Health care policy has assumed a higher profile in the 2016 gubernatorial election, punctuated by the public resurfacing of former Governor John Kitzhaber, Oregon’s long-time policy doctor.
In a debate with her GOP challenger Bud Pierce, Governor Kate Brown said she will protect funding for the Oregon Health Plan, which could face a budget hole next biennium of anywhere between $250 to $750 million. Pierce said he would avoid lopping anyone off the Oregon Health Plan, but deal with the budget gap by reducing services.
Meanwhile, Kitzhaber re-emerged from his self-imposed exile by calling for a shift in funding from medical services to social determinants of health, which are human services proven to help people stay healthy, but not always available or accessible to all low-income Oregonians.
What Kitzhaber proposes may already by set in action by Brown’s administration, which is preparing to ask for another Medicaid waiver and $1.3 billion in new federal funding to do just what the former governor recommended. Oregon previously received $1.9 billion in federal funds to support creation of CCOs as a way to hold down rising health care costs, which they have so far succeeded in accomplishing.
The waiver request would direct Coordinated Care Organizations (CCOs), which were created under Kitzhaber’s watch, to establish broad-based community partnerships to make certain human services more readily available and integrated with the health care system.
CCOs were established as a way to “bend the cost curve” on health care spending by eliminating inefficiencies in the health care delivery system and focusing on medical procedures with a track record of success. In many respects, part of the job of CCOs is to keep people out of the hospital or limit how long they stayed in the hospital, so an additional role of connecting patients to human services wouldn’t be that foreign.
Connecting mainstream health care to other systems, including public health, school clinics and veterans care, hasn’t been easy. Trying to make a connection with human services, which are provided by a mosaic of government and nonprofit organizations, could be an even more daunting challenge. CCOs could serve as an existing and capable center-point around which to organize medical and human services for lower income Oregonians.
Brown’s bigger challenger, if she is re-elected as expected, will be to keep her pledge to protect the Oregon Health Plan budget. Passage of Measure 97, which would add a projected $3 billion in tax revenue to the state’s general fund, could help plug the Plan’s budget shortfall, but there is no guarantee that Brown or the legislature would use Measure 97 funding for that purpose.
In fact, Brown may already be looking for other revenue sources to rescue Oregon’s expanded Medicaid coverage as federal funding under Obamacare begins to phase down. If Measure 97 fails, those revenue sources may go from possibilities to probabilities in the defense of the Oregon Health Plan. While there has been no public discussion of funding options, larger Oregon hospitals and health systems might be a tempting target.
Health care costs have received more attention thanks to anti-Measure 97 campaign ads that claim the gross receipts tax on large corporations could increase health care prices in Oregon by as much as $100 million annually.