Health Reform Dialog Begins Dramatic Shift in Oregon

by | Jul 6, 2009 | We Can Do Better - News |

In the last 12 months we’ve seen a dramatic shift in our dialog about health care. Though we are only just beginning the process of implementing reform efforts, there are many hopeful signs. The public now realizes that we can’t talk about health reform without talking about costs, and how it impacts individuals, business and taxpayers. We’ve agreed that “jump starting the economy” requires that we address the health care crisis.

Still, all too often the conversation falls back to simply addressing the number of people without insurance, and now the media is focused on talk of the “public option” and whether creating a public option would allow for a level playing field for private insurers. Politicians and pundits are still focusing too much on insurance and not enough on what we’re trying to accomplish – better health outcomes and improved patient experience at a lower per-capita cost. President Obama is speaking our language, but it’s unclear whether our congressional leaders understand the importance of this framing and how it will guide the options they choose. It’s up to us to keep letting them know.

Here in Oregon The Oregon Legislature has completed its 2009 session. It’s always a funny feeling to have a “wrap-up” in the middle of a calendar year, especially when there is so much work ahead of us. But we should take a moment to pause and look back at the successes of this past session, because there were some significant progress in terms of health reform and other areas that relate to the public’s health.

In late fall, 2008, the Oregon Health Fund Board delivered its final report to the Governor’s office and to legislative leadership. They laid out a set of building blocks for moving Oregon to universal health coverage. Representative Mitch Greenlick and his staff took that report and used it to craft House Bill 2009, which at its core:

  • creates the opportunity for a more rational and efficient way to control health care costs in Oregon through creation of the Oregon Health Authority,
  • paves the way for components such as an Oregon Health Insurance Exchange and development of a publicly owned, publicly administered (therefore publicly accountable) health plan within the exchange,
  • and incorporates several bills that started the session as separate bills, such as developing a POLST registry (Physician Orders for Life-Sustaining Treatment), developing an all-payor all-claims database, and efforts to shift more support to primary care.

The governor signed HB 2009 into law on June 26, 2009.

It is time to give some thanks to the leadership and members of both the House and Senate health committees, because they worked tirelessly to craft a companion bill that would generate revenue to support HB 2009 and House Bill 2116, which would cover close to 80,000 additional children and add about 35,000 adults to OHP Standard. Trying to find funds to support these efforts was challenging because Oregon was eventually facing a deficit for 2009-2011 that was close to $4 billion. HB 2116 was in negotiations throughout the session and its final agreements were released in early June. It continues and expands a tax on hospitals that can be matched with federal dollars coming to Oregon (you can’t get the federal portion of “matching dollars” unless the state can find their share of the match), and it imposes a tax on insurers based on premiums collected. This is not a sustainable option long term, but it is a credit to Oregon’s unique collaborative nature that we were able to craft such a solution when so many states are reducing public coverage.

Part of the reason for our success is our ability to think outside of the medical system box – that reframing that the Archimedes Movement is always talking about. Last fall we began sharing with our fellow advocates the need to understand the relationship between the health care crisis and the economic crisis. By doing so, employers – especially small businesses – got very involved with the discussions in Salem and in DC. When we are focused on improving population health we can see success in bills related to food sustainability, social services budgets, watersheds, and education, to name a few. These policy issues are inter-connected, and the more that we can move from being single issue advocates to an understanding of the complexities, the better we will have policies that are integrated and more effective at moving us to a better place. The Oregon House leadership has prepared a health bill summary (PDF).

But as the Oregon Legislature adjourns more work begins – implementing the structure that was passed in these two bills. An important aspect is the creation of an Oregon Health Policy Board – a nine-member board that will oversee the work of the Oregon Health Authority, and crafting of the administrative rules that will dictate the work of the state agencies. Public engagement in both of those areas is critical. Several members of our own Community Leadership Council are interested in serving on the Oregon Health Policy Board and have submitted their names for consideration. The official application form is not yet on the Governor’s website, but we will post a message on our site when it is available.

In Washington, D.C. President Obama has set an ambitious timeline for passing and signing legislation at the federal level. At least three committees are working on legislation:

Trying to find a way to influence the national debate is much harder from outside of Washington DC. It is a fast moving target that involves influence, power and access to the media. We have volunteers like Jo Beall who set time aside each day to contact the D.C. offices of our congressional delegation. She has developed some good relationships with staff and if anyone else has that kind of time, Jo can give some tips on how to keep your message on your congressman’s or senator’s desk.

You might recall that we sent an invitation to the Obama administration in February inviting them to Oregon to learn from our efforts and public engagement. We just received a reply via email 2 weeks ago. The administration said that while the President isn’t planning a trip to Oregon in the forseeable future, that they would keep our invitation “on file.” We have also extended invitations to others in the administration, including Peter Orszag, Kathleen Sebelius, and Nancy-Ann DeParle. While the president is asking Americans to help by joining in this debate we have to wonder – is Oregon too far from the Washington, D.C. beltway to warrant attention, even as we have the 2nd highest rate of unemployment and have managed to make an investment at the state level in a future health care system?

Get connected to your elected representatives We encourage you to get on the email list of your state representatives and your federal congressional delegation. It’s a way to keep up on what they’re proposing and to know when there are opportunities to meet with them when they are in their home district or if you happen to be in D.C. The links are here:

  • for Oregon legislators: Once you put in your email address it will take you to a page where you can indicate which email lists you want to be on; you can indicate legislators, committees, agency updates, etc.)
  • the Oregonian now has the easiest bill tracker program which provides a nice summary of where things are.
  • for US Representatives (the House): the website is name.house.gov (For example for Congressman Earl Blumenauer it would be blumenauer.house.gov)
  • for US Senators: the website is name.senate.gov (for example for Senator Merkley it would be merkley.senate.gov)

For the Archimedes Movement Looking internally, it’s been a year since our inaugural member conference and we have a group of volunteers who are working with us to plan a follow-up conference for the fall. Because of your efforts, a lot has happened in the past 12 months, including:

  • The Oregon Health Fund Board, in its executive summary, stated the Triple Aim among its objectives;
  • There were Archimedes Movement members on the Oregon Health Fund Board and on each of its committees;
  • The Oregon Health Fund Board held 15 community meetings around Oregon last fall and there were Archimedes Movement members at each meeting. I was the scribe at those meetings, and worked closely with the team that prepared the final summary of the input gathered at those meetings;
  • We launched a member-based organization, and have grown to almost 500 dues-paying members within our subscriber list that is now close to 10,000 people – mostly in Oregon, but also includes subscribers from 35 states!
  • From the time that the legislative session convened until it adjourned, there were people from the Archimedes Movement at every house and senate health care committee meeting, often providing testimony during public hearings.
  • We held a successful lobby day during a session when we did not have a bill being considered. It was an amazing day and throughout the session legislators expressed that, “there are Archimedes people everywhere I look.” That is public engagement at its best.

Because of you, the Archimedes Movement is looked to for engaged and informed public voices – grassroots voices – that can add to the policy issues under discussion.