2010 Legislative Wrap-up
04/06/10 Portland, OR
Voters made legislators’ job easier in this special session when they approved $733 million in new taxes in January. But politics from the Measure 66 & 67 fight still loomed over the session with charges of retaliation and paybacks.
Lobbyists or groups who opposed the tax measures saw their bills deep-sixed, often without a hearing. Others, who supported the measures, were rewarded. Legislative leaders denied it but the accusations were rampant.
Legislators hope this is the last time they will have to call themselves into Special Session as a mechanism for annual sessions. Voters will decide in November whether to amend the Constitution allowing annual sessions.
HB 3639 – Primary care loan repayment but no new money
COHO introduced a plan to create a new loan repayment program providing $10,000 per year to any/all primary care physicians, NPs and PAs. It was an unworkable proposal. But it became clear that legislators were interested in passing something, so the Oregon Academy of Family Physicians worked closely with the hospital association and the Office of Rural Health to “gut and stuff” COHO’s bill with a plan that revises the existing loan program while maintaining as much of the rural focus as possible.
The new plan:
- Moves the loan repayment program from the Oregon Student Assistance Commission to the Office of Rural Health at OHSU in July 2011
- Adds urban providers, split 75% rural / 25% urban
- Adds Naturopaths to those who are eligible
- Requires recipients to see Medicare, Medicaid and uninsured patients
- Standardizes awards of up to $25,000 per year with a three-year commitment and optional 4th, 5th and 6th years for physicians, nurse practitioners, physician assistants, dentists and pharmacists.
HB 3639 passed with no new money but it demonstrates a commitment to primary care by legislators and it gives us some new allies, i.e., health care groups with urban constituencies, to help push for significant loan repayment funding in 2011.
While we lost the exclusive rural focus in the program, the reality is that the rural-only plan had been defunded in 2009 and 75 percent of something is a lot better than 100 percent of nothing. We’ll know within a few years if this strategy works out.
SB 1046 – Psychologist Rx
After eight years of trying, psychologists finally passed legislation creating a pathway for them to prescribe medications after receiving additional training.
OAFP, with support from OMA and others, introduced an amendment clarifying that liability stays with the prescribing psychologist, not with a physician who is consulted in order to coordinate care.
Numerous details of the training and supervision requirements for psychologist who want prescribing privileges were delegated to the Oregon Medical Board.
With passage of this bill, Oregon becomes the third state after Louisiana and New Mexico that allows prescribing psychologists. Psychiatrists continue to oppose the plan, particularly prescribing for children under age 18.
HB 3642 – Expands Supervision for Physician Assistants
Zoom Care, a Portland-based chain of primary care clinics, introduced this bill to broaden supervision for physician assistants. The bill allows a second pathway for PA supervision. In addition to direct supervision of a PA by a physician, a panel of physicians, with one named as the physician in charge, could supervise a PA or group of PA’s.
The bill passed easily.
HB 3664 – Extends Medicaid to foster kids up to age 21
There are about 400 young adults, ages 18-21, in Oregon who have aged out of the foster care system. HB 3664 creates a new category of Medicaid eligibility for this group. Adding this group to OHP Plus will cost the state $1.75 million General Fund ($4.6 million including the Federal match) in the 2011-13 biennium. It will be paid for with the one percent premium tax as part of Healthy Kids.
HB 3611 – Tax deduction for individual insurance
Status: Interim Discussion
Employer-sponsored insurance is the largest “tax expenditure” in Oregon, costing the state $1.19 billion in 2009-11. It provides a significant benefit for the class of people who are eligible for and purchase group insurance but it leaves out the 450,000 to purchase individual insurance. Rep. Ron Maurer (R-Grants Pass) says individuals should receive the same benefit as an issue of fairness.
Maurer says the bill could be made revenue neutral to the state if it capped the business deduction while allowing some deductibility for individuals. The House Health Committee sent the bill to the Revenue Committee to work on the financial aspects of the plan during the interim. The goal is to have a proposal ready for the 2011 session.
HB 3632 – Play or Pay
Status: Interim Discussion
Unions proposed legislation telling the Oregon Health Authority to study a play or pay system that would require employers to provide health insurance for employees or pay into a pool to help cover the uninsured. Such a system requires careful structuring to sidestep federal ERISA laws.
The bill passed the House but the Senate Health Committee said a letter from the Oregon Health Authority attesting that a play or pay analysis is included in its work plan is all that was needed.
SB 1011 – Mandate flu shots for healthcare workers
In 2008, 51 percent of Oregon’s direct service healthcare providers received a seasonal flu shot according to the Public Health Division. In testimony before the Senate Human Services and Rural Health Policy Committee, Public Health said, “Healthcare providers should be vaccinated, in order to help keep patients safe and to prevent the spread of disease.”
The bill would allow individuals to opt out of the vaccination with a written statement.
Sen. Bill Morrisette (D-Springfield) ultimately withdrew the bill saying Public Health had the authority to do what he proposed.
Public Health plans to convene a work group to discuss how best to encourage health care workers to receive flu shots.
SB 1040 – Universal healthcare workforce registry
As part of Oregon’s health care reform efforts, the Office of Health Policy and Research has created a new healthcare workforce database. SEIU doesn’t think that database goes far enough.
The database that is just being implemented covers the major health licensing boards. SEIU says home health care workers and paraprofessionals should be included in a new healthcare registry.
The Oregon Health Authority testified that this idea is not well aligned with the law passed in 2009. The Authority and SEIU agreed to continue the conversation during the interim before 2011.
HJR 100 – Health care is a right
Rep. Mitch Greenlick (D-Portland) has tried for years to send to the voters a constitutional amendment that says, “health care is a right.” In the past, his measure has passed the House but not the Senate. This session he could only find 30 votes in the House, one short of passage. Greenlick says he is ending this quest.
Sales tax for health care
Status: Interim Discussion
One of the more intriguing discussions during the session wasn’t on a bill but just an idea – to create a sales tax and dedicate it to providing basic health care for all Oregonians.
John DiLorenzo, an attorney and lobbyist from Portland, proposes a 7 percent sales tax dedicated to health care. In testimony before the Senate Health Committee he said it could provide basic coverage, including prevention and hospitalization, for everyone. Employers or collective bargaining units would be able to “buy up” and provide additional benefits.
DiLorenzo says Oregon would become very attractive to businesses if they did not have to provide health insurance for their employees. Everyone is aware of Oregon’s aversion to a sales tax. But DiLorenzo and others argue that there would be broad support for a sales tax if everyone benefited through a basic level of health insurance.
The committee hopes to work with the Oregon Health Fund Board to better understand the feasibility of this plan. It’s possible we will see this plan resurface as legislation in the 2011 session.
SJR 41 – Annual sessions headed to voters
Status: Referred to Ballot
Rep. Vicki Berger (R-Salem) said after two annual session test runs that were technically special sessions she supports asking voters to amend the Constitution and allow annual sessions. “We’ve got to stop meeting like this,” she says.
There was bipartisan support in the Senate for a plan that would limit sessions to 45 days in even numbered years and 135 days in odd numbered years. But that plan and the bipartisan support blew up when House Democrats insisted on adding an additional 30 days.
The fight delayed sine die in this short session while a conference committee hammered out a compromise. The final plan would allow 35-day and 160-day sessions.
House Republicans proposed limiting the short session to budget balance measures and bills that have a bipartisan two-thirds vote in each chamber. Rep. Bruce Hanna (R-Roseburg) said, “You want to ban plastic bags, fine. Get a two-thirds vote in each body and you are good to go. This takes partisan politics out of the picture.” But that did not fly.
In the end, House Democrats imposed their will on everyone else and sent their proposal to the ballot. Voters will have their say in November.
Now that the special session is over, what’s next?
- Candidate filing deadline for this year’s elections is March 9.
- State agencies will begin budget preparation in March for the 2011-13 biennium.
- Interim committees are scheduled to meet the last week of May.
- Legislators also created a new calendar for the 2011 session. They plan to start in January, but only for two or three days to elect officers and get organized. Then they will adjourn until February when committee hearings and the regular session will begin.