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 November Hospitals win, OHP loses at Emergency Board Hospitals scored a $3.7 million victory at the expense of mental health, chemical dependency, adult dental and durable medical equipment benefits for Oregon Health Plan patients at the Nov. 8 Legislative Emergency Board — without a word of public testimony. “It’s unbelievable to me that a hospital association that represents non-profit community hospitals with positive bottom lines and deep reserves would grab this money and take it away from people who need mental health services,” said D’Anne Gilmore, executive director of the Oregon Coalition of Health Care Purchasers. Bruce Bishop, the hospital association’s lobbyist, acknowledged having conversations with many Emergency Board members prior to the vote. He defended the legislature’s action, saying the law is straightforward. “The statute clearly says you don’t cut eligibility and you don’t cut provider reimbursement,” he said. “From our perspective, we’re not saying what’s better or worse. What we’re saying is this is what the law says should be done.” The Department of Human Services had recommended the hospital cuts in an attempt to balance the state’s budget, with the assumption that Ballot Measure 28, the income tax surcharge, would fail. The hospitals weren’t the only victors in this brutal match-up — pharmacists also kept their reimbursement to average wholesale price minus 14 percent, not the 17 percent that had been recommended. And, obstetricians caring for Oregon Health Plan patients received a 30 percent boost in reimbursement. Embattled HRC faces legal, legislative challenges It’s not easy being the Health Resources Commission. A haze of hostility has clouded its meetings. The drug industry, which vehemently opposed the creation of the practitioner-managed prescription drug plan last session, considers the commission’s work a threat to its bottom line. Drug companies like Pfizer and AstraZeneca have continually tossed wrenches in the commission’s gears, attempting to slow down the process, said Dr. John Santa, administrator of the Office for Oregon Health Policy and Research. In early November, tempers flared again. Drug company representatives aired a series of complaints, some seemingly more legitimate than others, which ultimately led to an eruption. Russ Spencer, government relations manager for Phizer, argued the commission gives insufficient notification of meeting dates and sometimes only sends a detailed agenda the day before the meeting. That’s not enough time to decide whether to bring their scientific experts to the meetings, he said. “All of these discussions are important enough for your medical people to be here,” responded Santa. Women's Alliance marks a decade The Oregon’s Women’s Health and Wellness Alliance is celebrating its 10-year anniversary by making plenty of birthday wishes. Contraceptive parity, which failed last session but generated plenty of debate, is a top priority. Its fate may rest in the hands of the Republican House, whose leadership won’t forget that outgoing Rep. Jan Lee left the Republican party mid-session out of frustration when they wouldn’t give the bill a hearing. Alliance Chair Rep. Diane Rosenbaum has worked for years in women’s clinics in Oregon and California. As a legislator, she’s drawn inspiration from progressive women’s rights laws that thrive in other states. Meanwhile, President Bush is paying back the conservative interests that helped put him in office with his selection of Dr. W. David Hager to head the Food and Drug Administration’s panel on women’s health policy. In his private practice he won’t prescribe contraceptives to unmarried women, and he’s the author of a book that suggests women who suffer from premenstrual syndrome should seek help from reading the Bible and praying. “That’s a horrible sign of things to come,” Rosenbaum said. “But it focuses us to work harder at a state level.” She sat down with Oregon Health Forum Associate Editor Rory Carroll to talk about protecting women’s reproductive rights, the challenges facing the 2003 legislature and Kevin Mannix. OHF: Is contraceptive parity again going to be a priority? DR: Yes it is. The Department of Consumer and Business Services has a proposal as part of their legislative package. The state of Washington has adopted an administrative rule that requires insurance plans to cover it. We were trying to get a similar administrative rule here, and the Attorney General’s office came out and said our insurance commissioner didn’t have the authority to do it. At that point DCBS said it would create the statute that prohibits discrimination (based on gender) specifically, so there’s likely to be more than one proposal. As time has gone by, more and more states have passed it. New York and Arizona have recently passed comprehensive bills. About 20 other states have it altogether. We were like the 49th state to get a requirement to cover mammograms in women’s health exams. We certainly don’t want to be the last state to get contraceptive parity. Mental health slashed Still recoiling from the damage inflicted by the Legislative Emergency Board, which slashed funding for adult dental, mental health, chemical dependency and medical equipment for 100,000 Oregon Health Plan members starting March 1 -- providers are bracing for the worst and handing out pink slips. “It’s going to be terribly disruptive to our mental health program,” said Hank Collins, who runs Jackson County’s Health Department and anticipates having to layoff 10 staffers. What really stunned Collins, however, was the decision to reward hospitals at the expense of public health. “It was extremely unfair and short-sighted. The hospitals are one segment of our economy that have done well in this recession.” Single-payer down but not out Although Measure 23 took a beating on election night, the struggle has only just begun. The so-called “Son of 23” will pack its bags and head to Washington state for a shot in 2004, said Dan Isaacson, campaign manager. “While it would have been wonderful if Measure 23 had passed, the campaign has achieved — indeed, surpassed — my personal goals,” said Mark Lindgren, chair of Health Care for All-Oregon. Denturists win It took a little longer than expected, but denturists will finally be allowed to install partial dentures. Originally slated as part of the 1978 initiative that created the profession, sponsors thought it too risky to include because of objections voiced by the Oregon Dental Association. “They had more ammunition against that (component),” said Jim Davis, campaign coordinator for Citizens for Affordable Dental Care. “We decided to keep it simple and then go to the legislature and build the profession along the way. Little did we know the roadblocks they would put in front of us.” The denturist’s fears proved unfounded. The initiative passed 4 to 1. Medical liability Part little engine that could, part runaway train, part road to nowhere — Governor Kitzhaber’s task force on medical liability keeps chugging away. At least 30 solutions have risen to the surface — including tort reform, full disclosure of a physician’s insurance coverage and penalizing trial lawyers for bringing frivolous claims. With a January deadline to reach consensus, there’s too much to be accomplished in too short a time, said Lynn- Marie Crider with the Oregon AFL-CIO. “The idea is to talk through (the proposals), but I don’t know how we can get through 30 in one meeting.” Tort reform proponents are more optimistic. “I’m more confident in the process at this point because it appears we are looking for specific solutions,” said Jeff Heatherington, executive director of FamilyCare. “My hope is the committee will come out with some very specific proposals.” Nursing the nurses Where was your overworked nurse when you needed her? Possibly blowing the whistle on her department’s under staffing. As of Oct. 1, nurses can be anonymous reporters of unsafe staffing in their departments. Despite fierce objection from the Oregon Association of Hospitals and Health Systems, the legislature passed House Bill 2800 last year to help ensure safe nursing care. “Since 2000, 1,500 reports came in from nurses around the state who were concerned about staffing issues,” said Sue Davidson, nursing practice director with the Oregon Nurses Association. Now, these whistleblowers will be protected from hospital retaliation. The lesser of two evils The choices are definitely ugly — either eliminate all pharmaceuticals for 100,000 people on the Oregon Health Plan standard package — or not cover 50 medical conditions for the entire population, including liver, pancreatic, gallbladder and esophagus cancers, knee ligament tears, hearing loss, severe tooth decay and shoulder disorders. That’s the scenario being painted if voters reject Ballot Measure 28 next January. Medicaid officials have prepared documentation, asking permission from the federal government if voters say no. “We cannot wait until the tax vote, otherwise it would take months to achieve any savings,” said Jean Thorne, interim Medicaid director. Hospitals fare better than insurers Recent articles in the New York Times, The Oregonian and Portland Business Journal ignited a public debate about health care costs and the profitability of hospitals. After Oregon hospitals walked away from the latest Emergency Board with another $3.7 million at the expense of mental health, chemical dependency and adult dental care, the discussion exploded into a fireball of contempt. “What I would like is if non-profit hospitals regard their mission as seriously as their margin,” said D’Anne Gilmore, executive director of the Oregon Coalition of Health Care Purchasers. Also in this issue...
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