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Final week of 2023 Legislature made a mark on Oregon health care

Lawmakers pushed to pass nurse staffing, other bills as interrupted session wound to a close
The Capitol Building in Salem. | JAKE THOMAS/THE LUND REPORT
June 26, 2023

This article has been updated with additional responses from lawmakers. 

As the 2023 session came to a close, Oregon lawmakers pushed a new nurse staffing law and other key health care legislation past the finish line while also scuttling a bill that would beef up oversight on pharmacy middleman companies.  

Oregon lawmakers have spent the last week rushing to pass stacks of bills by the scheduled June 25 adjournment after Senate Republicans agreed to end a six-week boycott that deprived the chamber of a quorum. Bills setting price caps on medical staffing agencies, helping train medical workers and others passed out of the Legislature on the session’s final day. 

But another closely watched health care bill failed. 

House Bill 3013 would have given state regulators more resources and authority to police pharmacy benefit managers, controversial companies that negotiate drug prices between insurers and manufacturers. Oregon lawmakers have enacted previous regulations on pharmacy benefit managers, but they have resulted in no enforcement action

Four Senate Democrats on Sunday joined Republicans in voting down the bill that earlier passed the House with bipartisan support. 

“This was basically a David versus Goliath situation and Goliath won,” Brian Mayo, executive director of the Oregon State Pharmacy Association, told The Lund Report. 

The pharmacy association has raised alarms that pharmacy benefit managers’ business practices are causing pharmacies to close and patients, particularly in rural areas, to lose access. Lawmakers earlier passed legislation requiring pharmacy benefit mangers to disclose more information on drug pricing and restricting them from reducing payments to pharmacies after completing a sale. 

But Mayo said H.B. 3013 was his association’s central priority because it would’ve given teeth to previously enacted pharmacy benefit manager regulations. The bill’s demise will mean more pharmacies across the state will continue to close, he said. 

The pharmacy benefit manager trade group Pharmaceutical Care Management Association did not immediately respond to a request for comment.

Opponents of H.B. 3013 made a final push to kill the legislation. Scott Winkels, lobbyist with the League of Oregon Cities, warned lawmakers that the bill would require health plans to pay large dispensing fees to pharmacies. He said the fee would add up to $2.8 million increase in prescription drug costs for insurance plans used by local governments. 

State Sen. Michael Dembrow, D-Portland, acknowledged in a floor speech before the vote that there was “some last minute concern (and) angst raised by some stakeholders out there concerned that this would raise costs.”

The bill was expected to raise over $1 million in the upcoming two-year budget cycle to hire five staff members at the Department of Consumer and Business Services to oversee pharmacy benefit managers. That money would’ve been raised by fees on pharmacy benefit managers. 

While the bill’s vote tally in the Senate was 14-11, that wasn’t enough to meet Oregon’s three-fifth majority requirement for new taxes or fees.

The four Senate Democrats who voted against the bill included Chris Gorsek, WInsvey Campos, Janeen Sollman and Aaron Woods.

The Lund Report sought comment from the opponents  through the Senate Democrats’ office and the Senate Republicans’ office.

Gorsek, of Gresham, and Sollman, of Hillsboro, were the only lawmakers who responded. Sollman shared a vote explanation she filed Monday that stated that she supported more clarity for pharmacies and transparency for pharmacy benefit managers, but worried the bill would raise costs for consumers.

Gorsek said in an emailed statement that there wasn't enough time left in the session to resolve uncertainty surrounding the legislation. 


Hospitals and unions seal the deal

On the session’s final day, lawmakers approved House Bill 3396, which allocated $27 million to increase training for nurses and health care workers. It also pays for the Oregon Health Authority to staff a new task force that will look at challenges hospitals face with patients who no longer require acute care but can’t be discharged because of the lack of beds in skilled nursing and other facilities. 

The legislation is part of a package negotiated for months between labor unions and the Oregon Association of Hospitals and Health Systems that centers on a landmark bill setting minimum staffing levels in hospitals. The deal also included another bill passed a day earlier that exempted frontline medical workers wages from the state’s plan to cap health care cost growth to 3.4% annually.  

The hospital staffing bill will be phased in beginning in September and concluding in July 2026. Both the hospital association and labor unions applauded the deal. 

“We are proud of the collaborative efforts that led to this package of legislation, which will support our hospital staff who work so hard on behalf of patients,” Becky Hultberg, hospital association president and CEO, said in a statement. “The legislation also reduces many of the administrative burdens hospitals currently struggle with and builds partnerships that we hope will help ensure access to care for patients well into the future.”

The same statement included a quote from Meg Niemi, president of Service Employees International Union Local 49, expressing support of the deal. 

“By listening to the voices of frontline workers, this legislature has made historic investments in our workforce and for the first time ever included professional, technical, and service workers in staffing laws,” she said. “We couldn't be happier to be part of this agreement and celebrating a huge win for the health care industry.”

The Oregon Nurses Association, the state’s largest nurses union, spearheaded the staffing bill arguing it was needed to keep nurses from leaving the profession after years of understaffing. The union on Friday, the same day it concluded a five-day strike against Providence Health & Services, posted a less conciliatory message on its Facebook page.  

“Once the bill takes effect, some hospitals may still try to skirt the staffing law, so we will all be accountable for filing timely complaints to the Oregon Health Authority and ensuring that the agency enforces the law,” reads the post. 

Christmas trees and final bills

On the session’s final day, lawmakers passed Senate Bill 5506, a $1.1 billion spending measure known as the “Christmas tree bill.” Tucked in the bill are multiple health care-related measures:

  • $2.9 million for community mental health programs run by local governments.
  • $2 million for the Polk County Mental Health Treatment/Crisis Center.
  • $5 million for Lane County for the Behavioral Health Stabilization Center.
  • $20 million for the health authority’s public health modernization initiative. 
  •  $1.9 million to “promote diversity, equity and inclusion” at the Oregon State Hospital. 
  • $2 million for a health care interpreter program. 

As the days left in the session dwindled, lawmakers passed other health care legislation including bills to make opioid overdose-reversing medication more available, tighten hospital charity care requirements and study converting Oregon to a single-payer system.

They also passed other health care bills that include:

  • House Bill 3258 expands Oregon’s Prescription Drug Monitoring Program to include a class of drugs that are considered less likely to be addictive but still contain small amounts of narcotics. 
  • House Bill 2665 directs the Oregon Health Authority to set caps on how much medical staffing agencies can charge for in-demand workers. The bill came in response to complaints from long-term care providers that increasingly costly staffing firms are putting them out of business. 
  • House Bill 3610 creates a task force that will consider whether Oregon should increase taxes on alcoholic beverages. Oregon’s beer, wine and cider industries agreed to the task force if it also considers how the state spends taxes generated by alcohol sales. 
  • House Bill 3008 makes Oregon the first state to require insurers to first get the consent of dentists before leasing their services on a third-party network that can pay lower reimbursements. The bill also requires dentists to opt into receiving electronic credit card reimbursements that often come with fees. 

The bill was a priority of the Oregon Dental Association. But the association complained in an unsigned letter to the Legislature’s budget writers that they didn’t fund any of the association’s $20 million ask to train dental assistants and hygienists, vital oral health care providers. 

“Oregon is experiencing a critical shortage of dental assistants and hygienists, vital oral health care providers,” reads the letter. “Without enough auxiliary staff, dentists are forced to cut back their hours and the number of patients they serve, reducing access to care.” 

You can reach Jake Thomas at [email protected] or via Twitter @jakethomas2009.