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Handful Of Health Care Bills May Be Among Last To Survive Legislative Session

Oregon's House of Representatives passed a bill to restore double health insurance for public employees in June 2019. | ELON GLUCKLICH/THE LUND REPORT.
June 24, 2019

SALEM – Senate Republicans' walkout over a controversial carbon reduction bill has thrown the legislative session into turmoil in its final days.

Gov. Kate Brown is threatening to hold a July special session, with the session's mandatory adjournment date looming Sunday, and the Senate's 11 Republicans reportedly spread across neighboring states to deny Democrats a quorum.

But bills on infant care, end-of-life decisions, health care spending and others cleared major legislative hurdles just before Republicans fled the Capitol on Thursday. Five significant policy bills that passed their second chamber just ahead of the walkout just need signatures from House and Senate leaders and Brown to become law.

Those bills could be among the last to survive if the Republican walkout lasts through next weekend. Any bill that hasn't passed both chambers by the state's constitutionally mandated June 30 adjournment date will effectively be killed and need to be reintroduced in committees.

Here is a look at the health care bills that passed before the Legislature ground to a halt:

Senate Bill 526 would establish a statewide nursing home visit program for parents of newborns. The bill would spend an estimated $800,000 per year, mostly in general funds, to expand a Lincoln County nursing pilot program. The county program gives new parents the option to have a registered nurse visit them in their home to check on the child and mother's health and answer any questions while connecting parents with community resources based on their needs. The visit would be covered under the Oregon Health Plan or commercial insurance.

"Public health nurse visitation is one of the most effective ways to fill in knowledge gaps and answer the sometimes terrifying questions that new parents have," Rep. Sheri Schouten, D-Beaverton, a longtime nurse, said on the House floor last week.

The bipartisan bill was included in Brown's proposed 2019-21 state budget. It passed the Senate 22-5 on June 13 – exactly a week before Republicans walked out – and passed the House 48-11 last week.

The in-home visits would be voluntary. Some parents testified against it, worried that the visits would amount to government welfare checks, but Oregon Health Authority officials maintained that nurses wouldn't be reporting any negative behavior short of abuse or neglect.

Nursing visits are already available for some newborn parents on the Oregon Health Plan, but SB 526 would expand them to all low-income Oregonians next year and all newborn parents with commercial insurance in 2021, regardless of income. The visits would take place when a baby is between 2 and 3 weeks old.

The Family Connects program in Lincoln County is part of a Duke University Center for Child and Family Policy effort to reduce infant emergency room visits. It operates in Lincoln County and in communities in nine other states.

Senate Bill 579 expands some terminally ill patients' access to life-ending drugs under Oregon's Death with Dignity law.

Proposed by a Eugene physician and backed by state and national advocates of Oregon's pioneering assisted suicide law, SB 579 would eliminate a 15-day waiting period for patients near death if their physician determines the patient has less than 15 days to live.

The waiting period, included in the 1994 law, is one of many safeguards built into it to give patients with terminal illnesses time to consider their options and change their minds. But advocates say it has also prevented some of the sickest patients from accessing the medications in their last, painful days.

"If you have less than 15 days to live, it doesn't make sense to have to wait 15 days to have access to the program," Rep. Mitch Greenlick, D-Portland, said on the House floor last week before Representatives voted 35-22 to pass the bill. "We're not talking about changing the basic program, all the safeguards that are in it to make sure that people make the decision in a rational and calm way. What we're talking about is people who are at the very, very end of their life, people with less than 15 days to live. It would be perfect if we could all die clear of mind and free of pain, but the fact is that's not the way it goes."

The bill passed the Senate 16-11 last month, with two Democrats joining all Senate Republicans in opposition. Likewise, all House Republicans voted against the bill, and one Democrat joined them.

Oregon's Death with Dignity law was the first in the nation, and six states and Washington, D.C. have since followed suit. The law has been controversial, with religious groups arguing that any law expanding access to end-of-life drugs would lead the state on a path toward on-demand suicide.

More than 1,400 terminally ill patients have ended their lives with lethal drugs in the 25 years since the law was enacted, including 168 patients last year, according to Oregon Health Authority data.

Another bill that would have barred anyone but the patient from administering the end-of-life drug, House Bill 2217, stalled in a Senate committee after passing the House in April. Death with Dignity supporters worried it would lead to patients who are unable to swallow a lethal drug trying to take it intravenously and botching the procedure.

Senate Bill 889 puts the state on an ambitious, yet unclear, path toward capping private insurance cost growth at the same rates as public employee and Medicaid plans.

The product of a task force on health care costs established two years ago, SB 889 would establish a cost growth benchmark program tasked with holding annual health care spending to 3.4 percent on private plans. That figure is equal to the rate Oregon has pledged to cap cost growth under its federal Medicaid waiver. The state also has a self-imposed 3.4 percent limit for Public Employees’ Benefit Board and Oregon Educators Benefit Board plans.

But SB 889 doesn't say how the state will meet that goal. The benchmark program sets a general framework to identify the drivers of cost increases among insurance plans and hospital systems and release annual reports, but it requires a new committee to come up with ideas to actually lower costs.

The Centers for Medicare & Medicaid Services projects annual growth in private health insurance spending to average 4.7 percent through 2026. The Oregon Health Authority, advocating for the bill, told lawmakers lowering private health care cost growth from 4.7 percent to 3.4 percent would reduce state general fund spending by $700 million over the next four years. It would reduce spending by an estimated $2 billion across the health care system over that time.

"If anybody is above target, we can do a deep dive and try to understand what's driving those costs," Jeremy Vandehey, director of the Oregon Health Authority’s Health Policy and Analytics Division, told Senate Committee on Health Care members back in April.

The benchmark is modeled after a 2012 Massachusetts law tying health care cost growth to the state's economic growth. The state has consistently been below the national rate of cost growth since.

SB 889 passed the House 47-11 last week, after passing the Senate 28-0 on June 30. Only one House Republican. Rep. Ron Noble, R-McMinnville, explained his vote against it, saying the cap should only apply to hospitals, not more broadly across the health care system.

House Bill 2185 seeks to prohibit pharmacy benefit managers form imposing burdensome fees and restrictions on pharmacies.

Pharmacy benefit managers operate as powerful third-party intermediaries to negotiate wholesale prices with drug manufacturers and prescription drug claims with insurers.

Reform advocates and community pharmacies for years have pushed back against the companies' tactics, as the industry has consolidated into three giants – Express Scripts, CVS Health and United Health – that account for more than 75 percent of all prescription drug transactions nationwide.

Pharmacy benefit managers often tack on charges of several dollars for each prescription a pharmacy fills or refills, and advocates say those fees can add as much as $200 per year in unnecessary costs to seniors and other heavy prescription drug users through higher copays.

HB 2185 would give Oregon more oversight over the companies' practices in the state. Pharmacy benefit managers would be barred from requiring enrollees to fill prescriptions at mail-order pharmacies – typically owned by the benefit managers themselves.

The bill would also prohibit the benefit managers from penalizing a pharmacy that informs a customer about the difference between a drug's out-of-pocket cost and the pharmacy's retail price. The bill spells out the types of documents managers would have to submit to Oregon pharmacies to set costs, bar them from retroactively denying or reducing claims for most reimbursements by pharmacies and put a process into state statute for pharmacies to appeal benefit management requirements.

"These boundaries are designed to help protect Oregon consumers and pharmacies, especially those small operations that often find themselves without the power to negotiate important contract terms," Sen. Laurie Monnes Anderson, D-Gresham, said on the Senate floor last week.

The pharmacy benefit management industry has vigorously fought reforms in the state for years. It succeeded in weakening a 2017 law that would have given the Oregon Department of Consumer and Business Services the ability to revoke an entity's registration for engaging in dishonest, negligent or fraudulent behavior, using the threat of a lawsuit to make the law unenforceable.

Lobbyists for the industry and insurers like Providence and Moda testified that HB 2185 would lead to higher drug costs and premiums.

But lawmakers were undeterred, passing the bill unanimously in the House in April and unanimously in the Senate last week, two days before Republicans left Salem.

House Bill 2266 restores double health insurance coverage for couples both employed in the public sector and enrolled in health plans through the Public Employees’ Benefit Board or the Oregon Educators Benefit Board.

The bill essentially reverses part of an estimated $149 million to $163 million cost savings package Democrats passed in 2017. Democrats touted those savings, mostly through a new cap on Medicare hospital reimbursement rates.

But a provision eliminating a pair of popular provisions for couples both employed by the government sparked fierce opposition from public employee unions, teachers and school district administrators.

HB 2266 restores those two benefits for married couples insured through the boards: the ability for one member’s policy to cover health care expenses while the other picks up costs like copays; or a taxable monthly payment of $233 for employees who opt out of health coverage while retaining benefits through their partner's plan.

The bill does require the Public Employees’ Benefit Board and the Oregon Educators Benefit Board to assess a surcharge on an eligible employee who provides coverage for a spouse if that person could receive employee health care coverage in another government employee health benefit plan. The boards would determine those surcharge amounts.

HB 2266 also requires the boards to conduct eligibility reviews for dependents enrolled in coverage through their spouse and to report rate changes to the Legislature each year.

The bill enjoyed bipartisan support, with Democrats acceding to union pushback and Republicans heeding the warnings of several rural school district superintendents who said losing the benefits later this year would strip away one of their most valuable teacher recruitment and retention benefits. It passed the House 55-3 on June 6 before the Senate unanimously passed it last Tuesday, June 18.

"I think it's a really good bill, I think it'll save the state and these plans some money, and they're going to have to report to us by the end of this year to see if it's actually working," said Senate Minority Leader Herman Baertschiger, Jr., R-Grants Pass, less than two days before leading the Republican walkout that has upended the state.

Have a tip about the health-care industry or legislation? You can reach Elon Glucklich at [email protected].