The next Oregon Legislature will likely take up bills to boost the state’s health care workforce, free up hospital beds, ban flavored tobacco and increase reimbursements for naturopathic physicians as well as retail pharmacies, key lawmakers said Wednesday.
And while lawmakers have approved more than $1.5 billion since 2021 to plug gaps in the state’s behavioral health care system, state Rep. Rob Nosse, a Portland Democrat who chairs the House Committee on Behavioral Health and Health Care, summarized his goals for behavioral health in the 2025 session with one word: “more.”
“It’s more providers, more facilities with more beds, more money to pay people and more money for schooling and education so we create opportunities to get more people to get into these professions,” he said.
The panel discussion occurred before an audience of close to 400 at a conference organized at the Salem Convention center by CCO Oregon, a non profit association with members that include a variety of provider organizations and what are known as coordinated care organizations. Known as CCOs, the regional insurer-like entities contract with the state to oversee care for 1.4 million low-income people covered by the Oregon Health Plan.
Behavioral health needs remain
Nosse alluded to studies that have ranked Oregon poorly for access to mental health and substance use treatment services.
Despite recent increases in spending, a state-hired consultant found earlier this year that Oregon still faced a shortage of treatment beds. Another report found the state needs to spend about $170 million annually over the next five years to meet the expected behavioral health bed needs.
Several areas of health care are suffering from shortages of workers. State Rep. Cyrus Javadi, R-Tillamook, called for more tax credits, loan repayments and other programs to “widen the pipe.”
Javadi, a dentist who runs a practice in Tillamook, said that it’s been difficult to find staff in rural Oregon since the pandemic.
“It’s very frustrating to not have a pool of people who are qualified or interested,” he said. “And if you do find someone who happens to be interested, they may not be qualified. So how do you get them trained?”
Javadi called for increasing reimbursement rates for providers who take the Oregon Health Plan so they have more money to offer prospective employees.
State Rep. Hai Pham, a pediatric dentist and Hillsboro Democrat, said he’s heard from providers who say the Oregon Health Plan reimbursement rates are not keeping up with expenses.
“And then the patients are more acute, more sick as they’re coming in and taking a lot more work and time to get these patients back to health,” he said. “So what I propose is we need to look at how we determine these rates.”
Pham, who serves on a state board on workforce development, said that a problem for some health care workers is that there is not room for advancement. He said the board is looking into creating a system where they can more easily train up, such as a medical assistant becoming a nurse.
Nosse said he would also like to see higher rates. But he would need to get them past legislative leaders and the co-chairs of the state’s budget writing committee.
State Rep. Travis Nelson, a Portland Democrat who serves as vice-chair of the House Committee on Behavioral Health and Health Care said the problem is not just pay.
“I think a big part of the reason why we’re in the crisis we’re in on the behavioral health side is because we haven’t taken care of the people who actually do the work,” he said. “We haven’t treated them with the dignity and the respect that they deserve.”
During last year’s session, Nelson unsuccessfully sponsored legislation that would increase the criminal penalty for assaulting hospital employees. However, the bill stalled after opponents raised concerns it would ensnare people with disabilities or those in a mental health crisis.
Nelson is chairing a task force related to preventing workplace violence facing behavioral health care workers. He did not have specifics, but said he expects the task force will have recommendations that will become legislation.
Javadi said his district was a “real desert” when it came to behavioral health care.
“We need to look closely at rural areas as well as urban to see what we can do to incentivize the development and placement of facilities and providers in those regions,” he said.
A legislative task force is finalizing its recommendations for helping patients who do not need hospital-level care but cannot be discharged from the hospital because they still need a lower-level of care at a skilled nursing facility or some other setting. Many patients stuck in this situation have behavioral health needs, Nosse said. Freeing up hospital beds will enable nurses to focus on patients who are receiving care.
Other bills, ideas floated
Pham also said he hopes to float a bill to ease state requirements that the regional care organizations serving the Oregon Health Plan maintain hefty reserves to cover their risks and liabilities. Instead, he wants the groups “to reinvest those dollars back into their communities.”
State Rep. Lisa Reynolds, D-Portland, who chairs the House Committee on Early Childhood and Human Services, said she would introduce a bill to ban flavored tobacco products.
Tobacco companies are using the flavors to “hook” Oregon kids “into being lifelong tobacco customers,” she said. “It's a really nefarious scheme, and we're looking to put an end to it.”
Nosse said he is working on a bill to further regulate pharmacy benefit managers to increase reimbursement for local pharmacists who say the drug supply middlemen are squeezing them out of business.
He said he has 22 bills teed up to tackle the care organizations serving the Oregon Health Plan, such as by addressing a rule that requires 85 percent of their spending go toward care. Also, he will carry a bill to ensure equal pay for naturopathic physicians who are doing the same work as a physician with a more traditional background.
Reynolds added that she hopes the Legislature can find time to step back and take a longer-term look at agencies like the Oregon Health Authority, rather than just looking at needs every two years in connection with the state budget.
“Why don't we, at some point, take a super deep dive on what is going well in this agency. What is not going well?” she said. “Are there things, are there programs we can check? Are there programs we need to shore up? We don't have those deep conversations.
“I think we need some long-term goals,” she added. “I think we need to get bolder.”
I watched with interest the CCO of Oregon meeting on Wednesday. Being a dentist with long interest and history with all things Medicaid dental, I have to say as long as we have a system that treats the results of the dental infection rather than the infection, more money will be needed as both Dr. Javadi and Pham stated. If we start applying the new systems and medications that we now have that act like a vaccine and not only stop the cavity but also the disease going forward, I do not believe more money will be needed.
Mike Shirtcliff DMD