Independent Medical Board, Pharmaceutical Bills Among This Year’s Losers
Not all the healthcare bills debated this session made the cut. Some were poorly conceived, a few were addressed by other means, and others just lacked the votes, but most died quietly, without much public attention.
Here’s a look at nearly three dozen bills that The Lund Report covered but which were left behind when the 2015 Legislature adjourned July 6:
HB 2022 -- This legislation would have required hospitals to set up case management upon discharge for patients who are admitted for psychiatric crises. A lot of progress was made on mental health policy this session, but this one didn’t make the cut.
HB 2026 -- The health insurance industry pushed a bill that would have ensured that pharmacists are not restricted in their ability to prescribe biosimilar, or generic, biological medications. The bill didn’t go anywhere, but a 2013 policy that prevents pharmacists from prescribing biosimilars without first informing a physician expires at the end of 2015 anyway. A door was left open for real-time pharmacist-physician notification, which should be available technologically by the end of the decade.
HB 2048 -- Occupational therapists asked to be added to the long and uneven list of providers who get special tax breaks for working in small towns and rural areas. The bill didn’t go anywhere, but occupational therapists and other health professionals will likely be part of the discussion on how to improve healthcare access in rural and other chronically underserved communities, which will be studied as part of House Bill 3396. Sen. Alan Bates, D-Medford, said he believed the state could triple the money spent on these communities with a federal waiver to gain federal match money, turning the current $30 million state investment into $90 million. That could help improve the way aid is administered to rural and underserved communities without forcing any current beneficiary to lose a tax break. Despite evidence that some of the benefits such as tax breaks have been misdirected toward affluent small towns like Hood River, or for physicians with high six-figure incomes, the Legislature has been unable or unwilling to improve the policy.
HB 2421 -- The CCOs tried once more to take over management of psychiatric medications, which have no sideboards for the Oregon Health Plan and are heavily over-prescribed, particularly among Medicaid children. They are carved out of the CCO formularies largely based on the clout of PhARMA, but mental health advocates also criticized this proposal as jeopardizing patient access, and the bill died after just one hearing.
HB 2541 -- A bill from the Oregon Nurses Association requiring nurses at blood drives had strong bipartisan support in the House, but was killed behind closed doors in the Senate after the Red Cross insisted the policy was unnecessary.
HB 2678 -- Planned Parenthood and the Oregon Nurses Association failed to get a bill passed to allow nurse practitioners to perform simple vasectomy procedures. Planned Parenthood reported a huge wait time for men wanting the sterilization, and NPs in Washington have been able to do vasectomies for 20 years.
HB 2937 -- The Oregon Health Authority helped to snuff this bill, which would have required the state to pay for equipment for disabled people who want to leave their homes. The Department of Human Services has won increased federal dollars to emphasize home and community-based care, but the other state agency refuses to pay for the equipment that would make this possible for individuals with disabilities, insisting on coverage just for equipment that’s needed inside the home.
HB 2950 -- CareOregon supported this bill to help clean up problems the CCOs had working with the administration at the Oregon Health Authority over the enrollment of Medicaid members, but the bill was dropped after the health authority agreed to adopt most of CareOregon’s wishes administratively.
HB 2951 -- The Cascade AIDS Project sought this bill, which would have capped the out-of-pocket drug costs at $100 a month. Health insurers had been accused of discriminating against HIV patients by requiring them to pay upwards of $1,000 a month for drugs needed to keep them healthy and alive.
HB 3018 -- This bill would have prevented health insurers from charging higher copayments when patients choose out-of-network providers who haven’t signed a contract with the health plan. The policy could have hindered insurers’ ability to hold down costs by discouraging providers to sign a negotiated contract.
HB 3023 -- A bill requiring women who receive the Oregon Health Plan but are not members of CCOs to get a speciality dental appointment within 60 days did not go anywhere, but Rep. Alissa Keny-Guyer crafted a compromise in a separate bill, House Bill 3464, which requires the health authority to establish a timeframe for an initial dental screening for these women, which will buy them more time to get serious dental issues corrected before their coverage expires after their babies are born. These women are shut out of Oregon’s CCOs for mysterious and likely political reasons, since some of them are undocumented immigrant mothers of Oregon babies; instead they are offered a separate and unequal parallel health coverage with extremely limited access, even as the state makes great strides in improving care for other Medicaid recipients with the CCO transformation.
HB 3087 -- Sen. Chip Shields shepherded legislation in 2013 to reduce the number of self-referrals for physical therapy and radiology that hospitals and physician groups conduct, often at the expense of patient care. But the Oregon Health Authority sided with these special interests and against Shields and the physical therapists in the administrative process, causing the senator to introduce this bill, requiring an oral and written notice of a self-interested referral. It drew a public hearing but stood little chance of passage.
HB 3145 -- The bill, pushed by private home care agencies, required homecare workers employed through the state Home Care Commission, which operates more independently, to be held to the same training standards as their employees. The bill passed the House Health Committee but died in the budget committee.
HB 3300 -- Trillium Health Plan, the CCO in Lane County, pushed a policy requiring doctors to accept their patients if they wanted to provide care to state employees and teachers covered by PEBB and OEBB. Trillium has struggled to find enough providers to accept its members, and argued this would help them in the process. But Rep. Knute Buehler helped fight it off, arguing it was an attempt to strongarm physicians into accepting Trillium’s low reimbursement rates. The bill shuffled through three committees, but never made it to the House floor.
HB 3310 -- The bill asked the Department of Environmental Quality to develop a plan for phasing out old diesel engines from Oregon roads and industrial areas by 2020. After California adopted strict standards to eliminate these engines, public health activists argued that Oregon will become a dumping ground for the ones that California doesn’t want, but strong opposition from the trucking industry and counties limited this bill to a public hearing.
HB 3486 -- PhARMA stopped this bill, which would have required manufacturers of blockbuster drugs to report the costs of producing such medications to the Oregon Health Authority if the cost of the drug exceeded $10,000 a treatment. The bill was part of a menu of options the House Health Committee debated to contain the wildly rising costs of prescription drugs. None of the bills went anywhere.
HB 3506 -- Advantage Dental pushed this bill, requiring the state to pay for dentures for people who became eligible for Medicaid under the expansion. An outdated provision required Oregon Health Plan members to get their dentures within a year of losing their last tooth, but a number of people lost their teeth years ago before they gained coverage, and they have had no chance to get false teeth. The bill failed, but the policy didn’t; Advantage CEO Mike Shirtcliff told The Lund Report the policy was included in a budget bill and coverage will start Jan. 1.
HB 3517 -- This bill would have removed a restriction that prevents the Oregon Health Authority from seeking funds to cover medical services for children who lack the proper immigration paperwork. It passed the House but was brushed aside in the Senate. However, the Xmas Tree bill did include $10 million to award grants to Oregon’s safety-net clinics to help them provide care for such children who are not eligible for other state medical assistance.
SB 18 -- Sen. Shields tried again to increase oversight of the CCOs; this demonstration-only bill would have revoked the state-sanctioned immunity the CCOs were given from anti-trust laws. Their immunity exists in a legal gray area -- while Oregon can give away anti-trust exemptions, the federal government would be unlikely to concur with the state if this authority was challenged, given the state’s very limited involvement in the operations of the CCOs.
SB 146 -- Regence BlueCross BlueShield pushed this bill, which removed restrictions on Oregon companies offering health insurance if they had too many out-of-state employees. The bill passed the Senate but was rendered unnecessary after the passage of HB 2466, which aligned Oregon’s small group market definitions with federal law, which removed the restriction.
SB 147 -- The pharmaceutical industry tried to make permanent a policy that protects patents on their expensive biological medications by creating obstacles for pharmacists who wish to dispense biosimilars or generic biological drugs, including insulin. They were thwarted and the policy expires Dec. 31, just as these lower-cost drugs hit the market.
SB 279 -- The Oregon Medical Board sought to gain a quasi-independent status, arguing they could save costs if they were in control of their own budget, but the bill died in the Committee on Ways & Means, even after gaining the support of most of the Senate healthcare leaders.
SB 415 -- The tobacco lobby fought off a bill that would have banned candy-flavored tobacco products, spuriously arguing that the state would lose millions in revenue if Oregon went ahead with the ban, despite zero evidence that a federal ban on flavored cigarettes resulted in any loss in revenue.
SB 416 -- The bill would have required that smoke shops pay for their inspections to ensure their compliance with a special exemption from the Oregon Indoor Clean Air Act, instead of taking money for this service out of a fund to prevent kids from smoking. It died on the House floor, with moderate Democrats arguing the fees should be spelled out in statute and not set by the Oregon Health Authority.
SB 442 -- A rise in contagious preventable diseases led Sen. Elizabeth Steiner Hayward to seek the elimination of all nonmedical exemptions from vaccinations for schoolchildren, but she withdrew the bill after receiving threats from anti-vaccine activists, who created a media frenzy against the bill, including a rally by conspiracy theorist Robert F. Kennedy, Jr., who also used his family name to draw TV media attention in a failed attempt to defeat California’s successful law.
SB 626 -- Sen. Alan Bates pulled his own bill off the Senate floor after he realized that the legislation opening up the prescription drug monitoring program to more people would allow local health officials and the state epidemiologist to review personally identifiable health data. The bill never resurfaced.
SB 631 -- The latest bill to enact a single-payer health system in Oregon received a lively hearing in the Senate Health Committee, but just like previous bills, never stood a chance of passage. Activists are still hoping for a ballot measure in 2016 or 2018.
SB 663 -- Sen. Mark Hass pulled the bill setting up a state licensure system for tobacco retailers after the stakeholders would not come to any kind of agreeable compromise. A pyrrhic victory for the tobacconists, its failure will likely catalyze county-by-county tobacco retail regulation.
SB 665 -- Put forward by Rep. Rob Nosse, D-Portland, and Sen. Lee Beyer, D-Springfield, the legislation would have put the hospitals under the same kind of scrutiny and prior approval of prices now faced by insurance plans, but heavy lobbying against it by both the hospitals and the insurance industry stopped this bill after a public hearing.
SB 673 -- The Oregon Dental Association worked to allow trained dentists to offer vaccines, but the bill died after the Board of Dentistry raised red flags over the rules that dentists might follow to keep vaccines safe, as dentists don’t always have the same kind of refrigeration equipment as pharmacists, who have been granted the power to administer vaccines.
SB 880 -- Rep. Greenlick killed this bill, allowing non-physician business people to own medical practices, arguing against the creep of for-profit businesses in medicine. The bill had strong Senate support and was brought by two entrepreneurs who sought to open a chain of medical clinics in small, underserved rural towns.
SB 891 -- The hospital association and health insurance lobby put pressure on Senate President Peter Courtney to defeat this bill from OSPIRG and Sen. Steiner Hayward that would have required hospitals to post their prices for common medical procedures. The bill likely would have exposed hospitals to competition and driven down prices that are currently inflated by a lack of consumer knowledge.
SB 894 -- Courtney also scuttled the comprehensive women’s health bill, which would have guaranteed a woman’s right to abortion without excessive cost-sharing from insurance companies. The bill apparently made some Democrats in his caucus squeamish about making such a public stand in support of abortion.
SB 920 -- The Oregon State Public Interest Research Group raised awareness to the health problems associated with the rampant misuse of antibiotics on healthy farm animals. Factory farms have used them on animals to help them grow while keeping them in sordid conditions. The FDA banned that practice, but some farms continue to use them to ward off sickness, which depletes the effectiveness of the drugs when a bacterial outbreak occurs for animals and humans. SB 920 and a companion bill, HB 2598, would have allowed their use only to treat sickness, but the policy never advanced much farther than a Senate Health hearing.
SB 964 -- The House beat back an attempt by the Senate to nullify much of Measure 91 and give counties and cities an easy opportunity to ban marijuana dispensaries in their communities. A compromise was reached in HB 3400, allowing Eastern Oregon communities to ban the dispensaries but not the rest of the state, without a vote of the people.