Children’s health advocates and lawmakers were confident the Legislature would support the expansion of school-based health centers this year after legislative leaders declared that fighting the fentanyl addiction crisis was a priority this session.
These health centers provide a wide range of services, from treating sore throats to preventing suicide. They often play a crucial role in steering troubled youth away from drugs and addiction, avoiding expensive stays later in life in jail or residential treatment facilities, experts say.
House Bill 4070 would have put nearly $18 million toward the expansion of school health centers, with $7.8 million for mental health and addiction programs and another $10 million for new health centers.
That’s just a fraction of the $211 million lawmakers approved for drug treatment, court programs and related services that would largely benefit adults. But the bill for children quietly died this week, confounding advocates and disappointing lawmakers, including Rep. Maxine Dexter, D-Portland, and the bill’s chief sponsor.
“In a situation where you don’t have enough resources, there’s always going to be hard decisions,” Dexter, also a physician, said in an interview with the Capital Chronicle. “But the values that I heard us talking about were prioritizing the health and safety of our youth and trying to prevent addiction. And I don’t see that our values are being supported with our actions.”
Medical providers, often federally backed health centers that serve low-income people, set up the clinics in schools and they work with students, often on Medicaid. The clinics provide a variety of services, from physicals and treatment for minor injuries to drug and alcohol counseling.
They’re relatively rare in Oregon, existing in 87 schools statewide, about 7% of the approximately 1,200 schools in Oregon, state data show. But the ones that do exist are heavily used. In the 2021-2022 school year, about 40,000 students visited the clinics.
House Bill 4070 only had one hearing – in the House Behavioral Health and Health Care Committee – in mid-February. The committee approved it nearly unanimously, 10-1, with one Republican voting against it. It was sent to the Joint Ways and Means Committee, which decides how Oregon spends money.
And there it stayed, like a dusty folder on a shelf.
It would have paid for up to 10 more clinics in schools, helped others expand and provided more mental health and addiction-related services.
“We thought that it would be a straightforward ask this session – that we clearly need investments in school-based health centers,” Dexter said. “Honestly, I was really surprised that that wasn’t something prioritized.”
Critics said lawmakers failed students in school.
“We had a wonderful opportunity to make progress and now it appears that we won’t be able to do that,” said Doug Riggs, a lobbyist for the Oregon School-Based Health Alliance, a nonprofit that advocates for the health centers.
On the House floor on Wednesday afternoon, Dexter criticized the Legislature’s inaction, noting that suicide is the second leading cause of death for young people ages 5 to 24. Nearly 100 youth in Oregon died of suicide in 2021, Oregon Health Authority data show. Oregon also repeatedly ranks at or near the bottom of states in access to mental health and addiction treatment in national studies.
“I wish this session was a standout – a blip,” Dexter said. “However, we have a history of leaving our students behind when we make hard funding decisions. … We have made huge investments this session in treatment for adults, but we have underinvested in the prevention and treatment that our students need.”
Health authority gets involved
The bill would have spurred new spending in the middle of the state’s two-year budget cycle, something lawmakers said was a problem, even though they approved funding for other services.
“As we’re in the middle of a biennium, we prioritized one-time investments and right-sizing ongoing programs rather than new spending to limit rollup,” Hazel Tylinski, spokesperson for House Speaker Dan Rayfield, said in an email.
The Oregon Health Authority also played a role in the bill’s demise by trying to make last-minute changes that created confusion, according to Riggs. He said he wishes the Oregon Health Authority had supported the bill as it was.
“I was very disappointed that the Oregon Health Authority was not willing to step up right from the very beginning and say, ‘This is a great idea. It needs to pass immediately and we’re 100% behind it.’”
Robb Cowie, a spokesman for the Oregon Health Authority, said the agency had concerns that the funding would have been for one year only and that that would have made it hard for health centers to make long-term plans about operations and staffing.
The authority, with Dexter’s support, worked on an amendment to address that, Cowie said.
“OHA is committed to continuing to work with legislators and partners to expand the school-based health center model including expanding access for school-based mental health services across Oregon,” Cowie said.
In the 2023 session, a similar proposal would have put more money into school-based health centers at the start of the two-year budget. But it died amid the Republican-led walkout in the Senate.
Since then, the move for school-based health centers has generated widespread support among education and health care groups.
Now, advocates say immediate relief is necessary.
“One year of funding is better than no funding given what we have right now,” said Maureen Hinman, executive director of the Oregon School-Based Health Alliance. “I just think we need whatever we can get right now. Because we are in such a crisis.”
Dexter agreed.
“I still would say that not funding school-based health centers now is a mistake,” Dexter said. “It’s not strategic. It doesn’t show that we understand that prevention leads to future savings.”
Even amid the bill’s death, other lawmakers insist the state remains focused on youth addiction and behavioral health. For example, House Bill 4002, the omnibus addiction package, directs the Alcohol and Drug Policy Commission to conduct a study of youth opioid addiction treatment and how to increase access to medication and providers. The commission is required to complete a strategic plan by September 2025.
“There’s been a lot of talk about youth addiction issues,” Riggs said. “But all the money seems to be focused into having some commission filled with adults studying the issue instead of putting existing money into immediate – right now – programs that get kids at an important time in their life.”
So once again a solution is to create a committee. How about doing everything possible to be sure this passes next session?