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 May Is PEBB turning into the next PERS? Politicians, talk radio hosts, reporters and voters have spent countless hours debating solutions for the retirement system for state employees, yet the state’s health benefit system has flown under the radar of budget scrutiny. Not only do state employees have the richest retirement benefits, however, they also enjoyed the luxury of the richest health insurance benefits during 2002 compared to 10 other jurisdictions around the state -- including teachers, city and county employees. A report recently conducted by Aon Consulting showed that full-time state employees had a health plan that was 11 percent richer than their counterparts and cost 5 percent more. OHSU to limit Medicaid visits Oregon Health & Science University is fighting a two front war — and losing. Sandwiched between government cuts to its public mission and a spiraling investment portfolio, OHSU’s board approved a budget for 2004 to stop the financial bleeding. At the end of this fiscal year, OHSU anticipates a net income loss of $16 million instead of a projected gain of $14.8 million. To right the course, it will raise tuition, boost class sizes and lay off employees. In addition to these tried-and-true cost cutting strategies, OHSU will, for the first time, make a concerted effort to change its payer mix. OHP overhaul Once again, the Oregon Health Plan is getting a make over, courtesy of the legislature, but not everyone’s happy with the new look. The centerpiece, which passed unanimously out of the House Audit and Human Services Budget Reform Committee on May 13, emphasizes moving people off an open card and into managed care, even in counties where fully capitated health plans have little or no presence. But those health plans intend to play a dominating role. In counties such as Lincoln and Curry, the plans will provide administrative services, managing primary care, pharmaceutical and outpatient services, but not inpatient care, Jeff Heatherington, president of FamilyCare who chairs the Coalition for a Healthy Oregon, told the Oregon Health Plan medical directors on May 12. No minority ownership Non-dentists who hoped to purchase dental practices were handed a landslide defeat on the House floor when legislators voted overwhelmingly (42-14) against allowing minority ownership of up to 25 percent of dental businesses. The defeat came as a surprise to many of the bill’s sponsors, who said dentists would benefit from a tax break that’s available to corporations that have more than 5 percent ownership by non-professionals. “Some dental organizations were interested in being able to raise capitol through non-dental ownership, which would have allowed them to expand facilities and improve access,” said Doug Barber, lobbyist for Willamette Dental. Asking for taxing It’s a matter of trust. The Capitol is buzzing with talk about a provider tax to help the state bail out of a mounting deficit next biennium. But groups such as the Oregon Health Care Association aren’t so certain they’re willing to go along. “We don’t go there unless there are guarantees, in statute, that the money goes back into our programs. We aren’t interested in funding prisons or education,” said Jim Carlson, the OHCA’s executive director. Working man: AFL-CIO’s Tim Nesbitt As head of Oregon’s largest labor union, Tim Nesbitt speaks with the voice of 170,000 workers. Last election he used his sizable influence to persuade Oregon voters to pass a measure raising the minimum wage despite objections from the business community. He sat down with Oregon Health Forum Associate Editor Rory Carroll on May Day to discuss strong arming employers into offering health benefits, why business is supporting FHIAP and his concerns about consumer-directed health plans. OHF: By putting pressure on employers to provide health benefits, aren’t you jeopardizing jobs? TN: I don’t think so. We see some of our most profitable corporations, like Walmart, cutting costs and fattening their profits by abandoning their support for employer health care. That puts them at a competitive advantage with other retailers. Fred Meyer, Safeway, and Albertsons do provide health benefits. Tort reform in Congress If Congress enacts tort reform, the Oregon Medical Association won’t pursue a ballot measure calling for caps on non-economic damages. What are the odds of Congress taking such an action? If Oregon’s Senate delegation is any indication, it’s hard to tell. Both Sens. Ron Wyden (D) and Gordon Smith (R) put on a good poker face when asked that question. “Senator Wyden is worried about the impact of high insurance rates on rural health care providers, but wants to make certain the solution doesn’t trample legitimate consumer rights,” said spokesperson Geoff Stuckart. McMinnville pilot program edges closer Four leading insurance companies have jumped on board a project led by Dr. Erik Swensson that could put consumers squarely in the driver’s seat. Regence BlueCross BlueShield, ODS Health Plans, LifeWise and Health Net of Oregon have agreed to participate – assuming Swensson is successful in getting a waiver from state lawmakers that allows people to purchase their own health insurance using employer contributions and public and private funds. This pilot project, based in McMinnville, would be limited to 10,000 to 15,000 people. Tort reform up north Washington trial lawyers found a new and unlikely ally in their battle against caps on non-economic damages – the Washington State Hospital Association. The group amended the state’s major malpractice legislation – HB 1928 – to include a $500,000 cap on non-economic and economic damages for rural hospitals after it already passed the House. The modification torpedoed any chance of the bill passing, said Tom Curry, president of the Washington State Medical Association. “The bill appears dead, dead, dead. We’re profoundly disappointed in the hospital association.” Ombudsman bill waffles Picture Ralph Nader with an office inside the Department of Human Services. It’s not exactly what HB 3182 calls for, but the image works. Rep. Mitch Greenlick (D-Portland) wants to create a position for a health care ombudsman in state government. If created, the ombudsman would “educate the public, providers and consumers about managed health care programs” and “assist consumers in identifying, investigating and resolving complaints about managed health care.” The idea isn’t without precedent. Vermont and Nevada established similar positions in 1999. Indiana followed their lead in 2001. Measure 81 revisited The fight for tort reform in Salem may be coming and going with a whimper, but the real battle is just getting started. The Oregon Medical Association wants to raise $6-8 million to put the issue on the ballot again in November 2004. “It will not be cheap,” said Jim Kronenberg, associate executive director of the OMA, “but we assume the opposition will be well-financed.” Before the first signature lands on petitions to get the issue on the ballot, opponents are throwing jabs at the idea. SAIF-ty for rural docs Despite campaign promises to address the state’s malpractice woes, Governor Kulongoski stayed on the sidelines and watched physicians and trial attorneys duke it out over insurance reform during his first five months in office. Then on May 1 he stepped into the ring with a proposal to use SAIF to subsidize the malpractice premiums of rural physicians. Politicians and physicians alike welcomed him to the fray with immediate criticism. Premera in limbo Premera Blue Cross CEO Brereton “Gubby” Barlow’s been trying to drive his company down the road to for-profit status for seven months, but potholes and roadblocks continue to cross his path. Premera, whose for-profit subsidiary LifeWise has 160,000 Oregon members, filed its conversion application with Washington’s insurance commissioner on Oct. 25. It wants to set up a foundation that would use the money gained as a result of its tax-exempt status to fund public health initiatives. Yet consumers, editorial boards and health care executives have criticized the plan. An editorial in the Seattle Times said the plan is “not something likely to benefit people here.” More consumer options Eager health care consumers, executives, and insurance agents packed the Multnomah Athletic Club on April 30 to hear an Oregon Health Forum panel discussion about consumer-driven health plans. As the panelists suggested, the plans are rapidly gaining support as a remedy for ballooning health care costs. Four insurers in Oregon are in various stages of introducing consumer-driven health plans. Also in this issue...
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