Kitzhaber’s healthcare bill grows government and public employee unions

by Sen. Jeff Kruse (R-Roseburg)

As HB 3650 is currently written the biggest things it does is grow government authority and expand public employee unions.

It is time to get back to the discussion of health care reform.  As of this date only one of the significant bills in this area has had any real movement, and that is Senate Bill 99 which is the bill for the insurance exchange.  Senate Bill 99 has passed in the Senate and is now in aHouse Committee.  Due to provisions in the Federal Health Care Act we had one of two choices; we could either create an exchange or the federal government would do it.  We chose the first option.  We also put some tight sideboards around how development would happen moving forward, including Legislative approval for phase two next February.  A point to remember in this is the fact it is my intention to try and keep as much of the health care system in the private sector as possible as we try to comply with the federal mandates, which at this time seem unavoidable.

An interesting dynamic has developed in the discussion around the exchange bill.  It has been criticized from the left as not going far enough and from the right as going too far.  As one of the main writers of the bill I will stand accountable for what we have created.  I think it is a good first step.  Meanwhile, on the national level, AFP and other groups have come out in support of Congressman Paul Ryan’s version of the exchange.  What needs to be noted is Congressman Ryan’s version pretty much mirrors the provisions found in our bill.

The next big issue is health care “transformation”, which will be House Bill 3650. This has been a very interesting process, so let me walk you through it.  This really started two years ago with the passage of HB 2009, which created an entirely new state agency, The Oregon Health Authority (OHA).  The bill gave the director of the new agency the authority to do virtually anything he wanted as far as structure and direction.  I voted against the bill as I thought it was over reaching and was ceding too much power to the executive branch.  Many who voted for the bill now agree with my position and, if the bill was before us this Session I don’t think it would pass.  Unfortunately it is our reality.

At the beginning of this Session the Governor and OHA convened a “workgroup” of 48 people to “develop” a framework for health care transformation.  This group met for three hours once a week over an eight week period.  I was a member of this group.  Those who understand process would readily admit there is no way a group of this size, in this time frame, could come up with anything definitive.  To further prejudice the outcome all of the recorders assigned to the groups were employees of OHA.  At the end we were presented with a legislative concept, which I believe was pretty much written before we began.

The next step was taken by the Governor who convened a group of six, along with OHA, to further define the concept.  Next was the creation of a Joint Committee on Health Care Transformation, of which I am a member.  This committee meets once a week and we were given six weeks to come up with a finished product.  This would be a daunting task under the best of conditions, but in this case we did not even have an actual bill to work on for the first two weeks.  This committee meets on Wednesday nights and we had our first look at the actual bill Tuesday of week three.  This started out as a 71 page bill, so our ability to understand everything in it before our third meeting was limited.  At this point it is safe to say this process has been driven more by the executive branch than it has been by the legislators. This is a flawed process being driven to a predetermined outcome.

In the exchange bill we were trying to meet an actual timeline in the federal act.  The transformation bill is not being driven by any federal timeline.  Rather it is being driven by assumptions in the Governor’s budget. The Governor assumed $320 million in savings in transformation and much of those assumed savings are in our Co-Chairs Budget.  For the most part those savings are fictitious at best.  I think most will acknowledge this fact, but they are still in the calculations.  In my mind this is as bad as building a budget based on revenue you don’t have.  The end result will be the same; a hole in the budget.

Keeping in mind last Session we grew The Department of Human Services (DHS) by 30% and then divided it into two agencies, it is reasonable to assume we could fill the budget hole by going back to the 2007 budget. Unfortunately, once government has something, they don’t want to let it go.  Transformation is supposed to help avert a crisis, but could easily end up making it worse.  As HB 3650 is currently written the biggest things it does is grow government authority and expand public employee unions.

At the very beginning of this process many of us stated very clearly any transformation without medical liability reform was unacceptable.  We have made the point every Wednesday night for over three months and at every other opportunity.  When HB 3650 was introduced we tried to put tort reform into the bill and were told we couldn’t; although provisions for collective bargaining were already in the bill.  We tried to get a separate bill introduced into the joint committee and were stopped by the Senate President, who decides which bills are assigned to which committees.   To create more risk for medical providers without addressing their liability issues is just wrong.    For the Democratic Party to continue to do the bidding of the trial lawyers at the expense of the medical community is also wrong. Yet this is the position we find ourselves in.

I will continue over the next couple of weeks to try and find some reasonable accommodations to hopefully create a bill I can support, but at this time it is not looking good.  The Legislature is not here to do the bidding of the Governor, yet that is what some are more than willing to do.  When the issue comes down to what is good for government vs. what is good for the people I will always side with the people.  I truly believe that, in most cases, government doesn’t know best.