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What’s next after Cover Oregon?

OHSU president urges caution at Oregon Health Policy Board meeting as legislature moves quickly to dissolve the health insurance exchange.
February 9, 2015

Dr. Joe Robertson, the president of Oregon Health & Science University, sounded a cautionary note last week about the future oversight of the state’s health insurance exchange.

The state legislature is expected this session to dissolve Cover Oregon and transfer the responsibility for the health insurance exchange to the Department of Consumer & Business Services. When it does so, health leaders across the state need to be on guard to protect the system of care, Robertson warned his fellow members of the Oregon Health Policy Board at its meeting last Tuesday, Feb. 3.

“We are heavily invested in what has happened over the past four to five years with the coordinated care organizations. And although I absolutely understand the reasons behind Senate Bill 1, I think what we developed was a system of care. It was not about an insurance product,” Robertson said at the meeting, referring to the proposed legislation that would abolish the Oregon Health Insurance Exchange Corporation.

“This board and the Oregon Health Authority have to be eternally vigilant that we do not have unintended consequences when this is moved from a regulatory perspective to something that is much more along the lines of insurance,” he continued.

“It’s incumbent upon us to protect the system aspect. We saw incremental changes in this regard when the administrative rules were developed, and it could happen again. It’s something we need to be cognizant of,” Robertson said.

During the meeting, Carlos Crespo, director of the School of Community Health at Portland State University, asked Robertson to clarify his comments.

Robertson replied: “We developed a system of care. From a regulatory perspective, the forms that were used for the compliance were insurance forms, and they were out of necessity. But there is a certain loss of functionality; we developed a round peg and it had to be put in a square hole. You couldn’t completely convert what we had done and make it fit within the regulatory parameters.”

“All the forms that the CCOs ended up filling out were insurance forms. They were the same forms that you always fill out. … We developed a new system and used the old forms. If you use the old forms, you get a lot of what you used to get.”

Senate Bill 1 is sponsored by Sen. Laurie Monnes Anderson, D-Gresham, and Rep. Mitch Greenlick, D-Portland. Both serve on the joint committee on health insurance transition, which is scheduled to have

a public hearing and work session on the bill on Monday. The Lund Report covered Senate Bill 1 last week.

Courtney Westling, director of legislative and government affairs for the Oregon Health Authority, briefed the Oregon Health Policy Board on the authority’s legislative agenda at the meeting, and said that Senate Bill 1 “is the one to focus on” this session.

OHA has introduced eight bills this session, all approved by the governor, that Westling described as housekeeping measures. “I kind of joke that they’re not super sexy because a lot of them are clean-up and getting us in statutory alignment,” she said.

The most controversial among them is House Bill 2421, which would transfer the responsibility for management of all mental health drugs from OHA to coordinated care organizations.

“All the coordinated care organizations I’ve talked to want to do this,” Westling told the board. “On the advocate side there’s some concern that folks won’t have access to the right drugs. We understand the concern and are trying to work through that with our stakeholders.”

Another highlight for the Oregon Health Authority this session is the expected confirmation of Lynne Saxton as director of the agency. She is currently the acting director, with confirmation scheduled for the week of Feb. 23.

Saxton addressed the health policy board during the meeting. She identified key areas she intends to work on, and outlined a plan for first her 90 days on the job. She said that one of her concerns is addressing the “disproportionality” of healthcare services.

“In the last 13 years I’ve worked in the Medicaid system with children and families in the most extreme areas of need,” Saxton said. Based on the results of the recent performance review of the coordinated care organizations across the state, she cited one area of particular concern: pregnant African American women.

“I want to zero in on that right now in a targeted way,” she said. “What can we do right now to get on top of that challenge? If we do not get on it right now it will be baked in.”

Saxton inherits an agency in the midst of turmoil. The Oregon Health Authority has the largest budget and second-largest workforce among state agencies, and has been without a permanent leader for about a year. The Lund Report covered her appointment last December.