Health care reform shot down in Salem

By DON McINTOSH, Associate Editor

SALEM — On the issue of health care, the times may call for bold ideas, but nothing bold will be coming out of a divided Oregon legislature this year.

To clamp down on spiraling health care costs that are hitting nearly every Oregonian’s pocketbook, unions and their allies put forth a package of proposals, and found legislators in the 2005 Legislature to back them. Leading the way was Gresham Democratic Senator Laurie Monnes-Anderson, a nurse and member of the Oregon Nurses Association, and also chair of the Senate Health Policy Committee, where most health-related bills would be heard.

Known as the “five-pack,” the reform package included:

• Requiring insurance companies to justify rate increases before a state board, just like utilities;

• Regulating the rates hospitals charge;

• Requiring government approval for new hospital construction;

• Requiring hospitals to fulfill their charter as charitable non-profits by offering free or low-cost care to low-income patients who lack insurance; and

• Expanding Oregon’s new prescription drug bulk purchasing pool.

Several of the proposals have passed the majority-Democrat Senate. But none are likely to move forward in the Republican-dominated House, despite statements of support from the governor.

Here’s what happened to each of the five:

Want to raise insurance rates? Show us the money

Introduced in February, Senate Bill 501, the Insurance Industry Accountability Act, was supposed to create a seven-member board, appointed by the governor, to review health insurance premiums. To win the board’s approval for their rates, insurance companies would have to prove that the rates weren’t unfair or excessive. Referred to the Senate Health Policy Committee, it might have seemed like the bill had a bright future, at least in the Senate: After all, three of the committee’s five members were co-sponsors — Senate President Peter Courtney, Committee Chair Monnes-Anderson and Bill Morrissette. And yet on May 6, the committee voted to “gut and stuff” the bill, Salem-speak for amending a bill until it’s unrecognizable. After the amendments, the only parts that remained of Senate Bill 501 were the first four words “Relating to health insurance,” and Line 4: “Be It Enacted by the People of the State of Oregon.” Like salmon gutted and stuffed with chicken, Senate Bill 501 now required insurers to file a report with a state agency disclosing how many individuals they insure, what they charge for premiums, how much they pay out in claims and similar kinds of information.

It’s information they already report, Monnes-Anderson said, but at least under the amended bill it would be made public to a somewhat greater extent. Democrats caucused and caucused, Monnes-Anderson said, but the more aggressive measure couldn’t get enough votes.

The bill went on to pass the full Senate 18-10 on a strictly party-line vote, and then went to the House, where it was referred to the Committee on Business, Labor and Consumer Affairs, headed by Republican Alan Brown. There it got a three-minute hearing and was sent to the State and Federal Affairs Committee, which hadn’t met all year as of press time.

Senate Bill 1040, a similar bill introduced at the request of Governor Ted Kulongoski, also passed the Senate 19 to 9. In the House it was referred to the Budget Committee.

How to bring sanity to hospital prices

Senate Bill 502, the Hospital Fair Pricing Act, was supposed to regulate the rates hospitals charge, along the lines of a similar system in Maryland. It too was sponsored by three of the five members of the Health Policy Committee, and yet, there it died after hearings in February and April. Monnes-Anderson cited concern about the fiscal impact; it would cost something to enact. “At a time when education and public safety are being cut, an extra million to implement rate regulation is difficult,” Monnes-Anderson said. Plus, it wasn’t clear how much it would save; hospital prices still rose in states that enacted similar legislation. And, critics brought out, it would need a waiver from the federal government to tinker with the rates paid by Medicare.

Monnes-Anderson couldn’t get enough votes.

“I don’t think we had yet communicated to legislators the level of urgency to undertake something so bold,” said Lynn-Marie Crider, a health policy expert at Service Employees Local 49 who worked on the bill.

“There’s this free market ideology which doesn’t help us solve the health care crisis. But I think we’re going to have to make an investment in the public sector to make the private sector work right.”

Slow down the wave of duplicative construction

Senate Bill 503 would have required hospitals to get state approval before constructing or remodeling new facilities, or relocating. “We wanted to curb expansion and relocation,” Monnes-Anderson explained. “Hospitals haven’t taken into account community need. It’s been more about ‘keeping up with the Joneses’ and duplication.” But there too, Monnes-Anderson said she discovered the hospital industry has a very strong lobby, and she couldn’t get 16 votes in the Senate. She twice brought it to the Senate floor anyway as a way to get senators to go on record, but found that her legislation morphed into something health care reformers opposed: The hospital industry got the bill amended to limit only the construction of ambulatory surgical centers, a new form of competition hospitals are facing from physician groups. So Monnes-Anderson got it referred back to her committee at the request of labor allies.

Making hospitals live up to their charitable claims

Most hospitals are tax-deductible non-profits, on the basis of charity care they provide. And yet, critics point out, there’s an awful lot of profit in these non-profits.

“People are used to thinking of their hospital as a local charity,” says Crider. “But in fact, they’re aggressive, profit-seeking businesses. It’s a change that’s happened just in the last few decades.”

How about making free or low-cost treatment of poor uninsured patients a legal requirement instead of a voluntary commitment? Senate Bill 504 was supposed to do that. Monnes-Anderson couldn’t find the votes. She heard from rural legislators — in an echo of hospital lobbyists — that such requirements would put their local hospitals out of business. Rather than see her bill euthanized on the floor of the Oregon Senate, she let it die with dignity in committee.

Bulking up bulk purchasing of pharmaceuticals

Debuted to little ballyhoo six months ago, Oregon’s program of pooling individuals to negotiate drug discounts hasn’t amounted to much: Just 2,500 enrollees so far. So Senate Bill 505 was supposed to expand who’s eligible. It was soon superceded by a similar bill, Senate Bill 329, filed two weeks earlier. SB 329 passed the Senate 19-11, with the support of all 18 Democrats plus Republican Ben Westlund.

Currently the program is restricted to public agencies and uninsured individuals over 54 making less than $18,000 a year who’ve been without drug coverage for six months. SB 329 would open it up to private employers and middle-income uninsured individuals of all ages.

The Oregon House took it up, referring it to the Health and Human Services Committee, which gave it a hearing the Friday before Memorial Day before tossing it to the Budget Committee, chaired by Republican Dennis Richardson.

There it now sits, awaiting end-of-session “horse trading.” Health care reformer Maribeth Healey of Oregonians for Health Security said this bill has the greatest chance of any of the package to pass the Oregon House, which is majority Republican.

The bill deserves to get “an up-or-down” vote on the House floor, said Megan Sweeney, state director of Service Employees International Union.

“Fundamentally there wasn’t enough support even among Senate Democrats to take a direct and aggressive approach to solving the health care crisis,” Crider said. But Crider said while she’s very frustrated with Senate Democrats for failing to muster a majority in support of bold health care reform, she cautions letting Republicans off the hook. “Why should the Democrats be the only people we look to for solutions? The Republicans weren’t there either.”

Monnes-Anderson concedes that no health care bills of significance have passed the 2005 Legislature, except the bulk purchasing bill, whose prognosis was still uncertain as of press time. But she said she’s not discouraged.

© Oregon Labor Press Publishing Co. Inc.