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As baby boomers in Oregon inch toward 65, a new mental health care crisis looms. By 2025, nearly one million Oregonians will be 65 or older. According to the American Psychiatric Association, as many as 25 percent of all older Americans struggle with mental illnesses. And as the number of older Oregonians grows, the need for specialized geriatric services for substance abuse and depression will also increase. Suicide rates among older Oregonians already provide disturbing indications that a large percentage of seniors are not getting the mental health treatment they need. Detailed data that would help illustrate the problems more clearly is hard to find, in part because relatively few seniors seek treatment.

One reason seniors do not seek out mental health care may be because of stigma, but there is also evidence that care is not accessed because services are prohibitively expensive. State and federal legislation has attempted to expand access to mental health services for seniors, but funding continues to be a barrier at all levels of government.

"There is a serious lack of concern on the national level," said Verna Porter, state president of Oregon Alliance for Retired Americans and a retired registered nurse who specialized in geriatrics. "The 50 percent co-pay (for mental health) makes treatment unaffordable for many."

New austerity measures designed to divert costs from the federal government to state Medicaid programs have united legislators on both sides of the aisle. Several new rules defined by the Centers for Medicare and Medicaid Services (CMS) will eliminate services for which states had been receiving federal matching dollars. According to Dennis Smith, director of the Center for Medicaid and State Operations, the new regulations could save CMS more than $15 billion.

However, 43 states have independently done their own calculations, which put the cuts in federal matching dollars closer to $50 billion, according to Michael Stickler, senior federal policy analyst at the state’s department of human services. The new regulations test the state’s capacity to deliver services. To pay for services that aren’t covered by federal matching dollars under the new regulations, the state can limit the populations it covers or limit the number of benefits for each enrollee.

Medicaid enrollees with special needs and their case managers will be most directly affected.

Keeping health costs in check while meeting community needs and ensuring quality is a tricky business with which state and federal agencies have had decidedly mixed results.

Starting in New York State, certificate of need (CON) statutes were established more than 40 years ago to contain health care construction costs. Certificate of need was intended to prevent "the construction of excess hospital capacity that could cause competitors in oversaturated markets to cover costs by over-charging, or by convincing patients to accept hospitalization unnecessarily," according to the U.S. Healthcare Certificate of Need Sourcebook.

According to Sen. Alan Bates (D–Ashland) today health care providers don’t have the right incentives. "The incentive [for providers] is to pick those things that pay the most. Have you seen anybody set up any mental health and drug and alcohol programs to make money?"

Patient advocates, hospital lobbyists, legislators and physicians among many other stakeholders agree that certificate of need is a flawed approach in its current form.

Representative Ron Maurer (R–Grants Pass) served his first term as state representative for District 3 in the 2007 session. During the February 2008 supplemental session, Maurer served on the House Health Care Committee, chaired by Rep. Mitch Greenlick (D–Portland) and the Human Services and Women’s Wellness Committee. Maurer co-owns with his wife the Rogue River Health Clinic, a privately-run Rural Health Clinic. Maurer has been a staunch opponent of health care as a constitutional right and has recently voiced the need for a legislative auditor for health licensing boards.

Oregon Health News spoke recently with Maurer to get his views on the Oregon Legislative Assembly’s first-ever supplemental session and his concerns for the future of Oregon’s health care system.

OHN: Can you give me your impressions of the February session now that it’s finished?

RM: I was disappointed in the process, and this is a partisan view. I wasn’t allowed to submit bills. I wasn’t allowed to submit minority reports, where the Senate was. In a normal session we have traditionally been [able to do so]. My question is, does this set a new precedent – to silence the voice of the minority? If the roles were reversed I certainly hope I wouldn’t do that. There was no reason to have taken that tact. I think that ultimately when the June [economic] forecast comes out and it goes down again, that we may have to rebalance the budget. Of course that means one thing: program cuts, which is not a good thing. But that’s all speculation. And of course the Hope initiative didn’t make it, which … I’m glad it didn’t make it. But I’m sure we will see it again.

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