HOUSE COMMITTEE ON

AUDIT & HUMAN SERVICES BUDGET REFORM COMMITTEE

 

 

January 23, 2003   Hearing Room 50

3:00 PM     Tapes  4 - 5

 

MEMBERS PRESENT:            Rep. Ben 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. Gordon Anderson

                                                Rep. Laurie Rep. Monnes

                                                Rep. Carolyn Tomei

                                                Rep. Billy Dalto

 

 

STAFF PRESENT:                  Rick Berkobien, Committee Administrator

Kelly Fuller, Committee Assistant

 

 

ISSUES HEARD:                     Informational Meeting

                                                “The Health Care marketplace:  an Overview part II”

Bob DiPrete, Deputy Administrator Office of Health Policy and Research.

 

 

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 4, A

005

Chair Westlund

Calls meeting to order 3:05pm.  Introduces Erinn Kelley Siel Governors’ Health Policy Advisor as our guest and opens the informational meeting.

INFORMATIONAL MEETING

001

DiPrete

Deputy Administrator, Office of Oregon Health Policy & Research, introduces himself and his guest Dr. Bruce Goldberg, Administrator of Oregon Health Policy & Research.

015

DiPrete

Continued where he left off from Part I (EXHIBIT A (Revised Version))

061

Rep. Kruse

Asks how much is actual cost increase and how much is increased access?

065

DiPrete

Responds by saying we will get into that later and made some comments.

072

Rep. Bates

Asks when we compare to other countries, what are hospital and pharmacies. costs and the expected effect of the Tort System.

078

Rep. March

Asks how much will be included in elective type surgery in other countries.

085

Berkobien

Asks if we at some point will have information to show where the US falls in conjunction with overall health quality compared to different countries.

095

DiPrete

Defers to Dr. Goldberg to share the information on the questions asked.

096

Goldberg

Answers.

099

DiPrete

Continues testimony.

116

Chair Westlund

Asks if the forecast for this trend is to increase and grow at an accelerated pace.

117

DiPrete

Responds about growth in health care costs and continues.

132

Chair Westlund

Asks question about a graph in the EXHIBIT A, is there anything in your chart that shows 14%.

135

DiPrete

Gives the trends through current and the last period.

140

Chair Westlund

Appreciates and thanks Bob for clarification.

145

DiPrete

Continues presentation.

169

Rep. Kruse

Asks if we have data that shows any escalators relative to mandated testing services.

172

DiPrete

States that they do not have that information, but will find out.

184

Rep. Dalto

Asks if inflation and medical consumer price index is the same thing as this MCPI or is this something separate.

195

DiPrete

Responds to the question of inflation and medical consumer price index.

197

Rep. Dalto

Asks what definitions of inflation are we using.

200

DiPrete

Asks for the information Rep. Dalto is referring to and will take a look and see what differences there may be.

213

Rep. Merkley

Asks if Manage Care Organizations suppressed their prices for market share and is that a piece of this sudden jump.

218

Goldberg

Responds to the sudden jump..

228

Chair Westlund

Asks if Manage Care organizations artificially mask prices to gain market share.

235

Goldberg

Clarifies the answer.

245

Chair Westlund

Asks if that went on, would the result be a steeper increase.

251

Goldberg

Responds that he thinks that is part of it and elaborates with more detail.

258

Chair Westlund

Asks for clarification, when you talk about volume and intensity of each service does that mean each visit is a more expensive occurrence.

261

DiPrete

Yes, more resources are being used.

269

Rep. Dalto

Made an observation that we are paying for the latest and greatest services.

274

Rep. March

Stated interest in concrete examples of the cost of an MRI exam.

283

Goldberg

Responds and will get information about MRI exams and costs of the equipment.

295

DiPrete

Continues through handouts.

313

Rep. Bates

Makes comments about the tremendous amounts of documentation.

322

DiPrete

Continues presentation with new technologies.

340

Berkobien

Asks to what degree is public health playing into these volume intensity drivers.

351

Goldberg

Responds in detail about volume intensity drivers.

367

DiPrete

Continues with provider consolidation, direct consumer advertising, and managed care plans.

409

Rep. Dalto

Will there be a point where we will not have a sufficient numbers of nurses to meet the demands that we may break a federal rule and we will have something come down on us.

415

Goldberg

Responds to the question about sufficient amounts of nurses to meet demands.

434

Chair Westlund

Asks if there is any federal compliances minimums that we are falling below.

346

Goldberg

Responds to hospital compliance.

TAPE 5, A

 

 

028

Rep. Bates

Asks if every intensive care bed in the state is full, what do we do.

056

Chair Westlund

Sums up the conversation.

058

Rep. Dalto

We are going to spend a lot of money on importing nurses, is there a study on how the cost of nursing

061

Goldberg

We will try and get that for you.

065

DiPrete

Continues Presentation

129

Berkobien

Can find a way to map out how Oregon is changing their co-payment and how to look at that system.

140

DiPrete

Partially answers this question and will leave the rest to the invited testimony with Kelly Harms.

176

Berkobien

How many states have similar OMAP programs

179

DiPrete

30 states have similar programs.  He continues presentation.

219

Chair Westlund

Asks what the current costs of  Medicaid/Medicare reimbursement are.

230

Goldberg

Answers questions about Medicaid/Medicare reimbursement costs

241

Rep. Bates

Shares some statistics.

246

Goldberg

Elaborates on the comments from Rep. Bates.

252

Rep. Bates

Makes more comments about the issue of Medicaid/Medicare.

272

Chair Westlund

Makes comments to Rep. Bates and other members.  And gives a thank you to Dr. Goldberg for the RVU explanation.

278

DiPrete

Continues presentation.

308

Chair Westlund

Asks about HMO models.

310

DiPrete

Comments on HMO models refers to Dr. Goldberg about how managed care has other differences.

335

Goldberg

Elaborates on how manage care has differences.

362

Berkobien

Asks if we are seeing a decrease in the use of HMO’s, are people leaning more toward a preferred provider type of model.

365

DiPrete

Answers questions about the decrease in HMO’s.

374

Rep. G. Anderson

Asks if there is a way to contain costs to reduce the legs of service.

376

Goldberg

Responds to the way costs are contained and how benefits are limited.

400

Rep. Bates

Asks if there are cost drivers for the incredible increase in that last few years driven by increased utilization.

TAPE 4, B

 

 

010

DiPrete

Responds by saying he will try to find that information and continued his presentation.

060

Berkobien

Makes comments about a similar question was asked of the Kaiser Foundation.

078

DiPrete

Make comments about solutions at the National level and continues Presentation.

111

Rep. March

You mentioned new revenue sources dedicated to funding Medicaid, do you have suggestions of any that are recession proof.

115

DiPrete

Responds to having anything recession proof.

123

Rep. Morgan

As the costs keep rising but the money going into pay the costs is someone static, that it would have an effect on some of the services on the providing side and have an impact of holding the cost increases down to some extent.

135

Goldberg

Clarifies how system really works.

140

Rep. Morgan

Would the pressure that’s presented by not enough money going into paying the costs result in not as many new technology things being introduced because of not enough money to buy them and that having an impact of holding down the cost side..

153

Goldberg

Responds to Rep. Morgan.

165

Rep. Morgan

Looking at a private sector model, when industry is going well, we try to increase the way we do things and add better equip, when industry is low, we just maintain & sell services at the lowest costs possible with out looking at making the capital improvements.

185

Goldberg

Responds to Rep. Morgan

191

Rep. Monnes-Anderson

Comments on the some knowledge that she has and agrees with Dr. Goldberg’s comments.

215

Chair Westlund

Sums up question and the answers.

220

Goldberg

Concurs with Chair Westlund and elaborates.

245

Rep. Bates

Talks with Rep. Morgan and other members about her questions and makes comments about the system.

279

DiPrete

Continues through presentation.

325

Rep. G. Anderson

Asks if there is a difference between a health care plan that would run $300.00 to $400.00 how would the risk pool compare.

335

DiPrete

Defers to Kelly Harms

337

Harms

Calls Kelly Harms, Insurance Pool Governing board responds to Rep. G. Andersons question.

360

DiPrete

Continues presentation.

TAPE 5, B

 

 

058

DiPrete

End of the presentation material

066

Rep. March

Does any part of FHIAP (Family Health Insurance Assistance Program) count as under our waiver, and asks if it is at the same rate as the other programs.

069

DiPrete

Answers question about waivers.

074

Rep. March

Asks if the rate is higher for children.

089

DiPrete

Question answered about rate being higher for children.

082

Chair Westlund

Asks 3 basic questions about this material presented. 

085

Goldberg

Responds to the 3 questions about the material presented.

145

Rep. Merkley

Asks if there any reason to re-think that core piece of the way that the Oregon systems is designed.

157

Goldberg

Responds by asking if he was referring to what is the best way to limit a benefit.  He elaborates and answers the question.

198

Rep. Merkley

Asks with waivers from the federal government, will we have greater flexibility.

200

DiPrete

Responds by saying no and giving an explanation.

213

Chair Westlund

Makes comments to Dr. Bruce Goldberg.

219

Rep. Bates

Speaks to members with a few comments on the list.

244

Rep. Merkley

Made comments about low rankings on the list.

 

Rep. Bates

Made comments about the low rankings.

260

Rep. G. Anderson

Comment about patients choice.  And elaborates about insurance programs and states what he would like to see done.

289

Rep. Merkley

Asks for clarification from Rep. G. Anderson.

298

Rep. G. Anderson

Answers Rep. Merkley and makes additional comments.

331

Chair Westlund

Extends invitation to invited guests for Monday January 27, 2003

338

Goldberg

Makes an introduction of himself for those who were not here in the beginning.  He thanks the members and looks forward to working with us in the future.

345

Rep. Monnes-Anderson

Commented that she use to work with Dr. Bruce.

 

 

 

 

Chair Westlund

Closes informational meeting and adjourns 4:53 pm

 

 

EXHIBIT SUMMARY

 

A – Informational,  new revised presentation materials, Bob DiPrete, 38pp