statute, including a prescriber’s ability to write a “no substitution” prescription; (5) Substitution of Biological Products: Amend ORS 689.522 to require (rather than simply allow) a pharmacist to substitute a prescribed biological product with an interchangeable biological product unless the practitioner has specified there may be no substitution.

LC 1831 – a prescription drug bill that we have endorsed – copay transparency, primarily intended to help those with diseases that require very expensive drugs.

Bills to follow

Medicaid buy-in – Rep. Salinas and perhaps others will introduce a bill relating to a Medicaid buy-in. This is somewhat like a public option, though consumers would likely buy-in to private entities, Oregon’s CCOs, more than half of which are for-profit entities that have opposed appropriate reforms. At this time, it would be best to not bring up this bill in legislator visits. If it comes up, indicate that HCAO has concerns about the involvement of for-profit CCOs, about CCO lack of acceptance of appropriate transparency, about a buy-in’s effect on the provision of services to the current Medicaid population, about continuing to split the risk pool, about the inherent administrative complexity and costs of CCOs, and about paying an extra entity between a public payer and providers.

Steps to following a bill

Go to the Oregon State Legislature website: https://www.oregonlegislature.gov/

1.    On the main page, glide cursor over “Bills and Laws,” and click on the year of the “…Regular Session” you are interested in, e.g., “2017” or “2018”.

2.    Click on “Senate Bills” or “House Bills” and choose from the range of bill numbers listed.

3.    If you know the title or subject of the bill but not its number, type the subject, e.g. “coordinated care transparency” in any search window.  This may give a summary article only but may provide the bill number and the session year so you can use steps 1 and 2.

4.     If you want to follow this bill online, go to the bill’s page you found in step 2 above and click on a eSubscribe icon or link at the bottom or top of the page.  “Citizen Engagement” tab should pop up and give you a link, e-Subscribe to Alerts.  Click on that link and scroll to the bottom of the page to see where to enter your contact information.  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.”

5.    You can click on the names of various committees and bills to add to your e-subscription. We 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.”

6.     You can save the any page to your browser’s bookmarks..

7.    To find out which legislators are on the committee you want to follow, go to the main olis oregon  (https://www.oregonlegislature.gov/) page and click on Committees, e.g., “House Committee on Health Care” hyperlink. You can click to read each member’s biography and contact information to determine whom to approach in the committee.

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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    •   info@hcao.org

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