When it comes to health care, gubernatorial candidate Knute Buehler is not your average Republican lawmaker.
The Bend representative works as an orthopedic surgeon at The Center for Orthopedic and Neurosurgical Care and Research and previously served on the boards of the Ford Family Foundation and St. Charles Health System.
He’s pro-choice. He opposed President Trump’s proposal to ban taxpayer-funded clinics from referring women for abortions. He called congressional Republicans’ attempt to replace the Affordable Care Act a “bad plan for Oregon” since it would “blow a bigger hole” in the state budget and decrease coverage for opioid addiction treatment.
His challenger, Democratic Gov. Kate Brown is also pro-choice. She’s repeatedly opposed the Trump administration’s effort to undercut the Affordable Care Act. Her staff played a key role in a hospital tax approved by voters that will help fund Medicaid. She declared substance abuse and addiction a public health crisis.
Both Brown and Buehler are also both gearing up for implementing the next iteration of Oregon’s state Medicaid program, known as CCO 2.0.
Brown and Buehler have struggled to differentiate their health care platforms in a year when the federal government continues to undercut health coverage. Instead, the gubernatorial candidates, and their fellow party members, have criticized each other’s health records.
Shakeup At OHA
Three months after announcing his candidacy last August, Buehler sent Brown a sharply worded letter criticizing her leadership after the Oregon Health Authority misspent federal Medicaid money.
Brown told the Oregonian/OregonLive that she didn’t know that the state agency overpaid more than $74 million to coordinated care organizations for people ineligible for Medicaid, which may have included people who were dead.
“At a time when gubernatorial leadership is needed most to address these problems, your approach has been to ignore, avoid or deflect responsibility,” he wrote in the letter published by The Oregonian/OregonLive.
He called on Brown to hire an independent counsel to investigate the Medicaid overpayments and to require all the overpaid Medicaid providers to repay Oregon taxpayers through the state. He also urged Brown to make public all emails and communications related to the Medicaid misspending between her office, state agencies and providers.
Buehler pledged to introduce legislation that would require the providers to return the inappropriately spent money in full.
Brown originally did not call for repayment of $64 million of the $74 million that were misspent from 2014 to 2016, The Oregonian/OregonLive reported. But after Buehler’s letter, the governor reversed her position and directed the new Oregon Health Authority director, Patrick Allen, to collect repayment from the coordinated care providers.
Brown told Allen “to immediately evaluate OHA’s leadership team based on their ability to fulfill the agency’s critical mission responsibly and make personnel changes as you see fit.”
Brown’s campaign spokesman Christian Gaston told The Lund Report that the governor held OHA accountable as soon as she learned about the problem.
“Voters know they can trust Gov. Kate Brown to do what she says she's going to do and protect the Oregon that we love,” Gaston wrote in an email.
However, Rep. Rich Vial, R-Scholls, told The Lund Report that the incident is “indicative of a more pervasive problem that we have currently in state government.”
He said that many of the health officials at the agency during the overspending incident were not hired based on merit, but rather on relationships. Brown should have managed that better, he said.
Vial said that he respects Brown as his governor, but he criticized her and House Democrats asking voters to approve a constitutional amendment declaring healthcare a right “without doing the hard work to determine … what the consequences would be for us as a community.”
Legislators should first determine how the state will pay for expanded health care, he said.
“The reason I am supporting Knute as vociferously as I am is I sincerely believe he has demonstrated a much higher capacity to perform those leadership and management tasks than my friend Kate Brown,” Vial said. “I do not agree with the approach that she has taken to managing the state and healthcare.”
Rep. Andrea Salinas, D-Lake Oswego, defended Brown’s response to the Medicaid spending incident, which she said was “an administrative issue.”
“She’s putting in place a really good administrator now, and she realizes we need to look at the funding stream long term,” Salinas told The Lund Report.
Brown hired Allen to head the agency last year after asking former director Lynne Saxton to step down in August 2017.
Reproductive Health
Salinas questioned Buehler’s pro-choice platform after he voted against the Reproductive Health Equity Act. The law requires Oregon insurance companies to cover reproductive health care with no cost sharing, including for undocumented women. It also mandates Oregon insurance companies to cover abortions with no out-of-pocket costs and bans the denial of services based on race, gender identity, nationality or sexual preferences.
“It falls flat when I hear him say that he is pro-choice,” Salinas said. “I think what he means is he is pro-choice for those who can afford it.”
Buehler’s campaign noted that he voted for two Oregon Health Authority budgets that included public funding for abortion. He also opposed the ballot measure that would ban public funding for abortion.
He pushed for and voted “yes” on legislation that allowed women to get on-demand pharmacy prescriptions for birth control and voted “yes” on requiring insurers to cover 12 months’ worth of refills for all contraceptives.
“The commercials I’m seeing on TV against Knute on … women’s reproductive (rights) make me bristle,” Vial said. “They do not reflect what a thoughtful, effective legislator like Knute Buehler goes through when we deal with the complexities and nuances of bills that have such overlapping impacts on the other policy decisions…That oversimplification is just wrong.”
Covering Shortfalls
Though Buehler does not oppose abortion, he did oppose the hospital tax that voters approved in January. The approval marked a major health care victory for Brown, whose staff played a key role in the negotiations.
The deal will raise $210 million to $320 million in taxes on Oregon’s largest hospitals and many health insurance policies by 2019. It will also help cover an $882 million shortfall in the Oregon Health Authority budget that Democrats said would have caused 350,000 low-income Oregonians on Medicaid to lose their health insurance.
Large Oregon hospitals now pay a 0.7 percent tax and insurance companies pay a 1.5 percent tax on most policies.
Buehler opposed the tax on insurance policies, saying insurers would increase premiums, hurting college students, K-12 schools and small businesses.
He and other House Republicans proposed increasing existing hospital fees and raising tobacco taxes to cover Oregon Medicaid for a year. The alternative plan also called on Oregon health care managers to fix glitches in the Medicaid enrollment system and to ensure that Medicaid dollars are spent only on qualified enrollees.
Expanding Coverage, Limiting Costs
Brown’s campaign website touts the expanded health coverage that’s occurred in Oregon over the last few years. Coverage has been expanded to 94 percent of adults and 100 percent of children, it says. A state report this month showed that more than 6 percent of Oregon residents did not have health insurance in 2017.
Last year, Brown signed into law a rule that expanded medical coverage to all children within families at or below 300 percent of the federal poverty level, regardless of their immigration status.
Buehler voted against it.
Brown also has advocated for health coverage for people with pre-existing conditions, who were at risk of losing their coverage under the Trump administration’s proposed replacement for the Affordable Care Act.
“It’s up to the states to fill the void of leadership on this issue,” Brown said at a recent press conference. “We absolutely must fight to ensure these critical protections remain intact across the United States.”
Advocates for improving substance abuse and addiction services have also lauded Brown’s efforts over the last year after years of inaction. The governor declared substance abuse a public health crisis and set deadlines for implementing the statewide plan for preventing and treating addiction.
She also signed a prescription drug transparency act that requires drug companies to file annual reports justifying price increases for drugs that cost at least $100 per month and disclosing the costs, revenue and profit associated with producing the drug.
Buehler also ranked keeping drug prices down among his top six priorities.
He pledged to drive down drug prices by prosecuting “leaders of price-gouging pharmaceutical companies”, improve Oregon’s rate of child wellness checkups and cut the number of opioid-related deaths in half.
He said he plans to “order” the Oregon Health Authority’s Public Employees’ Benefit Board to enter lower-cost contracts with hospitals and clinics to reduce drug and health care costs.
Future Promises
Brown’s 2018 campaign website lists three main health care priorities. They include keeping kids and seniors healthy, talking the opioid addiction crisis and protecting access to reproductive health.
She also wants increase immunizations, strengthen clean drinking water protections, increase diversity and retention in Oregon’s health care workforce and improve health by creating “good jobs.” She plans to keep insurance rates down in the private market by using Oregon's reinsurance program.
Buehler announced his promises for health care reform in July.
Among his six major talking points, he pledged to protect Medicaid funding from federal cuts, improve access to mental health care and protect women’s rights for reproductive health care.
He vowed to improve access to mental health care services, to cut opioid abuse-related deaths in half.
He also promised to maintain Oregon’s status as a pro-choice state, decrease unintended pregnancies by 25 percent by 2023 and to improve Oregon Medicaid’s child wellness checkups. The state Medicaid program is currently ranked 46th for childhood wellness checkups and 42nd for child dental checkups, his website said. Buehler aims to raise the state’s rating to the top five.
“Health care is a fundamental need, not a luxury,” Buehler’s campaign website said.
