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

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

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 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/ohprwww.oregon.gov/ohpr –Call us at 503-373-1779 –Email at jeanene.smith@state.or.usjeanene.smith@state.or.us