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Stacks of health care bills in limbo as stances harden in Salem

They include legislation impacting Measure 110, hospital staffing levels, the opioid crisis and CCOs
Oregon Senate President Rob Wagner, D-Lake Oswego, presiding over the chamber on March 21, 2023. | JAKE THOMAS/THE LUND REPORT
May 25, 2023

This article has been updated with additional comment from the Oregon Health Authority. 

Legislation to stem the opioid crisis, boost Oregon’s health care workforce, set minimum hospital staffing levels, overhaul the state’s controversial drug decriminalization law and others hang in the balance as the Republican walkout halts legislative work. 

Democratic lawmakers say that months of work on health care legislation could unravel after a group of Senate Republicans and Independents announced Tuesday they’ll deny the chamber a quorum until June 25, the session’s last day. That’ll leave one day for lawmakers to pass a two-year budget as well as other legislation. Hundreds of bills have piled up since the walkout to protest abortion, gun and transgender health care bills began on May 3. 

The group of Republicans and Independents said in a statement they’ll return to “pass lawful, substantially bipartisan budgets and bills.” How those bills would be selected is unclear.

Democratic lawmakers, however, argued that the Republican proposal is not feasible and will instead leave hundreds of bipartisan bills languishing as the problems they seek to address continue to grow. 

“If (Republicans) come back on the last day just to do (state agency) budgets, it’s not going to work,” state Rep. Rob Nosse, a Portland Democrat who chairs the House Behavioral Health and Health Care Committee, told The Lund Report. “The session will crash and burn.”

He pointed out that Senate President Rob Wagner, D-Lake Oswego, has stated he won’t give minority Republicans what he described as an effective veto over legislation, and he said the chamber will pick up its agenda where it left off before the walkout. 

Nosse said, “that means a lot of bills will die, budgets won’t pass.”

Health care has been a key bipartisan issue during the legislative session as Democrats and Republicans struck a series of agreements around workforce training, funding for behavioral health, easing pressure on hospital capacity, adjusting the state’s cap on medical expense growth and others. Democrats say they’re surprised at the session’s turn. Republicans, meanwhile, say Democrats are to blame. 

“We have many bipartisan healthcare bills that would be good for Oregonians,” state Rep. Christine Goodwin, a Canyonville Republican and vice-chair of the health committee, told The Lund Report in an email. 

She said Democrats are “holding those bills hostage” by prioritizing House Bill 2002. The bill’s proponents say it’s needed to ensure access to abortion and transgender health care. But Goodwin and other Republicans say it’ll weaken parental consent and lacks safeguards for children receiving gender-affirming care. 

If the bill passes, children younger than 15 would still need their parents’ consent for medical procedures and doctors must follow standards of care that don’t include surgeries, according to reporting by the Oregon Capital Chronicle. 

Oregon Senate Republicans spokesperson Ashley Kuenzi did not respond to requests for comment from The Lund Report. 

‘An investment in their wellness, their health’

State Rep. Maxine Dexter, D-Portland, told The Lund Report, she is worried about House Bill 2395 and House Bill 2513, a pair of bipartisan bills intended to make naloxone, an overdose reversal medication more available as the state sees surging deaths from synthetic opioids. 

Dexter said she’s also concerned about what it will mean for Oregonians if the session ends without health care legislation being passed. She said in an email that the Senate impasse is “risking peoples’ lives and ability to access treatment.”

“I just feel like we are undermining what Oregonians need and deserve, which is an investment in their wellness, their health, their safety.”

“I just feel like we are undermining what Oregonians need and deserve, which is an investment in their wellness, their health, their safety,” she said. 

Another bill that’s in limbo would affect Oregon’s coordinated care organizations, 16 regional insurers contracted with the state to provide services under the Medicaid-funded Oregon Health Plan. House Bill 2446 extends the expiration of the contracts from 2024 to 2026, essentially postponing a procurement process in which the contracts would be renewed and potentially changed to address any concerns over the program’s spending and care.

The extension is intended to buy time while the state and coordinated care organizations implement federal changes allowing new flexibility to spend Medicaid funds on services affecting health such as food, housing and climate-related programs. It also would give the state and coordinated care organizations a reprieve from the complicated contracting process to allow them to focus on the resumption of eligibility checks after a three-year pause that began during the pandemic. 

Josh Balloch, vice president of government affairs and health policy for southern Oregon-based coordinated care organization AllCare Health, called the contract extension “vitally important.” He said the Oregon Health Authority and coordinated care organizations risk being “buried” in work instead of focusing on patients if the bill doesn’t pass. 

Oregon Health Authority spokesperson Robb Cowie told The Lund Report in an email that the agency is concerned about multiple bills. Those include legislation intended to provide more money for tribal health programs, increase access to vaccines for children, tighten monitoring of prescription drug prescriptions and others. 

The budget and beyond

State government won’t shut down if the Legislature adjourns without passing a budget because lawmakers earlier passed a resolution funding state agencies at their current levels until September.

State Sen. Elizabeth Steiner, a Portland Democrat who co-chairs the Joint Ways and Means Committee, told The Lund Report that state agencies would keep their doors open but new funding for program expansions won’t take effect if lawmakers don’t pass a budget. 

The Oregon Health Authority is planning to expand Healthier Oregon, a program that extends the Medicaid-funded Oregon Health Plan to people of all ages regardless of their immigration status. Currently, undocumented children younger than 18 and adults ages 19 to 25 years old or 55 years and older are eligible. Steiner said the state’s upcoming budget funds expanding the program to all adults by July, but that won’t happen if it stalls. 

Additionally, she said the upcoming budget includes new funding to keep low-income Oregonians insured while the state works through a federally mandated review of Medicaid roles as part of an unwinding of pandemic measures. The health authority is asking the federal government to allow people who would lose their Oregon Health Plan coverage to remain covered while the state develops a new low-income health plan

Steiner said the upcoming budget includes funding to keep this group insured and will include a federal contribution. She didn’t know exactly how many Oregonians could be affected but said an estimated 60,000 could be eligible. 

“If people churn off health insurance, it’s hard to get them back on,” she said. Interruptions to people’s health care means they stop getting care to manage chronic disease or health screenings, she said. 

If the budget doesn’t pass, the state won’t receive federal matching funds to help hospitals that care for large populations of indigent patients, Steiner said. 

Sen. Cedric Hayden, R-Fall Creek (at center), in the Oregon Senate Chamber in session on March 21, 2023, before the walkout.

Cowie said that if the Legislature doesn't pass a budget, Oregon will lose out on “hundreds of millions of dollars in potential federal matching funds, at a time when Oregon’s health care system is already strained and providers are grappling with the loss of federal COVID-19 relief funds.” 

“If the session ends without a state budget or passage of key legislation, tens of thousands of people – especially in rural counties – could lose healthcare coverage,” he said.

Cowie said that state health officials are closely watching the situation and are preparing to “help partners in local communities sustain their programs through this period of uncertainty.” 

He also said the walkout imperils Senate Bill 1044, a bill requested by Gov. Tina Kotek that allocates $70 million for behavioral health spending. 

State Sen. Cedric Hayden, a Fall Creek Republican and vice chair of the Senate Health Care Committee, told The Lund Report the session has been put on “pause” and Republicans will come back when Democrats negotiate in good faith.

Hayden said there are many budget items that Republicans support as well as policy bills. He said Republicans could support fixes to Measure 110 and funding for crisis-intervention line 988. He added that the Legislature could pass roughly a hundred bills in a day if each chamber suspended its rules. 

“I’m not saying it will turn out that way but it is possible,” he said. 

Nosse said that if the Legislature adjourns without approving a budget the state will “limp along” until Gov. Tina Kotek calls for a special session for lawmakers to pass a sweeping budget bill that includes provisions from leftover bills. 

He said he hopes that the bill would incorporate hospital staffing legislation that was negotiated for months between labor and health systems. He also said he hopes it includes bipartisan fixes to Measure 110, a drug decriminalization and treatment law widely criticized for its inept rollout. 

But he said it’s possible that in a shorter special session, lawmakers won’t have an appetite for more controversial bills, such as legislation that would protect access to reproductive and transgender health care, that could help spur another walkout. 

“Am I worried about a bunch of bills that we worked on in the House that are going to die? Yes, I am.”

“Am I worried about a bunch of bills that we worked on in the House that are going to die?” he said. “Yes, I am.” 

Hoping for a breakthrough

Democratic lawmakers told The Lund Report they are hoping for a breakthrough and are proceeding with legislative business to get bills ready for a Senate vote if the chamber resumes business. 

During the session, bills with funding requests have piled up at the Joint Ways and Means Committee, the principal budget-writing panel. Steiner said her committee and all others are set to finish their work by their June 12 deadline. 

Democrats hold a 17-seat majority in the 30-seat Senate. Two Republican senators are not participating in the walkout and Sen. Chris Gorsek, D-Troutdale, is absent recovering from surgery. If Gorsek returns and one Republican or Independent senator comes back, Democrats will have the 20-member quorum needed to resume business. 

State Sen. Deb Patterson, a Salem Democrat who chairs the Senate Health Care Committee, told The Lund Report that she’s not willing to give up on bills that have been carefully considered. She said that some Oregonians took time off from work to drive across the state multiple times to testify before committees. 

“I’m super worried,” she said. “There’s some really important stuff we need to move forward.”

If lawmakers end up with not enough time for every bill, Patterson listed her priority legislation:

Senate Bill 192 requires pharmacy benefit managers, controversial drug supply middlemen, to disclose information on their business practices.  

Senate Bill 420 creates services for people with brain injuries. 

Senate Bill 972 would create a state-based marketplace that Oregonians could use to buy health insurance. 

Senate Bill 1089 would set up a governance board to establish and oversee a single-payer health care system in Oregon. 

House Bill 3320 tightens hospital requirements to provide free medical care to low-income patients. 

Senate Bill 1079 sets up a task force to help hospitals with the costly logjam of not having enough settings to discharge patients who don’t need hospitalization but still require a lower-level of care.

Expanding the training pipeline for the state’s pandemic-drained workforce has been a key priority of the sessions that’s attracted bipartisan support. Earlier this week, 20 bipartisan lawmakers from both chambers sent a letter to the Joint Ways and Means Committee to support $40 million to create more training opportunities for nurses and other heath care workers. 

“Our state investment of $40 million could leverage up to an additional $107.5 million federal dollars for a total investment of $147.5 million dollars — a game changing investment to grow the health care workforce Oregon needs,” reads the letter. 

State Rep. Ben Bowman, D-Tigard, told The Lund Report that the requests in the letter grew out of conversations between labor unions and hospitals over the staffing bill. He said the health care workforce shortage is a “genuine crisis” that will get worse if the Legislature doesn’t act. 

“Hospitals are bowing under the strain of workforce and capacity challenges that are not going to end when session does,” Lisa Goodman, vice president of communications for the Oregon Association of Hospitals & Health Systems, told The Lund Report in an email.

She said her group would continue working with labor unions and lawmakers to address the labor shortage and hospital capacity. 

You can reach Jake Thomas at [email protected] or via Twitter @jakethomas2009.