As the Oregon legislative session approaches its halfway mark, lawmakers have advanced bills seeking to make overdose-reversing medication more widely available, regulate pharmaceutical middlemen, grow the health care workforce and begin transitioning the state to a single-payer health care system, among others.
March 17 marked the legislative session’s first deadline, allowing lawmakers, advocates and the public to take stock of what legislation is still alive and what is not. For most bills to remain viable, they needed to be scheduled for a committee debate and vote by that date. Bills need to be voted out of committee by April 4 to keep advancing.
Before the Legislature adjourns in June, lawmakers are hoping to complete a to-do list that includes brokering a compromise on a controversial hospital staffing bill, improving access to pharmaceuticals, expanding mental and behavioral health treatment in the state and more.
And looming over all of this work is the question of how to pay for it. Oregon is running out of federal coronavirus pandemic relief funds, and as a result some good bills will not be funded, state Sen. Deb Patterson, a Salem Democrat who chairs the Senate Health Care Committee, told The Lund Report. Democratic leaders will start to decide what will be funded after the May revenue forecast.
In the meantime, the co-chairs of the Legislature’s Joint Ways and Means Committee on Thursday released their framework for Oregon’s upcoming two-year budget. The plan doesn’t include major cuts, andstates that it avoids creating new programs to preserve funding for housing, education and health care in the event of an economic downturn.
“I honestly think the heaviest lift is going to be less the policy and is going to be trying to decide which things to fund or not,” Patterson said.
Both the House and Senate have passed various pieces of health care legislation, including bills tinkering with licensing boards, easing restrictions around pharmacy technicians administering vaccines, requiring insurers to cover prosthetic devices and others.
State Rep. Rob Nosse, a Portland Democrat who chairs the Behavioral Health and Health Care Committee, told The Lund Report said he’s preparing for more politically fraught legislation. He said that includes a bill intended to ensure access to abortion and protect gender-affirming health care, as well as revisions to Oregon’s controversial drug decriminalization law, Measure 110.
More money for more health workers
Lawmakers this session have focused on bolstering Oregon’s pandemic-depleted health care staffing. The House Behavioral Health and Health Care Committee has advanced multiple bills that dedicate money to rebuilding the state’s behavioral health, local public health and nursing workforces.
Perhaps the most high-profile shortage has been of nurses, many of whom have stepped back from the profession during the pandemic. The committee has scheduled votes on a pair of bi-partisan measures, House Bill 2928 and House Bill 2926, which would expand scholarships for nursing students and incentivize hospitals to provide clinical training.
State Rep. Christine Goodwin, a Canyonville Republican who serves as committee vice chair, told The Lund Report the bills will help rural health care providers with recruitment.
“The big kahuna out there that I am still opposed to is the nurse staffing ratios,” she said.
Goodwin was referring to House Bill 2697, a controversial measure establishing minimum staffing levels at hospitals. The bill is a priority of the Oregon Nurses Association, a politically connected union that’s argued it’s needed to bring nurses back to the bedside. The Oregon Association of Hospitals and Health Systems has called it unworkable, saying it will result in reduced services.
Nosse said the two sides are nearing a compromise on the bill that includes easing enforcement and providing leeway for rural hospitals. He said the compromise will be reflected in a forthcoming amendment that he hopes will receive bipartisan support.
“I think the hospitals are realizing they are putting too much pressure on their staff,” Tamie Cline, nurses association president, told The Lund Report.
Republican-backed legislation that would have entered Oregon into the Nurse Licensure Compact, a multi-state agreement allowing nurses to practice outside their home states, didn’t meet the cutoff. GOP lawmakers have complained that the bill died after pushback from the nurses union while a similar bill for occupational therapists remains moving.
The committee is planning to vote on two bills intended to boost the number of needed behavioral health workers. House Bill 2977 appropriates $1 million in scholarships and another $5 million in workforce development grants. House Bill 2651 directs $81 million to support existing financial support for behavioral health worker training.
Earlier this month, the committee advanced House Bill 2773, which asks for $87 million through 2027 to recruit and retain 11 local public health positions.
Also still moving is House Bill 2665, which would regulate how much health care staffing agencies can charge for scarce workers.
Mental health funding and state hospital
Nosse said that at this point in the session, a priority is securing funding for community mental health programs and secure residential treatment. Earlier this month, his committee unanimously voted in favor of House Bill 2544, which would build on previous spending intended to create less restrictive treatment settings than the Oregon State Hospital.
The bill has an unspecified price tag that the Ways and Means committee will set. An estimated $271 million is needed to create nearly 600 residential beds to treat Oregonians with substance use or mental health disorders.
On the Senate side, Gov. Tina Kotek is backing a bill that would direct $74.2 million for her five-year plan to address the state’s behavioral health crisis.
Goodwin said a nationwide movement to “deinstitutionalize” people with mental illness launched decades earlier didn’t include the creation of more community-based treatments settings.
“Now we’re playing catch up in a really frantic way, almost,” she said. “I’m concerned about how much crisis there is everywhere and how slowly all this rolls out.”
The Joint Ways and Means Committee co-chairs’ plan calls for spending an additional $1 billion on the state’s behavioral health system, including increased provider rates and community mental health services.
It also includes money for expanded capacity at the Oregon State Hospital and to help the Salem-based psychiatric facility comply with a federal court ruling that holds it to a timeline for the treatment of patients accused of crimes.
Senate Bill 219 would have put the state hospital in compliance with the federal court order, Meghan Moyer, public policy director for Disability Rights Oregon, told The Lund Report. But the bill didn’t make the cutoff.
“We’re reaching a point with the Oregon Health Authority where they are out of options to get into compliance within the limits of their power,” she said. “And the only way we’re going to get into compliance is if we start changing how we do things statutorily.”
Moyer said conversations are continuing in the Legislature about how to do that.
As the Legislature grapples with funding for mental health services, state Sen. Cedric Hayden, R-Fall Creek, said he wants to give people with lived experience more say over treatment. Hayden, vice-chair of the Senate Health Care Committee, is sponsoring Senate Bill 432, which directs the state to work with peer-run groups that would reach out to people in the mental health system, informing them of their rights and available benefits.
“We spend a lot of money on mental health but it’s not well coordinated and not spent with the end user in mind,” he told The Lund Report.
