Major Health Care Issues Remain Behind the Scenes

Reports persist the Oregon legislature is on the verge of appointing a major joint committee to pursue agreement on at least two major health care policy issues that have remained in the shadows for weeks.

One is the so-called "health care transformation" led by Oregon Health Authority Director Dr. Bruce Goldberg and Governor John Kitzhaber's health care policy assistant Mike Bonetto. Each Wednesday, they have led the "group of 43" in a review of how to achieve the governor's objective to control health care costs and avoid eating a larger chunk of the state budget.

The second is a sales tax for health care, proposed several months ago by Portland attorney John DiLorenzo, but so far not aired in any public forum this session.

Both issues are fraught with political peril. 

On transformation, Goldberg and Bonetto told the House Health Care Committee their charge is "to draft legislative language to create the legal framework and authorities to implement a high-value, accountable health care delivery system in Oregon."  They also said Kitzhaber has directed that "changes should begin with the Oregon Health Plan (expanded Medicaid) and then include broader markets."

One tension, almost palpable on some days in Salem, is that legislators are worried the governor's proposed changes in health care – as well as in early childhood education – will be too complex to tackle in the remaining three months of the current legislative session. Those who appear most worried are leaders of the Joint Ways and Means Committee who are focused on balancing the state budget.

It usually is a death knell for any Oregon politician to mention the phrase "sales tax."  Yet, DiLorenzo is continuing to push his idea, which to give it at least some credit represents "out-of-the-box thinking." 

In a presentation to the interim Senate Health Care Committee last year, DiLorenzo said "about $10 billion per year would provide an essential benefit package to every citizen of the state... In order to raise this amount, we would likely require an approximate 7 percent sales tax on goods and services.  This could raise $6 billion. Added to that would be an extra $910 million that could be redirected from the General Fund because employers would no longer take deductions for health care insurance."

On top of that, DiLorenzo proposed merging the Oregon Health Plan into the new universal health insurance plan funded by the sales tax.

Whether the new joint committee actually considers both the transformation and sales tax proposals for health care is not absolutely certain. Rumors circulated last week that the Senate decided on its four members of the joint committee, but the House was still arguing over its appointees.

If I were a legislator facing these challenges, I am not sure I would relish the appointment.