Transformation Bill Deal-Making Comes Down to the Wire

Collective bargaining for home health workers is a key sticking point
The Lund Report

June 17, 2011 -- In the final weeks of the Oregon legislative session, negotiations on a monumental bill to transform the Oregon Health Plan have largely taken place behind closed doors.

House Bill 3650 was moved to the Joint Ways and Means Committee two weeks ago before all the amendments had been ironed out. Rep. Tim Freeman (R-Roseburg) said lawmakers were still working on three aspects of the bill in recent weeks.

The bill aims to consolidate the roughly 40 managed care organizations that currently administer the Oregon Health Plan into regional organizations that can more effectivity manage chronic conditions and deliver preventive care. Those efforts are estimated to save roughly $700 million in total funds –  $240 million in general fund dollars – by the end of the next biennium.  

Reportedly still holding up the legislation is a controversial aspect related to collective bargaining for home health workers, which are expected to play an important role in the newly revamped Medicaid program.

The Service Employees International Union has lobbied strongly for language in the bill that would allow the union to organize home health workers as a single unit, while Republicans have argued strongly that it should be removed. A compromise reportedly would give those workers the option, but not require collective bargaining.

As the bill now awaits approval from a subcommittee of the Joint Ways and Means Committee, sources say this union issue could be the last piece that needs agreement.

The issues recently finalized include a section related to Indian Health Services in order to allow tribal health center to participate in newly formed regional coordinated care organizations, but not make that a requirement.

“The intent is to hold them harmless,” Freeman said. “We wanted to make sure we weren’t somehow disenfranchising them or make sure we weren’t over emphasizing their need to be involved.”

Lawmakers also solidified an aspect of the bill related to the governance of the new coordinated care organizations.

“The majority of the board has to be the ones who are at financial risk, along with a strong voice for consumers on that board,” said Sen. Alan Bates (D-Ashland).

One piece of the bill that would have instituted a drug formulary for mental health drugs under the state Medicaid program was eliminated. That provision was estimated to save around $7 million, while others thought it could increase costs due to unexpected hospitalizations possibly from drug interactions.

“Broadly speaking the bill will do what we want it to,” Bates said. “At a certain point you have to say the basis of the bill is there. Most of this doesn’t take place until February. We can tweak it then.”

The massive piece of legislation is still facing strong criticism that the estimated savings will not be realized next biennium.

Freeman said he doesn’t view this as savings. “There will be less money to provide the services, but this transformation bill will allow those people in the community who provide those services to manage those cuts better and coordinate their efforts,” Freeman said. “The intent is to better coordinate care with less money.”

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Comments

How Senator Bates connects a CCO board stacked with corporate shareholders to "a strong voice for consumers" is beyond my feeble ken. But then, I don't believe that the senator has many private conversations with people like me. Tim Baxter

Was there for original group of HCWs and did that as management. Grandpa was a shop steward. But.. I would counsel any potential coordinated care organization to run like he**. It's very hard to make this arrangement work, either practically or financially.

Things are remarkably quiet at the Lund report. Doing any reporting on HB 3650 and health care reform in Oregon? or are you waiting until Sine Die to learn what happened?

Hey there, we are very much doing reporting on HB 3650 and health reform, as sources speak to us. Keep looking for updates, Amanda Waldroupe The Lund Report