Oregon lawmakers have begun working through a deluge of bills aimed at bolstering the state’s thinning health care workforce, expanding community mental health programs and trying to contain medical costs, among other health-related legislation.
The Oregon Legislature on Tuesday began its 2023 legislative session, in which housing and homelessness are expected to be dominant topics as lawmakers also work out a two-year budget before adjourning in June. Nearly 2,000 bills or resolutions have been introduced, the vast majority of which won’t become law.
Health care is also expected to be a major priority. So far, 137 bills and one resolution have been assigned to the House Behavioral Health and Health Care Committee and 65 to the Senate Health Committee. Lawmakers still have until February 28 to introduce bills.
This is Oregon’s third legislative session since the COVID-19 pandemic was declared. Lawmakers are still seeking ways to stabilize the state’s rattled health care system that has shed workers and upended hospital finances.
Newly elected Gov. Tina Kotek said during a press briefing earlier this month that her budget would include money for community-based mental health services in order to ease the logjam at Oregon State Hospital. Legislators have also promised more money for residential treatment facilities.
But state economic forecasters have warned that Oregon could see declining revenues in 2023, potentially complicating how the Legislature pays for it all.
While there is broad agreement on what are the problems facing Oregon’s health care system, it’s not yet clear what solutions the Democratic-led Legislature will settle on.
“There is no magic bullet and there is no one bill that is going to address the complex needs of capacity and sustainability and for health systems and also for health professionals,” state Sen. Deb Patterson, a Salem Democrat who chairs the Senate Health Care Committee, said during the Oregon Health Forum last week.
Lawmakers work on workforce shortage
A driving issue for the legislative session will be growing the state’s health care workforce while preventing workers from leaving. The shortfalls extend to local public health workers, dental assistants and others.
“We’re experiencing a very bad workforce exodus in the public behavioral health system,” Cheryl Ramirez, executive director of the Association of Oregon Community Mental Health Programs, told the House Behavioral Health and Health Care Committee Wednesday. “It was bad already, but since COVID, it’s just multiplied. We probably could use at least double the number of workforce than we have in the public behavioral system right now.”
Legislation introduced so far seeks to ramp up the health care workforce by easing licensing requirements or offering financial incentives around training and education. Other proposals seek funding to expand training.
The Oregon Dental Association along with health care providers are backing House Bill 2979 that would direct $20 million in grants for training dental assistants, hygienists and others.
Tom Holt, a lobbyist who represents health care providers and associations, said it’s too soon to tell which workforce bills will advance.
“By the time we get to the end of the session there will be some significant action around the workforce,” he said.
One health care staffing bill already appears to have momentum and could significantly change hospital operations. Patterson and state Rep. Rob Nosse, who chairs the House Behavioral Health and Health Care Committee, have sponsored a bill mandating minimal hospital staffing ratios that specify how many patients registered nurses can be assigned.
The Oregon Nurses Association is backing the legislation, House Bill 2697, arguing it’s needed to halt hospitals from hemorrhaging nurses.
“Nurses and their colleagues in the hospital systems are beyond burned out,” Paige Spense, director of government relations for the nurses union, told the Senate Health Care Committee Wednesday. “They are physically and emotionally exhausted and many are choosing to leave the profession altogether, which is leading to the current staffing crisis.”
If the bill passes, hospitals would face penalties of $10,000 a day for violations as well as potential civil lawsuits.
Becky Hultberg, president and CEO of the Oregon Association of Hospitals and Health Systems, said during a press briefing Wednesday she agreed nurses are leaving the profession after three years of COVID-19. But she said the staffing bill will hurt already financially squeezed hospitals. She pointed to figures showing that three-quarters of hospitals lost money in the third quarter of 2022.
“Hospitals need to see recovery on the horizon or they're going to be facing really hard choices about what services they can provide,” she said.
The hospital association is supporting legislation intended to ramp up nurse training.
They include House Bill 2926, which would create financial incentives for hospitals to provide clinical training opportunities for nursing students. Hultberg said clinical training was diminished by the pandemic. Also backed by the association are House Bill 2928 and Senate Bill 485. Each extends an existing financial incentive to nursing students who commit to working in underserved areas.
It’s unclear how much the legislation will cost.
Additionally, the association is supporting House Bill 2742, which would exempt many hospital services from the state’s goal of limiting annual per-capita increases in health care costs statewide to 3.4%
‘More treatment all across our state’
Nosse said during a discussion last week at the Oregon Health Forum, a sister organization of The Lund Report, that his top priority will be “standing up our behavioral health system.” He said he’d introduce legislation that would fund community mental health programs and create “more services, more providers, more treatment all across our state.”
Kotek said during a press conference earlier this month she’ll release her proposed budget later this month that’ll include more money for community mental health programs so that people with mental illness don’t end up in the Oregon State Hospital or criminal justice system.
The Oregon Health Authority has compiled a list of $1.4 billion in budget asks that includes more money for the state psychiatric hospital and to help meet the demand for the recently launched 988 Suicide and Crisis Lifeline. The authority is also requesting money to create crisis stabilization centers across the state that would provide short-term residential care for people experiencing behavioral health crises.
Kevin Fitts, executive director of the Oregon Mental Health Consumers Association, told The Lund Report that these crisis stabilization centers will be limited and the request doesn’t cover the varying needs.
“What we could really use as a long-term facility that is secure for people coming out of the state hospital,” he said. “What we could use is a rehab old motel for semi-independent living.”
House Speaker Dan Rayfield, D-Corvallis, said during a media briefing Tuesday that the legislature has dedicated over $1 billion in behavioral health funding over the last two years that’s resulted in new residential treatment facilities. He said lawmakers will provide oversight for how the money is spent and how the new 988 hotline is connecting callers to services.
Patterson said during the Oregon Health Forum event that her biggest priority is legislation intended to make pharmaceuticals more affordable for patients and for pharmacies to stay open.
“This is the fastest growing segment of health care expenses,” she said.
Patterson in 2021 successfully spearheaded legislation creating the Oregon Prescription Drug Affordability Board that identifies drugs that pose affordability problems and makes legislative recommendations.
She’s now introduced Senate Bill 404 to give the board “more tools to help to address affordability of medications used by many Oregonians.”
Other bills also seek to lower health care costs. A Republican-backed bill would exempt prescription drugs sold by pharmacies from the corporate activity tax.
Holt, a lobbyist, said he also expects legislation aimed at pharmacy benefit managers, companies contracted by health insurers to oversee and negotiate drug benefits. Pharmacy benefit managers have been accused of driving up prices. Health insurance company Centene Corp. in December agreed to pay Oregon $17.8 million to settle allegations that its pharmacy benefit management program overcharged the Medicaid-funded Oregon Health Plan.
Multiple bills have been introduced that would restrict fees pharmacy benefit managers can charge or subject them to tighter licensing requirements.