This week marked a dividing point in the Oregon Legislative session: Bills that did not make it through House and Senate committees died, bringing those left on the table into sharper focus.
Oregon’s $920 million Medicaid funding gap has been partly filled by a $380 million package of taxes on health insurers and hospitals that Gov. Kate Brown signed into law last month. But Democratic leaders, armed with supermajorities in both chambers, are still working to shepherd contentious tobacco and employer taxes through committees and to the governor’s desk in hopes of filling the remaining shortfall.
And lawmakers like Rep. Andrea Salinas, D-Lake Oswego, are eyeing other changes to the state’s health care system, from prescription drug price and purchasing bills to legislation expanding low-income patients’ access to charitable hospital care and a Medicaid buy-in option for people ineligible for tax credits through the Affordable Care Act.
Salinas, a lobbyist and consultant appointed to the House in 2017 and elected to a full term that year, abruptly assumed the chair of the House Committee on Health Care in February, after House Speaker Tina Kotek stripped Rep. Mitch Greenlick of his longtime chairmanship over demeaning comments he made to lobbyists. Greenlick still serves on the health care committee.
After passing a last-minute flurry of bills out of the committee Tuesday to the full House floor or Joint Committee on Ways and Means, Salinas spoke with The Lund Report Wednesday about her priorities for the rest of the session.
The interview has been edited for clarity.
With the Legislative session half over, what are you hoping to accomplish by the session’s end?
Salinas: One is to start truly looking at cost containment, at how we bring down the cost of health care to the consumer overall. In the hospital system, does that mean looking at charity care options that work better for working families? In terms of prescription drugs and a 60-day notice (of proposed price increases), I know that’s something the pharmaceutical industry hates, but I actually think it would help insurers adjust formularies and consumers figure out, is there a different prescription? What does it mean for copays and premiums? I do think we’re starting to tackle some of the meaty foundational bills started last session, so I’m excited to get at that work. We’ve also had a lot of good bipartisan discussion looking at pharmacy benefit managers and their role in this (prescription drug cost) equation. What (legislation) might look like in the end, especially if it goes to ways and means, remains unclear. But I’ve heard from a lot of my constituents on this issue.
Are Gov. Brown’s priority bills on tobacco taxes and large employer assessments the best way to stabilize Medicaid funding in the state?
Salinas: They absolutely are. We need to get the tobacco tax done. We also need to do something on the employer tax. I feel like there’s a need for a public option as well, that’s offering employers who don’t offer the health insurance they should be, maybe giving them another option within the Medicaid buy-in. That is absolutely critical to fill the Medicaid funding gap. I also serve on the (Joint Committee on Ways and Means) Human Services subcommittee. We’re looking at 5 percent (budget) cuts pretty much across the board. That’s even after we get the $900 million Medicaid gap filled. So those are two pieces that are critical.
With Democrats owning a supermajority in both chambers, how are you weighing your moves on initiatives like the governor’s Medicaid plan against bills advocacy groups are pushing for, like single payer health care?
Salinas: We’ve had a lot of bills in front of us this session where I’ve said, ‘Yes, that sounded great.’ But with all these new programs all requiring funding, I was reluctant to move those bills before putting in place things like the governor’s opioid task force, other smaller things. I don’t think we should be making large investments until we get a strategic plan coordinated around how we want to improve mental health, substance abuse and other issues … That’s what I’ve been trying to tell advocates. It’s not that I don’t support these policies that are so needed. It’s about recognizing the need to come up with (a strategy). And I think with the hospital provider tax and the insurance premium tax, those I think will get us a lot further now, because we’re not going to be working on a two-year budget cycle. That will help with long-term funding, and getting the other two, the tobacco and employer assessment, I think that, too, will help stabilize us and free up some other funding for human services programs. That’s the idea. This was not a short-term plug.
But does that create friction between advocates pushing for a major overhaul of the state’s health care system and lawmakers like you who are responsible for moving legislation?
Salinas: I wouldn’t say it’s pressure. I think we just have different ideas about strategy. We’re working toward this incrementally … I don’t think anyone will dispute, at least on the Democratic side, wanting to get to a single-payer system. I just think it’s about how do you do it, and I don’t necessarily know (whether) undoing the whole system, ripping off the Band-Aid, is the right way to do it. I’ve talked about the things to get us there, like if the private market starts looking at value-based payments, how we start holding nonprofit hospitals accountable for their mission, getting coordinated care organizations to a place where they’re fully transparent with the public and to taxpayers. I think those are some of the challenges we need to meet and address before we start to move toward single payer.
You’re barely a month into chairing the House Committee on Health Care. How is it going, and how has it been to work with former chair Mitch Greenlick?
Salinas: It was unexpected. It’s been going as well as it could. I think my biggest challenge is that I had a bunch of my own bills in the health care committee that I wanted to move. And I didn’t realize when one becomes a chair, they have a hand in moving almost all pieces of legislation in the committee. So it has been fun to work more in a bipartisan fashion with the vice chairs, but outside of health care I had about 30 priority bills, so that has been challenging. Rep. Greenlick has been amazing with his expertise and advice. He provides counsel as he was before, and he wants to see me succeed. Recently I said to him, ‘I don’t know what I’m going to do. You’ve had years and years of true health care expertise. I’ve been a legislative aide and lobbyist in my own right, but I don’t have the academic knowledge of health care that you do.’ He was like, ‘Yeah, but you’ll learn.’ I still have a lot of learning to do. I feel like I’m just scratching the surface of the different hospital and insurance systems. My goal in the committee is to get us all up to speed and working with a knowledge of how these systems work.
You can reach Elon Glucklich at [email protected].
