Health Reform

What Matters Most to You in 2016?

As we head into a new year, CFM wants to know what policy priorities are most important to Oregonians for 2016. Lawmakers will convene a new legislative session in February, but they will only have 35 days to get their work done .

As we head into a new year, CFM wants to know what policy priorities are most important to Oregonians for 2016. Lawmakers will convene a new legislative session in February, but they will only have 35 days to get their work done.

From tackling Portland’s housing crisis to negotiating a plan for an unprecedented minimum wage hike, Oregon lawmakers have their work cut out for them in 2016.  

Education, health care, transportation, human services, consumer protection, environmental preservation, criminal justice, taxation: Those are just some of the priority areas calling for swift action and firm leadership in Salem as we look ahead to the next year. 

The Oregon legislature convenes February 1 for a brisk 35-day session. Soon after, statewide elected positions will be contested in the May primary and November general elections.

In the meantime, CFM wants to know what issues matter most to you. Is it finding more revenue for education and social services? Improving transportation infrastructure? Or maybe it’s something else entirely.

As we ponder the political battles ahead, CFM invites you to share what you believe demands the most attention from Oregon's elected leaders. Here’s what we’re looking for:

•  What are the top two policy priorities facing Oregon? 

•  For each of your two priorities, provide a short explanation of what you think should be done and how it should get done. Is legislation needed? Better enforcement? Bully pulpit leadership? Bipartisan support? Be as specific as you can.

•  In addition to your top two policy priorities, tell us what you expect in terms of leadership from Oregon's governor and from House and Senate leaders. What would you regard as real leadership? How can leadership be manifested so it produces positive results? What would you see as a lack of leadership?

Send us your submissions through Friday, January 8, and we’ll share them shortly after on our Oregon Insider blog.

This isn't a contest or a survey. Our intention is to reflect the range of thoughts and concerns that everyone shares with us. We will point out areas where a number of people's priorities overlap, but we also will include priorities that may generate only a single recommendation.

Please send your submissions to Justin Runquist, CFM’s communications counsel, at justinr@cfmpdx.com.

We look forward to hearing your thoughts.

The Risky Business of Government Risk-Taking

Risk-taking in government can be risky, as the authors of the Cover Oregon fiasco discovered.

Risk-taking in government can be risky, as the authors of the Cover Oregon fiasco discovered.

Government risk-taking is risky business. If government officials take a policy or program risk and it flops, they are criticized for wasting taxpayer money. If officials avoid taking a risk and a problem festers, they also get criticized for wasting taxpayer money.

Dick Hughes, editorial page editor for the Statesman Journal, says risk-taking is a good idea for government. "If we want government to succeed at a higher level, we must be willing to tolerate failures," Hughes said. "That sounds counter-intuitive, but most great leaders also have a string of failures – ones from which they learned.” 

That sounds good in theory, but maybe less so in practice. In many ways, the deck is stacked against government risk-taking. My 15 years in government service says no risk-taking, however successful, goes unpunished.

It is hard to quarrel with brickbats aimed at foolish risk-taking such as Cover Oregon's over-reaching attempt to build a health insurance exchange website. Other risk-taking, especially the kind that might take a while to prove out, still earns "gotcha" reporting in the media. Many public managers, who are no fools, quickly grasp the odds are low for risk-taking in government that earns kudos.

There is room for reasonable risk-taking in government, but it requires planning, strategy and discipline, not taking a spin on a roulette wheel. Here are some suggestions based on my experience:

•  The risk should result from a consensus. Even good ideas get better when a diverse team vets them and frontline people have a chance to suggest them. When I worked as part of the Executive Department's management team under Fred Miller, we launched the "Good Ideas Program" (we couldn't think of a better name), which encouraged fresh thinking and responsible risk-taking. None of the ideas were revolutionary, but many were very good and made a noticeable difference in program efficiency and effectiveness.

•  Risk-taking must be able to pass what I call the "front-page test." You should be able to make a cogent defense of the risk that would stand up in the light of front-page exposure. If an idea couldn't withstand that kind of public scrutiny, it probably isn't worth trying.

•  Reduce a bright idea to writing. The idea may sound good until you start laying it out on paper. When you write about an idea, you will think it through more clearly –  the rationale, the methods, the answers to tough questions and the results you can realistically achieve. If you can fill in those blanks, you probably have an idea worth considering and implementing.

•  Make sure someone is accountable for the good or bad. There will be plenty of people eager to crowd into the picture of a ribbon-cutting, but few willing to be seen on the podium explaining a failure. Make sure the risk has a clear chief risk-taker. Also make sure he or she won't be tossed to the wolves if there is a failure.

If lawmakers want public managers to take reasonable risks, they need to give them the elbow room to succeed or fail and not pounce on them if they fail. They need to accept some of Dick Hughes' advice and regard failure as a step toward ultimate success.

That may be harder to do for the news media, but at least reporters and editors can provide a context for risk-taking and explore lessons learned, not just scapegoats to blame.

Risk-taking will always be risky. That's why you need to do everything possible to make sure the benefits outweigh the risk and responsible risk-takers aren't skewered for taking risks.

[This blog was based on a post written by CFM Senior Partner Dave Fiskum for his personal blog, Perspective from the 19th Hole, and it draws on his extensive experience working for state government and as an Oregon lobbyist.]

 

Kitzhaber Keeps Pressing Health Care Reforms

Governor Kitzhaber and Kaiser CEO Bernard Tyson agree the health care business model is broken and one major reason why is the separation of care for physical and mental illnesses.

Appearing together at the Portland Business Alliance's annual breakfast, Kitzhaber and Tyson stressed the need to move from a "volume-driven" approach to a model that offers better care at more affordable prices.

The Portland Business Journal quoted Tyson as saying, "There is a mental health challenge we're working on, how to reattach the head to the body." Tyson said physical and mental illness is treated in separate locations, using separate records, even though 45 percent of physical health visits indicate a need for mental health services.

Tyson also said fee-for-service medicine needs to be "thrown out the window."

Kitzhaber touted the benefits being achieved through coordinated care organizations, which he credited for shrinking annual cost increases in care from 5.4 percent to 3.4 percent. The governor noted the 16 current CCOs care for 900,000 lower income Oregonians and are engaged in integrating physical, mental and dental care. He said he next wants to expand CCO cover to public employees and teachers and ultimately to the entire health insurance market.

Internet Voting and Cover Oregon

Oregon lawmakers are taking the first tiny steps to explore Internet voting in the shadow of the Cover Oregon website debacle. The two issues really don't deserve to be linked.

Voting via the Internet has gone on for business for years. Shareholders routinely cast ballots online for acquisitions, financial changes and corporate board members. Voting fraud is rarely an issue.

It is common for many Americans to purchase goods and conduct personal banking online, both of which require security measures.

People vote, buy and bank online because it is convenient.

No question that databases can be hacked, as apparently happened recently in the Oregon Secretary of State's office. That's a fair concern. Pointing to Cover Oregon's balky beginning online not so much.

Cover Oregon's struggle to get its web presence in order really has nothing to do with setting up an online voting system for registered voters. Yes, both may be complex, but not really comparable. Cover Oregon is an application portal that is supposed to walk people through various steps to evaluate various health insurance options and determine their eligibility for subsidies. A voting system allows people to cast their "ballot" online, with the only variability being the candidates and measures that are on their local "ballot."

Oregon Finds Itself in Dunce Chair

Oregon finds itself sitting on the unusual and embarrassing dunce chair for shortcomings in healthcare and education reforms.

At times, Oregon under Governor John Kitzhaber has seemed like the prize pupil of the Obama administration. But recent events have plopped Oregon on the dunce chair.

Oregon may be dead last in enrolling zero people online for health insurance under its health exchange, Cover Oregon. And now the U.S. Department of Education is threatening to withdraw the state's waiver from complying with the No Child Left Behind education requirements. 

Neither represents a policy divergence between Oregon's Democratic government and the Obama team. They reflect a bad poker hand.

Like the federal health care website, Oregon's electronic health insurance portal hasn't performed.  Oregon has pushed to enroll people using paper applications. And the state has added significant numbers of Oregonians to the Oregon Health Plan.

Kitzhaber said the state is too far downstream to change computer consultants, but promises a full accounting when the Cover Oregon website is up and running as intended. The governor has enlisted former Providence CEO Greg Van Pelt and Oregon Health Authority Director Bruce Goldberg to lend their management and medical expertise to unsnarling the IT logjam.

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.

The Governor as Prop

Governor Kitzhaber will be sitting in First Lady Michelle Obama's box tonight as the President delivers his State of the Union Address. Kitzhaber's presence will be highlighted on national television when Obama talks about health care and Medicaid reform.

While in the role of a prop tonight, Kitzhaber has been anything but inert in pushing for health care transformation. His energy for health care reform, early adoption of the health insurance exchange and his push for changes in the health care delivery system have thrust Oregon to the forefront. His ideas for change have won widespread support among health care providers and insurers, business leaders and legislators on both sides of the political aisle.

Perhaps the most fundamental change Kitzhaber is pushing is a system of coordinated care organizations through the state that are charged with improving patient outcomes while reducing costs. Early efforts are aimed at problems such as treatment of complex, chronic diseases to avoid unnecessary hospitalization or prescription drugs.

Oregonians are too often reflected nationally by the shenanigans of Tonya Harding or the caricatures of the televised comedy, Portlandia. We may not know how to act when Oregon is singled out for praise in such a high-profile moment.

Kitzhaber will be joined in the First Lady's box by a teacher from Sandy Hook Elementary, a police officer who responded to the massacre at a Sikh temple in Wisconsin and the parents of a girl killed by gunfire in Chicago, just days after she participated in Obama's inauguration. They will be reminders of the collateral damage of gun violence in America and symbols of why Obama is asking Congress to act on gun control.

Kitzhaber Emphasizes Education Investment

Saying Oregon cannot settle for an "uneven, unequal and hesitant recovery," Governor Kitzhaber, wearing his trademark jeans, called for investment in education from pre-school through college by easing "serious fiscal constraints" that keep money from classrooms.

Entering his 11th year as governor, Kitzhaber's State of the State address centered on "difficult choices" that include "reducing the cost of health care and corrections, reducing the cost drivers that are diverting resources from the classroom and undertaking serious review of Oregon tax expenditures."

The former emergency room physician said a new "high-quality, low-cost" care model developed by Coordinated Care Organizations could restrain Medicaid inflation to 3.4 percent in the second year of the coming biennium, saving the state's general fund $100 million. Kitzhaber said shifting public employees, including K-12 teachers, to a similar private health care model could result in a game-changing $5 billion savings over the next decade. 

Stemming the state's rising prison inmate population, the governor said, can avoid spending $30,000 per year per prisoner, compared to the $10,000 per year the state spends on K-12 students.

Kitzhaber repeated his call for changes in the Public Employees Retirement System, which he said is the cause of half of the projected  $1,000 per student increase in the K-12 budget.

Explaining his proposed changes, Kitzhaber said, "This is not about the value of our teachers. It is also not about a major overhaul of the retirement system that continues to be one of the best funded in the nation. It is simply about trying to have a conversation that allows us to strike a balance between the cost of our retirement system and our ability to put dollars in the classroom today to ensure that our students are successful tomorrow."

Reforms Will Push Up Premiums

Implementation of health care reforms in Oregon and America are beginning, but may occur in the backdraft of rising insurance premium rate shock.At the end of the 2011 and 2012 legislative sessions, headlines crowed about the progress Oregon had made on health care transformation as a result of bipartisan legislation from both sessions. In fact, Oregon has become a national leader on the topic with leadership from Oregon's governor, Dr. John Kitzhaber. From the establishment of Coordinated Care Organizations (CCOs) to the establishment of one of the first exchanges nationwide, Oregon took major steps forward in implementing health care reform.

As CCOs have begun to spring up in different communities throughout the state and details of the health insurance exchange have become more clear, a surprise that legislators didn’t anticipate is beginning to bubble-up to the surface: Major increases in health care costs will hit consumers just as the exchange debuts early next year.

Many of the causes of these cost increases are outside the control of Oregon legislators, but they nonetheless have the potential to unravel public support for reform as front-line consumers come face-to-face with the true cost of health care for the first time. 

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.

Banking on Health Care Coordination

A lot rides on the success of health reform ventures such as coordinated care organizations (CCOs), but not everybody knows what they are, including some of the people responsible for making them happen.

The Oregon Business Association honored 11 Oregonians this year for their contributions to CCOs, which are just being formed after winning legislative approval in 2011. One of the honorees said the task of CCOs is to fill in the white spaces between existing parts of the health care delivery system.

Senator Alan Bates, D-Ashland, talked about filling in the white spaces to ensure greater coordination in delivering health care services to improve patient outcomes and save money. He gave an example of a man who underwent extensive medical treatment for physical ailments, while his underlying psychological issues weren't diagnosed or addressed.

CCOs call for unprecedented levels of coordination between health care providers that are competitors. People seem to be playing well in the sandbox together now, but how it ultimately works out remains unknown.

Just as important is whether CCOs can help stem the tide of rising medical costs for low-income Oregonians as budget pressures build at the state and federal levels to find cuts in Medicaid and Medicare.

The predecessor term to CCOs — accountable care organizations — was first used in 2006 by Elliott Fisher, Director of the Center for Health Policy Research at Dartmouth Medical School, during a discussion at a public meeting of the Medicare Payment Advisory Commission. The term quickly gained credibility, reaching its pinnacle in 2009 when it was included in the federal Patient Protection and Affordable Care Act.  

Is Health Mandate Liberal or Conservative?

Following the U.S. Supreme Court's somewhat surprising ruling to uphold the Affordable Care Act, discussion now centers on a political verdict this November. Presumptive GOP presidential nominee Mitt Romney says he will recommend repeal on his first day in office.

If Romney has Republican majorities in the U.S. House and Senate, he may get his wish. The GOP majority in the House is voting today for the 31st time to repeal the act, which is a non-starter in the Democratically controlled Senate.

The venom over ObamaCare voiced in talk show commentary, letters to the editor and Republican speeches seems oddly out of touch with the history of the Act's most controversial provision — the individual health insurance mandate.

The idea emerged from the Heritage Foundation in 1989, which linked the mandate to its conservative political philosophy of individual responsibility. Early supporters included Utah Senator Orrin Hatch and then-Massachusetts Governor Mitt Romney. The 2006 Massachusetts universal health care law includes an individual health insurance mandate.

San Francisco Chronicle writer Debbie Saunders commented, "Mitt Romney, the former Massachusetts governor, the party’s all-but-certain nominee, is the only Republican in the country who imposed a health care plan with an individual mandate on his state. Romney used to call the provision 'the ultimate conservative idea,' as it told citizens that they’d get government help only if they couldn’t afford to take care of themselves. Team Obama is so smitten with Romney’s past that White House aides often credit Romney with coming up with the template for ObamaCare."

So how did an idea with such strong conservative appeal turn into anathema among conservatives? Ezra Klein, writing in The New Yorker, attributed it to politics. Republicans hated to see Obama score a major political victory.

However, a deeper analysis suggests many Republicans — and a fair number of Democrats — grew worried that achieving universal access without significant health care cost controls would push the price of health care up, not down. The Los Angeles Times reported in 2009 that the individual health care mandate without cost controls would "add up to higher costs for taxpayers and consumers."

The cost of health care is a concern shared widely over the political spectrum. It is likely to become the next battleground, regardless of whether the Affordable Care Act remains in place or not.

What Does Health Care Ruling Mean to Oregon?

There are probably as many interpretations as there are analysts looking at the words that Chief Justice John Roberts wrote for the Supreme Court in a historic 5-4 decision upholding major provisions of the Affordable Care Act.

It is tempting to delay comment because so much of what this landmark ruling means will play out over time, both in Washington, D.C. and around the country in states such as Oregon, where Governor John Kitzhaber has taken the lead in implementing reform measures.

Still, here are a few perceptions:

         *  Regardless of how the Court ruled, Oregon was committed to proceed with a number of reforms that emerged from the last two Oregon legislative sessions. That includes the governor's proposal to create Coordinated Care Organizations (CCOs) as mostly non-profit entities to handle the task of organizing and delivering Medicaid services to low-income Oregonians.

         From the governor's standpoint, the new CCOs — eight of which were approved this week to begin operating August 1 and a number of others are in the queue for a later start — will manage Medicaid closer to where people live, prompt providers to collaborate with each other for the benefit of patients and place a great emphasis on prevention, all (at least in theory) to save money.

         If money gets tighter and the CCO reforms don't work, the tough decisions — cutting recipients off Medicaid, cutting back on benefits or cutting provider reimbursements — will fall into the laps of regional or local CCO directors. In the past, these decisions would have been made on the Capitol Mall.

         *  The ruling does retain momentum toward the day, in late 2013 or early 2014, when Oregonians will have a chance to choose health insurance coverage through an online shopping center called an "insurance exchange."  Oregon already is a long way down the road toward starting its exchange and, arguably, would have continued regardless of how the court ruled. But the endorsement of an individual health insurance purchase mandate means the exchange will have a greater chance to succeed a year or so from now. With a few exceptions, those who now don't buy insurance will have to do so.

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.

The Possibility of a Nuanced Ruling

Most media focused last week on oral arguments before the U.S. Supreme Court on the controversial federal health insurance mandate for individual Americans. However, justices also heard arguments on other aspects of the legal challenge to what has become known as ObamaCare that could lead to a more nuanced decision and perhaps even more complexity for states.

Justices listened to arguments on whether the constitutional challenge of the individual mandate is ripe because it hasn't gone into effect yet. Commentators expressed doubt the court would effectively punt a big decision for this reason. They also considered the severability of the federal health care reform act. They wanted to know if voiding the individual mandate would void the popular ban on excluding health insurance because of pre-existing conditions. 

A ruling isn't expected until late June, which will allow for a lot of media speculation, political bombast and unease by state officials who will play a key role in implementing health care reform in whatever form it survives from the court case.

Based on the intense questioning by justices and the balky performance of the U.S. attorney arguing the government's case, you could easily conclude the federal individual health insurance mandate is in trouble. The court seems clearly split, but the split echoing from the questioning suggests at best a 5-4 rejection of the mandate.

However, the mandate underpins a grander bargain. Creating the largest possible pool of people with health insurance coverage gives health insurers the ability to absorb and spread costs, including from new insureds who may be combating cancer or suffering from a chronic disease. Dispatching the mandate could put even more pressure on health insurance premiums, which are continuing to rise. That, in turn, could erode the quality of existing employer-provided health insurance and, in some cases, cause employers to drop coverage for employees altogether.

The unspoken part of the story crowded out by commentary on the mandate is what happens if we return to the status quo before Congress approved ObamaCare. The truth is, that status quo has disappeared. 

  • The exclusion of pre-existing conditions and expansion of family coverage to children up to age 26 are very popular provisions, which few would want to lose — especially in an election year.

  • Many employers facing stiff domestic and international competition are looking for ways to trim their health insurance costs. One way is to hire temporary workers without benefits.

  • The public safety net has more holes in it, as Medicaid participation has been limited and funding cut for public health care clinics.

  • Heath care technology continues its steady march ahead, opening new diagnostic and treatment options and adding more costs.

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.

Huge Issues Loom in 2013 Session

The short 2012 session just ended and there are nine months until the 2013 legislature convenes, but it is still timely to look ahead at the issues that need resolution or are just ripening for action.

At the top of the list is how Governor Kitzhaber's health care transformation strategy will work and whether newly forming coordinated care organizations can squeeze out cost savings in serving Oregon's Medicaid population. The health insurance exchange will get up and running, just as the federal health care reform measure lands in the U.S. Supreme Court, which could toss some or all of the controversial reform legislation.

Despite a slow economic recovery, many parts of Oregon still feel the after-effects of recession and could benefit from state efforts to boost employment. Strong differences exist between Republicans and Democrats on how to stimulate job growth, especially in rural Oregon.

As a result of education reform measures pushed by Kitzhaber, K-12 school districts are signing achievement compacts to promote improved student learning. A question remains whether this reform will under-perform or have unintended consequences as have previous reforms such as No Child Left Behind and Race to the Top.

Lawmakers in February approved a measure that deals with home foreclosures. However, consumer advocates felt it didn't go far enough, while bank and title company officials said it might not work as expected.

Kitzhaber, who will be entering the last two years of his third term, has vowed to give tax reform another shot. This has proven to be as elusive as the pot of gold under the rainbow. While a majority of Oregonians feel the state's current tax system isn't sustainable, there is no clear consensus on how to refine or replace it. A state sales tax is certain to make another stage appearance, with a few clapping and others throwing big red tomatoes. 

Local governments are pressing for expanded access to property tax revenues. They are looking for authority to exceed property tax rate limitations for voter-approved levies. The temporary state hospital tax expires and hospital interests may be less willing to go along with an extension after proceeds were diverted from their original purpose.

Contrasting Views on Jobs Legislation

The Oregonian headline tells the story: "Congratulations and complaints."  Congratulations for handling the big issues of health, education and early learning reform. Complaints about the failure of a number of jobs bills.

Issues directly related to Oregon's economy tended to take a back seat during the short session in Salem, notwithstanding claims to the contrary in various post-session communications by legislators to their constituents.

In floor speeches on the Health Insurance Exchange (House Bill 4164), achievement compacts for school districts (Senate Bill 1581) and health care transformation (Senate Bill 1580), Democrats painted a picture of those major reforms mattering to small businesses in Oregon. Major business associations supported all of the reforms, but it is not clear that any of the bills will create jobs on their own. 

Democratic leaders said as health care costs go down, businesses will have more money to invest in creating jobs. Legislators on both sides of the political aisle and Governor Kitzhaber deserve credit for taking on big issues such as health and education reform.  

House Democratic Leader Tina Kotek, D-Portland, continued that theme in a piece in the Statesman-Journal, "We promised to give businesses the tools they need to grow and hire, stand up for middle-class Oregonians and prioritize the essential services Oregonians need most. Now that the dust has settled after last week's adjournment, I am happy to report that we delivered on those promises."

Republicans pointed out what was left on the cutting room floor during the legislative session and pointed the finger at Democratic opposition.

“With 190,000 unemployed Oregonians, the legislature’s inaction on jobs and the economy is inexcusable,” said House Republican Leader Kevin Cameron, R-Salem. “Nonetheless, House Republicans continued to work with the Governor and legislative Democrats to find common ground on other issues. We’ll continue to provide lea

Politics and Health Care Reform

Politics is never a stranger in legislative proceedings, as reflected this week by moves in both the Oregon House and Senate to slow down or hijack elements of Governor Kitzhaber's health care reform package.

The governor's provisions dealing with coordinated care organizations and a health care insurance exchange are likely to survive the short Oregon legislative session, now in its third week, but it may cause lawmakers to hang around Salem a few more days than expected.

At issue is whether the health care reform package will include tort reform to shield coordinated care organizations from expensive malpractice lawsuits. Republicans want it in while Democrats, including Kitzhaber, want to wait to consider it until the 2013 legislative session.

The first political twist occurred early in the weekend when House Republicans convinced Democratic Rep. Mike Schauffler to join them in voting to send the health care insurance exchange measure (House Bill 3164) back to committee. Observers watching health care legislation interpreted the unexpected move as a way to create trading stock with the Governor over tort reform.

Later in the week, Senate Republicans tried the unusual — and usually unsuccessful — tactic of trying to amend the health transformation measure (Senate Bill 1580) on the Senate floor. It failed. So did a subsequent effort to send SB 1580 back to committee, largely because Senator Betsy Johnson, D-Scappoose, stuck with her Democratic caucus in voting for the bill, despite earlier pledges to vote for tort reform