Buehler Calls for Bipartisanship, Backs Partisan Referendum

A referendum from a group of Oregon House Republicans to repeal the tax funding package for Medicaid has given Rep. Knute Buehler an opening to debate the governing Democrats on healthcare, but it has infuriated the healthcare industry that relies on that funding to do business.

Rep. Knute Buehler opened a conference of healthcare executives this week with a call for a return to Oregon’s tradition of bipartisanship that created the Oregon Health Plan and the coordinated care system for Medicaid, but mounting conflict over a partisan ballot referendum undermined the message from the leading Republican candidate for governor.

“The single-biggest threat is partisanship,” said Buehler, a state representative from Bend. “I think you all feel it. I feel it.”

Buehler said that it was legislative Republicans who worked with Democratic governors in the 1990s to stand up the Oregon Health Plan. In 2012, the two parties came together again to improve healthcare delivery for Medicaid with coordinated care organizations, which are paid in a lump-sum fashion to manage population health rather than getting paid per treatment when Medicaid members get sick.

While national Republicans pander to a Bible Belt-base and work aggressively to cut off women’s access to birth control, Buehler has worked just as assertively in the other direction, trying to move his party out of the political wilderness in secular, socially liberal Oregon by eliminating barriers to contraception. “We made birth control functionally over-the-counter,” he said, referencing legislation that allows most women to receive it after filling out a form with the pharmacist, skipping a doctor’s visit.

Buehler also admonished national Republicans for their attempts to scrap Obamacare without crafting a suitable replacement. “It needs to be repaired and reformed,” he told healthcare executives at the State of Reform conference in Portland on Wednesday. “The good part was the Medicaid expansion. The problem area was the individual market, which had no cost controls. We’re pricing people out of the market.”

But in the local healthcare arena, Buehler’s attempt to lay blame at the Democrats is contradicted by members of his own party who backed the tax package that Buehler dismisses as partisan treachery.

“Governor Brown and a few powerful politicians have made a choice -- partisanship instead of a lasting durable solution,” Buehler said. “We offered an alternative plan that would’ve covered everyone as opposed to a new sales tax on healthcare.”

A bipartisan group of legislators, including Sen. Jackie Winters, R-Salem, and Senate Minority Leader Ted Ferrioli, R-John Day, approved the negotiated package. Unhappy with its success, Buehler has backed a referendum from Rep. Julie Parrish, R-West Linn, that would repeal most of those taxes and force legislators to go back to the drawing board in February.

The referendum comes despite the support of most of the state’s healthcare industry, including the sectors most affected, for the series of provider taxes.

By parting with his Senate Republican peers, the referendum provides Buehler with a clear opening to play to his strengths as a physician and battle Gov. Kate Brown on health policy, even if it throws the funding for Medicaid and a reinsurance program into chaos, a problem Buehler and House Republicans say they’ll partially fix in February, assuming voters kill the funding.

The signatures for the referendum have not been certified, but last week Parrish turned in about 84,000 signatures, about 1.5 times as many as needed to force an election in January.

Parrish and Buehler argue the funding difference can be made up with cigarette taxes and smaller provider taxes, although the Legislative Fiscal Office has not yet scored their alternatives. Their package also never covered the reinsurance plan -- meaning people in the individual market would likely see a 6 percent increase in their rates if the Republicans are successful.

If repealed, employer-supported insurance would go down just $5 a month while individual insurance would increase an average of $25 a month.

Buehler told The Lund Report that the state could not continue to throw good money after bad in the individual market, which cannot be fixed until the delivery reforms put in place in the Medicaid system are shifted over to the private insurance market.

Sen. Elizabeth Steiner Hayward, D-Beaverton, has shepherded a series of low-profile bills to address those reforms, but that kind of change cannot happen overnight; in the meantime, without reinsurance and market stabilization, carriers will continue to pull out of the market, and rural parts of the state could soon have no one willing to insure them.

About 250,000 people depend on the individual market for insurance coverage, any number of whom would lose insurance if the market is allowed to fail.

The gambit from Parrish and Buehler may have encouraged the Coalition for a Healthy Oregon to throw their support behind Brown, who received $60,000 this year from COHO and other doctors’ groups that focus on the delivery of Medicaid. One of those groups, Salem-based Doctors for Healthy Communities, had generously supported Republican Dr. Bud Pierce in last year’s governor race.

At a later conference discussion, Phil Greenhill, the president of the Coalition for a Healthy Oregon, attacked the ballot referendum, spilling the tension into the open between the Buehler GOP faction and the healthcare industry.

“We’re going to see untold harm. This will be devastating to the system,” said Greenhill, as he stood in the audience and addressed Rep. Cedric Hayden, R-Cottage Grove, another advocate for the provider tax repeal. Greenhill said the referendum puts at risk $1 billion in federal money. Collection of state revenues to match those federal dollars has been put on hold until February, pending the Jan. 23 election.

“We’re gonna join with a group of people with an organized voice to support [the tax package],” Greenhill later told The Lund Report. The industry is likely to spend well more than $1 million persuading voters to give a yes to the funding package.

Reach Chris Gray at chris@thelundreport.org.


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