Speaking from downtown Portland on April 6th, 2018, the U.S. senator said Medicare and children’s health insurance programs are better off now than a year ago, though Oregon and the U.S. still have many challenges.
By Courtney Sherwood
Despite a political climate in Washington, D.C., that makes compromise challenging at best, critical healthcare programs have been protected and strengthened over the past year, Senator Ron Wyden, D-Ore., told about 150 people who gathered for the Oregon Health Forum’s Friday morning event.
Wyden keynoted the Portland breakfast, at which he outlined his healthcare priorities and explained why is does not support current proposals for national single-payer care. His speech was followed by a panel discussion among four Oregon leaders who discussed the interplay between state and local health policy – and the challenges of improving care while holding down costs.
“We spend more than $10,000 per person – substantially more – on American healthcare”
“You could send every family of four in America a check for more than $40,000 and say ‘here, go buy yourself a healthcare plan,’” for less than the amount the U.S. currently spends on healthcare per person, Wyden said. “We are spending enough money on healthcare. The question is, are we spending it in the right places?”
The senator advocated for a two-pronged approach to tackling health policy challenges: making incremental, politically achievable change now, while working to understand the deeply ingrained systems that limit access and drive up prices so that bigger change can eventually be enacted. He also emphasized the role that states like Oregon can play in improving the system, regardless of federal leadership. And he celebrated two unlikely successes that emerged out of the Republican-controlled Congress in the past year.
“With Donald Trump arriving in Washington and conservatives essentially controlling the whole government, if you could me that we would get the Children’s Health Insurance Program reauthorized for a decade, I would have said you are hallucinating. Will not happen. Can not happen,” Wyden said. “It has happened.”
Furthermore, he said, a change to Medicare that will have a big impact was approved – with little fanfare in a national media landscape more focused on celebrity and sex scandal than wonky policy news. The Chronic Care Act. That legislation, which passed with the support of Utah Republican Orrin Hatch, seeks to shift Medicare’s focus from short-term illness and medical emergencies, toward recognizing the importance of chronic conditions in caring for seniors.
“I said, ‘I’m going to get serious about turning Medicare, this huge ship which dominates the federal budget, from being just an acute care program to being a program that zeros in on chronic illness.’” Wyden said. “Orrin Hatch worked with me, and it is now law today.”
Wyden also noted that his victories came at a time the Affordable Care Act has been under prolonged attack. While efforts to repeal the law have been defeated so far, the White House has used administrative policy to undermine it – and more repeal attempts are likely.
“Nothing is ever final. We have Graham-Cassidy coming, which is basically the repeal of the Affordable Care Act on steroids,” Wyden said. “I’m telling you that’s a prescription for trouble for Oregon”
During a question-and-answer period with the audience, Health Care for All Oregon’s Lee Mercer noted that the state’s other senator, Democrat Jeff Merkley, has said he backs a “Medicare for all” style approach to single payer care, as have several of the state’s representatives in the House. Mercer challenged Wyden to join his colleagues in endorsing universal care.
Wyden pushed back, saying that he will not endorse a vague concept – he wants specifics first. For years, Republicans vowed to repeal and replace the Affordable Care Act, but when they took control of the executive and legislative branches, those vague promises fell apart.
“When their dog caught the car they did not know how to do it. I want you to know I’m not going to let that happen to our side,” Wyden said.
After the senator completed his presentation, Oregon Public Broadcasting reporter Kristian Foden-Vencil moderated a panel discussion in which Oregon leaders responded to and expounded on Wyden’s remarks.
Panelist Zeke Smith, chairman of the Oregon Health Policy Board and chief impact officer for United Way of the Columbia-Willamette, said he likes how Wyden approaches his work in Washington, D.C. “I took from it a bit of a reminder for us in Oregon as well that we have a responsibility to work offensively and defensively as we work on health transformation.”
Dr. Glenn Rodriguez, CareOregon board member and a member of state Rep. Mitch Greenlick’s Universal Care Work Group, noted that administrative costs associated with medical billing and insurance put a big burden on providers, and drive up medical expenses. He cited a study from Wisconsin that found doctors working an 11.5 hour day might spend five-and-a-half hours on data entry in the computer, and four hours in contact with patients.
“Even before we look at single payer we have to talk about single payment,” Rodriguez said. “If we can get to a single payment methodology, we could simplify ground-level work for clinicians.”
OSPIRG policy director Jesse O’Brien backed that idea, or something similar, noting that Oregon is looking into what a state rate-setting commission for hospitals would look like. “But we would need a Trump administration waiver,” he said, noting that he is not sure the president would be open to such a thing.
“I feel like I should just trash my prepared comments and say, ‘What they said,’” said the final panelist to speak on Friday morning, Nora Leibowitz, principal at Health Management Associates.
She then emphasized the role of Medicaid waivers in Oregon’s customization of the Affordable Care Act, and suggested that more local action will be the key to making progress sin 2018.
“I feel really hopeful that the next round of CCO innovation … is going to do a good job of thinking holistically about healthcare and interaction with housing and social determinants of health,” Leibowitz said.