Public Resources
SB 329 Oregon Health Fund – Passed
SB-329 Oregon Health Fund-Passed
Summary:
This bill aims to “pool” health dollars from a variety of existing sources to leverage better rates from insurers and to maximize federal dollars, (Oregon Health Fund program). As a member (cardholder) of this pool, Oregonians will receive primary, preventative and health care services at affordable rates. Additional benefits can be purchased directly from insurers. An oversight board will manage the pool through existing insurance carriers to control costs and set standards for essential health coverage. Also, by increasing transparency of health care costs, consumers will be able to make informed choices.
Establishes Oregon Health Fund program.
Establishes Oregon Health Fund Board to administer program.
Requires board to adopt enrollment procedures and defined set of essential health services. Requires board to contract with health plans licensed to transact business in state to provide coverage.
Requires board to issue Oregon Health Card to program participant.
Requires “accountable” health plan to enroll person with Oregon Health Card.
Requires uninsured individual with income greater than 250 percent of federal poverty guidelines to pay premium. Denies state income tax exemption credit for individual who fails to pay premium.
Requires board to adopt rules establishing quality and access standards applicable to defined set of essential health services covered by plans.
Authorizes board to adopt rules necessary to implement program.
Requires board to report to Legislative Assembly concerning operation of program.
Requires board to establish procedures to assist cardholders who choose to execute advance directives and to establish registry of advance directives.
Establishes Oregon Health Fund. Continuously appropriates moneys in fund to board to obtain coverage of defined set of essential health services for eligible persons from “accountable” health plans and to pay administrative costs.
Creates interim task force to develop potential strategies for streamlining state agencies and programs that deliver medical benefits.
Authorizes task force to pre-session file legislation.
Requires task force to report to Legislative Assembly.
More
Senate Bill 329 is intended to be a workable strategy for developing statewide health care reform in time for the 2009 legislative session. The proposed Board is the heart of S.B. 329-2 amendments. The Board is empowered to develop a plan for achieving the Act’s principles and the Fund’s program goals. In addition, the Board is given substantial power to develop universal, statewide access to health care and substantial responsibility over Oregon’s health care system authority and over all Oregon health-related programs and State Commissions. The Board is to create sub-committees and conduct public hearings to achieve the goal of designing a reformed health care delivery system for Oregon. In March, Senators Bates and Westlund and former Gov. Kitzhaber met and decided to merge SB 27 into SB 329. Therefore, many features of SB 27 are included in the proposed 329-2 amendments. A crack developed in that agreement when Sen. Bates and Sen. Westlund decided not to include a request that Oregon be allowed to utilize all of the Federal dollars spent on Oregonians by the federal government in the SB 329-2 amendments. Although vital to Governor Kitzhaber’s plan to reform current State and federal health care spending in Oregon, many believe such a provision would cause the downfall of the bill; especially when AARP members and families for the developmentally disabled got wind that a proposed Board was going to request power to redirect their Medicare benefits.
4/30 update? The two plans were to be joined together but a problem arose; AARP opposed the inclusion of Medicare into the discussion. The AARP ended up being the “deal breaker” that led to the demise of discussions between Bates/Westlund and Kitzh
4/30/2008 current activity of the Health Fund Board
In June 2007, the Oregon Legislature passed the Healthy Oregon Act (Senate Bill 329, Chapter 697 Oregon Laws 2007). The Oregon Health Fund Board created in accordance with SB 329 is a 7 member board appointed by the Governor. The Board is developing a comprehensive plan to ensure access to health care for Oregonians, contain health care costs, and address issues of quality in health care. The members of the Board represent the ethnic, professional, and moral diversity of Oregon. The members have experience, knowledge and expertise in the areas of consumer advocacy, management, finance, labor and health care.
Since its appointment, the Board has met six times. Working concurrently with the board that oversees them, six committees are in charge of specific aspects of healthcare. Each committee, comprised of a diverse array of stake holders, which represent diverse opinions and expertise, will then report their findings to the board for consideration in April/May. The board will then compile the recommendations for public comment in July- September, and the final report will be sent to the governor and legislative leadership in the fall of the 2008.
Below is a synopsis of the different committees, their intended focus and a brief outline of their progress to date.
Benefits Committee
Goal: to define a set of essential health services that should be available to all Oregonians. They will also discuss the level of subsidy and cost-sharing strategies that could be combined to crease various benefit packages.
This processes of this committee should ultimately produce a single set of ’essential’ health services to be made available to all Oregonians; while recognizing that certain groups of ’vulnerable’ (e.g. low-income) Oregonians may need to have their benefits supplemented. Any plan would inevitable rely on cost sharing as an important tool for ensuring sustainability, however, members do not believe that the extent of any cost-sharing is their responsibility (see finance committee) and will not consider it a priority to determine extent of cost sharing or financial sustainability.
Delivery System Committee
Goal: to discuss strategies and policy options to create a high performance health care system that provides quality care to all Oregonians. They will address cost containment, improving health outcomes and the experience of care.
The committee has received recommendations from the Safety Net Advisory Council on how to strengthen Oregon’s safety net and from Public Health on some initial recommendations for the expanded role for public health programs in a reformed health care system.
In addition the Committee has learned about value-based purchasing efforts in Oregon. In its January meeting they developed a framework for Oregon’s delivery system reform. The committee focused on promoting “integrated health homes” (the new name for medical homes developed by the Committee to capture the breadth of integrated care necessary in a reformed delivery system). The group also discussed principles it will use to analyze alternative payment reform options. They will be focusing on cost containment approaches in a reformed health care delivery system at subsequent meetings.
In addition the committee will have a workgroup which will focus on developing a ’health care quality institute’ for the state.
Delivery Systems Committee – Quality Institute Work Group
This work group was created in an effort to clearly define problems in the current health care system that could be addressed by a Quality Institute for Oregon. The aim is to determine appropriate roles for a Quality Institute The group discussed alternative governance structures and possible funding sources for a such an Institute, using models from within Oregon and from around the country. The group was updated about quality improvement and transparency efforts already underway in Oregon and discussed its vision for quality and transparency in a reformed health care system.
Eligibility and Enrolment Committee
Goal: to develop recommendations regarding eligibility requirements and enrolment procedures for the Oregon Health Fund program. They will address: affordability, outreach, enrolment and disenrollment procedures as well as eligibility as it relates to public subsidies and employer-sponsored insurance.
This committee has been developing recommendations for affordability, including recommendations for premium cost-sharing structures as well as consideration of other costs (e.g., co-pays and deductibles) associated with the Oregon Health Fund program.
The Committee has struggled to balance individual affordability, fairness, and sustainability. They have developed initial consensus around four options, two that described an income below which there would be no personal premium cost-sharing and two that described the income above which premium cost would be 100% personal responsibility.
Federal Laws Committee
Goal: The Federal Laws Committee will provide recommendations to the Board regarding the impact of federal law requirements on achieving the goals of the Healthy Oregon Act/health fund board, focusing particularly on barriers to reducing the number of uninsured Oregonians.
The Federal Laws Committee has met several times to discuss federal Medicaid and
Medicare requirements that may hinder Oregon’s reform efforts.
The twelve-member Committee will specifically focus on the following federal policy areas.
Medicaid, State Children’s Health Insurance Program (SCHIP), and the Family Health Insurance Assistance Program (FHIAP); Medicare, with a focus on reimbursement rates and the effect of these rates on cost, quality, and access; Indian Health Services; Employment Retirement Income Security Act (ERISA); Federal tax code policies; Emergency Medical Treatment and Active Labor Act (EMTALA); Health Insurance Portability and Accountability Act (HIPAA); Federal funding related to education of health care professionals.
The Committee is relying heavily on stakeholder participation to identify any federal law barriers and to suggest recommendations to remove these barriers. The Federal Laws Committee’s will report to Oregon’s congressional delegation and the United States Congress.
To give input as a stake holder go to:
http://www.oregon.gov/OHPPR/HFB/Federal_Laws/Misc/FederalLawsCommitteelettertostakeholders.pdf
Health Equities Committee
Goal: The Health Equities Committee will develop multicultural strategies for program eligibility and enrolment procedures and make policy recommendations to reduce health disparities through delivery system reform and benefit design of the Oregon Health Fund program.
The Health Equities Committee recently finalized recommendations that target disparities in health insurance status in Oregon, including recommendations concerning outreach approaches and eligibility criteria. The Committee also finalized recommendations on workforce issues, including strategies to ensure an adequate healthcare workforce that reflects the diversity of Oregonians and provides culturally-competent health care. In March, the committee will finalize recommendations on language and cultural access within the delivery system. The Health Equities Committee will also be looking at Public Health approaches that reduce health disparities by promoting health and disease prevention in the community setting.
In December, the Committee met to discuss outreach strategies for Oregon communities experiencing disparities in insurance status, as well as to begin discussions on recommendations for eligibility related to immigration status. The Committee heard testimony concerning the Welfare Reform Act and the subsequent exclusion of legal immigrants from Medicaid programs for the first five years following immigration. On January 10th and 24th, the Committee met to discuss the elements of primary care medical home models that reduce health disparities and provide culturally competent care. The Committee also discussed strategies to recruit and retain a diverse health care workforce with adequate rural representation, and the members finalized recommendations to the Board on a range of approaches for addressing eligibility related to immigration status. The Committee will meet twice in February to discuss financial incentives to reduce health disparities. Specifically, the Committee will address: incentives for:Providers to reduce targeted treatment disparities, Individuals to make healthy lifestyle choices, Supporting upstream community-based approaches to disease prevention for vulnerable populations, Sustainable funding strategies for elements of the delivery system that reduce health disparities. (E.g. linguistic services and chronic disease management).
At their March meetings, the Committee will discuss recommendations concerning benefit designs that support the health of women, minorities, and other vulnerable populations, including individuals with cognitive, mental health, or physical disabilities.
The Health Equities Committee will make recommendations to the Board on a plan to improve and increase collection of health-related data for people of color and other under-represented populations using techniques that are culturally sensitive and accurate.
Finance Committee
Goal: to develop recommendations strategies to finance a proposed comprehensive plan to expand access to uninsured Oregonians and to modify the operation of Oregon’s non-group (individual) market to provide access to affordable coverage for individuals complying with an individual mandate for coverage. This Committee will have one workgroup devoted to Insurance Market Changes/Health Insurance Exchange. (Also see SB 1093)
The eighteen-member Committee includes a wide range of stakeholders, including health plan providers, business, labor, and consumers.
The Committee is discussing potential revenue options for the Oregon Health Fund program. The members have defined a set of criteria to evaluate the various options and, with the technical assistance of staff from the Department of Revenue and the Legislative Revenue Office, have begun to weigh the pros and cons of different revenue streams, such as payroll taxes, personal and corporate income taxes, health care transaction taxes, and cigarette taxes, among others.
In addition to defining potential revenue sources, the Committee will begin structuring the proposal’s framework and identifying elements, such as a play-or-pay scenario, that need to be more carefully examined. The Institute for Health Policy Solutions is conducting a micro-simulation modeling process for the OHFB in order to aid them in determining the efficacy of various proposals. So far the committee has discussed two “straw plan” proposals for the purpose of initial modeling. Additionally they have worked to assess various tax scenarios in light of previously-identified financing principles and strategic policy questions. The Committee also discussed design issues with respect to a payroll tax at and health services transaction tax.
Finance Committee – Exchange Work Group
Under the direction of the Finance Committee, a fourteen-member workgroup was formed to address the issues surrounding the establishment of a health insurance exchange. Half of the workgroup’s members are also members of the Finance Committee. The Exchange Work Group finalized its market reform recommendations and identified areas where further development is needed. The recommendations include
Making the individual insurance market guaranteed issue, Implementing a risk adjustment mechanism, Requiring that all insurance plans sold are equal to or greater than a to-be-defined essential services benefit.
The Work Group provided a report on Health Insurance Exchanges and Market Reform to the Legislature and laid out options for potential functions, and populations which would be covered.
To find out more…
In order to keep the public informed about the work of the Board and its committees, staff of the Board maintain a website (http://healthfundboard.oregon.gov) that contains information about upcoming meetings, including agendas, written materials, and digital recordings of the meetings; as well as rosters of the Board and its committees; contact information for each committee; and links to committee reports. There is also a link on this website for the public to email their questions and comments to Board members, committee chairs, or staff (OHFB.info@state.or.us). Staff produce a monthly newsletter which contains summaries of each of the committees’ and the Health Fund Board’s activities and includes listings of upcoming meetings. In addition, the Northwest Health Foundation is hosting a blog (http://www.talkhealthreform.org) for the public to use to voice their support for, or concerns about, the state’s health care reform plan.
For further information go to http://healthfundboard.oregon.gov