HB 4008: Study the Mental Healthcare Shortage

This legislative session seems to have more than the normal collection of “study” bills, laws that will mandate some taskforce or commission study a policy issue. Last week, I wrote about SB 1503, a proposed task force on suicide and gun violence. It was highly specific.

In contrast to SB 1503, HB 4008 is very open-ended. The entire bill reads:

Be It Enacted by the People of the State of Oregon:

SECTION 1. The Oregon Health Authority shall study access to behavioral health treatment in this state. The authority shall submit a report in the manner provided by ORS 192.245, and may include recommendations for legislation, to the interim committees of the Legislative Assembly related to health no later than September 15, 2025.

SECTION 2. Section 1 of this 2024 Act is repealed on January 2, 2026.

While Section 2 is obviously redundant, the whole bill might be too. State agencies study issues that are in their lanes of jurisdiction all the time. Do we need to pass bills telling agencies to do their job? If the answer is yes, then I suspect there are two reasons why. 1) The Oregon Health Authority is unreasonably uncurious about barriers to mental healthcare access. 2) The sponsors of this bill seek to signal their concern about a lack of access.

I see no evidence for the former reason. The latter, however, is baked into the incentives of the legislative process.

Let me offer one hypothesis for this study to test: mandates for mental healthcare access from the Affordable Care Act and their associated price caps are a driving cause of this problem. Obamacare required mental health coverage and fixed the cost share of patients to a $5 copay. Mandating such coverage while preventing the economization of scheduling essentially guarantees long waiting times.

For example, everyone who wants a marriage counselor right now is essentially guaranteed access to one for only five bucks per session. Good luck getting an appointment with a marriage counselor using insurance. You are most likely to be placed on an endless waiting list. If you want to get moved to the head of the line, however, you merely need to seek an appointment on a cash-per-session basis without using your insurance. The amount of cash will be significantly higher than both the price-capped copay and also higher than the going insurance reimbursement rate for mental health services.

You cannot quite mandate actual access. You can pass mandates of coverage into law, but that is not the same thing as access. If this study bill passes, hopefully, the final report can explore the reality of healthcare economics.

Eric Shierman lives in Salem and is the author of We were winning when I was there.