This story has been updated to incorporate additional reporting.
Hundreds of proposed new health care laws are hitting the decision point in Salem at which Oregon legislative leaders determine if they live or die. Most bills have to be scheduled for a committee vote by Friday to have a chance at becoming law.
Over 200 bills were assigned this session to the Oregon House Behavioral Health and Health Care Committee, and over 100 were assigned to the Senate Health Care Committee this session.
And that doesn’t include the workload of other committees.
“It’s too much,” state Rep. Rob Nosse, a Portland Democrat who chairs the House health care committee, told The Lund Report. “I’m in hell. I’m oversubscribed.”
Nosse scheduled votes for over 50 bills on Wednesday so they would survive the Legislature’s first cutoff, saying that it’s better for their flaws to come out during hearings rather than be quashed by a “mean” committee chair.
State Sen. Deb Patterson, a Salem Democrat who chairs the Senate Health Care Committee, was unavailable for an interview but was able to provide updates on the status of bills via text and voicemail.
One bill did not face any problems. House Bill 2010 sailed through both houses of the Legislature and was signed into law by Gov. Tina Kotek Thursday, March 20. The bill renews and expands the hospital tax that unlocks federal matching dollars to fund the Oregon Health Plan, free coverage for low-income people that covers one in three Oregonians.
Even if the bills are scheduled for a hearing, those bearing a price tag for the state could be assigned to the Legislature’s budget-writing committee, a graveyard for many bills.
The committee’s co-chairs on Wednesday released a document outlining a potentially “dire impact” for services in the state if the Trump administration and Republicans in Congress make significant cuts to the federal budget.
Here is a roundup of where health care legislation stands.
Bills aim to improve access with less paperwork, more provider pay
Lack of providers continues to create a major barrier to accessing health care in Oregon. And a big driver of that lack is low reimbursement rates to providers.
A third of Oregonians rely on the Medicaid-funded Oregon Health Plan for insurance. But over half of dentists don’t accept it because of low reimbursements and administrative burden, leading to a lack of access in much of the state.
House Bill 2597, which made the cutoff, seeks to fix that by increasing dental reimbursement rates to nearly 60% of the average rate paid to insurers. Similarly, House Bill 2270 would increase reimbursement rates for addiction medicine services by 30%.
Both bills have been scheduled for votes. But other bills attempting to boost access to primary care have not.
Various analyses differ on whether Oregon's primary care access is adequate, with national surveys concluding Portland and Oregon have some of the worst access in the country, even as official reports find the number of providers is adequate or better.
Betsy Boyd-Flynn of the Oregon Academy of Family Physicians told The Lund Report the group’s biggest priority is Senate Bill 443, which would allocate $1.5 million for a program to train family medicine doctors at Oregon Health and Science University. The bill has not been scheduled for a vote.
Nor has another bill, Senate Bill 609, which would boost primary care reimbursement rates similar to what lawmakers are doing for dentists and behavioral health workers.
House Majority Leader Ben Bowman is trying again to pass a bill aimed at maintaining the independence of small medical practices as investors and large corporations, like UnitedHealth Group, purchase small clinics. His bill, Senate Bill 951, is scheduled for a committee vote next week.
“Access is declining because of some of these corporate and private equity arrangements,” Bowman told The Lund Report. “We’ve got to do other work on the structural problems of the health care system.”
Another bill sponsored by Bowman, House Bill 3554, would create a loan repayment program for primary providers while also helping them purchase expensive health record systems. Boyd-Flynn said that medical practices are often driven to affiliate with larger players because of the costs associated with upgrading to expensive medical records systems.
The family doctors’ group supports both of Bowman’s bills, Boyd-Flynn said.
She said that discussions about health care spending tend to focus on eligibility or reimbursements for care. But she said an important conversation concerns reducing the time providers spend on administrative chores to free up money to spend on care.
“If we can reduce how much we are spending on administration, that frees up what we can spend on who is covered and how much we pay for care,” she said. “And for primary care that is really, really important because primary care is not getting adequately reimbursed.”
Other bills are intended to help ease providers’ administrative burdens. House Bill 2210, which made the cutoff, would expand a database designed to streamline paperwork to help providers get reimbursed through the state’s Medicaid program.
Unlike in previous sessions, legislation that would enter the state into interstate agreements to allow health professionals from other states to work in Oregon are advancing.
The Oregon House last month passed House Bill 2596, which would approve such an agreement for school psychologists. Similar bills for social workers, mental health counselors, physician associates as well as dentists and dental hygienists have been scheduled for committee votes.
Bills would expand local health equity programs
Despite a push by state leaders to address health disparities, research continues to show that people of color in Oregon continue to have worse outcomes and face more difficulties accessing care.
Groups around the state are mobilizing to address federal proposals that would limit or prohibit access to some types of care.
One of the ways the state has tried to address disparities is through the Regional Health Equity Coalition program, which was set up over a decade ago that connects health officials with community members to work on local health problems.
Senate Bill 530 has been scheduled for a vote. It requires the grants the state gives to fund ten Regional Health Equity Coalition programs around the state for addressing disparities be adjusted for inflation.
Jayden Ruff, director of the South Coast Equity Coalition, told lawmakers in written testimony that the coalition engaged with Curry County’s Spanish-speaking community to fund programs including nutrition, diabetes prevention, community exercise programs and others.
A related bill, Senate Bill 528, has also been scheduled for vote. It would increase the number of those coalitions by five and would appropriate funds to pay staff and operate facilities while also paying and providing child care, transportation, and translation services for coalition members.
Meanwhile, state Sen. Lisa Reynolds, a Washington County Democrat and pediatrician, has been pursuing legislation to reduce child poverty and provide mental health support for new and expecting mothers.
Senate Bill 692 would fund culturally specific services for expectant mothers, including health care workers who assist parents with the birthing process known as doulas.
Black women face a higher maternal mortality rate than their white counterparts, and research suggests that doulas can lead to better outcomes.
Behavioral health spending turns to workforce
A national assessment has repeatedly found Oregon among the worst states when it comes to access to mental health services and outcomes.
Oregon lawmakers pumped more than $1 billion into behavioral health programs in recent sessions, but new facilities face staffing shortages.
House Bill 3129, which was amended, would appropriate $25.7 million over two years to establish a behavioral health workforce fund that would help mental health counseling training programs like one at Southern Oregon University.
“We really do need more workers,” Marc Overbeck, government relations director for Southern Oregon told The Lund Report. He said clinics have long wait times for new patients and local health programs are overwhelmed with demand.
Two other bills would also expand behavioral health workforce training. Gov. Tina Kotek last week testified in favor of Senate Bill 142, which would allocate $25.7 million for training programs in higher education, as well as $13.8 million for behavioral health training grants and another roughly $9 million to help rural providers pay back loans.
Kotek told lawmakers that despite lack of counselors, psychiatrists or other professionals “people who are considering a career in mental health and addiction treatment are, frankly, struggling to enter and stay in the field in the first place.”
SB 142 has yet to be scheduled for a vote. Another bill to boost workforce funding, House Bill 2024 has no specifics but has been scheduled for a vote.
Another bill, House Bill 2203, grew out of a work group’s recommendations last year on how to improve the safety of behavioral health workers, many of whom leave the profession because of violence they face on the job. Amendments to the bill would require employers to offer more training and develop safety plans, give communication devices to staff working alone with clients and others.
Medical debt, coverage targeted
Lawmakers are also considering legislation intended to protect consumers from unexpected medical bills and ensure coverage.
Senate Bill 605 is intended to prevent patients’ medical debt from being reported to a credit bureau or consumer reporting agency. The bill has been scheduled for a committee vote.
Charlie Fisher, the state director for Oregon State Public Interest Research Group, told The Lund Report that his group’s biggest priority is Senate Bill 539, which is intended to protect consumers from hospital “facility fees.” It has not been scheduled for a vote. However, Patterson, the chair of the Senate Health Care Committee, told The Lund Report on Friday that she would schedule it for a vote.
Hospitals charge patients facility fees for using the emergency department, as well as inpatient or outpatient services. The Hospital Association of Oregon opposes the bill, arguing that it will destabilize funding for financially struggling hospitals
However, Dr. Van Anh Nguyen, a family medicine physician in Beaverton, told lawmakers in written testimony that facility fees can be thousands of dollars and that patients have avoided care because of the cost.
Other bills backed by OSPIRG include House Bill 3243, which is intended to prevent “ambulance balance billing,” when patients receive a surprise bill after they are transported by ambulance that is not in their insurance network.
House Bill 3557 would require hospitals to publish a list of standard charges for services. Federal regulations already require hospitals to post prices. But a recent report from OSPIRG found that nearly two-thirds of Oregon hospitals required patients to first hand over personal information, which Fisher said is a barrier to comparing prices.
Lawmakers are also considering multiple bills intended to force insurers to pay for specific medical procedures without making their providers apply for approval first.
One of these bills that has been scheduled for a vote, Senate Bill 1137, would require insurance companies to cover breast reconstruction surgery after a mastectomy.
However, a bill that would expand coverage for in vitro fertilization services and other fertility treatments, House Bill 2959, has not been scheduled for a vote.
“That is a tough one,” Nosse said. “It is an expensive benefit. There are only so many insurance mandates you can do.”
Patterson told The Lund Report in a text she would schedule a vote for Senate Bill 535, which is the Senate version of the bill.
Correction: An earlier version of this article erroneously characterized a federal report on primary care. The Lund Report regrets the error.
