by Sen. Jeff Kruse (R-Roseburg)
The legislative Assembly should not be so easily turning over our Constitutional responsibilities to the Governor. And yet in both health care and education that is exactly what we are doing.
SENATE BILL 1580
On February 14, 2012 (Oregon’s birthday) The Senate passed the next version of “health care reform”. I put that in quotes because I am not sure we are getting what is advertised. I tend to get wrapped up in the details of whatever proposal we are dealing with but I thought maybe it is time to step back and talk about some of the basics. Specifically, what is Medicaid?
In the simplest of terms Medicaid is government sponsored and tax payer funded health care for low income people, but our understanding needs to go deeper. Medicaid is a health care rationing system in which the government makes the decisions. Even federal budgets are finite, which means we can’t do all things for all people. The government has three ways to control costs; the number of people covered, the services they get, and the amount providers are paid for those services. But it goes deeper yet.
The services covered are determined at the federal level and for a state to make any adjustment is called a waiver process that is very complicated and can take a great deal of time. The population covered is based on the poverty rate and the state does have some discretion at least until 2014 when the federal mandate will close to double Oregon’s Medicaid population without any state option. The provider reimbursement rate is the most volatile and the one of most concern.
Medicaid funding happens in a number of distinct and separate funding streams, which indeed makes it hard for any sort of coordination of care. When you add to this the fact providers are reimbursed at a level far below actual costs it makes any effort at coordination even more difficult. You will be told this transformation effort will lead to a locally driven coordination model, and if that is true it would be a good thing. But we need to go one step deeper.
We should start with the understanding there are those at both the federal and state level, including our Governor, who would like the complete government takeover of the health care system. (The Governor did say last summer his only regret in the 2011 Legislative Session was he wasn’t able to unionize, or make public employees of health care workers). We also need to understand this would have to happen in phases. I would submit we are well on our way, and it is being driven by provider rates.
In 2011 we “balanced” the budget on 235 million dollars in projected savings from health care transformation. We knew at the time this number was fictitious and was being used to drive an agenda. Now we are being told if we meet some undetermined federal criteria we will get an additional 500 million federal dollars into our Medicaid system. Local communities are scrambling to try and meet these criteria, and I can’t blame them. Providers have been told they will either meet whatever these new requirements are or face a 30% reduction in their rates. This was set up last year to drive the system to a predetermined outcome.
President Obama has been looking for a state to be the first to fully implement his health care plan, and I think he has chosen Oregon and our Governor is a willing participant. You will continue to hear how this is not “Obama Care”, but I am not sure how anyone can say that based on the fact we don’t know what the new federal requirements are. I would also submit there are those in the administration who do know, but are choosing not to tell us.
Simply put, there are still too many unanswered questions about the direction and structure of the system envisioned in this for us to be passing it. The information we did get we received at the 11th hour and was dramatically incomplete. It reminds me of Nancy Pelosi’s statement relative to the federal act when she said they needed to pass it before they read it. The legislative Assembly should not be so easily turning over our Constitutional responsibilities to the Governor. And yet in both health care and education that is exactly what we are doing.
The people deserve better.