Dembrow’s Healthcare Study Imperiled by Lack of Private Funds
The universal healthcare study that the Oregon Legislature authorized in 2013 has run into roadblocks to funding, and if money for the study is not raised soon, a comprehensive analysis may be impossible before the 2015 session.
Sen. Michael Dembrow, D-Portland, told The Lund Report after a town hall meeting Monday that the study would need nine months to complete. With the next session just 11 months away, researchers would need to begin in May but fundraisers are nowhere close to their goal of $200,000 to $600,000.
Dembrow’s study, laid out in House Bill 3260, relies on private money organized through the Northwest Health Foundation on behalf of the Oregon Health Authority, which will then contract for the research.
“I promised legislators that we wouldn’t ask for [public] money till we found a good deal of private money,” said Dembrow, conceding that hasn’t happened.
Dr. Sam Metz, who is leading the fundraising effort, told The Lund Report that less than $20,000 had been raised, although he remained optimistic: “I’ve anticipated we will be funded and the study will be under way but not complete in time for the legislative session.”
Metz said a number of people had been willing to pledge the last $10,000, but not the first $10,000, and he hoped for a cascade effect once a certain threshold was reached.
Dembrow said single-payer advocates had hoped to get a 2015 ballot referral, but he now says that timeline was “pretty ambitious.” The state is limited in its ability to adopt a single payer system or another significant alternative to the Affordable Care Act and its insurance exchange before 2017.
“It’s really important that we do this right so I do believe in the importance of the study,” said Dembrow. He designed the study so that it would systematically produce the most cost-effective means to provide quality healthcare to all Oregonians. The concept has been championed by single-payer insurance advocates, but the universal healthcare study will consider other alternatives including a public option and publicly financed private insurance, which Metz noted.
Vermont conducted a similar study only to approve a government-managed healthcare financing system that exempted large self-insured companies. While Vermont plans to open up its Medicare-style system in 2017, it is not a true single-payer system since providers will still have to file claims separately to these self-insured health plans.
Monday Town Hall
Dembrow gave his first post-session town hall as a senator Monday with the two representatives in his district, Rep. Barbara Smith Warner and Rep. Alissa Keny-Guyer.
The town hall, at an elementary school gymnasium in outer southeast Portland, drew several dozen constituents, who queried their representatives on topics ranging from single-payer healthcare to campaign finance reform to the wisdom of civic rules promoting bicycling and renewable energy.
“Even if it’s working really well, not everyone is going to get covered,” Cliff Goldman of Health Care for All Oregon, said of the Affordable Care Act.
“We need to be invested in its success,” said Smith Warner, before adding that she did plan to sign on as a sponsor of Dembrow’s next single-payer health insurance bill, likely to come in 2015.
Smith Warner was appointed in late 2013 to replace Dembrow, who was promoted to the Senate to replace Sen. Jackie Dingfelder, who resigned to work full time for Portland Mayor Charlie Hales. Dembrow was on his third term in the House.
The legislators laid out the 2014 successes and setbacks, which as usual included plenty of healthcare legislation, from fixes to Cover Oregon to a new pilot program to coordinate the reuse of durable medical equipment such as wheelchairs.
Keny-Guyer said even though the private study had run into trouble, the Legislature approved $60,000 in state funding to study a basic health plan option. This will help the state decide whether to create an alternative “basic health” plan through the coordinated care organizations for people up to 200 percent of the federal poverty line, including legal immigrants who are barred from receiving free care through the Oregon Health Plan.
Those immigrants may currently buy subsidized insurance on Cover Oregon, but only those whose income is above the poverty line, a key flaw of the Affordable Care Act that leaves many uninsured. Immigrants must reside in the United States legally for five years to qualify for Medicaid.
Radon Bill Stalled
One setback, Dembrow noted, was a failed bill to help eliminate radon in schools. Senate Bill 1511, which would have required testing and mitigation of radon for public schools conducting major renovations, passed out of the Senate Environment and Natural Resources Committee, which Dembrow chairs, but died in the legislative budget committee.
Dembrow told The Lund Report that without a detailed analysis of how many schools would seek upgrades, the legislative fiscal office assumed that all schools might need to undergo radon mitigation, putting the price tag at $500,000 -- something the state was not going to budget in a short session.
“We believe it’s no more than 10 percent of the schools,” that would renovate and therefore need to test for radon -- and fewer than that would actually detect any radon, said Dembrow. He plans to try again in 2015 after working on the issue with the Oregon School Board Association.
“It’s the first cause of lung cancer if you take out the smokers,” Keny-Guyer told her constituents.
Keny-Guyer is finishing out her first elected term after gaining her southeast Portland seat by appointment in late 2011. She ranks just behind Rep. Mitch Greenlick, D-Portland, on the House Health Care Committee, serving as the Democratic vice-chair.
She also sits on the Human Services Committee and the Consumer Protection Committee -- both of which saw health-related issues in 2014.
The Human Services Committee debated but did not agree on any legislation to regulate e-cigarettes, which are increasing exponentially in popularity but fall under little state or federal scrutiny. E-cigarette manufacturers market their product as a safer alternative to regular cigarettes, since the electronic cigarettes do not have smoke, and use nicotine but not necessarily any tobacco. However, little is known about other negative health effects and some have been found to use carcinogenic chemicals.
One bill would have banned e-cigarettes within indoor public places and for teenagers, while the other would have just set the inhaling age for e-cigarettes at 18.
The Human Services Committee also authorized lottery money to be spent on gambling treatment -- a longstanding policy that had recently been ruled unconstitutional by the Oregon Supreme Court.
The House Consumer Protection Committee developed an information technology law that will help hold future information technology endeavors more accountable, with the goal of preventing future debacles like Cover Oregon.
Smith Warner, Portland’s newest legislator, didn’t serve on any health policy committees, but she said she did hear a genetically modified organism labeling bill in the House Rules Committee.
House Bill 4100, from Rep. Paul Holvey, D-Eugene, would have referred a ballot measure to the people requiring GMO labeling, but died in the Rules Committee.
Smith Warner told The Lund Report that HB 4100 generated an interesting debate not only on whether to label for GMOs but how best to label. The Legislature might consider labeling products that had been certified GMO-free, since such a voluntary option had support of some farmers.
Currently, organic food can be authenticated by the U.S. Department of Agriculture, but there are no rules around the use of the term “natural” and processed as well as genetically modified foods could use “natural” as an advertising scheme. A state certification could provide more transparency.
Before she can serve a full term, Smith Warner faces a primary challenge in northeast Portland from Tom Sincic, a nurse practitioner and the former president of the Oregon School-Based Health Care Network. The winner of the primary in the heavily Democratic seat will be the presumptive representative-elect as no Republican entered the race.
Neither Keny-Guyer nor Dembrow face challengers for re-election.
Editor's Note: Rep. Keny-Guyer was appointed in late 2011, not 2012 as initially reported.