Health Policy in Oregon: Two Decades of Reform Efforts

1. Health Policy in Oregon: Two Decades of Reform Efforts State Coverage Initiatives Annual Meeting July 30-31, 2009 Albuquerque, NM

2. Health policy reform in Oregon over the last two decades 1980’s - Pre-Oregon Health Plan: early pioneers in managed care in selected cities 1994 - Oregon Health Plan: Prioritized List, hi-risk pool, created a policy office, aimed for an employer mandate 2003 - OHP2: reform efforts thwarted with budget cuts due to recession 2007 - Oregon Health Fund Board: statewide health reform planning process Now - HB 2009/2116 & Oregon Health Authority

3. Original Goals of the Oregon Health Plan • Health care for the uninsured • Basic benefit package of effective services • Broad participation by providers • Decrease cost shifting & charity care • A rational way to allocate resources for health care

4. Oregon Health Plan pre-2000 Medicaid 1115 Waiver • All Health Services Prioritized • Eligible Population Set in Law (100% FPL) • Deliver care via managed care Private Sector • High Risk Pool • Employer Mandate (never implemented) • Insurance Subsidy: Family Health Insurance Assist. Program (FHIAP) - • Employer coverage • Individual coverage

5. Uninsurance Remained Despite the success of the Oregon Health Plan, 12% of Oregonians remained uninsured. OHP Started 2/94

6. OHP2 Waiver: Restructuring and Reshaping the Oregon Health Plan • Aimed to extend access up to 185% of federal poverty level for OHP • Set a standard benefit package for one adult population in the plan with increased cost sharing • Federal match for Family Health Insurance Assistance program (FHIAP) to subsidize employer-sponsored insurance premiums.

7. 2003 Budget crisis Recession impacts OHP2 • Oregon continued to struggle with highest unemployment in the country as OHP2 changes are implemented • Funding cut for adult expansion population (OHP Standard): • Results in deeper benefit cuts • Loss of coverage for ~80,000 adults on OHP Standard • 24,000 adults maintained by taxes on hospitals and managed care plans

8. As Oregon’s Economy Recovered, New Reform Energy Emerges • Multiple healthcare ballot initiatives & efforts to gain public input to outline priorities • Governor’s HealthyKids initiative • Re-focused look at prevention and chronic diseases via the Prioritized List • Health reform plan development • Oregon Health Policy Commission • Senate Interim and 2007 Session Committees • Oregon Business Council & Archimedes Culminated in the creation of the Oregon Health Fund Board (SB 329)

9. Oregon Health Fund Board, 2007-08 • 7 member citizen board • Six committees • Benefits, Eligibility and Enrollment, Finance, Health Equity, Delivery Systems, Federal Laws • Two workgroups • Health Insurance Exchange, Quality Institute • Over 110 public meetings with 20 town hall meetings across state • Over 1,500 comments received through meetings and written comments

10. Oregon Health Fund Board’s“Action Plan to Build a Healthy Oregon” • Two track approach: • Expand Coverage • Contain Costs and Improve Quality • Keystone: Oregon Health Authority • Single state agency to act as a smart purchaser, integrator of services, and instigator of innovation

11. Oregon Health Fund Board’s“Action Plan to Build a Healthy Oregon” • Short-term impact • Cost and quality will be compared • Local innovation will be supported • Cover 1/3 of uninsured Oregonians (approximately 15,000) • Prevention and primary care will be emphasized

12. Oregon Health Fund Board’s“Action Plan to Build a Healthy Oregon” • Long-term impact • Reduce chronic disease, obesity, tobacco use and substance abuse • Address health care workforce • Adopt private, secure electronic medical records • Bend the health care cost curve • Provide affordable quality health care to all Oregonians

13. Stars in Alignment: Public Support for Reform • Household survey (n=500) and two focus groups held in April 2009 • Overwhelming support for reform (90%) • Support spanned political affiliation and insurance status • 84% concerned with the cost of health care • Overwhelming support for policies contained in proposed legislation (77%-89% depending on policy) • Health care and economy are linked in respondent’s minds

14. Legislative Action in 2009: Companion Bills for Health Reform HB 2116 • Affordable coverage for all children • Expand OHP Standard by 35,000 • Paid for by 1% assessment on insurers, 2.8% on large hospitals HB 2009 • Creates the Oregon Health Authority, overseen by the Oregon Health Policy Board • Sets system reform in motion through key cost containment and quality measures

15. HB 2116 – Expanding Coverage Children: “Healthy Kids” • Access to comprehensive health care coverage for uninsured Oregon children up to age 19 • Options for families at all income levels • Simplified application and enrollment processes • Enhanced outreach to children in under-served communities • Covers 80,000 currently uninsured children Low-income adults: OHP Standard • Covers approximately 60,000 uninsured, low-income adults • Provides limited coverage, including medical, emergency dental, mental health, prescription drug and chemical dependency services Financing • Restructures and renews provider taxes to replace those that sunset October 1, 2009

16. HB 2116 – Expanding Coverage

17. HB 2009 – Setting Reform in Motion: Streamlines State Health Functions Oregon Health Authority • Consolidates state health purchasing and aligns programs to maximize efficiencies • Public Employers Benefits/Oregon Educators • Medicaid • High Risk Pool and Premium subsidy (FHIAP) • Public Health • Mental Health and Addictions Oregon Health Policy Board • Guides the Health Authority as it implements reforms to gain value and reduce costs

18. HB 2009 – Setting Reform in Motion: Gaining Value and Cost Savings Care Coordination: • Statewide registry of physician orders for life sustaining treatment orders (POLST) • Implement uniform quality standards and payment reform, starting with primary care and chronic disease • Uniform use of Evidence-based health care guidelines and comparative effectiveness standards • Health Information Technology Oversight Council (HITOC)

19. HB 2009 – Setting Reform in Motion: Gaining Value and Cost Savings Improved Transparency • All-claims, all payer database • Public reporting on proposed hospital and ambulatory surgical center capital projects • Healthcare workforce database and coordinated policy

20. HB 2009’s Insurance Market Pieces Insurance Reform • Implement value-based small business product • Improve oversight of small group, individual, and portability premium rates • Develop uniform standards for health insurers • Enhance data submitted by Insurers and TPAs Business Plan for a Health Insurance Exchange due for next legislature’s approval Reinsurance/risk spreading options (HB 2755)

21. Health Reform: Insurance Commissioner Perspective Insurance Market Issues: • Financing Coverage: claims versus premium tax • The Dynamics of Rate Review

22. Health Reform: Governor’s Perspective Children’s Agenda – top priority: • Early focus and intermediate steps • Healthy Kids Align the Governor’s priorities with the “Best next steps” of the Oregon Health Fund Board and the Legislature: • Cover all kids and more adults • Bend the cost curve

23. Health Reform: Legislator’s Perspective Policy Development and the Politics • Previous “Healthy Oregon Act” development that led to OHFB process • Hours of committee and consensus work to build HB 2009 • Dynamics of Provider Tax deliberations to finance coverage

24. For more information Oregon Health Fund Board materials available at: http://www.oregon.gov/OHPPR/HFB/index.shtml HB 2116 & HB 2009 available at: http://www.leg.state.or.us/09reg Oregon Health Policy & Research • Website: www.oregon.gov/ohpr • Call us at 503-373-1779 • Email at jeanene.smith@state.or.us