Oregon lawmakers are again considering an attempt to provide them with better information when they consider bills to force insurers to cover specific devices or procedures.
The bill, House Bill 2690, would set up an advisory committee to help lawmakers with a dilemma that comes up routinely. Just about every session, advocates back a bill pressing lawmakers to require or mandate coverage of a certain treatment. And just about every time, insurers oppose the bill, saying it would lead to increased premiums for insurance ratepayers thanks to unnecessary or inappropriate treatment.
“The hearing process is just, frankly, lousy for vetting mandates,” state Rep. Rob Nosse, a Portland Democrat who chairs the House health committee, told The Lund Report. “When you’re in a busy committee like mine, it’s even worse.”
In this session alone, Oregon lawmakers have considered bills that would require insurance companies to cover prosthetic devices, cancer treatment medications, fertility services and others. In all, more than 20 bills were introduced, according to a tally provided by Kaiser Permanente.
The Oregon Health Authority already uses an independent expert committee to advise it on what services or procedures should be covered under the Oregon Health Plan. But state lawmakers often don’t get much in the way of outside assistance when they are asked to make similar decisions.
“Each mandate has a cost.”
Lawmakers have already approved a large number of the health insurance mandates, including mandates for proton beam therapy for cancer, drugs that prevent HIV infection, a treatment for pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections, breast examinations, bilateral cochlear implants and others.
The mandates boost patient access by overriding the sometimes controversial use of prior authorizations by insurance companies to deny care. But at times, as with proton beam therapy, the mandate provides far broader access to a very costly treatment than experts say is called for — when a less costly treatment would be just as effective.
As a result, the growing number of mandates adds to underlying health care costs. That helps fuel escalating health insurance premiums that are increasingly sparking concerns.
“Each mandate has a cost,” said state Rep. Hai Pham, a Hillsboro Democrat and a chief co-sponsor of the bill.
Many mandates, not enough information
HB 2690 would create a six-member committee tasked with reviewing proposed mandates for whether they will increase patient costs, the effectiveness of the treatment it seeks to cover and whether it will broadly benefit patients.
Supporters of the bill hope to avoid what has happened in the past, when Oregon lawmakers passed insurance mandates without complete information.
More than 30 other states have a process to review insurance mandates, advocates say.
“It’s challenging to truly understand the impact of each of these proposals,” Jen Lewis-Goff, government affairs director for managed care consortium Kaiser Permanente, told lawmakers during a hearing on the bill in February. “We think there are critical questions that must be asked during consideration of any insurance mandate.”
She said that mandates can cause monthly premium increases of less than 1% to more than 5%, which she said can add up.
“The hearing process is just, frankly, lousy for vetting mandates."
Rick Blackwell, lobbyist for PacificSource Health Plans, told lawmakers that it’s not uncommon for technical but important details to be missed while proponents of a mandate make their case.
“Understanding these nuances ahead of time can save years of wrangling and follow up bills from this from the (legislative) committees,” he said.
A spokesperson for Regence BlueCross BlueShield told The Lund Report in an email that the company supports the bill as increasing “transparency around equitable access to mandated benefits and cost.”
The committee would include representatives from insurers, health care providers, consumers, health equity advocates and an expert on rural health.
It would not make a recommendation as to how lawmakers would vote, but it would evaluate proposed mandates for cost, evidence and their effect on health care inequities.
New version seeks to limit its price tag
In past Legislatures, efforts to set up outside committees to advise their work tended to be met with skepticism, with party leaders viewing them as potentially infringing on their discretion.
It’s unclear if that’s why earlier versions of HB 2690 have failed in the past. Similar bills easily passed out of committee in the last two sessions, but died in the Legislature’s budget-writing committee.
Nosse believes cost was a problem, saying it has been difficult to justify spending on a service to help lawmakers. The previous bills were respectively projected to cost more than $500,000 a year.
Legislative analysts have not yet estimated a cost for the six-member Health Insurance Mandate Review Advisory Committee that would be created by HB 2690. But the bill would create only a limited pilot program, and Pham hopes it will cost less.
The committee would review no more than six proposed insurance mandates before it sunsets in June 2028, with the subjects requested by health legislative committee chairs or vice chairs.
Pham said he hopes lawmakers will vote to continue and expand the program after it is shown to support better decisions.
The bill is scheduled for a vote Tuesday in the Oregon House Behavioral Health and Health Care Committee.
You can reach Jake Thomas at [email protected] or at @jthomasreports on X.
