SENATE COMMITTEE ON HEALTH POLICY

 

 

February 16, 2005                                                                                                   Hearing Room B

1:00 P.M.                                                                                                                     Tapes  16 - 19

Correction 9/29/2005

MEMBERS PRESENT:         Sen. Laurie Monnes Anderson, Chair

Sen. Jeff Kruse, Vice-Chair

Sen. Peter Courtney

Sen. Gary George

Sen. Bill Morrisette

 

STAFF PRESENT:                 Rick Berkobien, Committee Administrator

Brittany Kenison, Committee Assistant

 

MEASURES/ISSUES HEARD:

The Healthcare Market Place: Public and Private Healthcare Systems, Cost Drivers and Health Insurance – Informational Meeting

 

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 16, A

005

Chair Monnes Anderson

Calls the meeting to order at 1:03 p.m.  Opens informational meeting on the healthcare market place: public and private healthcare systems, cost drivers, and health insurance.

THE HEALTHCARE MARKET PLACE: PUBLIC AND PRIVATE HEALTHCARE SYSTEMS, COST DRIVERS AND HEALTH INSURANCE - INFORMATIONAL MEETING

010

Chair Monnes Anderson

Reviews schedule of cost containment hearings and submits as testimony (EXHIBIT A).

040

Bruce Goldberg

Administrator, Oregon Health Policy and Research, Oregon Department of Human Services. Introduces himself.  Submits PowerPoint presentation on an overview of healthcare in Oregon (EXHIBIT B).

042

Bob Diprete

Oregon Health Policy and Research, Oregon Department of Human Services.  Introduces himself.

045

Goldberg

Provides overview of presentation.

050

Diprete

Provides objectives of the presentation.

060

Diprete

Provides overview of healthcare in Oregon:

·         Nationally and in Oregon:  The “System” isn’t a system

·         Resources and Programs are Fragmented or Overlap

·         It’s All Connected, System or Not

110

Goldberg

Begins to discuss expenditures.  Reviews chart of annual change in private health spending per capita, 1961-2001.

115

Kruse

Asks what caused the sharp drop of change in spending in early 1960’s.

118

Goldberg

Explains that it dropped when Medicaid and Medicare started.

122

Kruse

Clarifies that “dips” are caused when programs are attempting to change the market.

125

Goldberg

Affirms.  Reviews chart for increase in health insurance premiums compared to other indicators, 1988-2003.  Explains the significances are not in the “dips,” but the overall stability in overall inflation and wages.

145

Chair Monnes Anderson

Clarifies that there are no premiums with the Oregon Health Plan and that it is primarily managed care.

150

Goldberg

Affirms.  Explains that premiums are overall healthcare costs.  Explains other types of out of pocket expenses.

160

Goldberg

Reviews projected chart of average premiums and per capita income in the US.

170

Sen. Morrisette

Clarifies that premiums are related to the economy because health companies invest more money.

180

Goldberg

Explains what health cost driver factors that add to healthcare costs.

188

Sen. Morrisette

Re-clarifies question.  Comments that we are getting out of a recession.

195

Goldberg

Agrees.  Adds that when the economy is good when there is a rise in employer based health insurance, however businesses cannot afford health insurance when the economy’s employment is down.

218

Goldberg

Continues to provide overview of healthcare in Oregon:

·         National Healthcare Spending

·         Chart, “Trends in Personal Healthcare Expenditures Per Capita, Oregon and the US, 1991 to 1998

·         Healthcare Expenditures in Oregon

255

Rick Berkobien

Committee Administrator.  Asks if inequity in Medicare is reflected in a chart in the presentation.

260

Goldberg

Explains how payment rate is set by region and that Oregon’s is lower.  Adds that Oregon has lower expenditures.

285

Goldberg

Continues to provide overview of healthcare in Oregon:

·         Reviews chart, Average Monthly Worker Contribution for Single and Family Premiums, 1988-2003

·         Reviews chart, Average Monthly Total Employee Contribution

·         Reviews chart, Components of Healthcare Spending per Capita, 1998

·         Distribution of Medicaid Expenditures, 2003

360

Goldberg

Continues to provide overview of healthcare in Oregon:

·         Reviews chart, Distribution of OHP Expenditures

370

Chair Monnes Anderson

Asks Goldberg to explain “PMPM” as referred to in the charts.

372

Goldberg

Explains that it stands for Per Member Per Month (PMPM). Elaborates.

390

Berkobien

Asks for trends in percentages of the distribution of the Oregon Health Plan Expenditures.

392

Goldberg

Answers no, but adds that they are currently working on it. Discusses health insurance for asset protection, access to care and risk management.

TAPE 17, A

010

Goldberg

Discusses Oregon insurance status during 2004.

020

Goldberg

Compares Oregon to a national insurance status during 2003.

033

Goldberg

Reviews chart of trends in Oregon’s uninsured rate.

040

Goldberg

Continues to review heathcare in Oregon:

·         Reviews chart, Oregon Insurance Trends among Children, Adults, and Seniors

·         OHP Expansion/Standard Enrollment Trends

·         Consequences of being without health insurance

·         Uninsured Americans statistics

·         Inadequate health insurance

085

Sen. Kruse

Asks question relating to the spend down rate eligibility factor for elderly.

090

Goldberg

Answers that he does not know and offers to return information to committee.  Comments on people filing for bankruptcy due to medical debt.

105

Sen. Kruse

Clarifies that information is clearly from health care and not the system.

110

Goldberg

Notes that bankruptcies effect the community.

120

Goldberg

Discusses underlying issues with healthcare:

·         Cost increase factors

·         Quality of health care

145

Chair Monnes Anderson

Asks witness where he found statistic that one third of healthcare expenditures goes to care that is duplicative.

150

Goldberg

Answers from the Institute of Medicine performed the study.  Elaborates.  Offers to return the report to the committee.

158

Chair Monnes Anderson

Ask if report will show what services are being provided specifically that are duplicative.

159

Goldberg

Answers yes.

160

Sen. Kruse

Asks if self correcting conditions are covered and if it is a part of the duplicative.

165

Goldberg

Answers yes and explains that part of it includes failure to improve patient’s health.  Elaborates.

170

Sen. Morrisette

Comments on television commercials relating to treatments.

172

Goldberg

Comments on how treatments vary from communities.  Notes how outcomes of all the varied treatments are similar.  Comments that electronic recording keeping is needed to prevent information errors.

210

Goldberg

Continues to provide overview of healthcare in Oregon:

·         Quality of healthcare

·         Disparities in healthcare

·         Review chart, aging population and demographic changes in Oregon Legislative Administration

·         Other important information

250

Sen. Morrisette

Refers to chart of aging population. Asks why there is sharp rise in population from 74 to 85 year olds.

255

Goldberg

Answers how it results mostly from the Baby Boomers group.

290

Goldberg

Provides overview of healthcare in implications and prospects:

·         Stakeholder responses to rising healthcare costs

355

Sen. Kruse

Asks Goldberg if he knows anything about federal agencies looking to start block granting.

360

Goldberg

Explains how they are not looking at a block granting spending, but looking at the president’s budget.

370

Sen. Morrisette

Clarifies that federal budget is putting money into the rural health safety net clinics.

377

Goldberg

Affirms.

385

Goldberg

Summarizes and concludes.

388

Sen. Kruse

Comments on block grants and interested in Oregon State Senator Gordon Smith’s decision.

395

Goldberg

Comments on partnership needed.

400

Sen. Kruse

Notes that Sen. Smith did want input from state level.

407

Sen. Morrisette

Comments on flexibility of block granting.

410

Barney Speight

Administrator, Office of Medical Assistance Programs (OMAP).  Submits PowerPoint presentation on Healthcare Costs: Drivers and Responses. (EXHIBIT C).

TAPE 16, B

015

Speight

Discusses healthcare costs: drivers and responses:

·         Cost driver #1, aging population

·         Reviews chart, Relationship between age and annual health costs.

·         Cost driver #2, medical technology

085

Berkobien

Asks if a cost driver includes many places having and using the machinery.

090

Speight

Agrees, but cannot document that.  Explains learning the standards of care and the differences in technology and the uses.

120

Speight

Continues discussing healthcare costs, drivers and responses:

·         Cost driver #3, change in market power

·         Cost driver #4, work force shortages

155

Sen. Morrisette

Asks to comment how to solve the work force plan.

160

Speight

Speculates.  Comments on new form of coordination.

175

Sen. Morrisette

Comments on community colleges nursing programs. Asks to find out how many people are waiting to get into the nursing programs.

180

Speight

States that he will.

190

Chair Monnes Anderson

Comments that there will be a Health Policy meeting on February 25, 2005 about the healthcare workforce.

195

Sen. Morrisette

Expresses need for funding for healthcare programs.

208

Speight

Continues discussing healthcare costs, drivers and responses:

·         Cost driver #5, health insurance

·         Cost driver #6, capital spending

235

Chair Monnes Anderson

Asks Speight if he have percentage for replacement of ageing equipment and facilities.

240

Speight

Answer no.  Adds that there are cycles in capital funding.

255

Chair Monnes Anderson

Comments on OHSU construction asks if their cost was reflected in 2002.

265

Speight

Explains that graph on construction spending is national data.  Comments on high cost of informational technology, but that it is effective.

295

Sen. Kruse

Comments on capital cycles from the 1960’s.  Comments on construction in district.

310

Speight

Continues discussing healthcare costs, drivers and responses:

·         Cost driver #7, government policy

·         Cost driver # 8, primitive systems of care

·         Cost driver #9, medical-legal environment

415

Speight

Continues discussing healthcare costs, drivers and responses:

·         Response #1

·         Response,#2

·         Roles and Responsibilities for controlling future cost

TAPE 17, B

015

Joel Ario

Administrator, Insurance Division, Department of Consumer and Business Services (DCBS).  Submits written testimony (EXHIBIT D).

020

Ario

Discusses overview of public-private health insurance programs.

070

Ario

Discusses regulations of health insurance

075

Chair Monnes Anderson

Asks what is being regulated.

077

Ario

Answers that it is insurance policies and mandate regulations.  Explains the difference in rate regulations.

090

Chair Monnes Anderson

Asks what is available for small group (insurees) market.

095

Ario

Explains how they have to be pooled together and the restrictions.

140

Ario

Continues discussing how small groups are pooled for insurance.

150

Sen. Kruse

Asks who is exempt from form regulation.

151

Ario

Answers that self insured are and elaborates.

155

Sen. Kruse

Asks how to differentiate between health insurance companies.

160

Ario

Explains.

175

Howard “Rocky” King

Administrator, Insurance Pool Governing Board (IPGB), Oregon Medical Insurance Pool (OMIP).  Submits written testimony (EXHIBIT E).  Also submits informational packet on healthcare insurance programs (EXHIBIT F).  Begins discussion on private partnership programs.

220

King

Discusses starting a program to provide health insurance for children only through employer based health programs.

270

King

Discusses new group and individual health insurance programs and provides goals for enrollment.

290

King

Discusses increase number of phone calls regarding the need for health insurance.  Explains agent referral system.

300

King

Discusses independent market and funding.

350

Chair Monnes Anderson

Asks how much OMIP receives.

355

King

Answers 14 to15 million dollars among approximately 180 insurers.

365

Sen. Kruse

Asks if there is reason to the market increase.

375

King

Answers. Explains the resources they have.

410

Chair Monnes Anderson

Notes that meeting will recess until 5:30 p.m. in hearing room 50.  Recesses meeting at 2:55 p.m..

411

Chair Monnes Anderson

Reconvenes meeting in Hearing room 50 at 5:35 p.m.  Comments on testimony regarding healthcare market, insurance, and cost drivers.

TAPE 18, A

015

Patrick Pine

President, ESCO Corp.  Submits and reviews statistical comparisons of illustrations of representative changes in typical employer group plans (EXHIBIT G). 

065

Pine

Continues to review chart that addresses increase in health cost.

110

Pine

Summarizes and concludes.

135

Leslie Frane

Executive Director, Service Employees International Union (SEIU), Local 503.  Submits and presents written testimony concerning rising cost of health care (EXHIBIT H).

200

Frane

Summarizes and concludes.

230

Chair Monnes Anderson

Comments on the 500 series bills introduced.

255

Ellen Pinney

Executive Director, Oregon Health Action Campaign.  Explains the organization and how it supports people paying for premiums.

300

James Richards

Citizen, Falls City, OR.  Submits written testimony on personal experience owing significant amount of health bills (EXHIBIT I).

345

Sen. Morrisette

Clarifies that $42,000 is owed for supplies at Oregon Health and Science University (OHSU).

350

Richards

Affirms.  Continues to discuss experience.

415

Heather Sorensen

Submits and presents written testimony with personal experience owing significant amount to hospitals from fiancé’s car crash (EXHIBIT J).

TAPE 19, A

040

Sorensen

Continues discussing testimony.

065

Linda Ingham

Submits and presents written testimony (EXHIBIT K).

115

Ken Ingham

Concerned about increased cost for son’s healthcare.

125

Sen. Morrisette

Asks if they are receiving help from maker of the enzymes.

130

Linda Ingham

Answers that their insurance covers enzymes.

135

Sen. Morrisette

Clarifies that they are not eligible for the program.

140

Linda Ingham

Affirms.

141

Sen. Morrisette

Comments that if they are ever without insurance to consider contacting the pharmaceutical company for discounts.

145

Ken Ingham

Comments on a program started.  Speaks about increase in medications.

153

Kenny Ingham

Introduces himself.  Answers questions from the Chair.

165

David Bolton

Citizen.  Describes current and past designations.  Comments that they have reviewed the 500 series bills and commends committee.  Believes that work of the union needs to be considered.

190

Bolton

Discusses previous solutions that haven’t been effective and that Oregon needs legislation. 

210

Lupita Letcher

Citizen, Tigard, OR.  Describes center that helps patients with premiums.  Provides background of the Federally Qualified Health Center (FQHC) she works for.

245

Letcher

Reviews demographics of patients in clinic.

270

Letcher

Discusses preventive health care and why this is not happening.

285

Letcher

Provides examples of patients who attend clinic who are not practicing preventative health care.

325

Letcher

Explains what safety net clinics do and what they are experiencing.

345

Letcher

Summarizes and concludes.

355

Sen. Morrisette

Asks if the clinic has problem receiving wrap around payments.

365

Letcher

Answers that it can take up to a year to receive payments.  Adds that it is especially hard when a new clinic is opening.

375

Sen. Morrisette

Asks for break down of providers.

385

Letcher

Explains that there are four providers.

400

Sen. Morrisette

Asks if they provide dental maintenance work.

403

Letcher

Answers no, but adds that the center in Woodburn, OR will soon.

410

Sen. Morrisette

Clarifies that no one is turned away.

411

Letcher

Affirms.

415

Chair Monnes Anderson

Comments on dedication to staff working in a FQHC.

TAPE 18, B

015

Mary Lou Hennrich

Community Health Partnership.  Discusses a friend that was in an auto accident and lost her nursing license and job.  Explains her experiences since then and how it changed her life. 

065

Hennrich

Continues discussing her experience helping her friend.

090

Hennrich

Discusses that her son was diagnosed at 20 with bi-polar disorder.  Explains that he will no longer have insurance in one month.  Explains further issues to find new insurance for son.

130

Hennrich

Summarizes and concludes.

140

Sen. Morrisette

Asks what the prognosis is for her son for stabilization.

142

Hennrich

Comments on discussion with psychologist and goals set with him.

155

Sen. Morrisette

Asks if mental health parity would help.

160

Hennrich

Answers what Kaiser Permanente covers. Adds that mental health parity would be helpful to be covered other than medication management.

195

Rosalie Pedroza

Citizen, Turner, OR.  Testifies about her experience after having an accident.  Notes that she does have insurance, but still struggles to pay bills. Mentions that she took a 2 year pay freeze for health care.

240

George Stein

Citizen, Albany, OR. Describes his wife experience with cancer and her current diagnose of Alzheimer’s.  Describes cost related expenses.  Explains how he lost his house and now lives in a motor home.

300

Stein

Comments that he went back to work at the Albany General Hospital with benefits, but cannot work full time.  Continues to explain his medical issues. Speculates on his expenses that he will accrue with future surgeries. Explains that bills will be sent to collections.

355

Stein

Encourages committee to address increased healthcare costs.

372

Carlie Jackson

Oregon Health Plan.  Explains medical problems with herself her daughter.

415

Jackson

Explains that she had breast cancer and describes the incurred medical costs.

TAPE 19, B

020

Jackson

Continues to describe the consistent healthcare costs. Expresses concern to control medical cost. Describes importance of prevention.

045

Marie Arthur

Citizen, Salem, OR. Addresses concern for increase in premiums and health care costs. 

065

Chair Monnes Anderson

Comments on seniors and increase in premiums.

070

Arthur

Comment on Medicare setting premiums.

075

Chair Monnes Anderson

Mentions transparency bill introduced.

The following was submitted without public testimony:

 

Steve Dixon

Submits written testimony (EXHIBIT L).

080

Chair Monnes Anderson

Expresses impact of testimonies heard. Adjourns meeting at 7:02 p.m.

 

EXHIBIT SUMMARY

 

A.     The Healthcare Market Place, schedule, staff, 2 pp

B.     The Healthcare Market Place, PowerPoint presentation, Bruce Goldberg, 44 pp

C.     The Healthcare Market Place, PowerPoint presentation, Barney Speight, 15 pp

D.    The Healthcare Market Place, written testimony, Joel Ario, 7 pp

E.     The Healthcare Market Place, written testimony, Howard King, 16 pp

F.      The Healthcare Market Place, informational packet, Howard King, 22 pp

G.    The Healthcare Market Place, statistical comparisons, Patrick Pine, 1 p

H.    The Healthcare Market Place, written testimony, Leslie Frane, 4 pp

I.       The Healthcare Market Place, written testimony, James Richards, 2 pp

J.      The Healthcare Market Place, written testimony, Heather Sorensen, 4 pp

K.    The Healthcare Market Place, written testimony, Linda Ingham, 1 p

L.     The Healthcare Market Place, written testimony, Steve Dixon, 2 pp