Oregon’s sweeping changes to Medicaid don’t stand a chance of succeeding if the Legislature doesn’t stop bad bills such as House Bill 3309. Poison pill politics and health care reform do not mix.
Gov. John Kitzhaber’s Medicaid overhaul was designed to improve health and help hold down costs of Medicaid. It has hospitals, doctor groups and other providers working together to find solutions by forming what are called “coordinated care organizations,” or CCOs.
The state gives a CCO a fixed amount of money to provide Medicaid care for a region of the state. CCOs figure out how to make it work to meet targets.
When setting up a new system, there are going to be problems nobody expected. There was a process to settle disputes when a needed regional provider didn’t want to participate in a CCO. But there’s been a dispute in Salem that has highlighted that there may not be a good enough system in place to resolve disputes once a CCO is formed.
Salem Health, the parent company of the Salem Hospital, is a participant in the CCO that operates in Marion and Polk counties. Salem Health sued over reimbursement rates. It has also been unhappy about the balance of power on the board of the CCO.
We don’t know who is right or wrong in the dispute, but it could undermine the ability of the CCO to operate and provide care.
Rep. Brian Clem, D-Salem, proposed House Bill 3309. It would enable CCOs in Marion and Polk counties to petition the state to throw a member of a CCO out after a two-thirds vote of the CCO board. A removed provider would be forbidden from joining any CCO for five years and would only be able to receive severely lowered reimbursements — 58 percent of the Medicare reimbursement rate.
That would be bad for the provider and could be very bad for patients, too. The bill also contains language suggesting this same method of resolving disputes should be considered for statewide expansion.
It’s poison pill politics — similar to the sequester on the federal level. We all know how well that worked.
There’s a hearing for the bill on Monday. In its current form, it doesn’t deserve to get out of committee.
You may want to read the related opinion piece below.