Election Implication: Oregon as Health Care Laboratory Faces Uncertain Future

Governor-Elect John Kitzhaber, once an emergency room physician, may create a laboratory for health care reform in his new administration.A couple of years ago, the Oregonian editorialized in favor of Oregon "being a laboratory" for innovative health care reform in much the same way as happened when John Kitzhaber was governor.

Does that prospect still hold in the aftermath of the November election that will change the political landscape in Salem? The jury is out.

Here are some questions about the unknown future:

  • What type of role will Governor-Elect John Kitzhaber play? During his 16 years of his previous state service, first as Senate President and then as Governor, he focused on health care, including with the then-innovative Oregon Health Plan. The demands of his office this time around – prodding economic recovery around the state – might get in the way of health care policy.
  • What effect will the 30-30 split in the House have on reforms implemented as part of House Bill 2009 in the last session? First, no one knows whether Rep. Mitch Greenlick, D-Beaverton, will return as House Health Care chair in a divided body. If he does, some observers believe there may be a more methodical approach to reform because Rep. Greenlick, last time around, drove the process with a firm hand and, this time, both Republicans and Democrats will have to agree.
  • How will the new Oregon Health Authority (OHA) proceed and who will lead this new department? It is possible that some legislators do not yet know about all of the uncertainty they spawned by creating a new department of state government, the Oregon Health Authority, separate from the Department of Human Services. On the campaign trail, legislators said they were waiting for the OHA to initiate recommendations in light of all the proposal-writing authority granted in HB 2009. Lurking in the background is whom the new governor will appoint to lead the new department. The biggest question is whether current Department of Human Services Director Bruce Goldberg will be asked to stay on, perhaps as OHA head, or whether someone else will be tapped from inside or outside the department to run the health care policy and administrative apparatus.
  • Who will head the Department of Consumer and Business Services (DCBS)? The director under outgoing Governor Ted Kulongoski, Cory Streisinger, already has said she will not come back for 2011. Her successor will have to work closely with the new OHA, especially given DCBS' substantial role in health insurance regulation.
  • How will the Kitzhaber Administration deal with linkage between the state policy in House Bill 2009 and federal health care reform? Some observers in Oregon have worried that HB 2009 went too far, too fast, especially in relation to creating a new Health Insurance Exchange. Federal reform requires an Exchange by 2014; HB 2009 sets the stage for earlier action if policymakers go along with it. A key question, for instance, is whether all of the current eight health insurers domiciled in Oregon will be allowed to participate in the new Exchange. If some are prohibited, it could limit a piece of good news about the Oregon health insurance marketplace – healthy competition.
  • Who will lead the formation of health care policy in the Senate? Most observers are betting that Sen. Laurie Monnes Anderson, D-Gresham, will reprise her role as chair of the Senate committee, but she'll have to reckon with how the House will handle policy bills she sends over from the Senate. And, before she gets the Senate Health Care Committee gavel, the Democrats will have to verify that they are in control by a 16-14 margin. There still is controversy over the apparent election of Sen. Al Bates, D-Ashland, in Southern Oregon, which may only be resolved in court.
  • What health care legislation will pass in the 2011 session? Beyond the OHA list of proposals, some lawmakers, at the request of interest groups, are introducing bills that apply to the health care system in its current form, but could hinder the health reform process of OHA down the road. In one case, prospective legislation proposes a single payer system.

Watch in the next few weeks as these and other health care issues get sorted out, both as the new governor puts together elements of his transition plan and the new legislature decides how to share power.