Oregon lawmakers took the first step last week to secure funding for the Oregon Health Plan and the state’s reinsurance program that helps pay for expensive health care claims. The revenue plan outlined in HB 2010, which passed out of the Joint Ways and Means Committee last Friday, will generate more than $400 million toward the anticipated hole in the state’s Medicaid budget.
The funding plan, which health care industry officials negotiated and support, extends a 6 percent hospital tax and a 2 percent tax on insurance plans. The plan introduces a 2 percent tax on “stop loss coverage” for large, self-insured companies. The insurance tax is expected to generate $320 million and the hospital tax $98 million.
Unlike in previous legislative sessions, this funding plan will extend for six years, not just a single biennium.
Other components of Governor Brown’s Medicaid funding package not included in HB 2010, but which will eventually face debate in the Capitol, include a $2 per pack increase on the state’s tobacco tax, a tax on employers with employees covered by Medicaid and a state General Fund contribution. Many observers believe the $95 million projected from the tobacco tax could be in jeopardy because it will likely be referred to voters to approve.
Republicans on the House Health Care Committee, which heard the bill earlier last week, offered amendments to exempt K-12 school district, college students and small businesses from Medicaid-related taxes. Chair Mitch Greenlick counseled against the amendments, which he said could upset a delicately balanced funding plan agreement. The amendments were defeated and two Republicans on the policy committee voted for final passage of the measure, sending it to a Friday hearing in the Joint Ways and Means Committee.
Patching the Medicaid funding gap is one of several major funding proposals the 2019 Oregon legislature will face. Brown has called on lawmakers to unearth $2 billion in additional tax revenue to boost public education funding. The governor and Democratic legislative leaders also are committed to adopt some form of a cap and trade system that will impose costs on manufacturers and the transportation sector as a means to curb greenhouse gas emissions.
The Medicaid funding package is flanked by another health care initiative – the Health Care for All Oregon plan. Under Senate Bill 770, a board would be created to fill in details of what a plan would look like that replaces private and state employee insurance coverage, as well as estimate what such a plan would cost to implement.
Senator James Manning, D-Eugene, chief sponsor of the measure, says, “This is the first step. It’s not going to happen overnight. This bill provides an opportunity to get a fiscal analysis and develop a work group to drill down into the nuts and bolts of how we get there.”
With secure funding, the state Medicaid program, which serves more than 1 million Oregonians, will press for additional reforms carried out by coordinated care organizations (CCOs) throughout the state. Lori Coyner, who has resumed her job as the Medicaid director that she left in 2017, will be responsible for overseeing $5 billion in spending, holding annual cost increases to 3.4 percent and managing what is nicknamed CCO 2.0 over the next five years.
In an interview with the Lund Report, Coyner said her priorities include streamlining business processes, improving health equity, building stronger ties with tribes and addressing social determinants of health such as education, housing and transportation. This might involve spending dollars on non-medical costs, such as home air filters for families with asthmatic children. There also are efforts to tie affordable housing with social services.
“Another big priority is looking at the behavioral health system,” Coyner added. “We are hoping to get a new behavioral health director and work closely with [CCOs] to advance integration for members with mental health challenges and addiction issues. We made big strides in CCO 1.0 in that area, but there is a lot more that can be done.”