When Oregon lawmakers start the short five-week legislative session on Feb. 1, they will face a wide array of health care challenges nearly two years into a global pandemic.
Oregon’s health care workforce and its hospitals are strained amid the surge of COVID-19 cases. It’s increasingly hard for hospitals to find workers like nurses and other professionals to treat people.
The behavioral health care system in Oregon is equally burdened. Providers face challenges in recruiting people, and low reimbursement rates can make it difficult for providers to pay competitive wages, especially for entry-level workers.
The Oregon Health Authority wants money to beef up staffing at Oregon State Hospital, the state-run residential psychiatric facility.
The state’s enrollment of people on the Medicaid-funded Oregon Health Plan has swelled during the pandemic to nearly 1.4 million people.
Here’s a rundown of top health care issues for the Oregon Legislature, along with bills intended to address them:
Health care workforce: Rep. Rachel Prusak, chair of the House Committee on Health Care, will pursue a bill intended to bolster the state’s health care workforce of nurses in hospitals, long-term care facilities and other settings. The move comes as hospitals have been forced to rely upon contracted out-of-state traveling nurses and other health care workers during the COVID-19 surge.
“Several of the short-term solutions can be and must be addressed now,” said Prusak, D-Tualatin/West Linn and a nurse practitioner. She said the bill is the product of a workgroup that included nursing advocacy groups, hospitals, long-term care organizations and policy experts.
The bill directs the Oregon State Board of Nursing to issue a nurse internship license to qualified nursing students. The goal is to get them in the field where they can gain clinical experience and work under experienced nurses.
The bill also makes it easier for out-of-state nurses to work in Oregon, letting them stay for 90 days and work anywhere a nurse is needed, not just in critical care units for 30 days as is the current rule. This would not apply to situations that involve labor disputes, such as strikes. The 30-day limit is currently waived due to the COVID-19 emergency. The goal behind the change is to encourage nurses to seek a permanent Oregon license and stay long-term.
The bill also provides funding for the state nursing board to participate in a wellness program that would provide free counseling services to nurses. Stress and burnout have hit the workforce hard, highlighting the need for nurses to have a support system in place to deal with crises.
Anger, burnout and trauma have dealt a severe blow to the workforce as the pandemic continues.
“These challenges have had a profound impact on our health care delivery system that will be felt for yours to come,” Andi Easton, a lobbyist with the Oregon Association of Hospitals and Health Systems, told the House Interim Committee on Health Care in a hearing last week.
The bill establishes an advisory group to bring back long-term solutions in the future.
Access to care: Prusak is working on a bill that would provide coverage for people when they are kicked off the Medicaid-funded Oregon Health Plan. The move comes after a nearly two-year pandemic, during which federal officials temporarily paused the process of regularly checking the eligibility of people to participate in the plan, which is for low-income households. During the pandemic, Oregon Health Plan enrollment grew from 1.1 million to nearly 1.4 million Oregonians.
Prusak’s bill is intended to move the state closer to offering a so-called “public option,” which essentially is a state-sponsored insurance plan for people who lack or can’t afford commercial health insurance coverage and don’t qualify for Medicaid or Medicare.
Primary care: Prusak said she’s bringing back a bill that removes the cost share of three annual patient visits to primary care and behavioral health care. House Bill 3108 died in the 2021 session in the joint budget committee.
Prusak said the bill’s real focus is to promote access to health care, not just coverage. She said she’s confident it will pass this year.
COVID-19 After-Action Report: Lawmakers want to analyze Oregon’s response to the COVID-19 pandemic and study what worked and what could have gone better. Sen. Elizabeth Steiner Hayward, D-Northwest Portland/Beaverton, is sponsoring a bill that would direct the Oregon Health Authority to hire a consultant to prepare a series of three reports, culminating in an “after-action report.” The first preliminary report would be due Nov. 15 and identify areas of the public health system that needed improvement and make recommendations. The next reports would come out April 1, 2023, with a final comprehensive report due by Sept. 1, 2023. They would look at the roles of hospitals, long-term care facilities and other community organizations that aid public health.
Steiner Hayward said the work is crucial as the state works on modernizing its public health system.
“There is no greater opportunity to learn about what’s working well and what could be working better than looking carefully at how we handled the pandemic,” Steiner Hayward said in a recent hearing.
The bill was developed with input from counties, public health officials and the Oregon Health Authority.
Behavioral Health Funding: Behavioral health providers are squeezed. They struggle to find workers and have been forced to cut back on programs and services amid staffing shortages, even as demand has increased during the pandemic. Lawmakers want to make more funding available so providers are better-positioned to recruit and retain workers. Rep. Rob Nosse, D-Portland and chair of the joint budget committee’s subcommittee for human services, and Rep. Tawna Sanchez, D-North/NE Portland and chair of the House Committee on Behavioral Health, are working on a bill that would make money available to behavioral health providers to increase staff pay and for recruitment and retention incentives, such as bonuses or child-care stipends.
The exact amount isn’t known yet, but Nosse said he expects it will be well over $100 million. The funding will serve as a stop-gap to tide providers over while the state tackles long-term solutions for issues like provider rates.
Oregon State Hospital Staffing: Lawmakers will take up a request from the Oregon Health Authority to bolster staffing at Oregon State Hospital. The state hospital has been plagued with staffing shortages and recruitment challenges. The health authority’s plan asks for $33.5 million in state funding for the remainder of the 2021-2023 budget cycle to establish nearly 500 positions, most of them in direct care. The plan would cost an estimated $63.3 million in the 2023-2025 budget cycle.
The hospital has the capacity to serve up to 742 patients at its main campus in Salem and its satellite campus in Junction City. Its current budget of $726.2 million supports 2,425 positions.
The plan also calls for incentives to keep and recruit staff, such as 36-hour workweeks for nurses and better pension benefits.
The health authority’s plan comes at the direction of lawmakers, who asked state officials in the 2021 to draw up a proposal to adequately staff the state hospital.
Traumatic Brain Injury Support: The Senate Health Care Committee will take up a bill that provides more support to people with traumatic brain injuries. The bill directs the Oregon Department of Human Services to coordinate services, including counseling, skills training and advocacy for people with traumatic brain injuries.
“It’s to help them navigate what’s already out there,” Sen. Deb Patterson, D-Salem and the committee chair, said in an interview.
Fertility Treatments: Another bill in the Senate committee would require health benefit plans to cover fertility and reproductive endocrinology services. This would apply to plans on or after Jan. 1, 2023. The bill would require the fertility treatments to be provided to the same extent as other pregnancy-related health services. Religious insurers would be eligible for an exemption if fertility treatments run contrary to their religious beliefs. The bill also directs the Oregon Health Authority to study inequities in assisted reproduction services for people who are lesbian, gay, bisexual, transgender, queer or members of other minority gender identities or sexual orientations. That report would be due by Jan. 31, 2025.
Nick Budnick contributed to this report.