Oregon lawmakers are considering a bill that will give them more information on how proposed insurance coverage mandates would affect patient access and health care costs.
House Bill 4091 would establish the Health Insurance Mandate Review Advisory Committee, a six-member panel tasked with answering key questions about how proposed insurance requirements would play out.
The bipartisan bill comes as lawmakers have proposed over 20 new health care mandates since 2021 after hearing Oregonians’ stories about struggling to get their health insurance to pay for treatments for serious ailments. Lawmakers have approved some of these mandates without clear information on whether they’ll increase premiums or how well the treatment they’re requiring work.
During the 2023 session, lawmakers passed mandates on proton beam therapy for cancer, drugs that prevent HIV infection, a treatment for pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections, breast examinations and hearing devices. Other mandates that lawmakers didn’t pass included those related to glucose monitoring and donated human breast milk for infants.
“As part of my decision making process, I attempted to weigh the value of the benefits to the proponents with the cost to the system and to the people,” state Rep. Charlie Conrad, a Dexter Republican and bill cosponsor, told the House health care committee Monday. “As I did so, I realized that I either lacked or had insufficient information and details regarding the ultimate impact of our decisions on the people.”
State Rep. Hai Pham, a Hillsboro Democrat and the bill’s cosponsor, told the committee that the commission wouldn’t make recommendations but would help lawmakers “eliminate disparities and gaps in health care coverage and to increase transparency.”
The commission the bill would set up would include members representing health insurance interests, consumers, health equity advocates and an expert on rural health care. Legislative staff would provide support to the commission, which would be a pilot program that would sunset in June 2027.
The commission would be tasked with answering questions about proposed health insurance mandates. Those include whether there’s evidence supporting the medical need for a treatment and how many people would be affected by the mandate, as well as whether it would mean equitable access, and how many patients experience financial hardship without it. The commission will also look into whether the mandate is expected to increase or decrease the cost of services, particularly in rural areas.
No one testified against the bill at the hearing or posted testimony online opposing it. Lobbyists for insurers back the measure. Thirty-two other states currently have a process to study proposed mandates, according to testimony from Mary Anne Cooper, director of public affairs and government relations for Cambia Health Solutions.
“We talk a lot about how mandates could actually save the state money overall,” Rick Blackwell, the director of Oregon government relations for PacificSource Health Plans, told lawmakers. “It’s hard to really quantify that in the process we have now.”
Tom Holt, lobbyist for the Oregon chapter of the National Association of Benefits and Insurance Professionals, described to the Oregon House Behavioral Health and Health Care Committee a common scenario that precipitates a new mandate: An insurer hears from a company that they insure that an employee has complained to HR that they thought they had a good health plan, but found out it doesn’t cover a certain treatment.
Holt said that complaint will then make its way to lawmakers who have to “play some combination of medical director to figure out if that thing is evidence-based medicine and insurance commissioner to figure out what it costs.”
“It’s a hard set of problems,” he said.
In the early 2000s when I was managing benefits for a Portland based corporation I testified before the Oregon Legislature on this issue - noting that a proposed mandate would increase our per capita insurance costs by approximately 1% per month when per household monthly premiums were about $1000 - which would add about $10 per household per month. Today that effect would be perhaps $25 per household per month.
Since the majority of employer sponsored plans and multiemployer union plans like the one I currently manage are ERISA self insured plans and to some extent can ignore state mandates, it is problematic for multistate employers to deal with different mandates in different states and offer a plan with uniform benefits. The plan I manage now has significant numbers in seven states and individuals in another dozen states (mainly college students) we run into issues regarding different state mandates.
So the idea of having a governmental body to review the issue of mandates and costs makes a lot of sense.