In selecting Rep. Rob Nosse to chair the powerful House Committee on Health Care, Speaker Dan Rayfield opted for the veteran hand.
Nosse, a Democrat from southeast Portland, has been making health policy in Oregon since soon after he joined the Legislature in 2014, appointed to fill the vacancy left by Jules Bailey’s departure to run for Portland mayor.
Nosse served early on as vice-chair to the late long-time head of the committee, Mitch Greenlick. Starting in 2019, he has co-chaired the joint budget subcommittee that oversees health and human services funding. And in 2022, he chaired the House Behavioral Health Care Committee.
Now, he takes over as chair of Health Care —considered the busiest of panels in the Capitol — at a time when the committee, and the Legislature, face a level of turnover that is unprecedented in recent memory. Only one committee member from the 2022 short session, Rep. Maxine Dexter, D-Portland, will return to the House in 2023. The others are either not running for re-election or running for other seats in the state Senate or Congress.
If anything, the committee will only grow in importance. Rayfield is considering merging the Behavioral Health Committee that Nosse had chaired into the health care committee for the 2023 session. House leadership had set up a stand-alone committee for behavioral health in 2020, as lawmakers sought a way to devote more resources and attention to a system widely recognized as fragmented, underfunded and dysfunctional.
In short, Nosse’s new job is a big one. And insiders say that with his years of experience and affable style, he was a natural pick.
“He’s someone who brings people together to find solutions and he’s got a lot of experience, which we really need right now,” said Dan Cushing, vice president of health policy for Pac/West Lobby Group in Oregon.
Nosse: Affordability A ‘North Star’
In a typical session, the committee hears dozens of bills about the Oregon Health Plan, coordinated care organizations, pharmaceutical costs, hospital regulation and the health care workforce.
Nosse wants the committee to stay focused on how to cover more Oregonians with health plans that are affordable, the lawmaker recently told The Lund Report.
“That will still be a front and center North Star for me,” Nosse said. “Now how are we going to do that? You know, I don't know yet, to be totally honest.”
Nosse cited the complex issues ahead, such as the state’s redetermination process that will determine who is eligible to remain on the Medicaid-funded Oregon Health Plan. During the pandemic, the federal government kept people enrolled in Medicaid plans even if their incomes meant they were no longer eligible, causing the state’s rolls to grow to about 1.4 million people. With that rule expiring, about 300,000 people are expected to be discharged from coverage, and the state is trying to limit the impact for those people..
Affordability is not a new focus for Nosse. Greenlick deputized him to spearhead a high-profile work group to bring down the cost of prescription drugs.
There, Nosse led meetings for more than a year, hearing from different interests. He demonstrated an ability to work with people to sort through disagreements on complicated health issues. In 2018, he shepherded House Bill 4005, which started new prescription drug price reporting requirements for consumers through the Prescription Drug Transparency Act. It led to the state’s new Prescription Drug Affordability Board that began meeting earlier this year.
Known For Pragmatic Style
Nosse’s background as vice-chair of a budget subcommittee will be an asset as Oregon navigates the complicated health care landscape and tackles legislation with a big price tag. For example, task forces are considering a so-called “bridge plan” to cover people who make too much to qualify for the Oregon Health Plan, as well as whether to have universal health care.
He’ll scrutinize the budget implications of any measure without losing sight of the wider goal of bringing voices to the table – and negotiating, industry insiders and health care advocates say.
His predecessor as chair, Rep. Rachel Prusak D-Tualatin, isn’t running for reelection in November. A nurse practitioner who joined the Legislature in 2019, she was not averse to at times taking aggressive public stances, as when she joined with four other Democratic lawmakers in a letter in January to aggressively push the Oregon Health Authority to require hospitals employ additional patient care safeguards during the pandemic.
Nosse, for his part, has shown a tendency to push people in private, working closely with people in the health care industry. For example, he meets regularly with coordinated care organizations, a practice he says is necessary to stay on top of issues. And he sometimes will take the concerns he hears from them, such as complaints of regulatory overreach, to the Oregon Health Authority for feedback.
“I have regular meetings with hospitals; I have regular meetings with healthcare workers and their unions,” Nosse said. “I have regular meetings with all different kinds of providers and insurance plans. It's just part of the job.”
In addition to hearing from officials, Nosse likes holding small informational discussions just to hear from workers about problems and potential solutions.
A former union presentative for the Oregon Nurses Association, Nosse has shown a desire to help working-class and frontline health care professionals who keep the system running. Though he’s not a physician or nurse, observers say that drive to hear all voices, including frontline health care workers, will be an asset.
In the 2022 session, he took the lead in sponsoring House Bill 4004, which provided $132 million in grants to help behavioral health providers recruit and retain employees. The money funds recruitment and retention bonuses in an industry that struggles to fill openings and pay a competitive wage.
Nosse said the bill’s impact helps people who struggle: He heard from providers after the grants went out that they had “tears in their eyes.”
Committee May Expand Role
Folding behavioral health back into the larger health care committee would add to the importance of what is already considered one of the House’s most high-stakes committees.
Nothing is decided yet, but Nosse is preparing in case that happens.
“If it gets folded into health care, my strong preference would be that the healthcare committee gets to meet four days a week with that fourth day devoted to behavioral health and mental health because otherwise I think the topic gets lost,” Nosse said.
He’ll know more after the 2022 elections.
House Speaker Dan Rayfield, D-Corvallis, will reevaluate the committee structure for 2023 once the full membership of the House is known, said Danny Moran, a spokesman for Rayfield.
“A major focus of the coming session will be implementing the significant behavioral health system and workforce investments from prior sessions, and the speaker’s staff continues to support workgroups to this effect,” Moran said in an email.
Oregon routinely ranks low in national studies that assess access to behavioral health care. It’s only worsened during the pandemic, when behavioral health providers faced a workforce shortage amid increased demand for services as people faced isolation during lockdowns. It’s forced programs and facilities to shut down across Oregon.
In the 2021 session, lawmakers tried to address the problem, putting more than $1 billion into different incentives and programs to boost the workforce and build more residential facilities.
The Oregon Health Authority came under scrutiny earlier this year as lawmakers and advocates questioned why the new funding wasn’t pushed out sooner.
Kevin Fitts, an advocate for behavioral health, said he fears that merging the behavioral health committee would lead to less focus on the issue. He said behavioral health continues to need attention, given the state’s crisis of fentanyl and other drug addictions, homelessness and the ongoing crisis at Oregon State Hospital.
“Behavioral health is very important,” Fitts said. “People are dying. My worry that folding behavioral health into health just dilutes the soup of a specific focus.”
That attention is even more important, he added, as the state implements Measure 110, which decriminalized low-level drug possession and provided funds for new addiction treatment and recovery. That work has not been smooth so far.
More Changes Ahead
Prusak, his predecessor, said Nosse will be “fantastic,” given his willingness to listen to everyone and deep engagement in issues.
“Nosse is no stranger to health care policy and will no doubt continue to lead Oregon as we work to cover all people,” she said.
One skill that Nosse – or any chair of the health care committee – needs: the ability to say “no.” That’s due to the volume.
The House Health Care Committee had 184 bills referred to it in the 2021 regular session, the most of any committee. It voted out just 78.
“It’s very hard to share the news with colleagues their bill won’t be heard but it’s the only way to successfully keep Oregon as a state who leads on health care policy and impact the health of Oregonians,” Prusak said.
Though his appointment by Rayfield technically is for the interim, Nosse is expected to continue in the role in 2023, when lawmakers are hoping to resume in-person gatherings.
Nosse said he’s looking forward to in-person meetings of the committee after the pandemic forced legislative proceedings to unfold virtually.
Nosse said nuances can be lost during virtual meetings. He anticipates the committee will have a hybrid format that allows presenters to join virtually — “But I want to be able to look at members of the committee in the eye a little bit – and you can’t do that on a Zoom call,” Nosse said.
Even with the pandemic fading, challenges remain. They include workforce needs in hospitals, behavioral health providers and nursing homes.
Burned out health care workers in the industry have expressed discontent. For example, nurses at three Providence-affiliated hospitals, including Providence St. Vincent Medical Center in Portland, voted earlier this year to authorize a strike if labor negotiations fail. At St. Vincent, nurses then initially rejected a union-negotiated deal. Since then, one of those, Providence Willamette Falls Medical Center in Oregon, has finalized a deal with nurses, while the other two are pending
For Nosse, the strike votes underscore the tensions and strain on the system.
“There’s a lot of dissatisfaction with the hospital system,” Nosse said. “I would never have predicted four years ago that St. Vincent nurses would be voting to go on strike.”
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