This story was updated Monday afternoon with new information.
With about three weeks left in Oregon’s legislative session, dozens of health care bills await the judgment of budget writers, and this year, finances are tight.
State economists said in their May forecast that lawmakers have about $750 million less than expected to work with, something that came as a surprise even to veteran lawmakers like Democratic Rep. Rob Nosse, who’s represented Portland since 2014.
“This is the first budget cycle in 10 years of doing this that the May forecast came in lower than the February forecast,” Nosse told The Lund Report.
That means that many of the bills in the Joint Ways and Means Committee, which sets the budget and approves other spending, could die there. Once in Ways and Means, committee leaders have to assign the bill to a subcommittee for consideration. If the subcommittee approves it, then the full committee votes. If it passes there, it goes to both chambers for a final vote.
Nosse chairs the House Behavioral Health and Health Care Committee, which passed more than 60 bills this session. Many are now up to budget writers to decide. Nosse has four top priority bills in Ways and Means but they haven’t all been assigned to the subcommittee that oversees health and human services spending.
Nosse said if a health care bill hasn’t been assigned to the human services subcommittee, it is likely dead, though he said some could be considered by the Ways and Means capital construction subcommittee.
The human services subcommittee has several dozen bills to consider, including budgets for the Oregon Health Authority and other agencies. It is scheduled to meet three times this week and then is likely to be shut down for the session, lawmakers said.
Priority mental health bills
This year lawmakers again considered a host of bills to shore up Oregon’s behavioral health resources. Nosse said he has four top priority bills in Ways and Means.
House Bill 2024 would allocate $45 million to the Oregon Health Authority to increase the number of behavioral health professionals in Oregon, something that’s desperately needed.
“We're 49th in the country in terms of behavioral health access, so if you want more appointments you have to have more people that are trained,” Nosse said.
That bill is up for a hearing Tuesday in the Joint Ways and Means Subcommittee on Human Services.
So is another one of his top priorities: House Bill 2059, which passed the House health care committee unanimously. The proposal would allocate $90 million to the Oregon Health Authority for increasing residential behavioral health capacity. The state sorely lacks these facilities, which treat severe mental illness.
Building more residential capacity would help relieve emergency rooms, which end up “boarding” mental health patients who have nowhere else to go and ease demand for Oregon State Hospital beds, Nosse said.
The bill follows a report last year, which found that the state would need to add at least 3,700 more beds to treat all the people likely to need residential care by this fall.
Though the bill has a high dollar amount, it would be a one-time allocation, which Nosse said gives it a better chance of passing this year.
His third priority bill, House Bill 2203, is in the joint committee. It would require mental health residential facilities and other centers that help behavioral health patients to enact safety plans to protect staff and ensure they’re trained. Though it’s not moved to the subcommittee, Nosse said at at least some of the protections are likely to be incorporated into another bill.
He’s less optimistic about House Bill 2056, which would shore up behavioral health resources at the county level. It would allocate nearly $65 million to community mental health programs to help people in crisis and alleviate pressure on the Oregon State Hospital.
The hospital has had a tough time keeping up with all the so-called aid-and-assist patients who need treatment before they can face criminal charges. The hospital is under a court order to admit patients from jail within seven days, but many end up languishing in jail longer than that.
With so many aid-and-assist patients, the hospital has had little room for those who need to be civilly committed. On Friday, a federal judge issued a contempt order against the state for not doing enough to address its continuing violations of the court order.
The bill would give counties resources to help with both, which are not reimbursed by Medicaid, and bolster crisis services. The bill passed the House Committee on Behavioral Health and Health Care on a unanimous, bipartisan vote.
“Considering that the state hospital is oversubscribed, this is pretty important,” Nosse said.
But the price tag could doom it, Nosse said.
On Friday, following Nosse’s comments, a federal judge issued a contempt order against the state for not doing enough to address its continuing violations of the court order. It’s unclear how legislative leadership will respond.
Quicker hospital discharges
The chair of the Senate health care committee, Democrat Deb Patterson of Salem, has been working for a year on a bill that aims to relieve hospitals that have been stuck “boarding” patients because they have nowhere else to go, including patients in a mental health crisis.
“We have long waits in the ERs,” Patterson said. “We've got to give those ER doctors some relief.”
“We've got to give the hospital some relief, too,” she added. “A lot of our hospitals are so financially strapped they're wondering if they're gonna stay afloat.”
Senate Bill 296 is based on input from long-term care specialists, the Hospital Association, safety net clinics and homeless housing providers. It would aim to help low-income people leave hospitals sooner by requiring the Oregon Health Authority to track and streamline the Medicaid approval process for longer-term services. It would also ask the Department of Human Services to explore short-term options for patients while they’re waiting for an approval.
Patterson said the bill, which has a $12 million price tag, would help hospital finances and save lives.
“We don't want people being left on the streets to die,” she said.
Spending for mothers and babies
Another committee leader, Sen. Lisa Reynolds, D-Portland, prioritized legislation this year for mothers and babies. Chair of the newly created Senate Committee on Early Childhood and Behavioral Health, she spent months last year working with experts and residents on proposals to fill gaps in Oregon’s services from pregnancy through the first year after birth.
One bill, Senate Bill 690, initially mandated a study on perinatal health issues, which would require some state funds. It has been sitting in the Senate Rules Committee for a month — not a good sign, given that legislative leadership uses the committee to fine-tune bills before the overall committee votes.
On Monday the bill was amended to direct the Housing and Community Services Department to make children up to 12 months old a priority in administering programs to house homeless families or those at risk of homelessness.
Reynolds said that making it a policy bill without a need for state funds could increase its chances of passing.
Another one of her bills, Senate Bill 691, is focused on addiction support and treatment of pregnant people and new mothers. It has moved to the Joint Ways and Means Committee. It would allocate $6.5 million for an existing program, something Reynolds said could be reduced if needed. It also includes $218,000 for staff at Oregon Health Authority.
The bill has not been assigned to the budget subcommittee, which may suggest that budget writers do not plan to fund it..
But Reynolds is optimistic about another bill in the joint committee. Senate Bill 692 aims to increase the number of doulas in the state and access to their services helping parents through the birthing process. Medicaid reimburses doula services but commercial insurers often do not. They would be required to do so under the bill, which includes a $6 million price tag for the state. Reynolds said that, too, could be reduced if needed.
“We put a lot of work into that and the insurers agree to it,” Reynolds said. “We can't lose that opportunity because they don't want to give us $6 million.”
A fourth bill, Senate Bill 693, would create a task force on the perinatal workforce. Task forces aren’t free even if members aren’t paid: They come with administrative costs. But the bill’s cost would be relatively low.
It’s not been moved from the joint committee to the human services subcommittee, but Reynolds is hopeful that it will. She said the state needs more professionals specialized in pregnancy, birth and post-natal care, from OBGYNs to obstetrics nurses.
“We're seeing shortfalls everywhere,” Reynolds said. “There are some birthing centers across the state that don't do as many deliveries, and then it's hard to keep people's skills up.”
This week and next are likely to be hectic in Ways and Means. The committee is moving out the agency budgets first before attacking policy and other bills. And in the meantime, lawmakers have their eyes on Washington and the so-called “Big, Beautiful” bill being considered by Congress. It would make major cuts in Medicaid and other programs, kicking millions off of coverage.
“We all are on our pins and needles watching whatever the Senate does with the “Big, Beautiful Bill,” Nosse said. “Depending on what happens, that changes everything.”
