Dr. Bruce Goldberg, director of the Oregon Health Authority, visits the Salem Statesman-Journal
June 7th Update
SB 99A passed the Oregon House today. Having passed the Senate on April 25, it now awaits the Governor’s signature. You can read a report in the Salem Statesman-Journal.
The major questions being debated were:
- should employees of insurers and/or health care providers be allowed on the governance (board) of the Exchange corporation; and
- to what extent can the Exchange use its leverage to bring down the cost of insurance premiums?
The bill’s economic impact will have further discusion next year, as it requires that a business plan to be brought to legislators in 2012 for approval.
We support Oregon creating the opportunity to build its own health insurance marketplace and information center. It’s simple – Oregon wants to define its own Health Insurance Exchange and that means we want it to have a strong board, with a clear purpose, accountability and authority to actually do what it’s set up to do.
[fancy_titled_box title=”Track this Bill”]» The Oregonian’s SB 99 Bill-Tracking Page
» Text of current bill version (SB 99-A)[/fancy_titled_box]
Learn
It feels familiar. Whenever we move from ideas to politics things can get confusing in a hurry. Oregon, led by the Oregon Health Policy Board recommendations, has chosen to create a state-based Health Insurance Exchange instead of having the Feds come in and create an exchange. Senate Bill 99 that would create the organization – in this case a not-for-profit, state-chartered public corporation – along with the governance and rules for that corporation which will set up and run a Health Insurance Exchange. But since the corporation’s proposed name is the same as the thing it will be overseeing (the Oregon Health Insurance Exchange) public input on the bill and its amendments are all over the place.
We should care about who the corporation is accountable to, who will sit on the corporation’s board, and what the framework is for the corporation to take actions. We want a corporation that is able to leverage change in the cost of insurance, but also what gets covered and how services are delivered. Leverage to transform the health system, that’s what we’re after.
We don’t want to be so prescriptive that we unintentionally tie the corporation’s hands in statute, but we also don’t want to be unclear on its purpose. We want it to have enough authority to make the changes we want to see. That’s a fine line to identify, but that’s what we’re asking of legislators.
Also, read Peter Wong’s April 17th article, “Oregon bill would allow health care ‘exchanges’” in the Salem Statesman-Journal. Included is a video of their editorial board’s meeting with Dr. Bruce Goldberg, director of the Oregon Health Authority; Mike Bonetto, health policy advisor to Gov. Kitzhaber; and the Oregon Health Authority’s communications director, Patty Wentz.
» Watch a short conversation with Mike Bonetto and Bruce Goldberg on, “How can the Oregon Health Insurance Exchange improve health equities?“
by “public corporation” I assume you mean a publicly traded for profit company. Which raises the immediate question of “why?” Why would we want to take health insurance out of the hands of one set of for profit companies and simply hand it to another? The moral and societal benefit will be found in removing human health as a money making scheme.
Such an exchange should either be government operated or operated by a government regulated nonprofit NGO. That way there is never the incentive to prioritize shareholder dividends over giving the best health care possible.
Another name for this is “public-benefit corporation.” The U.S. Postal Service is an example of a federal public corporation. And as Liz points out below, SAIF is an example here in Oregon:
“SAIF Corporation is Oregon’s not-for-profit, state-chartered workers’ compensation insurance company.”
No, a public corporation is still a government entity. I apologize for the confusion, but this would not be a private corporation. For example, SAIF (the State Accident Insurance Fund) is a public corporation.
The thing about every state doing their own thing may become non-transferability. I buy my own individual health plan. However, if should become ill while outside of the state, I am not covered. If I should move outside of the state, I have to go through the application process again. It makes things confusing and costly.
Hi KO,
You are absolutely correct about limitations of a state-by-state model, but the same is true with the federal exchange, primarily because of how insurers are licensed by states and rarely cross state lines. There had been some discussion about doing a regional (multi-state) exchange, but the ultimate answer is a national plan that carries from state to state as Medicare does.
At least at the state level, it’s easier to tinker with legislation than it is to change federal legislation, wouldn’t you think?
Will there be a state equivalent to the desired “public option”? Also, of the 9 members appointed to the board, will any “special interest” appointees i.e., the pharmaceuticals, be considered?
This health care legislation can be very dangerous. Who is going to decide what Health Insurance companies are going to be qualified to sell insurance? Is it the free market or some political decsion based on companies that give the most political donations to the Governor or the majority party?
I see lots of potential problems from “state of the Art” health care to death panels, who is going to decide anybody’s health care?
The key is who will be on the Board of the exchange. After hearing testimony overwhelmingly in favor of amendments which would exclude board members with for-profit health insurance industry ties, the Senate Health Care Committee reportedly ignored the testimony and the clear arguments and voted to pass the bill without the amendments. The for-profit insurance industry will retain board members on the supposedly non-profit exchange, keeping their influence intact over how health care is administered in Oregon.
Legislators ignored to death in committee the only true reform bills for health care this session – HB 3510 and SB 888 – both single payer / single risk pool bills which would have given us universal coverage, no more medical bankruptcies, no more avoidable deaths and disability from underinsurance.
Hi,
Thanks for the comments. Matt is checking on the current status of the publicly owned plan (for which a bill was introduced by Senator Alan Bates) and will post a separate reply.
Larry, Francine and Frank each had comments about similar concerns – governance and the Board configuration overseeing the Exchange. The current version of SB 99, which will go through a process of consideration and possible amending in the House, states that the board will have seven members and that no more than two can be employed by, consultants to, board members of insurers, third party administrator, insurance producer (and I am not sure I know what that means), or health care provider, health facility or health clinic or their trade associations. You can get a copy of the version passed (SB 99A) here and the board description is in section 4.
The board will be in the decision making position, so who gets appointed to this board is critically important. But the process in the House Health Committee is very important, and the rules will be made in an administrative rule-making process after legislation is processed.
And regarding the single payer proposals, although HB 3510 did have a successful hearing (at which I provided testimony for) there has actually been some bipartisan support for doing a fiscal analysis of a dedicated sales tax for a health care, creating a different type of single payer system. But I agree that it is very difficult to find any significant focus this session outside of the Exchange discussion, even though other health care related bills have also passed the Senate.
I am very concerned that the Board be empowered to negotiate with insurers to get the best options for consumers in their plans. Without the power to negotiate with insurers, the Board will merely offer a clearing house of what we have now. How disappointing. This reminds me of what Bush did with the Medicare drug plans, prohibit federal negotiation with Drug companies for the benefit of participants.
Hi Emily,
There are more than a few advocacy organizations who agree with you about the ability to negotiate, wanting Oregon to have more than a simple clearinghouse – or rearranging – of what we have today.
One challenge of the exchange will be its ability to attract individuals and small businesses who are not going to get subsidies or tax credits. There are more than a few irrational sections to the bill that seem to get in the way of the exchange accomplishing this. Right now, if you are eligible for a premium subsidy or your business can get a tax credit for purchasing insurance, you must go through the exchange. But, if these are the only people/businesses that go to the exchange, the exchange will not be sustainable. So the exchange will have to achieve something that ‘outside the exchange’ cannot achieve. Currently the bill says that insurers who offer the same product inside and outside of the exchange must charge the same price for that same product. While on the surface it seems to make sense, it is also counter-intuitive. I would want the product in the exchange, with the leverage of thousands of purchasers, to drive down cost, of the premium and of services that are covered.
I am not of the belief that negotiation, by itself, will do anything to change the cost of insurance. the largest employers in the nation have been unable to impact the rising costs. I DO believe that the exchange can set standards, criteria and guidelines about how insurers who want to offer a product in the Exchange can put their premium together, and how transparent that pricing should be. That is leverage – the power to set the ‘rules of the road’ – rather than negotiating the cost with each individual company. That will consume 100% of the Exchange’s time. I’d rather the Exchange use its leverage to change what is purchased, how its delivered and whether anyone should be making unreasonable profit at the expense of the people of Oregon. Our dilemma is that we know what things cost today, and we want it to cost less, but we don’t really know what it “should” cost. I think we can do better.