Oregon’s political leaders will head to Salem next week with high hopes and big fears about the future of the state’s ongoing effort to reform and improve its healthcare programs, a bipartisan panel told nearly 400 people Wednesday morning, at an Oregon Health Forum gathering dedicated to the 2017 legislative session.
The gathering, moderated by Oregon Public Broadcasting health reporter Kristian Foden-Vencil, invited six panelists to share their outlooks:
- Rep. Knute Buehler (R-Bend), a surgeon based in Central Oregon, said expanding access to contraception and responding to the state’s opioid epidemic are among his top priorities for the coming session.
- Rep. Mitch Greenlick (D-Portland), who chairs the House Health Care Committee, said he hopes to continue improving coordinated care organization guidelines, and anticipates the Legislature will tackle nonprofit hospital spending on community benefits, high costs of prescription drugs and funding for public health.
- Rep. Cedric Hayden (R-Roseburg), a dentist and member on the House Health Care Committee, said he will focus on spending by healthcare organizations on community benefits, and stabilizing funding for CCOs in the coming session – but integration of oral health, mental health and physical health will be his main legislative priority.
- Rep. Alissa Keny-Guyer (D-Portland), who serves on the House Health Care Committee, said a reproductive health equity bill will seek to cover maternity care, abortion, and contraceptives at no cost to all women in Oregon; she also looks forward to working with Hayden on efforts to integrate oral and behavioral health with physical healthcare; and efforts to reduce tobacco use will be a high priority.
- Sen. Elizabeth Steiner Hayward (D-Portland), a family physician at OHSU and co-chair of the Human Services Subcommittee, said she expects to be heavily focused on funding state operations in face of a $1.8 billion budget shortfall, as well as efforts to limit tobacco use and to invest in the healthcare workforce.
- Jeremy Vandehey, healthcare policy advisor to Governor Kate Brown, said the governor’s healthcare priorities are to maintain the increases in number of people with insurance and to expand coverage to 15,000 children not eligible for the Oregon Health Plan, often because of immigration status.
But overshadowing all their goals and wish lists, officials and audience members said repeatedly, is uncertainty over the future of the Affordable Care Act, which President Donald Trump has vowed to repeal and replace, while some Republicans in the U.S. Congress would like to simply repeal without replacement.
Buehler, whose support for contraceptive access makes him unusual among Republicans, said he hopes that tough talk about repealing the ACA instead results in a better program for all.
“In my opinion, the Affordable Care Act needs a rebuild. Anyone who looks at that program – it did some great things with regard to access. But its fundamental policy foundations were not solid,” he said. In particular, the individual marketplace has proven unaffordable for many people, and the ACA did not offer a long-term funding solution for Medicaid expansion.
“One of the reasons those problems weren’t dealt with is that they are serious, difficult problems – problems people in this room have dealt with for more than two decades,” Buehler said. “Everyone sitting at this table is going to have to roll up their sleeves to address healthcare reform. What’s next after the Affordable Care Act?”
Greenlick said he is particularly concerned about how an overhaul or replacement of the ACA could disrupt Oregon’s one-of-a-kind CCO experiment, funded by Medicaid, which is still evolving.
“How can we restructure the CCO movement as we move into the next five years of the CCO contract, assuming there is still a Medicaid program and an Oregon Health Plan?” Greenlick asked. “The CCOs have done some remarkable things, and some things that are less than remarkable.”
As Hayden pointed out, however, Oregon’s leaders don’t yet know what kind of CCO funding to expect. Though the Center for Medicare & Medicaid Services granted the state a waiver to continue Oregon’s CCO experiment, it’s not clear if there’ll be sufficient funding to go down that path under a new presidential administration.
“There’s a strong possibility that funding is included,” Hayden said. “But it will be up to the new administration to process that funding.”
Also of concern: “Cover Oregon could be clawed back,” Hayden said – referring to the failed online marketplace that cost the state some $248 million before it was ultimately abandoned. The Affordable Care Act says states can be required to repay funds not used appropriately. “It would be helpful if we didn’t owe that money back. It could be hundreds of millions of dollars.”
“The change in administration and what’s going to happen with ACA is going to affect us profoundly. Rep. Hayden sounded a little more optimistic than I’m feeling,” Keny-Guyer said.
“If the federal match is further reduced or in fact eliminated, that’s going to be a very big hit to Oregonians,” she said. Oregon depends on federal matching funds to support CCOs.
With so much uncertainty about the ACA, Steiner Hayward suggested the Legislature cement the federal law’s gains into state law – or even take health reform further. The state could act to guarantee contraceptive access presently enshrined in the ACA, which could be repealed federally, or institute its own individual coverage mandate, for example, she said.
She also said U.S. Rep. Greg Walden, a Republican who represents a vast, largely rural, swathe of Oregon, appears to be a strong advocate in Congress for Oregon’s health reform efforts.
“I’m delighted to hear how Rep. Walden is speaking about the ACA – rather than replace and repeal, to rebuild and repair,” Steiner Hayward said.
Oregon’s healthcare inflation rate has fallen to 3.4 percent annually, compared to 5.4 percent nationwide. That savings could make Oregon a state to watch as the U.S. Congress looks to improve or replace the ACA, she said.
With so much uncertainty about how federal law will change, the governor’s office is focused at least as much on Oregon’s budget shortfall as on ACA reform, Vandehey said.
With a shortfall that the governor’s office estimates at $1.7 billion, and legislators say is closer to $1.8 billion, fully funding healthcare is going to be a challenge in the coming budget even with federal matching funds, he said.
“Assuming no changes at the federal level, the federal government would be expected to pay about 76 percent of the Medicaid budget,” he said. “If we go backwards and people lose coverage, they are forced to go back to the emergency room to receive care.”
That could ultimately cost the state – and push up healthcare spending – far more than the amount of any cut.
“We’ve been working as a state to continue to improve our healthcare system and Medicaid system for more than two decades,” Vandehey said. “We’ve faced challenges before, and I’m confident that as a state we’ll be able to work together to figure out how to solve this problem.”
Oregon’s Legislature convenes on Feb. 1.
Courtney Sherwood can be reached at [email protected]. Follow her on Twitter at @csherwood.
