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Oregon Health Policy Makers Navigate Fast-Changing Political Landscape

With Congress debating a replacement for the Affordable Care Act and the state Legislature mulling dozens of health-related bills, state healthcare policy is almost certain to change.
May 3, 2017

Policymakers who are trying to guide Oregon’s continuing healthcare transformation aren’t just sailing in uncharted waters – they’re navigating currents that seem to be changing as they work to keep the ship afloat.

The Oregon Health Policy Board, which makes policies and oversees the Oregon Health Authority, was briefed Tuesday on the continuing push to overhaul or replace the Affordable Care Act, as well as major legislative initiatives out of Salem that could affect the health authority’s work if passed.

Renewed Federal Health Reform Push Creates Uncertainty for Oregon

A vote on repealing Obamacare could come as soon as Thursday from Washington, D.C., said Leslie Clement, health policy and analytics director at the Oregon Health Authority.

“Sausage making is probably a good description of what’s happening at the federal level,” Clement told the board. “We just don’t have anything that’s baked or cooked at this point. There are some dangerous ingredients being discussed that are significant policy changes from the historical basis with which Medicaid has been funded.”

Congressional leaders appear to be looking to set per capita Medicaid funding caps, and to be looking at a significant shift from federal funding to increased state responsibility. But with negotiations under way and proposals shifting quickly, the health authority has not got a solid handle on what changes might get passed, she said.

Lynne Saxton, director of the Oregon Health Authority, noted that the agency is working with state legislators to develop a budget that may need to be completely overhauled, if Congress repeals and replaces the ACA.

“The current budget work we are doing and will be doing for the next 10 weeks is based on the status quo,” Saxton said. “Some of the proposals at the federal level would require us to go back into budgeting for Oregon.”

Despite Federal Uncertainty, State Efforts Continue

Beth Anne Darby, external relations director for the health authority, briefed the health policy board on pending Oregon legislation that could affect its work in the future.

“We’re at the fun part of the session, things are getting a lot more serious,” Darby said. “There were previously 2,789 bills, we are now down to 1,572. OHA was tracking 738 bills originally. We’re down to 406, with 116 of those Priority 1 bills. About a third of those have been assigned to Ways and Means, which means either they won’t see the light of day again, or they will come out at the last minute and make us all scurry around.”

House Bill 2122, which The Lund Report has covered extensively, would overhaul the rules governing coordinated care organizations. Backed by Rep. Mitch Greenlick, D-Portland, it would require CCOs to hold public meetings, boost financial accountability, and require new CCOs to be community-based tax-exempt organizations.

HB 2122 passed out of the House Health Care Committee, and has since been routed to the House Rules Committee, where it’s scheduled for a hearing May 4. Darby said she expects several amendments to be proposed at that time, including one that would allow new CCOs to organize B Corporations – for-profits that meet high standards for social responsibility, and another amendment that would direct the health authority to write detailed financial accountability rules for CCOs.

House Bill 3428, which would enroll public workers covered by Public Employees Benefit Board or Oregon Educators Benefit Board health plans into CCOs, has moved to House Rules, and Republicans are working hard to analyze the legislation’s fiscal implications, with support from the health authority, Darby said.

Darby is also tracking two Senate bills – SB 233 and SB 234 – that have been sent to the Ways and Means Committee. The first affects rate-setting and transparency rules, while the other relates to CCO contracts.

“Sending them to Ways and Means suggests they are looking for some more time to see how other pieces of legislation intersect,” she said. “We appreciate that move to have coordinated policy, rather than one-offs.”

Darby also noted that much of the progress that has been made in the Legislature so far this session is likely to be shaken up on May 16, when the next state revenue forecast is due out.

“The May revenue forecast will set the stage for the next round of negotiation,” she said.

State law requires the legislative session to conclude by July 10.

Reach Courtney Sherwood at [email protected].