This story has been updated with additional reporting.
In two weeks the health care committees in the Oregon Legislature will be flooded with bills concerning myriad issues such as prescription drugs, insurance requirements and more.
As in previous sessions, lawmakers are expected to try to address the state’s behavioral health care staffing shortages while trying to improve access for people covered by the low-income Oregon Health Plan.
Formal bills won’t be introduced until Jan. 13. But the Legislature this year is likely to address priorities that include hospital costs, corporate influence on the practice of medicine, and safety at behavioral health facilities, lawmakers said Tuesday. The remarks came at a legislative preview hosted by the Oregon Health Forum, an independent affiliate of The Lund Report.
Complicating the Legislature’s work on health care is uncertainty around the state budget, where other priorities such as transportation are expected to compete for limited resources. Not only that, but many expect the incoming Trump administration to make cuts and changes to federally funded programs.
Behavioral health workforce
In recent years, Oregon lawmakers have poured money into building more beds and facilities in order to address the state’s behavioral health crisis.
But there remains the challenge of training more counselors, social workers and other mental health professionals to staff the facilities and meet the need for services.
State Rep. Rob Nosse, a Portland Democrat who chairs the House health committee, predicted that lawmakers will approve more money on loan forgiveness, reduced tuition and fee waivers to help boost the state’s behavioral health workforce. But, he said, “it’s expensive.”
He added, “I’m a little suspect that we’ll do as much as we need to.”
State Rep. Travis Nelson, a Portland Democrat and nurse, said that difficult working conditions of behavioral health and health care workers also need to be addressed.
“We are in a working conditions crisis,” he said. “I think that both nurses and behavioral health workers go into their professions often thinking the working conditions will be one way and they end up being another.”
Nelson chaired a legislative task force that recently finalized recommendations to improve the safety of behavioral health workers. The recommendations include more safety training for employees and planning to keep workers from harm.
Nelson said he would also back a bill that will protect workers from retaliation if they complain.
Work remains on behavioral health
Despite increased spending on behavioral health in recent years, state-commissioned studies have found Oregon still needs hundreds of more beds to meet the need. On Tuesday, advocacy group Disability Rights Oregon filed a contempt motion seeking to force the Oregon Health Authority to increase spending on behavioral health.
One thing lawmakers could do to improve the situation is adding more care settings that are “not quite a hospital, but more than outpatient,” said Nosse.
Those settings could include residential treatment facilities for mental health as well as alcohol and drug addiction treatment. By the end of the year, Oregon is expected to add another 365 beds. However, a consulting company hired by the state found Oregon will need roughly 3,700 beds.
“When we’re talking about mental health we also have to talk about the kids and not forget about them,” state Sen. Deb Patterson, a Salem Democrat who chairs the Senate Health Care Committee, said.
Patterson said she will introduce a bill increasing funding for school-based health centers, which provide primary care services to students and are increasingly providing care for behavioral and mental health issues.
Additionally, Patterson said she was also looking at how to increase the number of psychiatric beds for youth, as well as safety net clinics that combine behavioral health with primary care.
The state also needs to spend more on prevention and providing support early on for youth who have mental health challenges. But she added that work on behavioral health will continue beyond 2025.
“I don’t think we’re going to turn this whole boat around in one legislative session,” she said.
Boarding bill
Since the pandemic Oregon hospitals have complained of growth in “boarding.” That’s when they must house patients who are ready for release but can’t be discharged because they still need care at facilities that don’t have room for them. That in turn creates significant costs for the hospitals, many of which continue to report losses.
Patterson, the Senate health care committee chair, said the individuals being boarded are often unsheltered or have complex medical and behavioral issues. So they are not easy to place in nursing or other facilities.
“We are in a working conditions crisis. I think that both nurses and behavioral health workers go into their professions often thinking the working conditions will be one way and they end up being another.”
A task force has finalized its recommendations on patient boarding. Patterson said she will introduce a bill to address hospital discharge challenges and create more settings for patients to recover.
Unclear if lawmakers will address primary care crisis
Patients in Oregon struggle to access primary care and providers face low reimbursements, despite studies indicating family medicine saves money.
Nosse said some bills will seek to improve primary care rates for the low-income Medicaid program.
“I don’t know if they will land,” he said, adding that they will cost the state money.
Another challenge, he said, is how the legislation would direct coordinated care organizations, regional Medicaid insurers, on how to compensate for care.
Previously, lawmakers passed a bill mandating that commercial health insurers and coordinated care organizations allocate at least 12% of expenditures to primary care. But Nosse said it’s hard to tell how well that has worked.
Complicating the picture are potential federal cuts to Medicaid spending under the new administration.
State Rep. Cyrus Javadi, R-Tillamook, said that should be a key part of the conversation about Medicaid rates in Oregon. Providers who serve large numbers of people covered by the Medicaid-funded Oregon Health Plan could see significant reductions already and will be wondering about their practice long term, he said.
Raising Medicaid reimbursements remains uncertain
Currently, 1.4 million Oregonians — a third of the state — are enrolled in the Medicaid-funded Oregon Health Plan. The plan pays less than commercial insurance, which adds to financial difficulties for providers and barriers for people covered by it.
Gov. Tina Kotek’s proposed two-year budget includes $35 million to increase the Oregon Health Plan’s hospital maternity rates. But the programs's very low reimbursement rates have sparked concerns in not just primary care but behavioral health, dental care and more.
When asked if the state could fund larger increases on a larger scale , state Sen. Wlnsvey Campos, D-Aloha — who is chair of the Human Services Subcommittee of the Joint Ways and Means Committee — said the state is in a “wait and see sort of situation.” At another point, she noted that there are limited funds available and a clearer budget picture wouldn't be known until later in the session.
Considering that the Medicaid-funded Oregon Health Plan covers nearly half of all births in the state, Nosse said the plan needs to pay more so that hospital maternity wards can cover their expenses.
Kotek’s budget also calls for extending a hospital and provider tax. As part of negotiations over the tax, Nosse said he expects hospitals to demand better Medicaid reimbursements for maternity services, as well as behavioral health and psychiatric care.
As state officials contemplate potential cuts in federal funding, some Oregon Health Plan contractors want them to reconsider their plans for a longtime state program used to limit program spending to services deemed cost-effective and supported by evidence and research. They say the program, known as the prioritized list, takes rationing decisions that are already happening in U.S. health care coverage and makes them impartial and subject to public input at hearings.
The Biden administration had questioned how the program is structured, which had former Gov. Kate Brown's health care officials planning to restructure the list but not eliminate it.
Under the Kotek administration, the Oregon Health Authority's leadership has said they're going to end the program and replace it with a program similar to what other states do, evaluating groups of benefits rather than a list of specific health care procedures and services.
Asked about the debate, Nosse said, "that's going to be a conversa-there are bills about that in my committee.”
A draft bill released last month would establish a task force.
Push to curb corporate medicine returns
A high-profile push to limit the role of corporations and private equity in health care is expected to return in the upcoming session.
Despite bipartisan support last year, a bill spearheaded by Rep. Ben Bowman of Tigard suddenly died after passing the House in last year’s short session. Now the House Majority Leader, Bowman has worked to revise it with input from a work group of providers, businesses and others.
Last year, Patterson said, “it was really hard for that bill to get a full hearing in the short session.” But she described the bill as being in a “very different place” this year.
“I think it has a real shot of coming of passing because of the hard work that’s been done to include everyone,” she said.
Clinics serving a high % of Medicaid patients already struggle to keep doors open and their staff employed. It's time to eliminate the CAT tax on public payer money to help lessen the financial burden on these practices before they close their doors and fewer providers are available to serve this vulnerable population.