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As Budget Battle Looms, Legislators Discuss Session’s Leading Health Bills

Republicans and Democrats from the Oregon Legislature gathered Tuesday at the Oregon Health Forum’s Salem breakfast event.
April 26, 2017

Legislators from both houses and both sides of the political aisle shared their aspirations and expectations for the current session at an Oregon Health Forum breakfast event on Tuesday morning.

The event, moderated by Rep. Bill Post, a Republican from Keizer, featured the views of politicians who hold key health related positions: Rep. Rob Nosse (D-Portland), Sen. Jeff Kruse (R-Roseburg), Rep. Bill Kennemer (R-Oregon City), Rep. Cedric Hayden (R-Roseburg), Rep. Knute Buehler (R-Bend) and Rep. Mitch Greenlick (D-Portland).

Some highlights from the two-hour panel discussion follow.

Balancing the Budget

“The budget looms over just about everything. How are we going to pay for the Oregon Health Plan?” Nosse asked early in the conversation. “Are we going to have an increase in the provider tax, the hospital tax? Will we tack on a premium for insurance plans? Will we raise taxes overall?”

He noted that some legislators are advocating for a business tax – not the same as the one defeated in Measure 97 failed, but perhaps a gross receipts tax.

Kruse criticized the conversations that have happened for years surrounding Oregon’s budgets.

“We assume on the front end that everything government does is wonderful and appropriate. Everything. We just roll up the costs of all those programs,” he said. “That’s how we come up with a budget that ways we have a deficit of $1.6 billion, even though we have an extra $1.4 billion to spend. If you add those two together, we have a 14 percent increase in the cost of state government.”

He noted that hospitals are paying an estimated $600 million extra this biennium through provider taxes. A Republican-backed government hiring freeze could cut $750 million in spending.

“We’re looking at saving the Medicaid program. I think we can do it without a tax increase,” Kruse said.

Fellow Republican Buehler echoed the sentiment.

“The profound lack of leadership and mismanagement of our state’s fiscal condition is astounding to me,” Buehler said. “Affordable Care Act, we all knew that the expansion was going to put us in this situation. … Everyone knew that was coming. We set th state in a really risky fiscal condition, and we did nothing.”

While Republicans argued against higher taxes, Nosse put forth a different view.

“We have among the lowest overall business tax burden in the country. Part of that is because we don’t’ have sales tax,” he said – noting that in other states, businesses pay taxes on pens, paper, all of which adds up.

Advocating for higher taxes prompted a flurry of rebuttals.

Kruse argued that Oregon’s corporate tax rate is middle of the pack, and that the state’s public pensions are often too high to be justified.

And Hayden expressed concern that some ideas for filling the state’s $575 million Medicaid funding gap could ultimately cost consumers.

“I want to insure folks who are concerned about an insurance premium, especially small businesses that are doing the right thing and providing health insurance,” Hayden said. “We want to balance the Medicaid budget within the major players that benefit – the hospitals, the CCOs – that benefit from this system”

Limiting Prescription Drug Prices

House Bill 2397, which aims to rein in price hikes by the pharmaceutical company, also garnered discussion on Tuesday.

Nosse, who backs the bill, noted that it would not only save consumers – it could also save the state money, because of savings to publicly funded insurance plans.

But Kennemer voiced concern held by many Republicans, that efforts to restrain egregious price hikes that have been seen in recent years, could have unintended consequences. He argue that the bill takes the wrong approach.

“Prescription meds in the United States run somewhere between 7 and 18 percent of the cost of healthcare,” he said. “It’s pretty hard to balance 100 percent of the problems with health care spending on the heads of medication – and that’s where we have a real problem”

CCO reform

Greenlick used his time in the spotlight to advocate for passage of House Bill 2122, which would force coordinated care organizations to open their meetings to the public, and would limit their profits. After Tuesday’s breakfast, the bill experienced a setback when it was bounced from the House floor to be reviewed by the Rules Committee.

“It’s a bill that creates an environment so that the preservation of the Oregon Health Plan can go forward in a sane and rational way,” Greenlick said.

“I’m hoping to get to some rational relationship between CCOs and the citizens of the state” he continued. “Do we want to give these 16 organizations $60 billion dollars over the next five years to spend behind closed doors?”

Other issues

Several attendees at the breakfast asked legislators to speak about the push for single-payer healthcare, in part in response to the release of a study commissioned on the topic.

Nosse seemed favorable to the idea, in theory – but also to see implementing single payer care as a low priority given the hurdles that exist.

“The things we would have to do to implement that, in terms of how we deliver our hospital system,” he said – noting that limiting spending on public employee health plans, lowering prescription drug costs, and other major efforts this year would all be easier with single payer.

“But when you have a system that was built in the 1940s around employment, trying to upend that is really hard,” Nosse said. “I don’t know”

Hayden contended that, while switching to single payer coverage would give more people access to care, the care available would be worse.

On another topic, Buehler said he would like to continue his previous efforts to expand access to contraception. The Republican physician backed the legislation that made birth control pills more widely available without prescription last session.

A lobbyist for Planned Parenthood pushed for legislators to increase access to abortion, not just contraception.

”I’m not doing anything to work on access to abortion,” Buehler responded. “I think we should work upstream on contraception. Abortion should be rare and legal.” Wants to increase education and make contraception easily to access over the counter

And Hayden said health officials need to pay closer attention to government-funded efforts to address mental health in Oregon.

“We have a disconnect between CCOs, county public health, county public safety and the state hospital,” he said. “What I mean by disconnect is, there are not funds that are attacked to a client that goes through that process.”

The Oregon Health Forum's next breakfast event will tackle that topic, asking whether CCOs and counties are on a collision course and looking into who should be responsible for delivering care. Tickets are on sale now.

Reach Courtney Sherwood at [email protected].