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 July PEBB $58 million short after 15 percent increase State employees won’t pay higher co-payments or deductibles for health coverage in 2005 despite a $58 million unanticipated rise in costs. The state’s 45,055 workers have Governor Ted Kulongoski to thank for the free pass. In a June 15 memo, the governor, through Tom Chamberlain, his labor policy advisor, insisted state employees not be hampered with additional costs because of their “sacrifice” in helping the state “mitigate one of the largest revenue shortfalls in recent memory” by accepting a two year wage and step freeze. OHP secret meetings It’s no secret the legislature needs to downsize the state’s budget by at least $500 million next biennium because of the poor economy. Some of that shortfall will undoubtedly come from the Oregon Health Plan, which is already struggling to keep the Standard population afloat. What troubles stakeholders, however, is a decision by the governor’s office to hold closed door meetings to discuss the health plan’s future. After hearing about the initial meeting held July 1, Rep. Alan Bates (D-Ashland) said, “He’s going off on his own; he has a perfect right; he’s governor. But he needs a consensus. The health plan contractors and other providers belong in that room.” Mandate-free plan unlikely to succeed The announcement by Governor Ted Kulongski of an employer-sponsored children’s group insurance plan made a big splash, appearing on the front pages of The Oregonian. But the governor failed to disclose the entire story. Last session, the legislature required the state agency that’s developing the plan to come up with a basic benefit option to help uninsured small businesses (2-50 employees). Virtually no one anticipates it will be successful, including the people charged with putting it together. “This basic plan hasn’t succeeded elsewhere,” said Joel Ario, insurance commissioner. “The children’s plan is more unique. If something succeeds here, this is more likely because the public doesn’t like a skinny benefit design.” Drug pool set for Oct. 1 launch Talk about ambitious plans. On Oct. 1, Missy Dolan is expected to have a prescription drug purchasing pool up and running for low-income Oregonians and state agencies. Not one to back away from a challenge and with only a $198,000 budget, Dolan’s plowing ahead, having spent the past 15 years developing financial strategies and negotiating multi-million contracts for insurance companies. In late April she joined the Office of Health Policy and Research on the urging of its administrator, Dr. Bruce Goldberg. Dolan shared her thoughts about the Oregon prescription drug program with Diane Lund-Muzikant, editor of Oregon Health News. OHN: What’s the motivation behind the purchasing pool? MD: To help the uninsured who may pay the highest prices for prescription drugs and give state agencies an opportunity to reduce their costs. Tort reform in the spotlight It has all the makings of a perfect photo op. A trial attorney with a reputation for winning large verdicts in medical malpractice cases running for vice president against a president who sees capping non-economic damages as a panacea for runaway health costs. Add in a state where voters will decide whether to cap non-economic damages, and all of a sudden Oregon becomes a prime campaign stop. Does that mean Sen. John Edwards might be landing soon at Portland International Airport? Maybe. While there’s no immediate plans for the Democratic hopeful to jet into the Rose City, Charlie Burr, campaign manager for the effort to defeat tort reform, believes Edwards will come to Portland before election day. If he does, however, tort reform won’t be the only issue on his agenda. “The electorate is going to want to hear about foreign policy and other issues,” Burr said. Measure to limit attorney fees pushed back to to 2006 When it tried to qualify a ballot measure limiting attorney expense fees to $100,000. the Oregon Medical Association learned a valuable lesson from the ensuing legal wrangling. At long last the Supreme Court cleared the measure, but the OMA didn’t have enough time to gather signatures. So they bagged their efforts. But only momentarily. Washingtonians to vote on caps Talk about direct democracy. The Washington State Medical Association wants everyone to weigh in on tort reform. State representatives, senators and the governor get their chance when the legislature meets in January. Voters may get their turn next November. The action is called a legislative initiative. Little used, it requires 197,000 signatures to qualify for the ballot. Such an initiative starts out in the legislature where lawmakers get the first shot. If they turn the measure down, it automatically gets referred to the voters. (The legislature can also amend the initiative, in which case voters would cast ballots on the original and the amended language.) Medicare law cuts cancer care Take a time out. That’s what oncologists want Congress to do. The cancer-treating doctors are cringing because of a huge cut in reimbursement as a result of the Medicare Modernization Act. They want Congress to delay the cuts – which go into effect Jan. 1 – while data is gathered on the cost of chemotherapy and other patient services, said Jenny Heumann, senior public affairs manager for the American Society of Clinical Oncology. Unless something is done, over $10 billion in funding for outpatient cancer services will be lost over the next decade. Assessment drops Oregon insurers couldn’t be much happier. They just saved themselves $2.25 million in assessments. The windfall came about after the high risk pool, which currently insures 9,500 members, saw its membership decrease by 700 members, its medical costs fall by 20 percent and its administrative costs drop by $623,468. The medical-loss ratio had been projected to reach 170-180 percent, similar to the last two years, but only stood at 151 percent on June 30. The Family Health Insurance Program, better known as FHIAP, helped make the difference. Its 1,100 members in the risk pool only had a 97 percent medical-loss ratio. Also in this issue...
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