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 February OHP in disarray; contractors clamor for solutions As the recession grows even deeper, with state economists forecasting another $100-$300 million dip, the Oregon Health Plan desperately needs a life raft. “It’s so sad to have been a leader and to be crushed under the current recession,” said Deborah Loy, OHP director for Capitol Dental Care. The latest blow came following the defeat of Measure 28. Now 110,000 people (single adults and couples without children) will lose their pharmaceutical benefits March 1. And, they could find themselves without a physician. The health plans say they’ve had enough — without more money, they’re unwilling to keep these people under their wing. PricewaterhouseCoopers, the state’s actuary, found no “credible evidence” to support giving the health plans more money once drugs are eliminated because of higher utilization costs. Proposal slammed by Democrats; lauded by activists Democrats responded with outrage to House Speaker Karen Minnis’ (R-Wood Village) “Emergency Care Package” proposal to restore $15 million in cuts to four Department of Human Service programs. Activists are applauding the move while being bewildered by Democrat opposition. The proposal is expected to clear the Republican-controlled House easily after unanimously sailing through the House Special Committee on Budget, but could face a difficult battle in the evenly divided Senate. “It’s unconscionable,” said Sen. Tony Corcoran (D-Cottage Grove) of Minnis’ proposal, which he called political posturing because it ignores the deep cuts needed to cope with projected shortfalls. “The House leadership’s proposal gives false hope to our most vulnerable,” said Sen. Kurt Schrader (D-Canby). “Why pander to $15 million when we have to cut $130 million?” Tapping the beer tax Shortly after Minnis announced her plan to restore funding to medically needy programs, Senate and House Democrats decided to leverage the Speaker’s commitment to their advantage. Enter the infamous beer tax. Rep. Jackie Dingfelder (D–Portland) proposes raising the tax by .10 cents for a 12 ounce bottle of beer and .15 cents for 750 milliliter bottles such as wine, earmarking some revenue for the medically needy program. Provider tax faces uphill battle Tough times call for inventive cash finding methods. Some Oregon politicians are eyeing a provider tax, which would apply to hospitals and pharmacists who participate in the Oregon Health Plan, to dig the plan out of its colossal financial hole. “To eliminate the Oregon Health Plan would be to walk away from up to $1 billion in federal match over the next two years,” said Rep. Alan Bates (D–Ashland). “Every dollar they put in will flow back to the hospitals. Let’s be pragmatic. Do you want a $2 match or no match at all?” McMinnville revolution The Chinese curse must have been cast on McMinnville. “There couldn’t be a more interesting time to work in health care,” said Anne Hamilton, executive director of the McMinnville Physicians Organization. Interesting, however, doesn’t necessarily mean good, as physicians in McMinnville are well aware. As payments from Medicare and Medicaid shrink, access for the poorest and sickest patients has declined. As the poor get sicker, doctors get a bad reputation. To bridge the growing divide, some inspired thinkers plan to open a walk-in clinic where volunteer physicians would treat the indigent. Although the town’s 62 physicians would initially give their time, once they logged a certain number of hours, they’d get paid. Kitzhaber’s new hats John Kitzhaber rode into office on the success of the Oregon Health Plan and left Salem with the plan on shaky ground. Lest anyone paint him a defeated man, as a private citizen Kitzhaber has rearmed and is charging back into the health care debate. He recently accepted the John Kitzhaber, MD Chair of Health Care Policy at The Foundation for Medical Excellence. In that capacity, he’ll help implement phase two of the organization’s Oregon Health Assessment Project and continue researching, writing and speaking on health care issues. Kitzhaber has also taken a position as president of the Estes Park Institute — a hospital education organization — where his duties will include policy formation and program planning. President Peter After much confusion about how to govern an evenly divided Senate, legislative veteran Peter Courtney (D-Salem) emerged as Senate President. Oregon Health Forum Associate Editor Rory Carroll spoke to him about his new title and how the legislature can learn from its dubious past. OHF: How has being elected Senate President changed you? PC: It isn’t that much different. I still wander the halls and go into people’s offices, which people kid me about because apparently other presidents didn’t do that. I’ve always spent a lot of time out of the office, and that hasn’t changed. But I find myself walking into committees and looking at them in kind of yearning because committee structure is what makes this system work. The Senate President doesn’t serve on committees. OHF: What was your reaction when you heard you were being considered for the position? PC: I was kind of numb. It’s a mystery to me. I’m still not used to being called Mr. President, that bothers me, I’m not made for that. Paying the price for hospitals Health care analysts who examine trends seem to agree the leading driver of increased spending is hospitals — not pharmaceuticals. In 2002, hospital spending accounted for 27.1 percent of the projected increase in health care spending, compared to prescription drugs at 16.3 percent and physicians at 16.5 percent, according to new federal health spending projections reported in the journal Health Affairs. Hospital inpatient costs represented the largest component of health care spending from 1998 to 2001, growing by 5.9 percent annually, twice the rate of inflation, according to experts from the University of Southern California, The Lewin Group and HealthShare Technology, Inc. Technology alone was responsible for 19 percent of these increases. Buying in bulk Cost-saving measures are whipping around the halls of the Capitol with the speed of an atom smasher, and bulk purchasing of prescription drugs is picking up speed at the front of the pack as OMAP predicts Oregon will spend over $1 billion on drugs this biennium. Governor Kulongoski proposed such a concept within state government as well as a coalition comprised of Idaho and Washington that could barter for lower drug prices. The Governor’s office isn’t the only place in Salem with minds mulling over ways to reduce drug costs. Sen. Kurt Schrader (D–Canby) introduced Senate Bill 324 that would establish such a program in the Department of Administrative Services. Smoking gun Portland schools aren’t the only state-funded program earning failing grades. Oregon’s tobacco prevention programs brought home a report card with two D’s and an F from the American Lung Association – although the state did earn an A for having the sixth highest cigarette tax in the nation. “We get $94 million a year from the master tobacco settlement,” said Warden Minor, president and CEO of the American Lung Association of Oregon, “and not one dime of that money is spent on tobacco prevention and control.” Minor isn’t the only one critical of the state’s efforts to control tobacco use. Also in this issue...
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