Rep. Mitch Greenlick, D-Portland, got the ball rolling when he introduced legislation in the 2016 session that would have required all CCOs to become non-profit by 2023. He also wanted their governing boards to be open to the public and adhere to the Open Meetings Law with 50 percent of its members representing the community. Of the remaining board members, only 25 percent could represent the risk-bearing CCO stakeholders, and 25 percent be healthcare providers.
Even though Greenlick pulled that bill ( House Bill 4100) before it could have a public hearing, he remains adamant about reforming the CCOs. He wants the CCOs to resemble a social insurance model with greater public accountability.
Greenlick intends to introduce a new bill when the Legislature convenes next February, and his timing couldn’t be more precise since CCO contracts come up for renewal the following year.
Earlier this week, former Governor John Kitzhaber also chimed into the fray when he appeared at a Portland City Club forum co-sponsored by Oregon Physicians for a National Health Program.
“We shouldn’t let any out-of-state companies buy CCOs,” Kitzhaber told the enthusiastic crowd. He was obviously referring to the recent multi-million dollar purchase of Trillium Community Health Plan’s parent organization, Agate Resources, to Centene Corporation, a Missouri-based Fortune 500 company. And, there’s speculation that Centene intends to spread its tentacles, buying up other CCOs.
Recently, Greenlick, who chairs the House Health Committee, met with officials from Governor Kate Brown’s office, along with Oregon Health Authority Director Lynne Saxton, Health Policy Board Policy Chairman Zeke Smith and other legislators to move the ball toward legislation.
To start the process, listening sessions will be held throughout the state starting in September, with the schedule announced shortly by the OHA.
An online survey will also be conducted, and the OHA also intends to share the quarterly performance of CCOs.
“We want people to speak about their experiences with CCO and hear about what’s working and what’s not,” Smith said. A three-member work group -- comprised of Dr. Joe Robertson, president of OHSU; Brenda Johnson, CEO of La Clinica in southern Oregon and Smith, Chief
Impact Officer of the United Way of the Columbia Willamette – will make recommendations to the Policy Board and legislators prior to the February session.
“We want what’s best for the communities so they can get the services they need, and want to hear from consumers and providers” Smith added. “It’s been five years, and we need to see if the CCOs are on the right path.”
Greenlick’s latest concerns come in the wake of new public disclosures that the physician investors of Trillium made off with $34 million in the sale of the CCO’s parent company to Centene Corporation, the bulk of the wealth generated from the profit potential of a government health plan designed for poor people.
Greenlick’s vision is unchanged from the failed House Bill 4100 that he introduced this winter, which calls for the removal of the CCOs’ massive reserves into a designated community trust and calls for the organizations to take steps toward a non-profit, community driven board subject to public records and meetings laws.
“I want to get the reserves out of the hands of the CCOs. I believe the reserves should be in escrow,” Greenlick told The Lund Report. “I don’t think Centene should own the reserves for the Lane County CCO. I think Lane County should own that.”
Greenlick believes that as providers of Medicaid, the CCOs should and must make those improvements regardless if the CCOs investing in these projects receive a dividend. “[The for-profit perspective] is not the solution, it’s the problem,” he said. To Greenlick, the CCOs are but stewards of public money, and any upstream investments are government investments into the health of low-income and vulnerable people, not a speculative venture borne by the CCO.
“The more that Medicaid is connected to helping poor people get out of poverty, the harder it is that medical care should be a source of personal wealth,” Taylor concurred. “Most people who pay tax dollars will want low-income people to receive healthcare and get help getting out of poverty. No one out there has the hope that it will help providers get rich.”
Under Greenlick's earlier legislation, reserve funds would be placed in a global escrow account housed in the state treasury starting in 2018 with the Policy Board developing new health metrics that CCOs would be required to meet or else forfeit their contracts.
Greenlick argued that the rules governing CCO operations were enacted in a rush fashion in 2012 so that Oregon could get quick approval from the federal government, and some decisions were based on political compromise rather than sound policy to ease passage in a House of Representatives that had been evenly split between Democrats and Republicans.
Diane can be reached at [email protected].