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Lawmakers Ready Bills On Prescription Drug Prices, Staffing Shortages 

Oregon State Capitol in Salem. | RENAUDE HATSEDAKIS
January 13, 2020

Oregon lawmakers are gearing up for another legislative session starting early next month, hoping to pass bills that would tackle soaring prescription drug prices, staffing shortages and a host of other issues.

The short 35-day session, customary for even-numbered years, means that Oregonians are unlikely to see major health care reforms. Most of the work will be on a smaller scale, with proposals on studies that could drive policy discussions in the future. But there’s plenty of health care legislation to follow. Bills are in the works for more affordable prescriptions, more privacy for uninsured hospital patients and more funding for state regulators tracking hospital nurse staffing. 

Here’s a look at the priorities of state lawmakers and ideas we’ll likely see this session:

Drugs, Insurance And Interpreters

After a  failed bill last session, advocates are pushing new legislation that would allow prescription drugs to be imported from Canada as a means of making them more affordable. Under the concept, the Oregon Health Authority would design a plan to import wholesale prescription drugs. The plan would then go to the U.S. Department of Health and Human Services for approval. 

The change is backed by OSPIRG, Oregon State Public Interest Research Group, a consumer advocacy organization. 

“Oregonians are paying too much for prescription drugs and need relief from big pharma's price gouging tactics,” said Numi Lee Griffith, health care advocate at OSPIRG. “There's no guarantee that the federal government can act to take on this issue, so we need to take real steps as a state, like expanding the importation of drugs from Canada, to promote competition and bring prices down.  This bill would create a state program for the importation of safe, FDA-equivalent prescription to Oregon."

A similar proposal, House Bill 2689, had a hearing in the 2019 session but died. The industry, including its powerful lobbying arm, the Pharmaceutical Research and Manufacturers of America, strongly opposed the bill, citing concerns about the safety and origins of drugs from Canada. Four other states have made a similar move: Colorado, Florida, Vermont and Maine.

Lawmakers will also look at changing the mechanism for how hospitals figure out which patients are eligible for Medicare or Medicaid. Under the change, people, including undocumented residents, would be able to opt out of the determination for privacy reasons.

Another bill could affect the cost of insurance premiums for dialysis. Rep. Andrea Salinas, D-Lake Oswego, plans to introduce legislation aimed at driving down the costs of coverage for dialysis care by classifying it as emergency medical care. This would lower rates for dialysis coverage, basing it on Medicare instead of the current blend of Medicare and high insurance premium costs, she said. The details are still in the works. 

Salinas, chair of the House Interim Committee on Health Care, is also working on a bill that would step up regulatory oversight for third-party contractors that provide language interpretation services for medical providers. The legislation is intended to address problems such as when third-party companies don’t pay workers or use unqualified people.

The Oregon Medical Association, the powerful lobbying group for doctors, is pushing for changes in the prior authorization processes that providers go through before treating a patient. A similar measure, Senate Bill 139, died in the 2019 session.

The newest version pares it back and makes some changes. For example, it would only cover commercial insurance plans. The 2019 version included Medicaid, state and commercial plans.

The proposal aims to reduce cost and delays for the patient. For example, the bill would allow one prior authorization for prescriptions for chronic conditions to last 12 months to avoid the applying for multiple prior authorizations throughout the year, Trevor Beltz, a lobbyist for the Oregon Medical Association told the House Interim Health Care Committee on Monday.

Insulin prices are also on the table this session. Rep. Sheri Schouten, D- Beaverton, is working on a bill that would cap the out-of-pocket insulin expenses for privately insured Oregonians at $100 for a 30-day supply. She said it’s needed, given the soaring costs of insulin and the prevalence of diabetes. She noted the proposed $100 cap is still a burden for many households.

Separately, Schouten is planning a bill that would require genetic counselors to be licensed. Genetic counselors help clients analyze their family medical background to help predict the risk of disease. 

Rep. Rachel Prusak, D-Tualatin/West Linn, is backing a telehealth bill that would ensure that Oregonians on Medicaid have access to virtual health services. The measure is intended to add parity to the system, including in rural, underserved areas where access is a challenge, she said.

As for Rep. Cedric Hayden, R-Roseburg, he’s backing legislation to increase access to dental care for children, especially in poorer communities. A dentist, Hayden said early care is critical. Studies have linked poor dental hygiene with serious health problems later in life.  

Lawmakers also will look at increased oversight for opioids prescribed by veterinarians. A secretary of state audit last year found lax controls that made theft and black market sales easier. One concept, recommended by the audit, would place opioids prescribed by veterinarians in Oregon’s prescription drug monitoring program, which tracks controlled substances. 

Rep. Mitch Greenlick, D-Portland, is making another run at a proposed state constitutional amendment that would enshrine the right to access health care. It’s an effort he has been working on since 2005. So far, he’s been unsuccessful in securing its passage.

“I haven’t given up and this will probably be my last run at it,” he said. He’s retiring after this session.

Workforce Needs 

Another bill would require the Oregon Health Authority to analyze the workforce gaps in behavioral health care. Salinas said she hopes that can fuel a discussion of where to invest taxpayer dollars in 2021. The analysis will aim at looking at what can be done to encourage Oregonians to enter the field and spur schools to help them chart ambitious career plans. For example, Salinas wants people in entry-level mental health jobs to have ways to advance their careers and earning potential. 

“How do we remove those barriers?” Salinas said. “How do we work with potentially our education institutions to make sure everybody has a path?”

Rep. Rob Nosse, D-Portland and vice chair of the House Interim Committee on Health Care, said he’s working on a bill with the Oregon Nurses Association that would add $1.3 million to the Oregon Health Authority’s unit that regulates nurse staffing levels in hospitals. The bill is intended to provide more money for staffing the unit, with an eye toward getting responses to complaints and follow-up work after an inspection processed more quickly, Nosse said. He is a union representative for the Oregon Nurses Association but is on leave from that job for the session. 

Social Services And Housing 

Rep. Alissa Keny-Guyer, D-Portland, has three top priorities this legislative session. 

She wants a family treatment court system established that would work with families and children who risk being separated from their parents because of substance abuse. The overall goal would be for each participating county to have a judge who develops expertise in the issue, enabling families and parents to get the help they need more quickly. 

The family treatment model ensures that the judge has the expertise and time to expedite these cases, said Keny-Guyer, chair of the House Interim Committee on Human Services and Housing and member of the health care committee.

A similar bill didn’t pass in the last session. The idea is to start the program in five counties: Coos, Clackamas, Marion, Jackson and Douglas, she said. 

She also supports legislation that would increase from $200 to $300 the monthly grants per child that nonprofit community operators get for providing case management services to foster youth. Those services include being connected to job training and cover incidentals, like the cost of college applications.

A child abuse omnibus bill that Keny-Guyer sponsored last year will return this session, with Rep. Anna Williams, D-Hood River, as chief sponsor. It includes a study that would entail interviews of K-12 students across urban, rural and frontier schools about the prevalence of child abuse; and funding for a full-time state worker to support Erin’s Law, a child sexual abuse prevention law that passed in 2015. Currently, only half a position is devoted to the law, Keny-Guyer said. The bill would include funding for child advocacy centers.

Keny-Guyer also has plans to work on homelessness and affordable housing issues.

There’s a bill that would devote $2.5 million toward programs and grants for unaccompanied homeless youth and pay for a statewide assessment that looks at factors like race, mental health and the sexual orientation of youth.

Keny-Guyer is backing a bill that would start a study of a statewide rental voucher program. She said that housing, a major social determinant of health, needs to be given a higher priority. The state needs to look at not only emergency needs and shelters, but also renters who are spending an increasingly larger share of their incomes on housing, she said. 

“We need to move toward a philosophy of ensuring that people’s housing for our most vulnerable citizens (is) just as important as food and health care,” she said. 

You can reach Ben Botkin at [email protected] or via Twitter @BenBotkin1.