Oregon Public Broadcasting

Insurers To Get Reminder About Oregon's Prescription Birth Control Law

A new law this year in Oregon requires insurance companies to cover a 12-month supply of prescription birth control, but its backers say some insurers haven't gotten the message.

One of those backers is Mary Nolan, director of Planned Parenthood Advocates of Oregon, which helped lead the push for the 2015 legislation. 

Nolan said when she stopped to pick up a prescription for her daughter last month, "the pharmacist was not aware of the law, and the health insurance carrier denied the claim for extended coverage because their claims adjusters weren't aware of the law."

Nolan told her experience Monday to a meeting of the Oregon Senate's Health Care Committee. She said Planned Parenthood has heard similar stories from many Oregon women.

The state's Department of Consumer and Business Services confirmed it's heard so many complaints that it's issuing a bulletin to insurance companies reminding them of their obligations.

Failure to comply with the birth control law is a violation of the Oregon Insurance Code, which could subject the insurer to civil penalties.

Insurance companies testified to the panel that they are working to make sure their providers are up to speed on the legislation.

Jessica Adamson, a lobbyist for Providence Health, also said a "technology glitch" prevented the automatic approval of 12-month birth control prescriptions at pharmacies that are a part of the Providence network.

"But the pharmacist or member could make the phone call and it would be approved through the claims department," Adamson said.

It took Providence more than 11 months to fix the glitch after the law took effect in January.

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Governor Wants To Secure A Slimmed-Down Medicaid Waiver Before Trump Takes Office

Oregon Gov. Kate Brown is trying to squeeze a new, slimmed-down health care waiver out of the federal government — before the Trump administration starts.

Oregon has had a Medicaid waiver since 1994 when former Gov. John Kitzhaber started the Oregon Health Plan.

The latest extension was granted in 2012 and sunsets next year. It allowed the state to roll out a new system of Coordinated Care Organizations.

Before the 2016 presidential election, the state hoped the new extension would allow them to support the homeless and the hungry, saying that would improve the health of a whole population.

But now, because of President-elect Trump’s stated intention to repeal Obamacare, the governor’s advisor, Jeremy Vandehey, said they’re asking the Centers for Medicaid Services, for a quick renewal before the new administration is in office. “Given the amount of time that’s left," said Vandehey. "It would have to be a much more straightforward extension and it likely would not include a lot of the bigger asks, that we frankly weren’t expecting to have with CMS until next year anyway.”

2012’s waiver extension came with $1.9 billion of federal support. Hopes for similar support for the next extension have faded, meaning the Oregon Health Plan is facing significant cuts.

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Oregon Says Its Plan Could End HIV Infections By 2021

Oregonians have a 1 in 200 chance of being diagnosed with HIV, according to the CDC.

But the Oregon Health Authority thinks that by focusing on three key strategies, all new infections can be stopped by 2021.

Dr. Sean Schafer with the Public Health Division said the first strategy is get more testing for the infection done in the state.

“Testing’s easy. Everyone has an HIV status. You’re either positive or you’re negative and you should know it," Schafer said. "When people know their status, they immediately take steps to avoid infecting others. And they start medical treatment.”

Only 35 percent of Oregonians have been tested.

The two other strategies are prevention — that is, high risk individuals taking a pill to stop them passing-on the virus — and treatment. Thanks to modern drugs, individuals who get early treatment can lead long lives.

Health departments are applying for grants to help cover any extra cost.

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Study: Spending Money On Mental Health Care Saves Jail Expenditures

Every dollar a state spends on mental health cuts about 25 cents from jail expenditures, according to a new study from Oregon State University.

The study, published in the journal "Social Science & Medicine," looked at 44 states and Washington, D.C., over a period of nine years.

Professor Jangho Yoon with the College of Public Health and Human Sciences, says 35 of the states could have reduced their jail populations by spending more money on inpatient mental health care.

“We find that $1 increase in inpatient mental health expenditures would lead to a 25-cent decrease in jail costs overall,” Yoon said.

The idea is that the more help you give someone struggling with mental illness, the less likely they are to run afoul of the law and go to jail.

The U.S. Department of Justice estimates that more than half of inmates have a mental health problem.

The average cost for housing a jail inmate is $60 a day.

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When The 4-Year Plan Turns Into A 2-Year Scramble: Pierce's Run For Governor

It's early September, and Bud Pierce is touring a Clackamas County non-profit that helps down-on-their-luck veterans. It's a cause near and dear to Pierce's heart. He's a former Marine Reservist himself. But as campaign stops go, this one won over relatively few voters. Just a handful of people were there, and there's not a single TV or newspaper camera around.

Pierce is a cancer doctor with a long-time practice in Salem. Until now the extent of his political involvement has been to chair the Oregon Medical Association. He wasn't planning to run for governor—not yet, anyway. He had his sight set on 2018, when the seat was supposed to next open. And then, in 2015, John Kitzhaber resigned.

"So that really sped it up," Pierce said.

The next gubernatorial election would be in 2016, instead. The winner would serve the remaining two years of Kitzhaber's term. For Pierce, that meant that what was going to be a four year plan to take the governor's office instead shifted into high gear.

"And so it really got rid of the first two years, which was the introduction to the state as someone who's interested in political office," he said. "So that part went away."

Pierce suddenly found himself criss-crossing the state, at first juggling campaign appearances with his ongoing medical work in Salem. His message has been that Democrats have controlled the governor's office for too long, and that his experience running a business—in his case, a medical practice—would give him the tools to make state government more efficient. He also thinks it's given him a different bedside manner, if you will, than a career politician.

"Just taking care of many thousands of patients and learning how to relate to people who have different backgrounds than you and different lives than you has really helped me in that way," Pierce said.

For the most part, Pierce is staking out traditional Republican positions on the issues. He said he would cut red tape on business, fight to regain state control over federal lands, and would try to repeal the new law that regulates the carbon content of motor vehicle fuels. He's also against Measure 97, which would increase taxes on companies with more than 25 million dollars in annual sales in Oregon.

Pierce handily won the Republican primary in May, but since then he's struggled to attract donors. He and his wife have pitched in more than a million dollars of their own money. But not enough to win a statewide election, according to Dan Lavey of Gallatin Public Affairs in Portland. Lavey has served as an advisor to Republican candidates in Oregon but isn't working with the Pierce campaign.

"You really gotta have the capacity to raise or spend a significant amount of money when you're taking on an incumbent politician," he said.

In 2010, Lavey served as an advisor to Republican gubernatorial nominee Chris Dudley. Like Pierce, Dudley was making his first run for elected office. Unlike Pierce, Dudley was a prodigious fundraiser. The former NBA player drew upon a vast network of donors to bring in more than $10 million.  Dudley's cash haul far outpaced that of his Democratic rival, John Kitzhaber, who raised just over $7 million during the 2010 election cycle. It wasn't enough for Dudley to defeat Kitzhaber, but the difference was less than two percentage points in an election where nearly 1.5 million Oregonians cast a vote for governor.

This year, both Pierce and incumbent Democrat Kate Brown have raised far less than their counterparts in 2010. Pierce has raised just over $3 million so far, with roughly half of those contributions coming from Pierce and his wife's personal checkbooks. Brown has raised about $4.5 million since becoming governor last year  in the wake of Kitzhaber's resignation. Brown has served in public office for more than 25 years. That experience is serving her well during this, her first campaign for governor, says Lavey. "Being a political candidate isn't something you just turn on and start doing on day one. It takes a lot of practice. It's a lot of hard work," he said.

Meanwhile, Pierce's lack of experience showed during a debate at the Portland City Club in the closing weeks of the race, at a time when more voters are paying attention. In response to a question about domestic violence, Pierce said this:

"A woman that has great education and training and a great job is not susceptible to this kind of abuse by men, women or anyone."

Pierce issued several apologies and calls his statement, quote, "ignorant and dangerous." But it didn't take long for Democrats to release a video featuring news coverage of Pierce's mis-step.

"The Republican candidate for governor drew boos at a Portland debate Friday. Pierce is taking some criticism this morning. Pierce earned boos from the crowd …"

It took Pierce more than a week to regain his footing, and a steady stream of polls shows him with a long way to go to catch up with Brown. Regardless of how this race turns out, it's definitely been a change of pace for him.

"I started medical school 40 years ago and I don't think I've been away from thinking about some aspect of medicine for more than two or three weeks since that time," Pierce said.

Pierce grew up in southern California, the son of a public school janitor and a homemaker. His parents named him William, but he became known as "Bud" at a very young age. "Bud Blattner was the color announcer of the California Angels," he said. "We were a big baseball family. I wanted to be a Major League Baseball player like every other kid. And my sister nicknamed be Bud, and it stuck."

Pierce says his first vote for president went to Jimmy Carter but over the years his political views shifted to the center. This year he initially endorsed Donald Trump but withdrew his support in September, citing a series of controversial statements from the Republican presidential nominee.

At 60 years old, Pierce said he'll go back to treating cancer patients if he loses the governor's race. And Republicans will go back to wondering what it takes to win the Oregon governor's office.

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Nurse Practioners Are Increasingly Helping Patients Fill Out End-Of-Life Forms

A study of end-of-life medical directives shows nurse practitioners — rather than doctors — are helping people make plans for dying.

Physician Orders for Life Sustaining Treatment, or POLST forms, tell doctors what treatment a patient wants as they die.

Do they want to be resuscitated if they stop breathing? Patients can ask for comfort measures only — like pain relief. Or they can ask for full treatment, like breathing tubes and trip to the emergency room.

When POLST forms were first developed in Oregon, it was mainly doctors who had the delicate conversation.

But now Dr. Susan Tolle, with OHSU says, 11 percent of forms are filled out by nurse practitioners.

“The roll of advanced practice nurses is substantially greater than anyone else has ever found,” she said.

The study, published in the Journal of Palliative Medicine, found that of the 19 states using POLST forms now, three don’t allow nurse practitioners to fill them out — Georgia, New York and Louisiana.

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