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 June Hospitals must treat all OHP enrollees, for now Hospitals have lost another battle in the fight to restructure the Oregon Health Plan — but the war is far from over. During its final meeting on June 13, the Senate Special Committee on the Oregon Health Plan considered two nearly identical sets of amendments to House Bill 3624, which increase OHP enrollment in managed care plans. One amendment mandated that hospitals treat fully-capitated health plans and the other set did not. The committee voted unanimously to require hospitals to treat Oregon Health Plan patients, although legislators issued a stern warning to the plans and hospitals to work out a compromise quickly. Drug debate subsides It’s been a contentious road, but the debate over the management of mental health drugs appears to have subsided. Medicaid spent $12 million a month on mental health drugs every month during 2002, while an equivalent amount went toward mental health and addiction services. Unlike other medications, there’s no oversight of mental health drugs for Oregon Health Plan clients. But that's likely to change next biennium. All mental health drugs — anti-depressants, anti-psychotics and mood stabilizers — would be jointly managed by the mental health organizations and the fully capitated health plans, according to amendments introduced into HB 3624. SB6: reducing costs for some at the expense of others With the intensity and brevity of a Rose Festival dragon boat race, Senate Bill 6 entered and exited the Revenue Committee in a legislative nanosecond – 15 days. Endorsed by the governor, it would create a health benefit pool for school districts similar to what exists for state employees. “We have to look at getting some sort of cost lid in place,” said Sen. Ryan Deckert (D– Beaverton) its sponsor, who chairs the Revenue Committee. “Without question, pooling all employees saves you a great deal of resources in the long run.” The expeditious handling, however, is not due to legislative solidarity. Opponents have their major criticisms: increased costs for some school districts; the loss of autonomy over plan design and the threat to small insurers with the consolidation of the marketplace. Yet, with health care costs continuing their aggressive upward trend, the doctor may be calling for just such a measure. Oregon school districts spend $700 million annually on health benefits, said Steve Carlson, a consulting actuary for the Oregon Education Association. With annual increases of 10-15 percent, that number could reach $1 billion by 2006. Basic health revived Add prophet to Rep. Joanne Verger’s (D–Coos Bay) resume. In the pages of Oregon Health Forum last month, she lamented the fate of one of her bill’s, House Bill 2537. After being sent to the Audit and Human Services Budget Reform Committee in February, the bill idled for over three months. Last month, Verger opined that if the bill was sent to Rep. Jeff Kruse’s (R–Roseburg) Health and Human Services Committee it would make it to the House floor. Right on cue, Speaker Karen Minnis shipped the bill over to Kruse, and within two weeks it motored out of committee and through a victorious 32-25 floor vote. PEBB defends itself Pool the resources. Save money. Sounds like basic economics. Yet the governor’s proposal for a new health benefit plan for teachers that mirrors the one that exists for state employees has drawn both praise and scorn. The debate focuses on whether the pool that exists for state employees — the Public Employees’ Benefit Board — is worth re-creating. “A PEBB board to me is the industry of the past,” said Mike Shirtcliff, president and CEO of Advantage Dental Plan, citing the increase in consumer-driven plans and the rigidity of PEBB’s plan design. As soon as Shirtcliff questioned the plan, however, supporters objected. “PEBB does a very good job,” said Sen. Tony Corcoran (D–Cottage Grove). “It’s a pretty good benefit at a pretty good level,” said Rep. Max Williams (R–Tigard). Rookie of the year When Governor Kulongoski took office, many people were concerned about his inexperience dealing with health policy issues. They were left scratching their heads when he hired a novice, Erinn Kelley-Siel, as his health and human services policy advisor — especially given the vast challenges facing the Oregon Health Plan. How much credit Kulongoski and Kelley-Siel deserve for saving the plan is still unclear, but a recent letter from the governor to the federal government indicates the standard population won’t be dropped — a remarkable achievement no matter who gets the credit. She recently spoke with Oregon Health Forum Associate Editor Rory Carroll from her Salem office. OHF: Some people feel the governor has turned his back on health care in favor of education. EKS: I disagree. Education is certainly an issue he’s focused on, but the holistic nature of our crisis necessitates a focus on all areas of government. It’s not easy for this governor to follow in the shoes of the previous governor in the level of intensity and focus that he placed on health care issues. HMOs finally cooling off Health care economists are fond of saying that health care lags behind the rest of the economy. When a recession hits the rest of the marketplace, hospitals, physicians and insurance companies are last to feel the pinch. If that’s the case, the the economic ripples might finally be rocking the once stable HMO boat. Overall, Oregon’s HMOs have little to brag about. Membership is down 19 percent (191,583 people) since last year, leading to a corresponding net income decline of 10 percent ($2,154,425). Clearly the cumulative statistics are weighed down by Kaiser Permanente and PacifiCare, both of which saw sharp declines in their net incomes. Error reporting legislation moves The Board of Medical Examiners hopes physicians report errors faster than the Health and Human Services Committee passes bills. House Bill 2165 requires all health care professionals licensed by the board to report within 10 working days any action that could show a licensee is “medically incompetent or is or may be guilty of unprofessional or dishonorable conduct.” “Hospitals have not been complying” with the current statute because it does not stipulate how long a licensee has to report, said Kathleen Haley, executive director of the board. The bill simply requires them to report within 10 days. Attorney fees questioned A losing candidate on a reality television show — worse than that, a loser on a television show that parodies reality shows. That’s how bad the tort system has gotten in the eyes of Nancy Udell, general counsel for Washington, D.C.-based Common Good. “It’s very clear, especially in the medical malpractice context, that it's totally broken, it’s a total Gong Show.” Let Udell fill in for the polyester-clad Chuck Barris, though, and she thinks the audience would stop laughing long enough to make a minor adjustment to the tort system. Out with the patients, in with the lawyers Less money for human services equals more money for the lawyers. Decreases in funding at the Department of Human Services have translated into a windfall for attorneys. “The theme is when the state eliminates programs, it gets sued,” said Kevin Neeley, spokesperson for Attorney General Hardy Myers. A total of 18 lawsuits against the department sits on the desks of attorneys in Myers’ office, a number that Neeley calls “extraordinary.” They range from cases with a single plaintiff to cases where all of the litigants couldn’t fit in a single courtroom and could amount to the state restoring tens of millions of dollars in funding. Federal money Legislators will soon find themselves in an unfamiliar position — how to spend a surplus of money — thanks to the federal government’s passage of a $20 billion economic relief package that will net Oregon $216.6 million. A little less than half of the money — $100.3 million — must be used to increase the federal matching rate for the state’s Medicaid program (currently around 60 percent) by 2.95 percent. “One of the conditions of the money is a maintenance of effort,” said Lynn Read, Medicaid Director. That means if Medicaid eligibility dips below the population groups covered on Sept. 2, 2003, the funds could be in jeopardy. It’s not clear, however, if cuts to the Oregon Health Plan after Sept. 2 would result in a loss of the enhanced federal match for just the quarter in which the eligibility levels drop, or the entire three quarters. The Centers for Medicare and Medicaid Services will address the confusion in a forthcoming conference call and letter, Read said. Also in this issue...
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