Oregon Health Authority officials plan to ask the Legislature to pass bills to set up a state-based insurance marketplace, give Medicaid recipients more say over the program, reduce the logjam at the state hospital and more.
The agency has drafted two dozen “legislative concepts,” which are early versions of bills that will be submitted to lawmakers when they gather in Salem in January. It’s also prepared $4.2 billion in additional funding requests, notably $286 million to modernize Oregon’s public health system and $269 million to expand the state’s behavioral health services.
Jeff Scroggin, the health authority’s interim director of government relations, gave the Oregon Health Policy Board an overview of the agency’s legislative priorities Tuesday morning.
Scroggin noted that Governor-elect Tina Kotek will be sworn in next month and said that the health authority has yet to receive information on her health care priorities. But Scroggin pointed to Kotek’s goals listed on her campaign website of addressing racism in the health care system and improving behavioral health.
“I think that our agenda is in pretty good shape for the governor-elect,” Scroggin said. “I think a lot of the priorities that I just shared are aligned with the agency’s priorities.”
Oregon’s Own Health Insurance Market
Among Oregon Health Authority’s more expansive proposals is legislation creating the state’s own health insurance marketplace where Oregonians can shop for federally subsidized plans. Oregon is currently among 33 states that rely on the federal marketplace, with 18 states and the District of Columbia using their own insurance exchanges.
Oregon officials had been reluctant to push for a state-based exchange after Cover Oregon failed to function after its launch in 2014, despite costing $300 million. Since then, the shadow of Cover Oregon has faded and technology has improved.
The state agency now says a state-based exchange would give it better data and control over its market, allowing it to extend enrollment periods or customize efforts to enroll disproportionately uninsured populations. Oregon could operate the marketplace used by about 320,000 residents for an estimated $10 million annually, half of what it pays to connect to the federal marketplace, according to a health authority document.
“This is a good idea; we have to do this,” state Rep. Rob Nosse, a Portland Democrat who chairs the House Health Care Committee, told The Lund Report.
Nosse said he’s confident the state can overcome any technological hurdles, adding that if it doesn’t, “At least when IT goes bad with the government, you find out about it.”
State Hospital
The Oregon Health Authority is pursuing legislative changes in response to recommendations from a court-appointed expert on how to streamline treatment of Oregon State Hospital patients. The Salem-based psychiatric hospital has been the subject of ongoing litigation over delays in admitting patients accused of crimes who’ve remained stuck in county jails waiting treatment.
The legislation would require the Oregon State Hospital to more frequently submit to courts evaluations of patients being treated so they can aid and assist in their own defense. It also sets a timeframe for the hospital to restore competency for patients depending on the severity of their offense, ranging from 90 days for a misdemeanor to one year for a violent felony.
The proposal will improve the timely transfer of patients to the state hospital, Emily Cooper, legal director for Disability Rights Oregon, told The Lund Report in an email. She said the increased evaluations will identify patients ready to be released and the timeframes “are rooted in sound clinical data and will make sure the finite hospital beds are being held only for patients who need them.”
The health authority is also asking for $50 million to support the hospital’s staffing plan.
More Medicaid Changes
The Oregon Health Authority will ask lawmakers to sign off on its plans for a new committee that will guide the priorities of the state’s coordinated care organizations, which are responsible for serving Oregonians enrolled in the Medicaid-funded Oregon Health Plan. Oregon’s unique Medicaid system operates a recently reauthorized federal waiver that gives coordinated care organizations financial incentives for measurable improvements in enrollees’ health.
The legislation requested by the agency would create a new Health Equity Quality Metrics Committee to oversee the incentive structure. Two-thirds of the new committee’s members would be Medicaid recipients, community members and health equity experts. The remaining seats would come from coordinated care organizations and providers.
Plans for the new committee have been discussed at length inside the agency and in public meetings. The Lund Report has reached out to CCO Oregon, the association of coordinated care organizations, for comment.
Among its other bills, the health authority is seeking to block data on individuals’ race, ethnicity, sexual orientation, gender identity and other sensitive information from being released through public records requests. The authority said in a document that the legislative change is needed to prevent individuals who respond to its questionnaires from being exposed to “racism, disablism, linguistic discrimination, transphobia, homophobia and heterosexism.”
Shielding the information from disclosure will mean better data because individuals will feel more comfortable providing information, according to health authority documents. The legislative proposal would still allow data to be released in aggregated form that doesn't identify individuals.
Under another legislative proposal, the agency would be allowed to compensate Oregonians who serve on volunteer advisory committees that help the agency write policy. The authority worries that Oregonians may shy away from serving on these committees if they have to take time off of work, or shoulder the cost of transportation or child care to participate. That could mean the authority is less likely to hear from disadvantaged groups it’s trying to help.
Pharmacy Vaccines, Dental Pilots and Others
Other legislation the health authority is seeking would allow children 6 months of age to be vaccinated against the flu at pharmacies, ban the sale of flavored tobacco products and mandate insurers pay for behavioral health crisis services. Another bill would remove the residency requirement of Oregon’s Death With Dignity law in response to a lawsuit settled earlier this year.
The agency is also seeking to remove the sunset date for its Dental Pilot Project Program that allows communities to carry out monitored projects aimed at expanding training for oral health positions. The agency points to how an earlier pilot led to the creation of dental therapists, a new position authorized to fill minor cavities and perform simple extractions but is not a licensed dentist.
Nosse said addressing Oregon’s shortage of health care workers will be a key focus of the session, and the development of dental therapists has helped with the lack of dentists.
You can reach Jake at [email protected] or via Twitter @jakethomas2009.
How sad. Not one word about the Oregon Universal Health Plan as recommended by the Task Force for Universal Healthcare.