September 2023 Legislative Update

Legislative Day Highlights

• Agenda highlights include the drug addiction and behavioral health crisis, housing, healthcare spending and supporting Oregon’s kids.
• Rep. Jeff Helfrich (R-Hood River) was selected by House Republicans to serve as their new leader. Rep. Helfrich was a sergeant with the Portland Police Bureau for 25 years. 
• Work is underway on bills for the 2024 session, including a bipartisan workgroup to prevent violence against healthcare workers in hospitals.

September Legislative Days Update 

Legislators convened from September 27-29 for quarterly legislative days at the State Capitol, which is still under heavy construction. The hallways were narrowed and lobbyists leaning against the fresh drywall found themselves dusted with white powder. 

Every legislative cycle has an ebb and a flow. After the intensity of the 2023 legislative session, committee agendas focused on routine state agency reports and program updates while legislators and advocates consulted on possible legislation for the 2024 Legislative Session which begins Feb. 5. The big question about the upcoming session is whether or not Republican senators who have met the Measure 113 threshold will show up for the 35-day session. Given that, the strategy is to avoid controversial topics and to advance consensus bills that are budget neutral with no cost. 

Spotlight Issue: Preventing Violence Against Healthcare Workers in Hospitals

Bills to increase penalties for assaulting a healthcare worker in a hospital were introduced in 2015, 2017, 2021, 2022 and 2023. None have advanced, despite a robust effort in 2022 to pass a bill to provide relief to healthcare providers after their sacrifices during the pandemic. 

Rep. Shelly Boshart-Davis, R-Albany, and Rep. Travis Nelson, D-Portland, are leading a bi-partisan stakeholder group to resume discussions in response to the tragedy at Legacy where Bobby Smallwood, a security guard was killed outside the maternity ward in late July. The co-chairs have a personal connection to the issue of violence in hospitals. Rep. Boshart-Davis, the chief sponsor of past bills to increase penalties for assault, has a sister who is an emergency nurse. Rep. Nelson, vice-chair of the House Behavioral Health and Health Care Committee, is a nurse and has emergency room experience.

Currently, an assault on a hospital worker is a 4th degree, Class A misdemeanor. The maximum imprisonment is 364 days and a $6,250 fine. Emergency physicians and nurses say people are reoffending frequently because they know there are no real consequences, especially for harassment. Increasing the penalties to a Class C felony is punishable by five years imprisonment and a $125,000 fine. Bills to increase the penalty for assault failed to advance because of concerns the law could be misapplied to people with mental illness and people of color. 

The broad stakeholder group of legislators and lobbyists includes Sen. Sara Gelser Blouin, D-Corvallis, the chair of the Senate Human Services Committee, Sen. Deb Patterson, D-Salem, the chair of the Senate Health Care, Rep. Jason Kropf, D-Bend and Sen. Floyd Prozanski, D-Eugene, the chairs of House and Senate Judiciary Committees and Rep. Lisa Reynolds, D-Beaverton. She is the chair of the Early Childhood Committee, a pediatrician and a long-time activist for reducing gun violence. The goal is to discuss strategies for prevention and measures to ensure the safety of healthcare workers and to bring a consensus bill forward during the short 2024 session.

2024 Election Watch

September 14 was the first day for people to file for office and there were some surprises. All 60 House seats and half of the 30 Senate seats will be on the ballot, including statewide races for a new Secretary of State, State Treasurer and Attorney General. 

Here’s what to know:

• Several senators who reached the Measure 113 threshold for unexcused absences have filed to run again, despite the Secretary of State’s ruling they were not allowed. Republicans are appealing this decision. Sen. Tim Knopp, R-Bend, the Senate Republican Leader, filed to run despite being prohibited from doing so. Anthony Broadman, a Bend City Councilor, filed to run against him to try to flip the seat from Republican to Democrat. 
• Sen. James Manning (D-Eugene) and State Treasurer Tobias Read announced they are running for Secretary of State.
• Sen. Elizabeth Steiner, D-Portland, the Ways and Means Co-Chair and a family physician, is running for Treasurer.  If elected, she would be the first woman treasurer in Oregon.
• Attorney General Ellen Rosenblum, the first female AG, is not running for re-election after three terms. 
• Rep. Charlie Conrad, R-Dexter, was the only Republican to vote for HB 2002, the Reproductive Health and Gender Affirming Care bill. He is facing Darin Harbick, who aligns with Oregon Right to Life, an opponent of HB 2002.
• House Republican Leader Vicki Breese Iverson, R-Prineville is stepping down from her position, despite a good working relationship with House Speaker Dan Rayfield, D-Corvallis. Rep. Helfrich was chosen by the caucus to replace her.
• Rep. Khanh Pham, D-SE Portland, will run to replace Democratic Sen. Michael Dembrow, who is retiring. 

• Oregonians will receive a record $5.6 billion kicker rebate next year, a new record. This is $1.6 billion more than the forecast three months ago. 
• The General Fund Resources are projected to be up $437 million more than June. 
• State economists say Oregonians will have about $2 billion more to spend up from February. The total revenues are $33.8 billion in lottery and general fund expected for 2023-25.
• Next Revenue Forecast is November 15.

Legislative Days Reports

Senate Health Care

Health Care Costs

Sen. Deb Patterson, D-Salem, the chair of the Senate Health Care Committee looked at two things this week: the entry of “Wall Street” investors in healthcare services and the rising costs of healthcare in Oregon. A recent report showed that 10 percent of Oregonians used up their savings to pay for medical bills. Rep. Ben Bowman, D-Tigard/Tualatin, is introducing a bill to protect patients from corporate interests, protect physician independence and would specifically prohibit gag clauses and non-compete agreements. The goal is to keep patient healthcare decisions in the hands of doctors and to prevent corporate takeover of medicine. 

Quick stats on healthcare costs:

• The Oregon Health Authority reported that Oregon households spend more on healthcare than they do on housing and utilities, spending nearly 22 percent of their budget on health-related expenses. 
• Per-person spending on healthcare is approaching $8,000 per person, an increase of 40 percent since 2013. (The 2020 data reflects the pause on non-emergency and non-essential services during the COVID-19 pandemic) 
• Health plan premiums for commercial insurance continue to increase — 36 percent for single plans and 32 percent for family plans.
• As many as 2 out of 5 people are underinsured, causing delays in medical care.
• Almost 60 percent of private sector employees in Oregon were enrolled in high deductible health plans, with out-of-pocket expenses for care in addition to premiums and deductibles. This means that many people with health insurance can’t afford to use it. 
• More than a third of Oregonians struggle to pay their medical bills with 10 percent reporting they had to use all their savings to pay medical bills.

House Behavioral Health and Health Care

Rep. Rob Nosse, D-Portland, the chair of the committee, did a deep dive on state agency reports on CCO profits, Measure 110, the Drug Addiction and Recovery Act, the Basic Health Plan update and Oregon’s five-year CMS waiver for health care services. Rep. Nosse is also introducing three omnibus committee bills for 2024, which will include provisions without significant opposition or fiscal impact.

Coordinated Care Organizations (CCO) Profit Update

Rep. Nosse, the Chair of the House Behavioral Health and Health Care Committee and Sen. Deb Patterson, chair of the Senate Health Care Committee, are taking a closer look at Coordinated Care Organization (CCO) profits and community investments over the next year. Gov. Tina Kotek requested an additional $25M invested across all CCOs focusing on expansion of capacity in Behavioral Health Services across Oregon.

The stats:

• CCOs receive over $7 billion dollars in revenue annually to cover 1.4 million Oregon Health Plan (OHP) members.
• CCO revenue/rates are a mixture of federal funds (~70%) and state funds (~30%)
• In 2024, CCOs will receive an average of $506 per member, per month
• Rates vary from ~$200 for Children age 1-5 and ~$1,600 for the Breast and Cervical Cancer program.
• CCOs retain $833 million in reserves with $108 million projected for the Community Reinvestment program.

Drug Addiction and Recovery Act (Measure 110)

Measure 110, the Drug Addiction and Treatment Act, was approved by voters in 2020. It has established 42 behavioral health networks, (BHRNs) at least one in every county. The intent is to provide a full continuum of care with overdose prevention and treatment services. The main challenge is the lack of workforce and they are studying traditional and emerging practices to meet the need of individuals seeking sobriety.

Measure 110 providers have reported an increasing amount in the number of people served by the program. Substance use treatment providers reported 41 percent more clients in quarterly gains and 104 percent (for over 7,000 people) in the last three quarters. Mobile services with a team going out to distribute Narcan, food, clothing and other services, have also been increased.

Personal amounts of illicit drugs were decriminalized in February 2021, but the governor and other elected officials are calling for a ban on public use. Sen. Floyd Prozanski, the chair of the Senate Judiciary Committee, is planning a bill to make changes in 2024. His intent isn’t to put drug addicts in prison but to look for ways to get them into treatment. He will be moving to a public health and medical-oriented model to deal with addictions rather than the criminal justice system. The Legislature also established a Joint Interim Committee on Addiction and Community Safety Response.

Basic Health Plan Update (HB 4035, 2022)

The Oregon Health Policy Board has approved a blueprint for a Basic Health Program that will provide comprehensive medical, mental health and dental care to more than 100,000 low-income Oregonians. It will be similar to Oregon Health Plan (OHP) coverage and reduce disruptions for people who churn on and off the OHP.  The next step is to submit the plan for federal approval. Federal funding is expected to cover most expenses — for each dollar the state invests, the federal match is $500. 

Oregon Health Authority 2022-2027 Waiver Update

Every state has to follow federal rules for operation of Medicaid but states can ask for a  waiver to provide care in a different way. Oregon renews its waiver for the Oregon Health Plan (OHP) every five years and was approved for new flexibilities in 2022 that would do the following:

• Keep kids on the OHP covered from birth to age six.
• Keep them OHP members ages six and up to be covered for two years (instead of one) for renewal.
• Cover more services for people from birth to age 21.
• Cover health related social needs for eligible members including support for food, housing and climate-related resources such as air conditioners. 
• Provide enhanced coverage for youth with special health care needs ages 19-26, with income up to 300 percent poverty level. 

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