SALEM – A legislative session marked by partisan tension is entering its final weeks with plenty of unfinished business on the health care front.
Bills to fund the state's Medicaid program, expand access to the uninsured and tame rising prescription drug costs remain in limbo, days after Senate Republicans returned to the capitol and ended a weeklong walkout over Democrats' $2 billion education funding push.
Getting Republicans back to the table cost Democrats a mandatory vaccination bill for school-aged children. And Republicans are using other tactics to slow the legislative process to a crawl, requiring clerks in both chambers to read the texts of bills in full instead of brief summaries.
The result is a slew of major legislation still awaiting committee hearings with a June 30 deadline to end the session looming.
Many Democrats in the majority call the biggest still-unmet goal the passage of Gov. Kate Brown's $350 million package of cigarette tax hikes to help fund the Oregon Health Plan.
There are also other health care bills attempting to wind toward Brown's desk. Many of them are awaiting hearings or votes in the House Committee on Revenue or Joint Committee on Ways and Means, where all bills that employ taxing or spending powers go before reaching the House and Senate floor.
No one knows when any of them will move through the committees to a full floor vote. Privately, lawmakers said that some worthwhile bills could die because the Legislature runs out of time.
Following are some of the health care bills more than a dozen House and Senate lawmakers, mostly speaking off the record to candidly discuss ongoing deliberations, say must pass this session in order for them to be able to tell constituents they delivered on promises to improve Oregon's health care system.
Tobacco Taxes (House Bills 2123, 2158, 2159, 2169 And 2270)
Brown began the legislative session vowing to fill Oregon's nearly $1 billion Medicaid funding gap with a series of taxes on hospitals, insurance premiums, large employers – and a $2 per pack hike on cigarettes, as well as a new e-cigarette tax.
The cigarette taxes would raise an estimated $350 million per biennium to fund health care for low-income residents on the Oregon Health Plan – covering more than a third of the total Medicaid funding gap.
The bill "not only provides the funding we need to continue to provide health care coverage to Oregonians," Brown told lawmakers last month. "It invests in intervention and cessation to improve the health of our communities."
There has been no movement on the bill since it received a public hearing in the House Committee on Revenue a month ago, where medical officials praising the taxes faced pushback from tobacco industry officials and cigar shop and convenience store representatives. No committee vote has been scheduled on the taxes.
In public statements earlier this month following the behind-the-scenes death of another Medicaid funding bill Brown called the tobacco tax revenue critical to maintaining Oregon Health Plan benefits.
"Without the tobacco money, it's going to take a massive infusion from the general fund to just maintain (health) coverage," a Senate Democrat told The Lund Report. "I don't see much appetite for that while we're trying to fund schools and pass the carbon (cap-and-trade) bill."
There appears to be a bipartisan consensus about the tobacco taxes, with lawmakers considering them too important to Brown's plan for them to stall this session.
"I expect it to get out of committee at some point, with it being a major priority of the governor and the employer tax dead," a House Republican told The Lund Report. "But I also expect it will get referred to voters."
Medicaid Buy-In (House Bill 2012)
With Democrats enjoying supermajorities in both chambers, lawmakers are debating several broad study bills to reform Oregon's health care system beyond the Affordable Care Act.
Most are moving forward along party lines.
A bill by Rep. Mitch Greenlick, D-Portland, to study long-term changes to Oregon's health care delivery system passed the House with all Democrats in favor, but just three Republican votes. It passed out of the Senate Committee on Health Care this week on party lines.
A bill establishing a Universal Health Care Commission to study a government-managed health care program in Oregon also passed on party lines out of the Senate health care committee. It is awaiting a hearing in the Joint Committee on Ways and Means.
But a bill proposed by Rep. Andrea Salinas, D-Lake Oswego, has gained broader support. Her Medicaid buy-in bill would allow lower-income Oregonians making too little to qualify for the Oregon Health Plan or for federal premium subsidies through the Affordable Care Act to receive care through their regional coordinated care organization. It passed unanimously out of the House Committee on Health Care last month and is awaiting a ways and means committee hearing.
Salinas, who chairs the House health care committee, has called the bill a sensible path to chipping away at the pool of Oregonians still without health insurance post-Affordable Care Act, about 6 percent of the population. Most of them are employed in low-wage jobs that put them just above the Medicaid eligibility line.
"I feel like there's a need for offering workers for employers who don’t offer the health insurance they should be, maybe giving them another option within the Medicaid buy-in," Salinas recently told The Lund Report.
Passage of House Bill 2012 would make Oregon just the second state in the country allowing residents above the Medicaid eligibility cutoff line to buy into public coverage, joining Washington state. Five other states are considering similar legislation this year.
"This is something we can pass with real bipartisan support and be able to say, 'We did something big this session, we took some concrete steps to close that (6 percent) coverage gap,'" a House Democrat told The Lund Report.
Prescription Drug Bills
Democrats hope to use their majorities to rein in one of the largest sources of runaway health care spending: prescription drug costs.
Several bills sponsored by leading Democrats seek to negotiate lower drug purchasing prices through collaborations with other states and countries, or develop new drug importation programs.
Several House and Senate Democrats pointed to House Bills 2679 and 2680, authorizing the Oregon Health Authority to pursue cooperative drug purchasing agreements with California and Canada, respectively, as priority bills.
A separate bill, House Bill 2689, would require the health authority to design a state-run program to buy drugs that are expensive in the United State from wholesalers who purchase them in Canada.
The California bill would replicate parts of an existing agreement Oregon has with Washington state through their Northwest Prescription Drug Program, a consortium that budget analysts say resulted in $800 million in combined savings for the two states last year.
"I think there's intense interest in getting them all through," a House Democrat told The Lund Report. "I know a lot of my colleagues across the aisle are worried about the feasibility of working with Canada on something that could really break new ground. But I think Oregonians gave (Democrats) a supermajority in part to push for big changes, especially to health care, and this is way to do it."
All three bills are awaiting hearings in the Joint Committee on Ways and Means. In fact, seven of the eight active health care bills that seek to address prescription drug costs await ways and means hearings.
The only bill currently moving is House Bill 2658, which would require prescription drug manufacturers to report planned price increases of most drugs to the state at least 60 days before they take effect. A hearing on the bill is set for next week in the Senate Committee on Health Care.
Financial Transparency Bills
Several bills seek to impose greater financial transparency requirements on hospitals and coordinated care organizations.
Democrats have lined up behind House Bill 3076, an effort led by Salinas that would require Oregon's 58 nonprofit hospitals to spend more on financial assistance programs known as charity care.
The hospitals are fighting back hard against HB 3076, with Republicans joining them in opposition, saying that the bill's spending floors and other requirements would inhibit steps they're taking on their own to increase charitable spending.
The bill passed out of the House Committee on Rules this week and is awaiting a vote on the House floor.
Several Democrats called the bill a crucial step to define how much hospitals are truly spending on their neediest patients who can't afford medically necessary treatment.
"It's a scattered system where you have these big hospital systems and smaller rural providers spread around the state, and they're all defining charity care differently," one Democrat said. "But their patients' needs are basically the same, so there's a need for some uniform standards which I think makes (HB 3076) a must-pass bill."
Other financial transparency bills have come out of the Senate, highlighted by efforts to reform Oregon's coordinated care organizations as they prepare to receive their second round of Medicaid funding.
Senate Bill 1030, proposed by the defunct coordinated care organization FamilyCare, would require care organizations to make publicly available a wide range of budget, third-party contracting and employee compensation documents.
The Oregon Health Authority is backing Senate Bill 1041, meanwhile, which would give the agency greater financial oversight and regulatory powers over care organizations, including the ability to place a struggling organization under state supervision.
Both bills have ideas popular among Democrats. But several House and Senate Democrats say SB 1030 is so broad that it's unlikely to pass, amid opposition from the care organizations and the state's desire for a smooth transition into the second round of five-year Medicaid funding, from 2020 through 2024.
SB 1041, carried by Sen. Laurie Monnes Anderson, D-Gresham, passed 25-4 in the Senate last month and is awaiting a hearing in the House Committee on Health Care. But SB 1030 is stuck in the logjam of bills awaiting a Ways and Means hearing.
"I liked a lot of what's in (SB) 1030 regarding transparency," Monnes Anderson told The Lund Report. But, "I'm not sure how much influence I'm going to have on ways and means."
Have a tip about the health-care industry or legislation? You can reach Elon Glucklich at [email protected].