“You can’t be what you can’t see.”
Former Gov. Barbara Roberts about being a role model for female candidates

In this newsletter:

2022 Primary Election: Women win!

Oregon is the first in the nation to have a three-way race with women candidates.
Jamie McLeod-Skinner defeats 7-term Congressman Kurt Schrader for CD 5.

Quarterly Revenue Forecast: Up $1.2 billion from 2021

The good news: the personal kicker next year will be over three billion dollars.
The bad news: looks like the state is heading towards a recession.

June Interim Legislative Days

Preliminary proposals are released for a Universal Health Plan. (It is similar to the one for state employees. Who pays for it? You do. Plus, there’s an employer payroll tax.)
A task force is designing a bridge plan for the 300,000 Oregonians likely to lose coverage after the Public Health Emergency.
Behavioral health investments are pushed out to prop up an ailing system.
The Measure 110 council approves grant agreements for drug treatment and recovery as part of the $1.35 billion investment toward transformational change in Oregon’s behavioral health system.
The Clinician’s Caucus wants bills to prevent opioid overdose deaths in 2023.
OHSU pediatricians urge vaccinations for children under the age of 5 when they become available on June 21.

2022 Primary: Women Win in Oregon

The big news is the wave of women sweeping the 2022 elections in Oregon.

We’ll see three women vying for governor in the fall: former House Speaker Tina Kotek, D-Portland, former House Republican Leader Christine Drazen, R-Canby, and Independent candidate, former state senator Betsy Johnson, I-Scappoose. Kotek and Drazen won their primaries. Johnson needs to get enough signatures to make the November ballot. In a surprise upset, Jamie McLeod-Skinner won the Democratic Primary against incumbent U.S. Congressman Kurt Schrader in the redrawn 5th District. McLeod Skinner will face Lori Chavez-DeRemer in the fall.

Portland Tribune Editor Dana Haynes says: “That would be the first time in the nation that a female trio would battle it out for a governorship. If the cards fall right, Oregon’s membership in the U.S. House of Representatives could grow from one woman to four. The Oregon House already is majority-women.

“The next labor commissioner will be a woman: Christina Stephenson of Portland or Cheri Helt of Bend. There are only five Oregon government positions voted on statewide, and by January, four of the five will be held by women: governor and labor commissioner, alongside Attorney General Ellen Rosenblum and Secretary of State Shemia Fagan, leaving Treasurer Tobias Read as the only guy. Multnomah County is about to get its first female sheriff, Nicole Morrisey O’Donnell. And the list goes on.”

In other races, Rep. Andrea Salinas, former chair of the House Health Care Committee and former chair of the House Behavioral Health Committee, won her race in the newly created 6th Congressional District. Mike Erickson won the Republican nomination. All physician members of the Legislature —Sen. Elizabeth Steiner Hayward, Rep. Maxine Dexter and Rep. Lisa Reynolds — won their primaries in redrawn districts.

Quarterly Revenue Forecast is up $1.2 billion more than in 2021

State Economist Mark McMullen called the latest revenue forecast “nothing short of shocking.”

Projected tax revenues continue to rise — a whopping $427 million more for the 2023-25 biennium since the March forecast. The latest forecast also will lead to a higher kicker of over $3 billion for individual taxpayers in 2023-24. The Corporate Kicker, which is earmarked for the State School Fund, is projected to be $931 million.

While the revenue news is welcome, Mr. McMullen noted the cost of providing public services is going up rapidly and a recession may be on the horizon in 2023 and 2024.

June Legislative Days Highlights

Legislators received informational hearings on a number of issues during interim legislative days: preliminary proposals on a universal health care plan; a bridge program plan for insurance coverage for 300,000 Oregonians after the public health emergency; details on the historic behavioral health investments; Measure 110 rollout; prevention of opioid-related overdoses; vaccine efficacy and planning for kids under 5; and finally, long COVID and what is known about recovery and prognosis.

The Spotlight Issue: Preliminary proposals on a single-payer universal health plan for Oregon

Dr. Bruce Goldberg, the chair of the Joint Task Force on Universal Health Care, presented the draft proposal for a single-payer health plan to the Senate Health Care Committee. The report and final recommendations are due September 2022.

Background: This task force was created in 2019 by SB 770. The charge is to create a universal health care system for the state. It must be equitable, affordable and comprehensive. This coverage is uncoupled from employment. Design decisions have a level of trade-offs. The more that is covered — the more expensive. Provider reimbursement — the more paid, the higher the cost. The less paid, then access is reduced. Affordability for individuals — co-pays and insurance — these are all trade-offs, Goldberg said.

System winners

Uninsured and underinsured people will have improved coverage similar to the benefits of state employees.
Enrollees will not pay copays, deductibles, or any other cost sharing at point of service.
Providers will be able to capture a portion of the administrative savings (from not having to interface with multiple payers) estimated to be between 8-12 percent. Four percent of the funds will be reinvested in behavioral health, rural networks, primary care, and to provide needed access to care.
Larger insurers may see a reduction in their payroll tax and no longer need to provide benefits.
Individuals who has a $3,000 – $4,000 deductible will likely see costs decrease.
Instead of paying for health care at the point of service, households with income above 200% of the Federal Poverty Level (FPL) will contribute through the state revenue system.

System losers

Insurers will have a limited role in the new system and this will be contentious. Providers may not accept reduced payment and this will create an access issue.
Small businesses that aren’t paying for health insurance will have to pay the tax.
People who have benefits provided through their employer will have an income tax.

Preliminary estimates

The current system cost is $58.12 billion. Universal Health Plan is $57.12 billion. Projected savings for year one: $990 million. This includes improved purchasing power, administrative savings, decreased fraud, waste and abuse from a single payer system, removal of insurer profits. Increased costs will come from no cost sharing, upgraded benefits and covering the uninsured.

Next steps: The legal framework is that 40-50 percent of the state get their health insurance from Medicare and Medicaid. Oregon will need to get federal waivers. There’s been 25 meetings to date. In July, the task force will host six forums for the health care and business community. Her’s a link to the task force: https://olis.oregonlegislature.gov/liz/2021I1/Committees/JTFUHC/Overview

Health Care Redeterminations and Continuity of Coverage

A task force is developing a plan for a bridge program plan for insurance coverage for 300,000 Oregonians after the public health emergency

Background: Throughout the public health emergency, CMS suspended the regular determination process to remove administrative barriers to Medicaid enrollment. When the public health emergency ends, OHA has14 months to redetermine eligibility for all 1.4 million people on the OHP. About 300,000 no longer will be eligible. The overarching goal is for people to retain their health care coverage and to give clear direction on options for alternative coverage. The percentage of people insured in Oregon in 2021 is 95.4 percent. OHA is working on outreach.

Challenges: OHA is serving more individuals than ever, with the highest case loads ever recorded. Staffing problems with 400,000 additional applications without additional staff. This has created backlogs and wait times. The workforce shortage has meant that many staff have fewer than two years of experience. There is a relatively short time frame to complete the redetermination process. DHS needs more staff — otherwise there will be backlogs, larger delays and longer wait times.

Behavioral Health Provider Rate Increase

This is part two of a three-part historic investment for behavioral health providers.

Behavioral health care providers may see an increase of approximately 30 percent in their fee-for-services rates. The purpose of this investment is to increase access to services in a very fragile behavioral health system. The state’s Medicaid Behavioral Health system has been under significant duress from a combination of forces, including behavioral health fallout from the COVID-19 Public Health Emergency, high levels of substance use and low levels of access, and high staff turnover due in part to uncompetitive wages. The legislative appropriation seeks to address these challenges.

The first investment, through HB 4004, was a $132 million allocation to providers across the state for recruitment and retention. OHA awarded the fund the last week of May. Part three is increases for CCOs for the 2023 contract year. This requires federal approval from the Centers for Medicare and Medicaid Services (CMS) and is on top of the 3.4 percent total global budget target. As instructed in a budget note, OHA’s proposal is for the FFS and CCO rate increases to take effect July 1, 2022 and January 1, 2023, respectively.

Ballot Measure 110 Update

Voters passed Measure 110, the Drug Addiction Treatment and Recovery Act in Nov 2020

The goal was to establish a more equitable and effective approach to substance use disorder treatment while decriminalizing possession of drugs. Oregon is the first in the nation to pass such a law and OHA has struggled to implement it.

OHA Behavioral Health Director Steve Allen testified that the new system to treat drug addiction was designed by people with lived experience. For people who use drugs and alcohol, only 10 percent seek and receive addiction services, many because of the way services are provided. Measure 110 is an experiment. As such, it led to delays in implementation and a Secretary of State audit. In her opening remarks, Secretary of State Shemia Fagan shared that her mom battled meth addiction for most of her childhood and she grew up homeless. Her mom overdosed and survived. She was six years clean and sober before she passed away. She was able to reach the place of an “ordinary life.” Fagan said she is deeply affected by this measure and policy. Everyone struggling is someone’s mom, son, daughter, friend.

Her audit noted that M110 as written didn’t provide sufficient clarity around roles and responsibilities of the OHA and Oversight and Accountability Council. It contributed to delays, confusion and strained relationships between OHA and OAC. Other conclusions: lack of support for OAC, inefficient grant evaluation process, grant management and data reporting in progress but incomplete, conflict of interest mechanisms appear reasonable.

After a delayed start, the program has received 356 applications with 230 approved to date by the council. The total amounts disbursed will be $39.9 million. Grantees within a county must work to establish a memorandum of agreement among themselves. OHA will facilitate the process. Funding will go out beginning of June through October.

Thing to Know: What is a BHRN? Measure 110 requires the creation of at least one Behavioral Health Resource Network (BHRN) in each county region. Note: there’s a slide better showing how the BHRN works. https://olis.oregonlegislature.gov/liz/2021I1/Downloads/CommitteeMeetingDocument/255704

Preventing opioid-related overdoses in Oregon

The Clinician’s Caucus will work on legislation for 2023.

https://olis.oregonlegislature.gov/liz/2021I1/Downloads/CommitteeMeetingDocument/255708

Rep. Maxine Dexter, a critical care physician, led a panel on preventing opioid-related overdoses before the Senate Health Care Committee. Nationally, Oregon ranks first in illicit drug use disorder, based on recent data from the National Survey on Drug Use and Health, and last in the percentage of the population needing but not receiving treatment for substance use disorders. In 2021, Oregon drug overdose deaths increased at least 33.6 percent, according to the National Center for Health Statistics, compared to an average 16 percent increase nationwide.

Dexter said we need to put in place practice interventions and policies to save as many as possible, including access to naloxone. The changing epidemic means there are fewer deaths and overdoses from prescription medications and more deaths and overdoses from illicit drugs; illicitly manufactured fentanyl, meth, heroin. Trends are increasing for all age groups, including youth. Emergency department and urgent care visits are up.

Rachel Banks, the OHA Public Health Director, talked about culturally and community specific responses to overdose prevention and creating a harm reduction framework to save lives.

Strategies include; fentanyl test strips, syringe services, naloxone and training, crisis support, stigma reduction, low-barrier housing, employment opportunities, peer connections and connections to treatment.

Rep. Dacia Grayber is a full-time firefighter and paramedic. As such, she is a frontline responder to the opioid epidemic but she has personal experience too. She lost her best friend 29 years ago to heroin overdose. She said that when Narcan became available to law enforcement, that was a game-changer and a life saver. She advocated for funding detox and rehab centers as well.

House Special Committee on COVID-19 Response

OHSU pediatricians encourage vaccinations for kids under the age of 5 in anticipation of eligibility on June 21.

OHA Director Pat Allen gave the committee an overview of COVID in Oregon, noting lower COVID vaccination rates for kids ages 5-11. Rep. Lisa Reynolds, a pediatrician, said that she has been heartbroken by the lack of childhood vaccinations for the youngest children. Allen said misinformation about vaccines were a challenge for the younger age cohort.

The committee heard from OHSU experts about the serious medical consequences of COVID for children. Dr. Dawn Nolt, Medical Director of Infection Prevention and Control at Doernbecher Children’s Hospital, focused her testimony on MIS-C and long COVID. MIS-C is a condition in which body parts can become inflamed. It usually means being hospitalized in the ICU. Children with this have either have COVID-19 in the past or exposure to it. Pediatric case counts of COVID peaked dramatically in January 2022 and have been increasing since mid-March. Eight child deaths from COVID-19 have been reported and 69 MIS-C cases.

Long COVID also is alarming experts. The OHSU Pediatric Long COVID Program is seeing patients with symptoms that develop before or after infection and continue for 12 weeks or more. It can be a waxing and waning condition and spans multiple body parts. You don’t have to be very sick with your initial infections but still have persistent symptoms including brain fog, fatigue, shortness of breath and more. The mental health impact is a factor too. Over 100 kids have been referred to the long covid clinic. The OHSU Pediatric Long COVID program is suspended due to resource limitations but still following current patients.

Dr. Hayes Bakken, Medical and Quality Director, Pediatric and Adolescent Clinic, Associate

Professor of Pediatrics, Doernbecher Children’s Hospital, testified that children under 5 are a more vulnerable group. They don’t recommend masking under 2 because of risk of suffocation and inability to remove their own mask. Some parents feel they are back in 2020 with every single decision causing risk. It’s specially challenging for those with underlying conditions. Therapeutics aren’t available for young children. There are not great options. Dr. Bakken is seeing decreased vaccine rates as well. She strongly encouraged parents to vaccinate their children for COVID and for other routine childhood immunizations

Media

Portland Tribune: History in the making: 3 women vie for Oregon Governor

OPB: COVID-19 is not stopping Oregon Senate President Peter Courtney

Oregon Capital Chronicle: Oregon state legislators prepare for U.S. Supreme Court to overturn Roe v. Wade

Oregon Capital Insider: Oregon politics: Governor’s race poll

Oregon Capital Chronicle: Uncertainty looms over first open Oregon governor’s race in two decades.

New York Times:Children under the age of 5 will be come eligible for vaccination as soon as June 21