Health care is front and center as Oregon lawmakers begin the 2021 legislative session on Tuesday in the midst of a raging pandemic, a push for racial justice and unfinished business after health care reform efforts died last year in the GOP-led walkout to kill a carbon tax bill.
The pandemic is certain to dominate the session. Lawmakers will have a COVID-19 committee overseeing policies related to the pandemic and vaccine rollout. To curb the spread of COVID-19 and keep down in-person contact, lawmakers will hold committee hearings and testimony virtually. House and Senate votes will be on the chamber floors, with masks and social distancing protocols for legislators and staffers.
But lawmakers also will tackle issues that were simmering before the pandemic, including access to affordable health care insurance, pay for behavioral health workers and capping prescription drug costs.
Lawmakers spoke on Monday at a forum about what to expect at the session. The virtual event, organized by the Oregon Health Forum, an affiliate of The Lund Report, had more than 350 viewers.
“COVID-19 has stretched our health care system,” said Rep. Rachel Prusak, D-West Linn and Tualatin, a nurse practitioner and chairperson of the House Health Care Committee. Prusak said access to and affordability of health care will be key focus areas.
Prusak and Sen. Deb Patterson, D-Salem and chairperson of the Senate Health Care Committee, said the pandemic has highlighted disparities among demographic groups in the health care system. Racial justice and equity will be a part of health policy work this session, she said. The pandemic has hit communities of color hard, prompting state and national examinations of racial equity.
“There’s still more work to be done to make health care more affordable and accessible to all,” Patterson said.
Rep. Maxine Dexter, a physician and chairperson of the House Subcommittee on COVID-19, said Oregon needs to reach out more to communities of color as it fights the pandemic. There isn’t effective communication about the pandemic to communities that don’t speak English as their primary language, and the vaccine rollout has been largely virtual and difficult for people who lack online access, Dexter said.
The needs of behavioral health workers is another area of concern, said Rep. Rob Nosse, D-Portland, vice chairperson of the House Committee on Behavioral Health. He said Oregon needs to address its low national rankings on the quality of its mental health care. The state needs to attract and keep professionals in mental health care, he said.
“We are significantly challenged to find people to do this work and to compensate them adequately,” Nosse said.
Unknowns remain, even as the Legislature gets to work. For example, lawmakers are waiting for more information about how much federal money the state will get to help tackle COVID-19. President-elect Joe Biden has a COVID-19 relief package of $1.9 trillion, a key priority for his administration which takes over the White House on Wednesday.
In Oregon, Rep. Cedric Hayden, R-Roseburg and a dentist, said the health care landscape has changed in a short time. Health care providers had to hold off on elective procedures to ensure they had enough space for COVID-19 patients, forcing layoffs. The suspension of elective procedures hit the industry hard even as hospital intensive care units in some regions filled up with COVID-19 patients.
Also the pandemic has affected Medicaid. Enrollment in the state now stands at 1.25 million, up over 180,000 since the pandemic began. Providing care to the new enrollees will cost roughly $1 billion a year. The money comes from federal and state funding.
“Health care drives the economy, but the economy also drives health care,” Hayden said.
New Policy Changes
State policies also have changed since the last session. Voters in November passed Measure 110, which changes low-level drug possession criminal charges to $100 citations and puts existing marijuana tax revenue toward addiction recovery centers.
The measure called for the funding shift to start this year. Gov. Kate Brown has proposed delaying the change for a year as the state faces the pandemic. Without a delay, lawmakers will be forced to find other sources of money for programs that currently rely upon marijuana taxes, including state police and education. Under the ballot measure, all marijuana tax revenues after the first $45 million would go to addiction services.
This would force lawmakers to backfill funding losses in other areas. For example, public schools would lose an estimated $73 million.
Lawmakers also will get more money to fund Medicaid. Voters passed Measure 108, which raises the tobacco tax by $2 per pack and puts a new tax in place on e-cigarettes.
The state projects the measure will generate an estimated $331 million for the 2021-2023 biennium. The money will go to Medicaid and programs to stop tobacco use and vaping.
Becky Hultberg, president and chief executive officer of the Oregon Association of Hospitals & Health Systems, said the pandemic has altered the health care area since the last legislative session, which ended in March 2020.
“We might have heard of the virus, but it had yet to impact our lives,” Hultberg said.
She spoke at the Oregon Health Forum event. The Lund Report also interviewed lawmakers and others separately.
Public Option Legislation
Charlie Fisher, state director with Oregon State Public Interest Research Group, said the so-called “public option” legislation and prescription drug bills are two priorities for the consumer advocacy group. The push comes as the cost of premiums on the commercial health insurance marketplace has increased in Oregon by about 70% since 2013.
“We see a public option as a way to increase competition and give consumers more choices when it comes to health insurance,” Fisher said.
Under the public option concept, the state would ensure that people who earn too much to qualify for Medicaid would still be able to buy a Medicaid-type health insurance policy at about the same per-person price that the state pays insurers to cover Medicaid members. That would probably be significantly cheaper than policies available from commercial health insurance providers.
Rep. Andrea Salinas, D-Lake Oswego, is working on public option legislation. In an interview, she said a public option would help people who fall in the middle: They don’t qualify for Medicaid, aren’t old enough to be on Medicare, don’t get quality health coverage through their employer and can’t afford expensive, high-deductible individual policies on the health insurance marketplace.
“The point of it is essentially to address a lack of affordable qualified health plans” for these people, Salinas said.
Prescription Drug Price Reforms
Maribeth Guarino, health care advocate for OSPIRG, said legislation the group backs builds on the 2018 prescription drug price transparency law passed in 2018.
“Transparency really isn’t enough if we want to address costs,” Guarino said. “We have to address costs and the affordability challenges they pose.”
The group wants legislation that would establish a prescription drug affordability board that looks at expensive drugs and sets an upper payment limit on what the state will pay. The details are still in the works, but the limit could apply to Medicaid, other state insurance plans that provide prescription drugs or both.
Another bill would ban a practice called “pay for delay,” which entails the manufacturer of a drug for which the patent has expired paying another manufacturer to not produce a generic version of the drug. The practice can enrich pharmaceutical companies but cut off a consumer’s access to cheaper alternatives.
OSPIRG also backs legislation that would require pharmaceutical sales representatives to file disclosures and undergo ethics training. The bill would shine a light on how pharmaceutical representatives make sales pitches to health care providers.
Problems with prescription drug co-pays will also get a look. Sen. Sara Gelser, D-Corvallis, said one bill would eliminate a hurdle that some people face when charitable organizations help
to directly cover the co-pay costs of prescription drugs.
Some insurance companies have started to say that if the payment comes to them directly from the charitable group instead of from the patient, it doesn't count towards the co-pay. The bill would end that problem.
Health Care Workforce Issues
Labor groups have stepped up with bills to protect workers and patients who rely on the health care and long-term care systems.
The Service Employees International Union Local 503, which represents health care workers, is backing legislation that would require facilities that care for the elderly and people with disabilities to have planning and safeguards to prepare for natural disasters or pandemics. The bill would put state standards in place for how much personal protective equipment a facility needs and require frontline workers to play a role in the development of response plans.
The SEIU also backs a bill that would pay employers an increased Medicaid rate if they gave workers a seat at the table to discuss increased wages, health care benefits and training for employees.
Nurse Staffing Plans
The Oregon Nurses Association wants a change in the state law that would give nurses a voice in contingency staff planning during long-lasting state-decreed emergencies -- like the pandemic. Currently, when an executive order is in place, all nurse staffing plans are suspended at hospitals across the state. The staffing plans are required by state law and are developed by hospital administrators and nurses. The bill would give 90 days for hospitals and nurses to work on a contingency plan for staffing under emergency executive orders. Under the bill, nurses and hospitals would start working on a contingency plan 30 days after the emergency executive order starts and have 60 days to agree upon it. Contingency and staff plans deal with issues like adequate staffing, breaks and working conditions.
When the pandemic started, no one thought it would last a year or more, said Deborah Riddick, director of public policy and government relations for the nurses group. Riddick said nurses would still make sacrifices in a long-term emergency.
“The reality is, whatever the contingency plan is, it will still (provide for) far less” staffing, Riddick said.