Legislative Session Was Short But Substantial For Oregon Health Care

Salem capitol outside angle Ben Botkin.jpg

Clouds hover over the Oregon Capitol building.

Oregon lawmakers tackled complex health policy legislation during a short session that coincided with what many hope is the nation’s exit from a two-year global pandemic.

At its core, the session represented an acknowledgement that the health care system cannot simply revert to its status quo before the pandemic without changes to prepare it for the future. Nurses need more support to avoid burnout. Behavioral health providers need more funding to pay employees a competitive wage. Oregonians need more training opportunities to enter the workforce.

Lawmakers accomplished a range of health care measures during the short session that ended Friday, three days ahead of its Monday deadline. Even-year short sessions, which were approved by voters in 2010 to last 35 days at most, were pitched as   quieter affairs with mid-cycle budget work, simple bills and work that sets the stage for longer-term complex policy decisions.

But this year was not that. The COVID-19 pandemic has exacerbated and exposed problems in the state health care system, including a dire shortage of nurses and other key support staff. The behavioral health system is hurting for more beds and struggles to find employees.

The state also wants to develop a program to provide health coverage to the working poor when their income exceeds the limits set for the Medicaid-funded Oregon Health Plan. The pandemic’s federal emergency measures kept them enrolled in the Oregon Health Plan, but it will lift later this year, forcing the state to look for ways to maintain coverage for people who will be removed.

Here’s a look at health care bills the Legislature passed this session: 

Oregon Health Plan: Lawmakers approved legislation that will allow Oregon to create a so-called “bridge plan” – or Basic Health Plan that would serve Oregonians who are low-income, yet make too much to qualify for the Medicaid-funded Oregon Health Plan. 

House Bill 4035 is a roadmap for the state to develop that plan and also tend to the existing Oregon Health Plan, which serves 1.4 million low-income Oregonians. During the pandemic, the federal emergency declaration forced states, including Oregon, to keep people enrolled in Medicaid programs, even if their income grew beyond the limits of the program. The Oregon Health Plan’s participation during that time grew from 1.1 million people to 1.4 million. Later this year, currently scheduled for April 15, the federal public health emergency will lift. At that point, states will have to start determining who is eligible to remain enrolled and who should be removed.

Health insurance coverage increased among minorities and people of color during the pandemic and officials want to preserve those gains, whether through this bill or other efforts.

“That needs to be the focus moving forward,” Gov. Kate Brown told reporters Friday. “I think the pandemic has taught us that every single person, every single human being deserves access to quality, affordable health care.”

The bill sets the stage for a complex double-pronged process. As the state will determine eligibility for all participants across a 12-month period. During that time, a task force will develop a Basic Health Plan, which would serve Oregonians who make between 138% to 200% of the federal poverty level. For one person, that’s an annual income of $18,754 to $27,180. For a family of four, that range is $38,295 to $55,500. 

Those who make up to 138% of the federal poverty level already qualify for the Oregon Health Plan. 

The new program would serve an estimated 55,000 people of the 300,000 participants in the Oregon Health Plan who likely will lose coverage. 

The complex work will require outreach to people on the Oregon Health Plan and negotiations with the federal government.

Upfront costs for the bill include $120 million in state general funding to cover staffing, marketing and outreach to Oregon Health Plan participants and continue to cover people enrolled in the plan. Those estimated costs, especially for coverage, could change based on factors like the number of participants and how quickly people enroll in the new program.

When factoring in federal matching funding, the program is estimated to cost about $589 million for the rest of the 2021-2023 biennium, according to the bill’s fiscal impact statement.

Nursing workforce: The pandemic burned out nurses, who worked overtime and multiple shifts, covered for sick colleagues and endured stressful conditions as Oregon locked down. 

It also showed the high demand for nurses, as providers struggle to fill openings and have relied on out-of-state providers to fill gaps.

House Bill 4003 will allow nursing students to get an internship license through the Oregon State Board of Nursing, a move intended to open up more opportunities for hands-on training for students working under qualified nurses in clinical settings.

The bill also allows out-of-state nurses to work in Oregon for up to 90 days when providers can’t meet the demand for service and it doesn’t involve a strike. Currently, the limit is 30 days. 

It also provides $500,000 for nurses to participate in a wellness program that offers free counseling services. 

Governor’s Workforce Plan: Gov. Kate Brown’s  workforce development legislation, called Future Ready Oregon, will put $200 million toward training programs and grants for people in underrepresented communities, including people of color and rural regions. 

It includes a variety of sectors, including health care and manufacturing. It’s unknown how much will go directly to health care because the funding will go out in grants to applicants, usually local economic development agencies.

Behavioral health workforce: Behavioral health providers struggle to attract workers as they face low reimbursement rates that keep wages low. House Bill 4004 makes $132 million available in grants to behavioral heath care providers to use for staff recruitment, retention and bonuses. They can use the money to hire more staff, increase wages and boost benefits. The goal is to get money to providers quickly – by May 31. The quick turnaround comes as providers struggle to keep their doors open.

It’s intended to keep providers afloat as work continues on long-term solutions like better reimbursement rates for providers. 

“Across the state, behavioral health providers are struggling to attract and maintain a workforce,” said Sen. Kate Lieber, D-Beaverton, and co-chair of the joint budget committee's subcommittee on human services. “Many workers serve in these roles because of a deep passion for the work, and compassion for their community.  However, that passion is not enough to sustain themselves or their families on current wages, and many are making the heartbreaking decision to leave the field and move to positions where they can make a decent living.” 

Housing For Behavioral Health Needs: Lawmakers put $100 million toward behavioral health residential and housing needs. Sen. Lieber, Senate President Peter Courtney, D-Salem, and Rep. Rob Nosse, D-Portland and chair of the House Behavioral Health Committee, worked on the budget measure.

The move is intended to help local community mental health providers get more resources and prevent people with behavioral health needs from becoming homeless. 

The money comes as Oregon State Hospital, the state-run psychiatric care facility, faces shortages of beds. People ready to exit the hospital cannot return to their communities due to a lack of services. They are forced to remain at the hospital as people in jail who need treatment are forced to wait for openings.

The money can pay for new facilities, expansion in existing programs, short-term needs like cots and immediate needs like food and clothing.

 “Oregonians struggling with mental illness should not end up in a tent along the road,” Courtney said in a statement. “We have to start dealing with homelessness from a mental health approach. This is a remarkable investment. We can make a difference in a person’s life before they end up in the Oregon State Hospital or on the street.”

In response to a reporter’s question, Courtney said Oregon is “behind in so many ways” in mental health. 

“If that works, that will be a major success and housing for the state of Oregon,” Courtney said of the bill.

Oregon lawmakers appropriated about $1 billion for behavioral health needs in the 2021 session. But much of that money has not yet funded any services as the Oregon Health Authority sets up new programs, rules and hires people to oversee the work.

“So many people in our state are hurting or in crisis,” Nosse said. “This funding will give our communities more of the resources they need for people to receive treatment near family and friends.”

Oregon State Hospital: The state hospital’s staffing struggles are such that the Oregon National Guard has provided support services to the facility during the pandemic. Rank-and-file workers, in multiple interviews with The Lund Report, have said they are overworked and in an understaffed situation where a crisis could lead to a tragedy. 

The state-run hospital has a main campus in Salem and a smaller unit in Junction City. The hospital serves more than 500 patients each day. 

State lawmakers appropriated $10.8 million to cover staffing shortfalls and bolster the ranks of permanent staffing. That plan involves 228 positions total. First, it will allow the hospital to convert 134 non-budgeted temporary nursing jobs into permanent full-time positions. Second, it funds 94 new positions, including direct care, clinical and support roles.

Under the plan, the state hospital must submit monthly progress reports to the Legislature about new hires, vacancies and overtime usage.

Mobile health units: Lawmakers approved a pilot program with mobile health units in two separate communities. House Bill 4052 will send teams of health care workers into areas where access to basic primary health care services is lacking. They’ll  hold events with services such as checkups and preventative screenings, with an eye toward improving health care access through other means, such as primary providers.

Grant awards will determine where the program starts. The $2 million pilot program could become a blueprint for a statewide program.

Community violence prevention: Lawmakers put $5 million to provide and expand programs that serve victims of community violence. 

House Bill 4045 puts $1.5 million to increase the capacity of Healing Hurt People, which is a national model run locally through the Portland Opportunities Industrialization Center in partnership with Portland and Gresham police at Legacy Emanuel and Oregon Health & Science University hospitals.

Examples of services include counseling, mentorship, conflict mediation, crisis intervention and referrals to health care and social service providers. The bill also puts  $2.5 million toward grants for other organizations for community violence prevention and intervention efforts.

With the remaining $1 million, the Oregon Health Authority will develop  hospital-based violence intervention and reduction services in communities outside of Multnomah County. The bill also directs the state to seek federal approval for Medicaid coverage for community violence prevention services by Oct. 1.

COVID-19 Response Evaluation: The state will get an after-action report about Oregon’s COVID-19 pandemic response. The report will examine lessons learned, what Oregon did right and shortcomings in the state’s response. The state will hire a consultant for the in-depth report, which will come out in 2023.

Sen. Deb Patterson, D-Salem and chair of the Senate Health Care Committee was one of five chief sponsors of the bill. 

“As we’re working on public health modernization, it’s a good time now to pause and take a look at how we did,” Patterson said.

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

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