Kitzhaber Brings Home Bacon

The big news last week revolved around Governor Kitzhaber's successful, last-minute trip to Washington, D.C. where he negotiated final terms of a deal that will bring Oregon almost $2 billion in federal money over the next four years to finance health care reform. The first installment — $620 million — is expected to arrive in Oregon by July 1.

As The Oregonian put it in its lead story on the successful trip: "Kitzhaber saves Oregon budget and his reputation in health care deal with Obama Administration." Both points are true. Oregon needs the money to fund reform. And, Kitzhaber, a former emergency room doctor who thinks, lives and breaths health care policy, had almost no choice but to succeed in D.C.

What remains is a question about whether the new federal money can be used to fill budget holes or must be devoted to new health care reforms. But that question, as important as it may be to budget analysts, ignores the basic policy point — the money will go to reform and that will mean that the reforms have a better chance for success here.

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Retired Law School Dean Reflects on Ruling

Symeon Symeonides pondered a moment, then said he had no idea how the U.S. Supreme Court would rule on the constitutionality of the Obama health care law, especially the individual mandate requiring every citizen to have health insurance. The high court will hear arguments in the case next week.

An internationally renowned constitutional law scholar, as well as one of Salem's best-kept secrets, Symeonides said it might be easier for states like Oregon to impose a health insurance buying mandate than for the federal government to do so. After all, he said, Massachusetts passed a mandate a few years ago and it appears to be working — though Republican presidential candidate and former Massachusetts governor Mitt Romney would rather kick the issue to the background. 

Symeonides and I, along with Willamette Law School's development director, Mike Bennett, sat down for a drink last week to reflect on the Supreme Court case, which stands to be one of the most significant in years, perhaps even rivaling the abortion or desegregation decisions. It was only about a week before Symeonides headed off to Brussels, where he will be working for several months to advise the European Union on how to draft a new constitution.

If states found the political wherewithal to impose an individual mandate — and Symeonides, ever an astute observer of political winds, thinks that could be a tall order — it might be easier legally because it wouldn't run up against the U.S. Constitution's commerce clause. Under Article 1, the clause gives Congress "the power to regulate commerce with foreign nations and among the several states, as well as Indian tribes."  The outcome of the court case rests, at least in part, on how current justices interpret the commerce clause and whether regulating commerce "among the several states" allows for an individual health insurance mandate.

The New York Times published an article last week, with the headline,  "At Heart of Health Law Clash, a 1942 Case of a Farmer's Wheat."

"If the Obama Administration persuades the Supreme Court to uphold its health care overhaul law, it will be in large part thanks to a 70-year-old precedent involving an Ohio farmer named Roscoe C. Filburn."

Seems that Mr. Filburn sued to overturn a 1938 law that told him how much wheat he could grow on his property and imposed a penalty on him if he grew too much. The Court ruled against Mr. Filburn, and that ruling serves as the pivot for what the justices will begin considering next week. The Times says interpretations of the Filburn case may form the basis for decisions by the two current-day justices who are considered the swing votes in this case, Anthony Kennedy and Antonin Scalia.

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Three Down – Only 26 to Go

As legislators headed home Friday to gear up for a second week in Salem, it was difficult for anyone accurately to describe the activities of the first three days because things moved much faster than normal at the Capitol — especially for opening days of a legislative session.

There was a crush of business as committees posted hearings on a large number of bills that probably will go nowhere. It prompted a lot of scurrying around, as lobbyists tried to figure what had a chance of passage and what didn't.

Three major "reforms" proposed by Governor Kitzhaber — education, health care and early learning — began moving down paths toward probable approval later this month. If you were betting, you would say the governor would win, but not without push-back by some Republicans who believe change is moving too fast for anyone to accommodate.

A so-called "budget deal" announced on the second day of the session last Thursday produced a bit of buzz, plus a couple headlines, but no one was sure about the real scope or impact of the deal. It turned out to be a "budget re-balance" plan, which means it represented an attempt by Joint Ways and Means Committee leaders to solve internal problems in the budget that had emerged in the last six months since adjournment last June.

The re-balance plan didn't address the current shortfall in state tax revenue, which has been pegged at about $305 million. Nor did the plan address any new revenue shortfall, which could be announced Wednesday when the state economist releases the latest revenue forecast at a joint meeting of the House and Senate Revenue Committees. It also prompted criticism of the Ways and Means co-chairs who took some of a recent Phillip Morris tobacco tax court-ordered payment — about $56 million — and applied most of it to the general budget deficit, not, as proposed, to funding for crime victims. Such is the stuff of Ways and Means.  Money ostensibly for one purpose is swept for another purpose.

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Promise of Cash Makes Reform Vote Likely

Governor Kitzhaber and one of his health care gurus — Dr. Bruce Goldberg, head of the Oregon Health Authority — returned from Washington, D.C. a couple weeks ago with a load of cash. They reported the Obama Administration promised to help Oregon continue reforming its health care system with $2.5 billion over five years.

As always with such pledges, some observers will say "show me the money."  But the Kitzhaber/Goldberg report made headlines just as legislative committees met at the Capitol to prepare in earnest for the February legislative session, at which health care reform will be one of the big topics.

Embodied in Legislative Counsel bill draft #97, the details of a key reform — Coordinated Care Organizations (CCOs) — made its debut. The idea is to focus care, especially for low-income Medicaid recipients, closer to where they live around the state.

News of the prospective $2.5 billion to finance reform probably came close to assuring that the legislature will pass reform legislation in February. It will be almost impossible to say no.

Here are other developments from last week's legislative committee meeting days:

       *  Three officials — Goldberg; Eric Parsons, chair of the Oregon Health Policy Board; and Mike Bonetto, the governor's health care policy assistant — gave House and Senate committees a report on reform progress and received a respectful reception.

       *  A group of health care policy leaders from the Portland metropolitan area, led by Greg Van Pelt, CEO of Providence Health & Services, and George Brown, CEO of Legacy Health System, updated lawmakers on progress to form a CCO that would organize care for citizens in the tri-county area.  The group, which has been meeting for three weeks and intends to keep working, calls itself the "Tri-County Medicaid Collaborative." It was viewed as a significant development because so many organizations – about 30, including health systems, insurers, counties and MCOs – have taken the initiative to follow-up on the governor's health care transformation vision. Similar, though smaller efforts are under way in other parts of the state.

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Accurate Expectations for Short Session

Many Oregon legislators have lived through the different pace of the "experiments" with two short legislative sessions – one in 2008 and one in 2010. A number of new legislators and — perhaps more important — Governor Kitzhaber have not had the special experience.

That raises questions about proper expectations for the short session, which comes amid a lingering recession that has resulted in declining state tax revenue projections and just before the campaign season formally launches that will determine which party controls the House and Senate. The special session is scheduled to end no later than March 5, the day before the filing deadline for the May primary and November general elections.  

There are at least five major issues on the special session platter. Four of them are there because of initiatives by the governor as he seeks to re-make state government. The issues are:

         *  The need to balance the state budget in the face of a continuing recession that is sapping general fund resources for K-12, higher education, law enforcement, prisons and social services. The prospect of spending cuts is viewed as so dire that SEIU and AARP have bought advertising to decry further reductions in home, health and long-term care.

         *  Taking the next steps in the governor's education investment strategy, which will consolidate education management and funding priorities from kindergarten through graduate school under his leadership and an appointed education czar.

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Words Matter as Much as Policies

Will Oregon Governor John Kitzhaber convince the federal government to give money back to the state because of progress here on health care reform?As a person who likes and uses words, I have noticed that the health care debate — both heading toward the U.S. Supreme Court and the 2012 Oregon Legislative session — has been marked by words apparently designed to get the attention of those involved.

Consider these examples:

• Regarding the "you-have-to-buy-health-insurance mandate" that is heading to the U.S. Supreme Court, a health economist at the Massachusetts Institute of Technology, put it this way:  "Health reform without an individual requirement is the spinach you need to get the chocolate you want."
• On the same issue, a former health care policy advisor to President Bill Clinton was quoted last week as saying that "health reform without an individual mandate is like driving a train without tracks; you can still move, but you can't get to your destination and it will be a tougher and far more costly trip."
• Or, consider this quote used last week in an update for Oregon legislators on the Health Insurance Exchange: "Our assumption is that the exchange is being born in a political battlefield. Half of Oregon never wanted you to exist and other half wanted much more than what you are. It seems your biggest challenge will be to gain the trust from both sides that you are an honest broker of information and opportunity — not the purveyor of a political agenda."

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That R Word is Back

The R word — recession — is back on the lips of economists again, both nationally and in Oregon. The prospect of a double-dip recession prompted Governor Kitzhaber to direct state agencies to look for another 10 percent to trim from their budgets.

Unless the economy suddenly turns on a dime, that means the 2012 legislative session may be staring at more spending cuts — not exactly what legislators want to focus on right before their re-election campaigns. It opens the door to political challengers who can criticize failed efforts by the state to stimulate job creation. The cuts also will evince political squeals.

First, the health care reform measure, House Bill 3650, passed in the 2011 session, calls for saving $240 million in low-income health care under Medicaid. Many observers believe this "savings" will amount to a just another cut.

Second, several state agency budgets passed by the 2011 session will be good essentially only for the first year of the biennium. In the case of the budget for to serve senior citizens and persons with disabilities, for instance, there is already not enough money to continue current services for 2012-13. Legislators could face the uncomfortable reality of having to cut programs for those who are the most dependent on state services.

There is a substantial disagreement in Salem over whether a state such as Oregon can pull itself out of the depths of a stubborn recession. No less a figure than Senate Minority Leader Ted Ferrioli, R-John Day, believes in the prospects of a "jobs agenda." There are always differing political views on what the agenda should look like, but with split control in the House and possibly in the Senate next February, there may be a greater willingness to take ideas from both sides of the aisle.

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Lawmakers Anticipate Busy February Session

Anticipating a busy 2012 session, lawmakers will hold three more sets of "legislative committee days" before February to tee up issues as they nervously await two more revenue forecasts that could determine whether budget-cutting will be a focus of their attention.

Here are three examples of what we already know will be on the agenda:

Ways and Means leaders Sen. Richard Devlin, D-Tualatin, and Rep. Dennis Richardson, R-Central Point, may need to make budget adjustments in February.STATE REVENUE: Taking stock of a volatile state budget is an obvious reason for annual sessions. This time, the stakes will be very high as the state struggles to emerge from a stubborn recession.

August's forecast, released two weeks ago, showed state tax revenue declined by almost $200 million from projections at the end of the legislative session last June. While new State Economist Mike McMullen did not predict an "echo recession," he noted a loss of consumer confidence following congressional wrangling over the federal deficit.

The $200 million drop in revenue can be managed with the reserve legislators wrote into the budget, but deeper declines could mean more cuts.

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Push to Adjourn Follows Weekend Off

Legislators came close to adjourning late last week, but decided to take the weekend off and return today for the final push.
   
Standing in the way is an agreement on the Corrections Department and a way to fill a $20 million budget hole.

Here's the way one legislator, Rep. Dennis Richardson, R-Central Point, put it in a newsletter to his constituents:

"Two weeks ago, I expected we would have adjourned this legislative session by last Friday, June17th. Last Friday I expected we would be adjourned by Wednesday, June 22nd. Last Wednesday I expected we would be adjourned by today, Friday, June 24th. Today I have no idea how long this session will continue. Constitutionally, it must adjourn by July 10th, the final date allowed for the session without a 2/3 vote.

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Health Care Transformation Looms Large in Session End-Game

Now that lawmakers, the governor and interest groups have cut a deal on education bills, including the governor's proposal for a super-board, the Education Investment Board, one of the major issues left to resolve this week goes by a high-sounding name — health care transformation.

Embodied in House Bill 3650, it is a proposal envisioned first by Governor John Kitzhaber to change how health care services are delivered to low-income Oregonians under the joint state-federal Medicaid program. It calls for new delivery organizations, Coordinated Care Organizations (CCOs), which would be created by local initiative around the state, replacing "managed care organizations" that for years have functioned much like insurance companies for Medicaid.

The idea, according to Kitzhaber, is "to create a more coordinated system that focuses on prevention, wellness, and community-based management of chronic conditions, making it easier for all Oregonians to access effective, high-quality, low-cost services."

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