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LEGISLATIVE UPDATE
Prepared for OAFP
February26, 2017
Revenue Forecast Up Again
Oregon’s economy is cooking, adding jobs at the rate of 3,500 per month. As a result, personal and corporate income tax revenues to the state are up $200 million in the latest revenue forecast.
This is welcome news and will help narrow the budget gap, which was at $1.8 billion. Senate President Peter Courtney (D-Salem) said, “Our budget isn’t balanced. We’re going to have to make some cuts. We’re going to have to raise some revenues. Both are tough.”
The next revenue forecast, to be released in mid-May, will be used by legislators to craft the 2017-19 state budget.
SB 485 – Medical Practice Ownership
Sen. Floyd Prozanski (D-Eugene) brought back this bill that would expand who may own a medical practice.
Oliver Alexander, Co-founder of Orchid Health, says there are 650,000 rural Oregonians but there are 130,000 who lack access to healthcare. Orchid Health would like to expand the medical practice ownership statute to allow majority ownership of a practice by someone other than a physician. SB 485 would allow this if the clinic is a Federally Qualified Health Center in rural Oregon.
“I’ve been on this committee when you’ve brought this bill before and I was dubious, but I am not dubious anymore. I think this is a great idea,” Sen. Elizabeth Steiner Hayward (D-Portland) told her colleagues.
HB 2103 – NP Vasectomies
Jenn Baker, Oregon Nurses Asssociation, says “Vasectomies are safer, less invasive and more affordable than birth control options for women, and unfortunately, here in Oregon, are underutilized because, in large part, there is an access issue. Patients are waiting up to 3 months both in rural and urban areas.” She says the Nursing Board has deemed vasectomies to be within the scope of practice for nurse practitioners.
Rep. Knute Buehler (R-Bend) asked, “Can you outline what training in particular nurse practitioners have to perform vasectomies?”
A representative from the Board of Nursing responded that this training comes largely on the job.
Rep. Buehler followed up, “Can you give me a single randomized trial showing the outcomes of vasectomies performed by nurse practitioners?”
Baker responded that they believe that there are not but that there are many trials showing comparable outcomes for qualitatively similar procedures.
Dr. Eugene Fuchs, Professor of Urology at OHSU, on behalf of the Oregon Urologic Society, testified in opposition to the bill. “Every urologist will tell you that vasectomy is the most difficult office procedure to master,” says Fuchs. After reviewing the coursework of 25 nursing schools in the country, he found none that had training in basic surgery. He said that there are 150 practicing urologists in the state, most of whom perform vasectomies, and at least that many family physicians who perform vasectomies. He also noted that every major urology office in the state accepts Medicaid. He put it bluntly, “I do not believe there is an access issue.”
Sam Barber, Oregon Academy of Family Physicians, testified that they would want to see appropriate training requirements and ongoing proof of competency in any bill that expanded scope of practice, but that neither are present in the bill as written.
SB 423 – PA Prescribing
Representatives from Zoom+Care say current law allows physician assistants (PAs) prescribing authority based on whether they practice in a rural area, not on their competence or ability. This bill would remove that limitation from statute and allow PAs to prescribe schedule III and IV “under strict supervision” statewide.
Sen. Elizabeth Steiner Hayward (D-Portland) says she is not worried about these drugs at all and that’s why she agreed to introduce the bill on their behalf.
The Oregon State Pharmacy Association and the Oregon Society of the Health-System Pharmacists oppose the bill.
SB 526 – Step Therapy
Step therapy protocols require a patient to fail on “preferred drugs” before certain drugs will be reimbursed.
Patrick Stone, National Psoriasis Foundation, testified in support of the bill. He says it would prevent insurers from requiring a patient who is stable on a drug to go through step therapy protocols each year.
Tom Holt, Cambia, testified in opposition. “We make decisions about our formulary by looking at peer reviewed research,” he told the committee. “It is not our intent to keep patients from getting the drugs they need.”
Elise Brown, America’s Health Insurance Plans, added, “If you pull the layers back, the real issue here is the rising cost of prescription drugs… Because of that, cost management tools [such as step therapy] are so important.”
HB 2394 – “Impaired Health Professionals” added to HPSP
Oregon’s Health Professionals’ Services Program (HPSP) allows licensees of some health professional boards with certain behavioral health diagnoses to continue practicing for 1 year under oversight from the program to provide evidence of safe practice.
This bill would add two circumstances to the eligibility criteria:
1) Impairing medical conditions that require monitoring for safe practice,
2) Criminal histories (such as a DUI) involving a substance but without an eligible behavioral health diagnosis.
SB 272 – Prescription Drug Formulary Transparency
This bill would require insurers to provide a complete list of drugs covered by each of their health plans. It would also require that insurers provide the average cost sharing for a member and to notify members of any changes to their formulary. Cancer advocates, mental health advocates, and multiple sclerosis advocates all testified in support of the bill.
Sen. Laurie Monnes Anderson (D-Gresham) told the Senate Health Committee, “It is my intent to hear all of the pharmacy [transparency] bills and then we can have a work session.”
Providence’s Jessica Adamson says they are opposed to the bill. “We look at this bill as a small piece of what we need to address to deal with this problem.” She urged the Senate and House Health Committees to look at all of the transparency and cost reduction bills together. Representatives from Kaiser Permanente and Cambia testified in opposition as well.
BJ Cavnor, 1 in 4 Chronic Health, says, “I have a hard time believing that providing this amount of transparency would hurt insurers’ bottom line when the top five insurers nationwide made $105 billion in profit last year.”
Exploring the Cost Drivers of Health Care
The House Health Committee brought in numerous health care professionals on Friday to discuss the rising cost of health care.
Jim Rickards, M.D., Chief Medical Officer at the Oregon Health Authority (OHA) provided data about the high cost of specialty drugs. “15% of the total prescriptions filled are brand name drugs yet they account for the vast majority of the cost,” he says. “Price is the problem, these drugs can be brought to market at really any price the market will bear.”
OHA’s presentation highlighted Hepatitis C drugs explicitly, noting that just these drugs cost the OHA $38 million in 2015. They also noted that the price of Sovaldi—the first Hepatitis C drug to enter the market—has dropped from $68,000 to $34,000 for one course of treatment. They say this is due to more drugs coming onto the market.
Rep. Mitch Greenlick (D-Portland) responded, “The fact that the price has dropped that much and pharmaceutical companies are still making a profit, shows just how arbitrary and capricious the price of these drugs really is. At least, I haven’t heard of any pharmaceutical companies going out of business because of this.”
John McConnell, Ph.D.,Center for Health Systems Effectiveness, Director, Oregon Health and Sciences University, says technology is a major force in health care spending as well. “This is going to be a constant pressure and the challenge is to figure out which advances are beneficial and which are simply more expensive.”
Hospitals took much of the blame for high costs as well. The OHA presented data showing that hospitals operating revenue grew 17% from 2013-2015 while uncompensated care dropped 65%. Total profit grew from $391 million in 2011 to $857 million in 2015 said Leslie Clement, Director of Health Policy and Analytics, OHA.
Sean Kolmer from the Oregon Association of Hospitals and Health Systems had the last word. He noted that hospitals provided more than $2 billion in community benefit. He asked that the committee continue to look at this issue within the broader conversation of how the system functions.
The committee will hear testimony on community benefit next week.
HB 2644 – Vitamin K by Injection Mandate
Currently, Oregon statute says that the nurse midwife at a birth is responsible for administering, either orally or through injection, vitamin K within 24 hours of birth. This bill would require vitamin K be administered through injection.
Rep. Knute Buehler (R-Bend) voiced concern about putting medical best practice in statute. “Say a nasal spray were to come on the market in 6 months. We would have to wait until the next legislative session to change the statute. This seems like a bad use of our time and a bad use of your time.”
Parents’ rights advocates testified that there are real risks to vitamin K injections and suggested that the bill include a requirement that parents be notified of the risk.
HB 2726 – Cover All Kids
Governor Kate Brown told the House Health Committee, “While we have made great strides together in getting Oregonians healthcare, there are still thousands that do not have coverage… Oregonians should feel confident that a medical event won’t change the direction of their lives.”
This bill would allow all children in the state, including those here illegally, to qualify for the Oregon Health Plan.
Rep. John Huffman (R-Hood River) supports the bill as well. “For me it just makes sense. It makes sense morally and makes sense economically.”
There was no objection to the bill in the Health Committee but raised red flags for some members of the Human Services Subcommittee of Ways and Means. Rep. Knute Buehler (R-Bend) said those children can now receive care through an FQHC (Federally Qualified Health Center) that is paid for 100% by the federal government.
An estimated 17,000 children would qualify for OHP under this bill at a cost of $55 million in state General Funds for the next biennium.
HB 2675 – CHIPS Focus on Health Integration
The legislation that created coordinated care organizations (CCOs) required community advisory councils (CACs) to oversee and develop Community Health Improvement Plans (CHIPS) “to serve as a strategic population health and health care system service plan for the community.”
Capitol Dental’s Deborah Loy and Rep. Cedric Hayden (R-Cottage Grove) testified in support of the bill. Loy says the intent of HB 2675 is to add a requirement that CCOs’ CHIPS include a plan and strategy for integrating oral health as part of its overall plan. Currently, CHIPS are not required to address oral health or how a CCO will integrate oral health with physical and behavioral health.
HB 2660 – Insurance Coverage for Breast Cancer Patients
This bill would require the Oregon Health Authority and the Department of Consumer and Business Services to create and implement an educational campaign about options available to breast cancer patients.Insurance that covers breast cancer care is required by federal law to cover breast reconstruction surgery, breast prostheses and breast forms.
The Oregon Women’s Health and Wellness Alliance provided written testimony that said despite required insurance coverage for breast reconstruction post-mastectomy, “70% of women who are eligible for this are not informed of their care options.”
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