HOUSE COMMITTEE ON

AUDIT & HUMAN SERVICES BUDGET REFORM COMMITTEE

 

 

January 27, 2003   Hearing Room 50

3:00 PM     Tapes  6 - 7

 

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

 

GUEST MEMBERS:               Rep. Billy Dalto

                                                Rep. Gordon Anderson

                                                Rep. Laurie Monnes-Anderson

                                                Rep. Carolyn Tomei

 

MEMBER EXCUSED:            Rep. Randy Miller

 

STAFF PRESENT:                  Rick Berkobien, Committee Administrator

Kelly Fuller, Committee Assistant

 

 

ISSUES HEARD:                     Informational Meeting

                                                Invited Testimony - Bob DiPrete, and Dr. Bruce Goldberg

                                                “The Health Care Marketplace”

 

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 6, A

005

Chair Westlund

Called meeting to order 3:10 pm, introduces Bob DiPrete and opens the meeting.

INFORMATIONAL MEETING

025

Berkobien

Announcements and overview of materials presented on the Dais.  Invitation to the next two Judiciary Committee meetings on Mental Health in the Criminal Justice System.

028

Chair Westlund

If your schedule allows you to attend the judiciary meeting this will aid the process of the committee.  Welcome to Bob DiPrete and Dr. Bruce Goldberg from the Office for Policy & Research.

030

DiPrete

Introduction, recap and answers to questions of last weeks presentation.

086

Rep. Kruse

Questions about the High Risk pool, he can wait for the details from Rocky King’s presentation.

100

DiPrete

Made comments about those that are denied coverage because of pre-existing conditions will be looked at for the High Risk Pool.  Continues presentation.

164

Rep. Merkley

Are their any states that have been given permission to essentially provide the participant in their Medicaid demonstration project with a subsidy that they use in the private market rather than a specific designed Insurance program like the Oregon Health Plan?

175

DiPrete

Answers question about other states insurance programs.

180

Rep. Merkley

In the OHP we define what is covered and such, but a subsidy that is a voucher.  Have any states been allowed to do something like that within the demonstration project?

189

DiPrete

Answers about subsidized insurance.

195

Rep. Kruse

Is the Utah waiver a define benefit, or is it a series of choices?

215

DiPrete

Discusses the Utah waiver, concludes his summary and asks for questions.

228

Rep. Kruse

Are there other States that have been more aggressive and innovative with match dollars with Medicaid.

244

Goldberg

Is aware there in interest in what other states are doing and have done.  Comments about preparing a brief summary to answer these questions.

251

Chair Westlund

Yes, it would be very handy to know what other States are doing.

258

Rep. Bates

Made comments about an innovative program in Washington.  Would like Bob DiPrete to look into user fees.

300

Rep. Monnes Anderson

I would like to be aware of what litigation could occur with the decision making about cutting back benefits.

312

Chair Westlund

Comment on the issue of litigation.

322

Rep. March

His question and others concerns are the inner section of the Oregon Health Plan and the long term care issues.  It would be nice to know where our dollars are expending there what we can expect as the Federal Government cuts back on Medicare and will that cause an acceleration on our costs?

332

Rep. Merkley

Comment on a call he received today from a constituent about waivers.  Would like to see a list of the current waivers and what they do.

346

Berkobien

Could we get some updates on SCHIP dollars being used?

350

DiPrete

Responded to the question on the SCHIP dollars.

377

Rep. Monnes Anderson

Could SCHIP dollars be used for providing health care in the school system.

385

DiPrete

Responded on the use of Federal Funds.

408

Rep. Monnes Anderson

Why couldn’t we come up with an insurance plan or a Managed Care Plan with that approach?

421

DiPrete

Responded about an insurance plan with that approach.

TAPE 7, A

 

 

015

Chair Westlund

Makes comments about utilization.

 

Rep. Monnes Anderson

Comments on percentages.

025

Rep. Bates

Articulates his understanding of what has just been said.

030

DiPrete

Responds to Rep. Bates his understanding is correct and elaborates.

042

Rep. Bates

Could a school base clinic access CHIP money, not on an individual basis for students but could ask for a capitated amount base number of student that qualify for SCHIP.

049

DiPrete

Responds to the SCHIP program for schools.

052

Rep. Bates

Would that be based on the number of student treated that qualified for SCHIP?

058

DiPrete

Responds.

064

Rep. Bates

Would you envision the Federal Government might require a full panel for that or would they be satisfied that children were receiving there primary care in a school based setting and would give us a waiver for that to happen.

067

DiPrete

Response and can’t answer the question as it is a Federal issue.

070

Chair Westlund

Responds to try to get clarification on Rep. Bates comment.

075

Rep. Bates

Gives clarification about his comments.

085

Rep. Kruse

Would we have to do Means testing to see what student are eligible for CHIP Funding.

098

Rep. Bates

Comments that this is already being done though the school based lunch & breakfast program.

101

Rep. Kruse

The rules around free and reduced are rather loose, basically anyone showing up can eat breakfast or lunch, we might need to be a little tighter around something like this.

105

Goldberg

Makes comments to the members about their questions on the lunch programs. Vs. CHIP dollars

107

Rep. Kruse

Questions about the federal government being this loose with this stuff.

 

Goldberg

Gives clarification about the dollars that would be used.

125

Rep. Bates

They would fund some of the program not all of it.  It is an innovate way of getting money into these health clinics.

 

Rep. Kruse

Would it be safe to assume 40% of kids will be eligible for CHIP money?

139

Rep. Bates

Comments about the percentage of kids on CHIP.

142

Chair Westlund

Comment on relative value of service that is on the list.

155

Rep. Kruse

Shares concern about how steep the hoops are to jump through.

162

DiPrete

Comments on the Federal government requirements.

178

Rep. Kruse

Would it have to be part of a larger safety net?

182

DiPrete

Makes comment to Rep. Kruse on his question.

190

Rep. Merkley

Is part of the challenge, where people are to go and the paperwork to follow up with it.

200

Goldberg

Responds to the challenges that Rep. Merkley raised.

226

Rep. Anderson

Comments on the school based clinic.

235

Chair Westlund

Any other questions before we move off this topic.

257

Rep. Monnes Anderson

You know our special ed dollars from the Feds does not cover the services that we need and that we are mandated to provide in the schools and some of these children have skilled nursing in the system.  Is this another way to tap dollars that are obviously needed in health care that schools are providing already?

258

Goldberg

Comments that his understanding is that everyone is saying is how can we be creative and still maximize all of the SCHIP dollars.

260

Chair Westlund

Dr. Goldberg, do not hesitate to bring any ideas or comment you have forward.

261

Chair Westlund

How much money gets shifted to the commercial markets?

275

DiPrete

Makes comments to money being shifted in commercial markets.

295

Chair Westlund

Part two of this question, how many money goes on top for the administration before it gets shifted.

325

Goldberg

Comments to part two of the question.

373

Chair Westlund

Understands the comments from Dr. Goldberg, but how do they shift cost to someone who is not paying a full reimbursement to begin with.

400

DiPrete

Comment on what is not covered by the person receiving the service.

405

Chair Westlund

Agrees but still does not understand how that shift; which he knows occurs, works.

410

Rep. Bates

In Oregon that dollar shift goes right straight to commercial and private pay.

TAPE 6, B

 

 

026

Goldberg

Comments on fees and how he feels the program works.

040

Chair Westlund

How much of the dollars of medical dollars get shifted in Oregon, is 100% is that correct.

045

Goldberg

Yes, that is correct and elaborates.

047

Chair Westlund

Hospitals are functionally made whole?

050

DiPrete

Articulates his opinion about hospitals.

052

Chair Westlund

Comments of physicians costs.

055

Goldberg

Discusses the access issue of services in different markets.

070

Chair Westlund

If you live in a geographic area with a large enough market of private/commercial payers.

071

Goldberg

Yes and furthers comments.

080

Rep. Merkley

Made some comments on some articles he read last year and it would be useful to have a report about what percentage of the state is no longer served by doctor that except OHP patients or Medicare Patients.

098

Rep. March

Relates his opinion that a number of the hospital are non-profit, so the costs end up getting spread out though the tax payers.

107

Chair Westlund

Makes comments that he feels that hospitals do not have the choice not to serve someone, physicians do.

114

Rep. Bates

Gives facts about patients that are excepted with there insurance or not.  He elaborate some of his experiences.

142

Goldberg

Makes additional comments on this issue.

157

Rep. Anderson

Comments that he would hate to see people penalized, it would be better to give incentives.

169

Berkobien

How much providers write off in loss?  Is it an issue, do providers of any type write off loss on their taxes.

181

Rep. Bates

Not allowed to write off losses.

195

Chair Westlund

Had questions about loss of profits.

204

Rep. Bates

Comment about his loss experiences.

229

Rep. Morgan

Would like to pursue the conversations above about writing off bad debt.

242

Rep. March

Comments that you can only write off your costs, not your earnings or losses.

248

Rep. Merkley

You have a receivable and what you are writing off is a receivable when it is un collectable.

253

Chair Westlund

Here is an instance when you have an institutionalized loss.

 

Rep. Kruse

Comments about the above conversations.

302

Westlund

Thanks Bob DiPrete and Dr. Bruce Goldberg.  Closes informational meeting and adjourns.

 

EXHIBIT SUMMARY

 

None