2009 Legislative Agenda

Status: Failed

This was the big loss of the 2009 legislative session. Since its inception in 1999, the rural health loan repayment program has received $400,000 per biennium. It’s been terribly under-funded (see HB 2632 below), but the funding has been consistent until this year. The Ways and Means co-chairs zeroed out the budget for this program as part of their $2 billion in cuts to balance the budget.

Status: Failed

The Rural Health Services loan repayment program is no longer a good fit for the Oregon Student Assistance Commission (OSAC). Almost all of OSAC’s other programs help students with scholarships while they are in school.

HB 2581 would have moved the program to the Office of Rural Health. Scott Ekblad, director of the Office of Rural Health, says he’s talked with foundations that may be interested in supporting the loan repayment program, but not if it is in a state agency, and while OSAC is a state agency, the Office of Rural Health is not.

Ekblad also testified about the need for more health professionals in rural Oregon. In urban Oregon there is one physician for every 327 people, while in rural Oregon the ratio is 1:819.

HB 2581 passed the House Health Committee, the House floor and the Senate Health Committee but got stuck in the Education Subcommittee of Ways and Means. Scott Ekblad did not want the program with no funding and the co-chairs zeroed out the budget for the rural health loan repayment program.

Status: Failed

Funding for the Rural Health Services loan repayment program has been stuck at $400,000 per biennium since the program began in 1989. HB 2631 would have increased the funding to $3 million. We did not expect to receive that increase during the recession, but thought it was important to demonstrate the need.

Oregon competes with other states for young physicians who are interested and willing to work in rural areas. Last year, there was only enough money for four awards: one physician, one dentist, a nurse practitioner and one physician assistant. The state of Washington, our nearest competitor, funds its program at $9 million per year.

It was no surprise that HB 2632 did not move out of the House Health Committee. However, it was a big surprise and a big setback when the $400,000 base funding was eliminated.

Legislators added sunsets to 51 tax credits including the rural health tax credit. This could have been disastrous for rural communities that use the tax credit to recruit new health care professionals. ORHA and the Oregon Academy of Family Physicians teamed up to oppose the new rural health sunset.

We did not succeed in removing the sunset, but Sen. Ginny Burdick (D-Portland) and Sen. Frank Morse (R-Albany) came up with a creative solution. “In the unlikely event the rural health tax credit sunsets,” Sen. Burdick said, “anyone who qualified for the credit in 2013 would continue receiving the credit for 10 years as long as they continue to practice in a rural area.” This 10-year horizon is long enough that the tax credit can still be used for recruiting.

Sen. Morse said, “Certainty for those who make a commitment to practice in rural area is very important.”

HB 2067 groups the sunsets in three blocks: 2012, 2014 and 2016. The Rural Health Tax Credit would sunset in 2014.

Legislators say they want to review each of the tax credits to make sure they are achieving their goals. It’s also an easy way for legislators to raise revenues without having to vote for higher taxes. When a tax credit sunsets, it simply goes away unless legislators take affirmative action to maintain the credit.

Status: Failed

The bill would have provided a $12,000 per year tax credit for a physician, physician assistant, dentist, pharmacist or nurse practitioner that works in a medically underserved area and still has qualifying loans.

Hospitals throughout the state are using two-way video connections with specialists at OHSU and Doernbecher Children’s Hospital to confirm diagnoses and avoid unnecessary transports. Grande Ronde Hospital saved $74,000 by avoiding three transports in April. PeaceHealth in Eugene saves more than $6,000 each time it avoids a ground transport to Portland.

SB 24 requires insurers to pay for medically necessary procedures and consults even if they are done using telemedicine.

Evidence is piling up about how long it takes for the Oregon Medical Board to license qualified physicians moving to Oregon. In testimony to the Senate Health Care Committee, Holy Rosary Medical Center in Ontario gave one example of a physician assistant who took six months to get licensed in Oregon; three weeks to get licensed in Idaho.

The solution originally proposed in HB 2435 would grant temporary licenses to physicians who were licensed in another state, had a clean practice history and cleared a background check. But concerns were raised about what happens if a red flag pops up after the physician has already begun practicing in Oregon. What happens if they are ultimately denied a license?

The Oregon Medical Board, OMA and the Hospital Association created an alternative plan. License by endorsement would allow the OMB to accept documents from the state where the physician was first licensed to prove medical education, national medical exam scores, and postgraduate training. They say this should speed up the process.

In the future, DMAP will have to pay rural clinics within 45 days for Oregon Health Plan services. Currently, rural clinics receive partial payment for OHP services from the managed care organizations (MCO) but it usually takes 9 to 12 months for them to receive final payment.

There are 50 certified rural health clinics in Oregon. Some — in places such as La Pine, Jordan Valley, Christmas Valley and Halfway — are the only health care provider in their community. “Many of them are already operating in the red,” Rep. Ron Maurer (R-Grants Pass) testified. “They can’t afford to wait a year to get paid.”

To avoid any fiscal impact on the 2009-11 budget, SB 37 does not take effect until May 2011.

Status: Failed

This bill would have:

• Expanded the rural EMT tax credit from $250 to $500 per year.
• Added eligibility for first responders.
• Redefined rural so areas around Grants Pass and McMinnville would qualify.
• Removed the sunset on the tax credit that is scheduled for January 1, 2011.
  

Currently, 727 people qualify for this tax credit.

The idea was to take about $7 million of the existing tobacco tax money and allocate it to help rural health clinics.

The bill would have allowed the Office of Rural Health to use the money for:

• EMS training,
• Improvements at isolated rural health clinics and
• Grants for rural hospitals to replace or remodel their facilities.

The political problem for this bill was that cities, counties and Oregon Health Plan would have lost money if it passed. The bill was in the Ways and Means Committee at the end of the session.