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Entries in Oregon Health Plan (5)

Friday
Feb222013

Kitzhaber Makes National Waves

Governor Kitzhaber went from a face in the crowd in the First Lady's State of the Union box to a news media headliner talking about Oregon's bold venture into transforming the health care delivery system to deliver better quality at less cost.

The former emergency room physician told national audiences this week he couldn't accept budget cuts that forced low-income and working poor families to access their health care in the ER. He told The Washington Post he still vividly recalls an elderly man who was culled for budgetary reasons from the state's Medicaid rolls, but who showed up at his emergency room after suffering a stroke. "These people don't disappear," Kitzhaber said.

Appearing on NPR's Here and Now show, Oregon's third-term governor explained the approach the state is pioneering to "bend the cost curve" of health care by creating incentives to keep people healthy rather than just treat them when they are sick. 

Kitzhaber focused on the care of patients with chronic illnesses who can avoid hospital admissions and additional prescription drugs through more personalized care, often in the form of a Registered Nurse. He said helping to manage chronic illnesses can result in better outcomes for patients and drastic reductions in medical costs. Another cost driver is untreated mental illness, which can result in frequent, costly medical incidents that are treated, but without getting to their root cause.

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Tuesday
Dec042012

Oregon Emphatic on Expanding Medicaid

While some states have debated whether to expand Medicaid as part of implementation of the federal Affordable Care Act, Oregon appears not even to have considered the possibility of saying no.

Led by an activist governor, John Kitzhaber, Oregon has proceeded as if health care reform was a foregone conclusion.  In fact, the governor, a former emergency room physician and one of the country's acknowledged health care policy experts, has taken action to put the state ahead of almost all others, contending there is no choice but to reform a system that could threaten to bankrupt the state budget.

Kitzhaber encouraged the state to develop an online health insurance shopping center before there were any federal rules on such health insurance exchanges. He proposed a new approach to delivering health care to Medicaid recipients through "coordinated care organizations" and prodded the legislature to go along with him. In the new budget Kitzhaber unveiled for 2013-15, he continued moving down the road aggressively toward reform.

Lawmakers, even with a nearly even split between Democrats and Republicans in the 2011 legislative session, went along with the governor in large numbers. The vote on the underpinning of reform, Senate Bill 1580, passed on a party line vote in the Senate, but cleared the House by a wide margin, 53 to 7.

Few legislators went on record with statements in opposition to reform, though a couple Republican voices in the Senate asked whether the state wanted to get linked up with Obamacare when so little was known about long-range costs.

Last week, one Republican said he was concerned that the governor had included Medicaid expansion population in his Oregon Health Plan budget recommendation, exposing the state to unfunded costs down the road.

Meanwhile, other states have moved more slowly than Oregon. An Associated Press story this week reported several governors have resisted submitting to the federal directives.

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Friday
Nov302012

Governor Rolls Out "Education Budget"

Governor Kitzhaber unveiled a budget proposal today that he called "first and foremost an education budget."  He said his budget "creates space for front-end investments in education and early learning by cutting back-end spending on health care and corrections." 

His 2013-15 budget, which was previewed by The Oregonian and Salem Statesman Journal today, puts controversial changes to the Public Employees Retirement System (PERS) squarely in the center of an effort to carve out more money for schools. And that could bump into political resistance from the newly Democratically controlled House.

Despite that, the atmosphere in the state Capitol was markedly different than in Washington, DC, where partisan wrangling continues over how to avoid plunging over the so-called fiscal cliff. While there is no looming fiscal cliff here, the governor's budget will only serve as the framework for the 2013 legislature to hash out a final budget with Democrats at the controls in both the House and Senate.

Senator Richard Devlin, D-Tualatin, already named to be Senate co-chair of the Joint Ways and Means Committee, was charitable toward the governor, as quoted in the Salem Statesman-Journal.  "I appreciate the governor's candor about the specific challenges we face in funding education and the Oregon Health Plan in the next biennium," Devlin said.  "With his recommended budget, Governor Kitzhaber has provided a good starting point for the budget negotiations ahead of us."

New House Republican Leader Mike McLane, R-Powell Butte, praised Kitzhaber for addressing PERS, but questioned the rosiness of revenue projections and the lack of any fund reserves to cushion the budget in case the economy falters in the next two years.

The governor's plan for more money for K-12 schools rests on the premise that the legislature will accept his recommendations to reform PERS in two ways:

• By limiting cost-of-living increases to the first $24,000 in retirement income; and

• By closing a benefit loophole for out-of-state retirees. 

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Monday
Jun112012

Surprise Decision Strains Reform Support

The decision caught almost everyone by surprise last week. The Governor's Office and the Oregon Health Authority said they would not make any of the $2 billion in new federal money obtained by the Administration available for the first year of health care reform in Oregon.

"Members of the new groups (Coordinated Care Organizations, CCOs) are crying foul," reported The Oregonian, "after a directive Thursday that they'll receive no new funds for the additional responsibilities they've agreed to take on — mental health care, prevention efforts, quality measurements and new patient-care staff, among others."

In fact, managers of the new, still-not-yet-approved CCOs have been told they will have to live with last year's rates, which themselves represented an 11 percent cut. Leaders of the new groups say their success relates directly to the new money to fund them. They say it takes money to revamp care for more than 600,000 Oregonians covered by Medicaid, the joint federal-state program that provides care for low-income citizens.

In touting health care reforms such as CCOs and the Health Insurance Exchange, Kitzhaber has stressed the need to control costs through competition and innovation.

For many in the health care reform orbit, all of this conjures up images of the original Oregon Health Plan more than 15 years ago, also designed by Governor Kitzhaber in his earlier service as Oregon Senate President and as governor in his first term. A key tenet of the plan then was that providers would be paid close to their costs for delivering services. The clear objective was to limit the cost shift onto the backs of private health insurance payers.

Well, that tenet apparently has been lost in the intervening years.

Today, those with private health insurance pay about 20 per cent more in premiums as they bear the "hidden tax" of paying for Medicaid underfunding. In a 2008 study, the Milliman Group estimated underfunding of Medicaid and Medicare amounted to more than $90 billion annually.  Though four years old, the study is still applicable today.

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Wednesday
Nov232011

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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