A nearly unanimous vote moves one of the legislature’s most important bills to the Senate
June 27, 2011 – The Oregon House of Representatives passed sweeping reforms to the Oregon Health Plan today by a vote of 59-to-1.
House Bill 3650, known as healthcare “transformation,” heads next to the Senate. The bill marks one of the Oregon legislature’s most significant achievements this session.
Rep. Jim Weidner (R-Yamhill) cast the single dissenting vote because he said he did not believe the legislation could achieve the estimated $240 million in general fund savings by the end of the next biennium.
Weidner pointed to the Congressional Budget Office, which determined in its analysis of the Affordable Care Act in 2009 that care coordination and preventive services would not save as much money as the White House had projected in the short term.
An equally rigorous analysis of the Oregon legislation, which seeks a similar solution to a Medicaid population, has not been performed although Governor John Kitzhaber and his staff point to several case studies.
“These are perceived savings that won’t come to fruition,” Weidner said.
Rep. Tim Freeman (R-Roseburg) dismissed Weidner’s claim as unrelated, and said doing nothing was not an option.
“It’s not about the money,” Freeman said. “It has to be about providing better healthcare with better outcomes. If you don’t get a handle on providing better healthcare, we’ll never be able to balance these budgets. We’ll never have enough money.”
The legislation puts in motion a plan to consolidate the roughly 40 managed care organizations that currently administer the Oregon Health Plan into regional “coordinated care organizations” that can better manage chronic conditions and offer preventive services. By coordinating physical, dental and mental healthcare, which are currently handled in silos, the hope is that the state can improve care and save money.
“My hope is that through this process we’re giving providers in our community some tools to manage what will be less money in the future,” Freeman said.
Rep. Tina Kotek (D-Portland) said the Oregon Health Plan is unsustainable.
“Many people worry we won’t start seeing these types of efficiencies in the latter half of the biennium,” Kotek said. “But into the future, and for the rest of the healthcare system in this state, this bill is going to transform healthcare.”
At the heart of the plan to improve care to more than 600,000 poor and disabled Oregonians is the creation of “community health workers,” a new class of healthcare providers who will receive training from the Oregon Home Care Commission. The bill does not say, however, how many of these workers would be required.
Community health workers would operate similar to a case manager with limited medical duties and would visit OHP members who suffer from chronic conditions to make sure, for instance, that someone with diabetes was taking insulin. They would also be crucial linchpins to ensuring that coordination between physical and mental healthcare actually takes place, said Arthur Towers, political director of SEIU Local 503.
Whether these new types of workers would be offered collective bargaining rights to join a union had become a key sticking point in negotiations of the bill. In the end, this controversial provision was stripped out.
“Our fear is that if you don’t do that, the community health worker becomes a low wage, dead end job that’s not valued by the medical community,” Towers said. “And the savings won’t be realized.”
Towers said the 11,000 home care workers currently organized by SEIU and the clients they serve have benefited from collective bargaining over the past 10 years. Home care workers currently provide help to seniors and people with disabilities. Since 2001, Towers said collective bargaining has helped increase their minimum wage and given them a voice at the Capitol.
“We felt that by giving these workers the choice of whether to form a statewide union you’d be able to create that same dynamic where workers can be advocates for their clients and this kind of care,” Towers said.
The bill also requires the Oregon Health Authority to come back to the legislature next February for approval on several key aspects. The bill also calls for the state to consider using coordinated care organizations to manage public employee and school teacher benefits under PEBB and OEBB.
Rep. Mitch Greenlick (D-Portland) who helped spearhead the legislation as co-chair of the Joint Committee on Healthcare Transformation, said he had high hopes for the bill’s impact to the entire healthcare system in Oregon.
“This moves us in a rational way that makes sense, not only for the Oregon Health Plan but for PEBB and OEBB and eventually the private sector,” Greenlick said.
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