HOUSE COMMITTEE ON

AUDIT & HUMAN SERVICES BUDGET REFORM COMMITTEE

 

 

January 22, 2003   Hearing Room 50

3:00 PM    Tapes  2 – 3

 

MEMBERS PRESENT:            Rep. Ben Chair Westlund, Chair

Rep. Steve March, Vice-Chair

Rep. Susan Morgan, Vice Chair

Rep. Alan Bates

Rep. Jeff Kruse

Rep. Jeff Merkley

 

MEMBER EXCUSED:            Rep. Randy Miller

 

 

GUEST MEMBERS:               Rep. Billy Dalto

                                                Rep. Laurie Monnes-Anderson

                                                Rep. Carolyn Tomei

 

STAFF PRESENT:                  Rick Berkobien, Committee Administrator

Kelly Fuller, Committee Assistant

 

 

ISSUES HEARD:            Informational Meeting

                                    “The Health Care Marketplace” Part I

 

 

 

These minutes are in compliance with Senate and House Rules.  Only text enclosed in quotation marks reports a speaker’s exact words.  For complete contents, please refer to the tapes.

 

TAPE/#

Speaker

Comments

TAPE 2, A

010

Chair Westlund

Calls the meeting to order 3:12 pm and opens the Informational Meeting.

INFORMATIONAL MEETING

011

Chair Westlund

Reviews today’s agenda, makes announcements and states what to expect of today’s meeting.

042

Bob DiPrete

Deputy Administrator, Office of Oregon Health Policy & Research.

058

Chair Westlund

Expresses thank you for the introduction of the material, it is a very good road map.

059

DiPrete

Continues presentation.

107

Rep. Morgan

Asks if the system described has always been this way.

110

DiPrete

Responds about how the system works.

123

Westlund

Appreciates Rep. Morgan question and repeats to make sure it is clear.

125

DiPrete

Responds by tell Chair Westlund he is correct.

126

DiPrete

Presentation Continues

146

Rep. Dalto

Asks how large the client population is in the high risk pool.

147

DiPrete

Responds to the risk pool population.

150

Chair Westlund

Asks for the numbers to be read.

152

DiPrete

Responds with numbers in his materials.

160

Rep. Bates

Points of interest and comments, what is the waiting list for the Family Health Insurance Assistance Program at this time.

165

DiPrete

Responds and defers to a Kelly Harms, Office of Oregon Health Policy and Research in the audience.

 

Rep. Kruse

Asks how much capacity do we now have in group that is under utilized.

185

Kelly Harms

Responds to the capacity we now have in group that is under utilized.

187

Rep. Kruse

In this population it is harder to quality for group, while it is cheaper we can get a lot of folks in individually, but it is harder to get people in that population that are qualified to enter into group.

193

Chair Westlund

Comments that we will spend a good time on the other topic later.

202

DiPrete

Continues presentation.

 

Berkobien

Asks for the definition of employer mandate.

214

DiPrete

Gives explanation of an employer mandate.

 

Rep. Merkley

Asked if it was a legislative passed employer mandate or was it an initiative, and what year did that occur.

228

DiPrete

Responds.

 

Berkobien

Asks questions about prohibitions.

230

DiPrete

Responds about prohibitions.

239

Rep. Dalto

Asks if this was mandated or required on employers, if they did not offer a health insurance package for employees they required or mandated to pay into the health plan for any one not covered regardless of other circumstances.

250

DiPrete

Responds about the mandated coverage and continues his presentation.

279

Berkobien

Asks what percentage of Medicaid do we cover.

288

DiPrete

Responds to percentage of Medicaid, and what percentage we cover.  Continues presentation

325

Rep. Kruse

Asks if it would it be safe to say that there are other states that have asked for and received greater flexibility in some aspects than we have.

330

DiPrete

Responds about other states having greater flexibility.  Continues presentation.

400

Rep. Kruse

Asks how do they determine mortality, by age group?

401

DiPrete

Answers questions about age and income and those with or without insurance and continues presentation

TAPE 3 A

 

 

003

DiPrete

Answers the question and continues presentation

005

Rep. Kruse

One would assume there are other factors other than insurance that play into that.

015

Rep. Bates

We are talking about pre-mature mortality; all things are factored into the reports.  It does in fact matter if you have insurance or not.  Primarily because of preventative care.

035

Rep. Monnes Anderson

The word rates would clarify it better rather than saying generally higher mortality rates.

043

Chair Westlund

Makes comments to the group.

046

Rep. Kruse

Comments that statistics are statistics and the other factors are what they are.  There are lifestyle things that differ for other social economic groups.  Not that this isn’t a factor or the sole factor.

049

Rep. March

Asks for a copy of the study.

051

Chair Westlund

Comments that he likes Representative Monnes-Anderson’s word change.

065

Berkobien

Are there any other studies, that tie in with the economic impact etc.

076

DiPrete

Responds about studies that have been done.

080

Merkley

Asks about the higher in hospital mortality, and what is driving that.

083

DiPrete

Responds to the higher in hospital mortality.

090

Rep. Bates

Relates a memory of the study, that people are entering hospitals much sicker to the point that hospitals can’t turn the illnesses around in time.

100

DiPrete

Continues presentation and discusses the topic of uninsured women.

103

Rep. Dalto

Asks if we have data to show the breakdown of uninsured folks by gender.  Remarks that it would be helpful.

110

DiPrete

We do have, it is outdated.

113

Liz Stephenson

Liz Stevenson, Manager of Research and Data Unit Office of Oregon Health Policy and Research.  Just got results from Oregon Population survey in 2002, it will be analyzed soon.

120

Rep. Dalto

Would like info about access issues, broken down by gender, and asks if there are access problems.

128

Rep. Bates

Responds, asks if the questions was, is there more access for males than females.  Makes more comments.

134

Rep. Monnes-Anderson

Relates her comments about the study.

142

DiPrete

Continues presentation.

160

Tomei

Asks if people on Medicare can have private insurance too, are they included in these figures.

162

DiPrete

Responds about people on Medicare having private insurance.

166

Rep. Bates

Makes comments about private insurers.

174

Rep. Kruse

Makes comments about Medicaid and Medicare.

176

Rep. Kruse

Asks if we have segregated those with Medicare & Medicaid, and are we double counting.

178

DiPrete

Responds to double counting.

181

Rep. Morgan

Asks what is the overriding governor of this the general economy.

185

DiPrete

Responds to the question about the economy and continues presentation.

190

Rep. Morgan

Asks if it is a fair assumption to say when the economy is in healthier shape more people are covered on insurance than when it is in the tank like it is now.

193

DiPrete

Responds to the other questions on the economy.

215

Rep. Monnes-Anderson

Questions that when you say the rate for Hispanic is more than twice the overall rate, does that mean that most of them are not eligible for insurance.

219

DiPrete

Responds to the Hispanic population and insurance.

240

Rep. Dalto

Asks that if this Hispanic rate also includes resident’s aliens and citizens that identify as Hispanic but probably not folks who are not resident are aliens and citizens.  Asks if it could actually be higher than twice the overall all rate.

255

DiPrete

Responds to the rates being higher.

259

Rep. Bates

Makes comments to members to clarify issue of the number of people on the plan.

283

DiPrete

Responds and agrees.

290

Rep. Dalto

Asks if there is there any data or studies about population migration patterns of people coming for the Oregon Health Plan.

304

DiPrete

Responds and makes final point on insurance status in Oregon.

328

Chair Westlund

Asks if it is a fair comments to say that implications on a national basis say that most of the nation has caught up with us and that most of the nation doesn’t have such an aggressive health care program as Oregon.

339

DiPrete

Responds to the national basis of insurance.

345

Westlund

On a national basis with our economy you could argue is worse than other places.

376

Rep. Bates

States his opinion on how we look different than other states.

379

DiPrete

Responds about Oregon being different than other states.

385

Chair Westlund

Made comments about Medicare payments.

394

Rep. Bates

Made comments about commercial people not being able to afford the premiums.

399

Merkley

Question about Medicare payments.

405

Chair Westlund

Makes comments about Medicare and we will discuss this in more detail later.

413

DiPrete

Presentation continues with Managed Care in Oregon.

431

Chair Westlund

Asks what a closed panel HMO is.

435

DiPrete

Gives an explanation of closed and open panel HMO’s.

440

Westlund

Asks what a staff model is.

441

DiPrete

Gives definition of a staff model.

 

 

 

TAPE 2 B

 

 

031

Berkobien

Asks for clarification on concepts of HMO

034

DiPrete

Offers a brief overview of the HMO model.

051

Rep. Bates

Relates 3 major factors in the cost of health care for Provider Services.

061

DiPrete

Agrees

063

Merkley

Asks question of Rep. Bates and Bob for clarification of terminology on what a capitated plan is.

070

DiPrete

Concurs with the comment above.

073

Rep. Kruse

Asks when folks like Regence Blue Cross Blue Shield dropped out and we went to IPA’s did the amount of capitalization for risk change or did it stay the same.

047

DiPrete

Gives explanation.

085

Rep. Kruse

I know that there some creative reserving part of payments and different things like that so that they have reserves and just wondered if the numbers were different.

095

Berkobien

Ask for a quick 101 on risks and what some of these plans have to have.

097

DiPrete

Expresses that he can’t speak on that issue and will get the data necessary to answer the question.  Continues his presentation.

114

Chair Westlund

Asks if the root of Rep. Merkley’s question is regarding disparity in payments.

117

DiPrete

Agrees.

154

Rep. Kruse

Elaborates on his understanding of the Medicare issue.

160

Chair Westlund

Can you go over this page again so we make sure we understand?

177

DiPrete

Will explain to the best of his ability and recommends inviting others involved in these topic areas.

185

Rep. Westlund

By premium you mean payment?

 

DiPrete

Concurs and gives an explanation.

 

Rep. March

Offers a brief overview of his understanding on this issue.

189

Rep. Kruse

Makes comments about rates in the 1980’s.

195

DiPrete

Agrees.

199

Rep. Bates

Elaborates about cost verses what they pay us is the key problem and talks about other issues.

229

DiPrete

Responds to the conversation.

237

Chair Westlund

Makes comments and clarifies his understating of what has been said.

244

DiPrete

Continues with Managed Care Enrollment in Oregon.

255

Tomei

Ask for the definition of what choice risk is.

257

DiPrete

Responds and answers questions and will get more detail later as he is not the expert in that area.

266

DiPrete

Continues with Health Care costs in Oregon.

278

Rep. Kruse

Explains his understanding.

280

Chair Westlund

Comments that it is a double edge sword that cuts both ways with one swipe.

284

DiPrete

Continues presentation.

291

Rep. Bates

Wants clarification on true costs and other bullets in the handouts.

306

DiPrete

Introduces Barney Speight, Director Government Relations Kaiser Permanente Health Plan and elaborates on the questions asked above.

328

Rep. Morgan

Asks for clarification on the first bullet point.

337

Mr. Spade

Gives an explanation of the first bullet point.  And changes the word “Costs” to the word “expenditures” to clarify this page.

349

Rep. Morgan

Wants clarification on second and third bullet points.

356

Mr. Spade

Responds and asks members to be careful adding the word “reimbursement” and explains.

387

Rep. Kruse

Makes comments about cost shifts and problems with the system.

391

Chair Westlund

Asks for more clarification on the first bullet point.

397

Mr. Spade

Articulates his point and answers the questions.

TAPE 3 B

 

 

014

Chair Westlund

Asks for clarification of word units, does it translate as benefits.

016

Mr. Spade

Responds and continues.

020

Rep. Bates

Gives an explanation of his expertise.

041

Mr. Spade

Generally agrees.

045

Rep. Kruse

Asks if we are talking about East coast verses West coast, they utilize the system more because they get closer to true costs, so they can afford to utilize more, am I off base there.

048

Mr. Spade

Responds to fundamental equations of health care.

077

Rep. Kruse

Has comments and asks questions.

085

Mr. Spade

Agrees to a small degree and makes comments.

106

Rep. Bates

Makes comments about rewarding behavior and what that does.

117

Rep. March

Makes comments to Rep. Morgan and cautions to stay away from a certain word.

124

Tomei

Asks for clarification about second bullet on expenditures for Medicaid.

136

DiPrete

Agrees with Rep. Tomei’s comment and elaborates.

150

DiPrete

Continues presentation.

161

Rep. Kruse

Asks if we are on par percentage wise with other states.  Asks if they have you broken that out with states with tort caps and states without tort caps.

167

Rep. Dalto

Questions about medical inflation are we going to go over that.

174

DiPrete

Responds about continuing presentation to make this clearer.

176

Chair Westlund

Makes comments to close meeting.

151

Rep. Bates

Comments that this stuff will get easier to understand.

 

 

Meeting adjourned 4:35 pm

 

 

EXHIBIT SUMMARY

 

A – Informational, prepared testimony, Bob DiPrete,  38pp