The week before the state Legislature convenes for a short session, agency leaders and elected officials say now is the time to start planning for a $1.5 billion Medicaid funding gap the state will face in two years.
By Courtney Sherwood
No matter what happens in Washington, D.C., Oregon is pushing health reform forward, leaders of state agencies and health-focused legislators told a crowd of more than 250 people who gathered Tuesday morning for the Oregon Health Forum’s panel discussion on Challenges Facing Our Healthcare System.
At the start of the breakfast discussion, moderator Tim Nesbitt, a public policy consultant, noted that when panelist Rep. Mitch Greenlick, D-Portland, joined the state Legislature in 2002, 17 percent of Oregonians lacked health insurance and healthcare spending was rising at a rate far above inflation. Now only 5 percent of state residents are uninsured, and healthcare spending is climbing just barely faster than inflation.
“My question is, call it good, or can we do better?” Nesbitt asked the panelists. In addition to Greenlick, Republican Rep. Cedric Hayden of Roseburg and the heads of two state agencies, the Oregon Health Authority and the Department of Consumer and Business Services, weighed in – discussing the current state of reform, and looking ahead to the short legislative session that begins next week, as well as 2019 and beyond.
“My theme for the day would be, hope for the best, plan for the worst,” Greenlick said.
“This is a very important inflection point in the healthcare system. We made progress over the 16 years I’ve been in the legislature. The progress has been astounding and we’ve been able to make that progress because we’ve had a very strong partner in the federal government. That partnership is at risk,” he said. “The president at least, and Congress as well, are working hard to tear down 50 years of progress sin the healthcare system.”
Greenlick credited John Kitzhaber, former governor and physician, for launching the state’s transformation – but also noted that Oregon still has a long way to go.
To that end, he is pushing to refer a question to voters this fall, asking if the state should enshrine access to healthcare as a right in Oregon’s constitution. If the electorate says yes, Greenlick said, he expects 2019’s longer legislative session to look into how to make universal care happen – and not necessarily through a single payer plan.
As he looks to the long-term, Greenlick also has his eye focused on smaller goals for the 2018 session that’s about to start. He called for greater transparency for coordinated care organizations – something that was debated but not passed in the 2017 session. He also said legislators expect to look at legislation to look at drug pricing, and they may work to expand the role of ambulatory surgery centers in providing care in this state.
Hayden, whose push to roll-back a healthcare tax expansion through Measure 101 failed earlier this month, spoke next, saying that despite the recent partisanship over that funding effort, healthcare remains a bipartisan issue in Oregon.
“My hope is that, as we go into the 2018 session, we put Measure 101 behind us,” he said. “You guys won.”
He noted that the taxes that were protected when Measure 101 passed will only stay in place for two years, at which point Oregon will be on the hook for a larger share of Medicaid costs, as the federal government cuts its own contribution. When that happens, the state will have a new $1.5 billion budget hole to fill, he said.
Hayden said he hopes that legislators start exploring long-term expanded funding options now, so that they can come up with a new plan for 2019 and beyond – and he noted that a number of potential groups could be taxed in Oregon but are not. “Let’s expand the provider base of those who contribute to healthcare,” he said.
Acknowledging Greenlick’s discussion of ambulatory surgery centers expanding their scope, Hayden said: “I think that’s OK, we need to look at that closely. But if they want to be a bigger participant, maybe they should be looked at as one of the entities that should be paying the provider tax.”
Pat Allen, director of the Oregon Health Authority, spoke next.
“A lot of people have been asking me about the upcoming legislative session. It’s hard to think that 10 days ago we didn’t know the status of Measure 101” he said. “We didn’t know the status of funding for the CHIP program either, he added, referring to the children’s health insurance program that Congress finally reauthorized after a long lapse.
With those immediate funding dilemmas now addressed, Allen said he hopes to focus on long-term, stable funding for the Oregon Health Plan, as well as the evolution of the Oregon Health Plan that has been dubbed CCO 2.0.
In addition to those priorities, which will be shaped by legislation, he said he is working to strengthen the agency he was appointed to lead in September. The Oregon Health Authority was established in 2009, and has been plagued by scandal since shortly after its birth. Founding director Bruce Goldberg resigned after a costly debacle surrounding the state’s failed attempt to develop its own online marketplace. His successor Lynn Saxton was pushed out last year after a memo emerged demonstrating a strategy to smear one of the state’s coordinated care organizations, and audits revealed challenges with properly enrolling Medicaid members.
“I’ve taken to seeing OHA as something akin to a startup,” Allen said. “The agency in more or less a constant state of crisis and change.”
He noted that positive work has come out of the agency, which has added 400,000 people to the Oregon Health Plan since the Affordable Care Act’s implementation, and is spending less than Washington state for comparable work. He also said that reforms at the Oregon State Hospital have been successful.
“Now we’re trying to add that structure and business rigor, so we can stop moving from crisis to crisis,” Allen said. “We’re trying to get the agency to a place where we can focus on system transformation.”
Cameron Smith, who is acting director of Oregon’s Department of Consumer and Business Services, and is likely to be confirmed formally into that job when the Legislature convenes in February, spoke highly of Allen’s work. Allen directed DCBS until he was recruited by Governor Kate Brown to lead the Oregon Health Authority, at which point Smith was named his successor.
“What attracted me to DCBS was an incredible and professional team, well respected,” Smith said, noting that in addition to regulating health insurance plans, the agency also affects business codes and works on overarching consumer protections.
“I do not want to recommend any of you joining a healthcare policy panel in your first month,” Smith joked, as he praised the agency he has inherited but remained quieter than his fellow panelists.
The Oregon Health Forum is a program of The Lund Report that brings leaders and experts in healthcare together to discuss the major issues and events of our time.