For a summary of the RAND report to the Oregon Legislature, see below.
Info for Legislative Constituent Contact Teams Regarding 2017 Bills
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.
Bills and revenue of interest to HCAO
CCO reform – HB 2122, in Joint Ways and Means. Senators need an extra push.
The bill is intended to make CCOs more transparent and accountable. They must publicly file governing meeting minutes, they must be non-profits or benefit corporations by the contracting cycle after the one coming up now (by 2023), and OHA will create rules to help protect the public money (HCAO will need to be active in this process).
Message: These CCO reforms will likely be critical for our future plans. CCOs currently serve 25% of Oregonians and will need to be effective community organizations. Although the bill is weaker than what we wanted, it is still a useful reform and needs the support of our legislators. We cannot allow CCOs to misuse public money as profligately as some already have.
Health Care industry tax increase – will be put into HB 2391, in Joint Ways and Means
The Oregon Center for Public Policy (OCPP) is urging lawmakers to explore the following options for filling the health care budget gap: (1) Increase hospital tax; (2) Reinstate tax on managed care organizations and insurers; (3) Tax additional provider types; (4) Tax health insurance claims; (5) Tax other non-providers in the health industry. For details, see http://www.ocpp.org/media/uploads/pdf/2017/01/rptes20170118MedicaidFunding-fnl.pdf.
Message: Tell your legislator that HCAO agrees with OCPP that all of these options should be explored, and that the revenue raised should be great enough to cover the Oregon Medicaid budget gap (the federal government will match this portion 16 to 1), Cover All Kids (see below), and public health modernization. Lobbying for this is especially important for anyone who is a constituent of a Republican.
Cover All Kids – SB 558 and HB 2726 (part of Fair Shot /HEA agenda). In Joint Ways and Means
Developed by the Oregon Health Equity Alliance (OHEA), of which HCAO is a member, these matching bills extend coverage to all Oregon residents under 19 whose family income is below 300% of federal poverty level (FPL). It is expected to cover an additional 18,000 children and cost $55 million.
Message: HCAO is a coalition partner advocating for this important move towards universal coverage. This bill should be fine if the health care industry tax increase is sufficient (see above).
Drug Pricing Bill – HB 2387, in Joint Ways and Means
This bill grew from the interim drug pricing work group and has portions from the Senate Committee on Health Care. It has proposals that are sufficiently likely to result in system savings for prescription drugs that big PhRMA has taken out multiple full page ads in major Oregon newspapers touting it as a give-away to insurance companies. The bill also has provisions to lower consumer costs of very expensive prescription drugs, to require PhRMA to explain the underlying reasons for new drugs costing more than $10,000 per year, the reasoning for a cost increase above 3.4% in a year, and some transparency regarding patient assistance programs.
Message: The bill is a comprehensive attempt to deal with drug pricing at a state level, and is innovative enough to be getting national attention. It is especially important to push senators to support it – emphasize that it has been amended to include provisions suggested by the Senate Committee on Health Care.
Public Health Emergency Coverage – HB 3276, in Joint Ways and Means
HB 3276 requires health benefit plan coverage of health services necessary to combat public health emergencies.
Message: Urge legislature support for this bill.
Reproductive Health Equity Act – HB 3391 (Fair Shot/OHEA agenda), in Joint Ways and Means
This bill requires health benefit plan coverage of specified health care services, drugs, devices, products and procedures related to reproductive health, while allowing exemption for plans sold to religious employers. It requires Oregon Health Authority to implement program to reimburse costs of services, drugs, devices, products and procedures related to reproductive health provided to individuals who can become pregnant and who would be eligible for medical assistance if not for certain federal requirements.
Message: Oregon needs step up to protect women’s health care with the current national climate.
Nonprofit Hospital Requirements – HB 2115, in House Committee on Revenue
The bill establishes some community benefit requirements for nonprofit hospitals. HCAO Action will push for stronger requirements than currently described in the bill, but does not yet have specific language.
Message: Oregon needs enforceable community benefit requirements for hospitals, and there is a general need for nonprofit to have real meaning when applied to healthcare providers.
Small Donor Funded Elections – HB 2578, In Joint Ways and Means
This bill is being promoted by Common Cause, who is joining forces with HCAO in today’s lobbying effort. It provides a 6 to 1 publicly funded match for small donor contributions HB 3276 requires health benefit plan coverage of health services necessary to combat public health emergencies.
Message: Urge legislators to support this bill. This sort of match will help us elect more supportive representatives, with more time to legislate rather than fund raise.
Other Revenue – overall, increasing revenue is critical for Oregon. This is especially important to emphasize with any Republican legislator.
Steps to Track 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/
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