State Coverage Initiatives Annual Meeting July 30-31, 2009

Albuquerque, NM

Health Policy in Oregon: Two Decades of Reform Efforts

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

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

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

Uninsurance Remained

02468

101214161820

1990 1992 1994 1996 1998 2000

% U

nin

su

red

Ore

go

nia

ns OHP Started

2/94

Despite the success of the Oregon Health Plan, 12% of Oregonians remained uninsured.

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.

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

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)

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

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

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

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

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

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

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

HB 2116 – Expanding Coverage

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

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)

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

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)

Health Reform: Insurance Commissioner Perspective

Insurance Market Issues:

• Financing Coverage: claims versus premium tax

• The Dynamics of Rate Review

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

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

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