Legislative Information
OAHU LEGISLATIVE UPDATE
May 19, 2013
SB 604 – Centralized Credentialing
Sen. Alan Bates (D-Medford) told the Human Services Subcommittee of Ways and Means that as a physician he has to go through credentialing by 40 insurance companies, two hospitals, plus some federal and state agencies in order to do his work and get paid. “Each has a different form to fill out that has to has to be updated every 90 days,” he told the committee.
SB 604 is designed to standardize and simply the process. It would create a central repository of information where physicians, nurses, dentists and others who need to be credentialed would submit one time and keep it updated. “Everyone who wants information would draw from that data base,” Bates said. “If they want additional information, they can request it but most will find everything they need is there.”
He projects the centralized system could save as much as $140 million in unnecessary work.
There is no cost estimate on the project yet. The first step if for a work group to determine who should manage the IT project.
SB 413 – Rate review notice to consumers
A compromise was worked out on the Senate side saying insurers must notify policyholders each year about how they can participate in the rate review process. Now the bill is in the House Health Committee and OSPIRG wants to change the deal. They want a special notice sent plus a check off box on enrollment or renewal notices that insurers would then have to forward to the Insurance Division.
The committee is trying to decide which, if any, of the amendments to adopt.
Revenue Forecast Up – Kickers Could Still Kick
State economists say slow and steady improvement in the state economy are responsible for an additional $126 million in revenues for the current biennium to $15.3 billion and their projection that the 2013-15 biennium will have $16.9 billion to spend, up $161 million from previous estimates. Both figures are up 1% from the March forecast.
Economists say this is primarily due to “tremendous growth in investment income and from high income taxpayers.”
The only word of caution from the economists is that depending on tax receipts over the final six weeks of the biennium, the kickers may kick. They say the personal kicker is “still in play.” They say it would be “surprising but possible.” The corporate kicker, on the other hand, is “better than 50/50 that it kicks.” If it does kick, $20.3 million would have to be returned to corporate taxpayers, baring legislative action.
This is all good news for legislators who are trying to put together the final budget deal for 2013-15.
Governor Proposes Budget Deal
Gov. Kitzhaber says legislators could balance the budget with funds available given the revenue forecast (see above). But he says Oregonians shouldn’t be satisfied with that. “We can do better,” he said in a news conference the day before the revenue forecast was released.
So he offered a two-part plan to break through the partisan impass that had deadlocked budget negotiations. He proposed:
- Additional PERS reform of $400 million targeting money match for inactive accounts
- Raising $200 million in new revenues. The Governor says he is agnostic about exactly where that revenue comes from.
In addition, he proposes a legislative work group that would report back by June 1 on how to lower tax rates for small business.
The Governor said all four legislative caucuses needed to agree to work on his plan by Friday in order to get it done by the end of June. That didn’t happen.
So the Governor says they should just pass budgets with available revenues and go home. But Senate Republicans still want more PERS reforms before they will agree to the hospital tax (see below). So the drama’s not over yet.
HB 2216 – House Passes Hospital Tax to fund OHP
By a 54-5 vote, the House overwhelmingly passed the hospital tax to fund the Oregon Health Plan for the next two years. During debate on the House floor, Rep. Peter Buckley (D-Ashland) said, “We will be providing 220,000 Oregonian with health care coverage; Oregonians who have not had access to health insurance in the past.”
Some complained about combining the Long Term Care Assessment with the Hospital Assessment. Rep. Julie Parrish (R-Tualatin) said, “I’m disappointed that we are not able to look at concepts on their own merits and push them together into these mega-bills.”
But House Majority Leader Val Hoyle (D-Eugene) said both bills were the product of bipartisan work groups.
The bills now go to the Senate. Senate Republicans have said they will not support these taxes until PERS and other aspects of the budget are resolved.
HB 2132 – Churn on the Exchange
An OHA study estimates that 60,000 Oregonians will move between CCOs and private insurance on Cover Oregon in 2016. This churn raises a difficult issue of continuity of care. HB 2132 simply requires the OHA to report back to the Legislature on a regular basis on what it is doing, in consultation with Cover Oregon, to facilitate movement between the Oregon Health Plan and private insurance as people’s incomes change.
The Senate Health Committee held a brief hearing on the bill. It is waiting for an amendment before taking action.
SB 169 – Diabetes Prevention
According to recent CDC report, there has been a 65% increase in diabetes in Oregon between 1995 – 2010. Currently, about 800,000 Oregon residents are affected by diabetes. SB 169 would require the Oregon Health Authority to report on the prevalence and cost of diabetes, and develop a strategic plan to address diabetes.
The House Health Care passed the bill. It now goes to the floor for debate.
SB 460A – Restricts Biosimilar Substitution
The two sides reached an agreement on the biosimilar bill. Before a pharmacist can substitute a biosimilar for a biologic drug the:
- Biosimilar must have FDA approval
- Prescriber may choose not to allow substitution
- Patient must be informed about the substitution
- Pharmacist must keep records about the substitution and
- Pharmacist must inform the prescriber about the substitution. This last provision will sunset in two years.
The two sides said they may be back before the legislature arguing over prescriber notification in the 2015 session. But the agreement is good enough for now. So the House Health Committee approved the bill and sent it to the House floor for debate.
SB 724 – Non-traditional CCO billing & ASC direct payments
Currently, CCOs account for non-medical health expenditures under administration. This could include the Governor’s now famous air conditioner example, non-traditional health workers or anything a CCO chooses to spend money on that doesn’t have a billing code. SB 724 would create a third type of expenditure for these non-traditional member services.
The House Health Committee is also considering an amendment to the bill dealing with insurance payments to ambulatory surgery centers (ASCs). When a policyholder receives services from an out-of-network ASC, the insurance company sends the check to the policyholder. The ASCs say, too often, the policyholder keeps the check and doesn’t pay for their, often expensive, surgery.
The ASCs tried, without success, to pass legislation requiring insurers to pay them directly. Proposed amendments to SB 724 would have insurers sending the check to the patient but requiring that it be dual endorsed by the ASC. However, the ASCs and insurers are still arguing over whether the insurance payment would be payment in full or whether the ASC could balance bill the patient. House Health Committee chair Rep. Mitch Greenlick (D-Portland) told the two sides to work it out or the committee would simply choose.
HB 2922 – Single Payer System
The House Health Committee spent an entire session on a hearing on this proposal for a single payer system in Oregon to be paid for by an as-yet-to-be-determined tax.
Rep. Michael Dembrow (D-Portland) sponsored the bill saying, for all of the progress on health care reform in Oregon, “We will continue to have jobs kept temporary part time for no good reason other than to keep workers from being eligible for coverage.”
Dembrow says if we rely on private insurance companies, the best we will have is an expensive, complicated patchwork system. “Fortunately, there is a very simple solution out there; a model that has existed legally and to great affect for the last 50 years in this country. And that is Medicare. Medicare gives us very low administrative fees, individual choice, a high level of care for our most vulnerable and expensive population, and universal access.”
The rest of the nearly two-hour hearing was people describing the insurance problems they’ve had.
One man from Ashland told how he paid premiums through the high-risk pool but the insurance company still blocked him from getting services. “Let’s get em the hell out of this and pass this bill.,“ he said to laughter and cheers from the audience.
Another said, “For as long as I’ve been alive, the health insurance companies have had a chance to solve this problem of providing adequate health care for people and they have failed in every sense of the word. People are going bankrupt. People are dying. People are getting inadequate care and there’s just constant problems throughout the whole system. Why don’t we give state government a chance?”
There aren’t the votes in the legislature to pass this bill. A companion bill (HB 3260 – see below) to study the best funding for insurance in Oregon, including a single-payer system, is much more likely.
HB 3260 – Study of health care funding models in Oregon
This bill would have the OHA oversee the study of four health care funding options:
- Single payer – essentially Medicare for all (HB 2922)
- Public option offered on the Exchange
- Status quo with CCOs and Cover Oregon, the ACA playing itself out
- Sales tax for health care
Supporters told the Human Services Subcommittee of Ways and Means that the
$600,000 price tag would be paid for with a combination of public and private grants. No state funds would be used.
Sen. Elizabeth Steiner Hayward (D-Portland) said, “If this is done correctly, it would give us some objective third party information we can use to make a decision. It’s a great bill.”
The subcommittee is waiting for a minor amendment before taking action on the bill.
