This article has been updated with additional information from the Oregon Health Authority.
A state program seeking to curb rising health care costs is hitting a major turning point as officials consider how it will bring companies into compliance with new requirements as well as penalize those that don’t.
Next week an advisory committee will begin drafting regulations for the state’s Sustainable Health Care Cost Growth Target Program. The program aims to keep health care spending per capita from rising above 3.4% each year and was passed in 2019 in response to medical expenses causing hardships for Oregonians.
The program has seen the program’s implementation delayed even as health care costs skyrocketed during the pandemic. The steep inflation helped fuel lawmakers’ decision last year to exempt frontline medical workers’ wages from the target, a move that some feared would significantly undermine the effort.. Now, the Oregon Health Authority has formed a rules advisory committee to tackle regulations to guide the program’s next phase.
Sarah Bartelmann, health authority program manager, told a different advisory committee Tuesday that it has more than 40 members, but didn't mention any names. Since then, health authority posted the committee's roster, which lists a range of executives from the state's largest insurers, health care systems and others. They include Moda Health, Samaritan Health Plans, Providence, Kaiser, Oregon Health & Sciences University and Asante, as well as the Coquille Indian Tribe, SEIU Oregon State Council and others.
A key task for the committee is how the regulations will hold insurers and heath care providers accountable for meeting the target, according to materials posted online. By 2025, the program will begin imposing “performance improvement plans” on companies that don’t meet the target and fining those that remain out of compliance by 2027.
The program allows companies to avoid penalties if costs rose for “good reasons,” including changes in mandates, taxes, natural disasters and others. The committee will consider what are reasonable justifications for missing the target.
The committee will have four meetings with its last in April. Its input on the rules is advisory and not binding on the health authority. After the rules are drafted, they will go for a hearing in May.
The Cost Growth Target Advisory Committee, the program’s governance committee, is also looking for a consumer advocate or representative. More information can be found on the health authority’s website.