Universal health care, Medicaid gap on the agenda at Health Care Town Hall

December 12, 2018

Oregon should take incremental steps toward universal health care and a single-payer insurance system, State Rep. Andrea Salinas said Monday night at a Health Care Town Hall, hosted in partnership with Multnomah County Commissioner Sharon Meieran.

Valdez Bravo, Vice President of Healthcare for All Oregon, speaks up at town hall on universal access

“Single payer is the right thing to do,” Salinas said to residents gathered in the auditorium at Markham Elementary School in Southwest Portland. Among those who attended were representatives from the Oregon Medical Association, Oregon Physicians for National Healthcare, Project Access Now, the National Alliance on Mental Illness and Health Care for All Oregon.

Salinas, a Democrat from Lake Oswego, sits on the Oregon House’s Universal Access to Health Care Work Group, which released the “Report on Barriers and Incremental Steps to Universal Access” this week. The report is  the culmination of a year’s work by representatives from the healthcare industry, advocacy groups and government agencies.

Meieran and the County Board of Commissioners have championed the concept of universal health care, calling on the Governor and the Legislature to “continue working to develop a comprehensive, equitable, and high-quality system of health care that is accessible to all.”

Monday’s meeting provided an overview of the County’s healthcare system and the statewide initiatives that support it. It included an update on changes to Oregon’s Coordinated Care Organizations and gaps in Medicaid funding.

As Oregon’s economy has stabilized, the federal matching rate for Medicaid has decreased. At the same time, one-time-only funding has dried up. The state expects to be $950 million short next year in its budget for Medicaid, which covers more than 1 million Oregonians. To help bridge that gap, Salinas said, the Legislature is considering options that  include increasing a tax assessment on hospitals and raising tobacco tax rates.

Tobacco-related illness accounts for 9 percent of all Medicaid expenditures, and it’s the leading cause of preventable death in Oregon. Increasing the tax would bring Oregon’s rate in line with rates in California and Washington (Oregon places a $1.33 tax on a pack of cigarettes, compared to nearly $3 in Washington and California).

“Talking about revenue, a tobacco tax makes sense,” said David B. Still, a member of Healthcare for All Oregon. “But I haven’t seen a wine and beer tax hike since the 70s. There’s so much damage by that industry and they’re not held accountable.” (taxes on spirits are second highest in the nation).

Rep. Andrea Salinas sits on a House committee seeking to edge Oregon closer to universal healthcare.

“If you’re going to pass a sin tax, why just one sin?” chimed in resident John Murphy.

Salinas said she wouldn’t be surprised to see new legislation proposing to tax alcohol. “It’s past due,” she said.

Salinas said Oregon is also negotiating its contracts with Coordinated Care Organizations, seeking to incentivize the integration of social determinants of health and increase access to behavioral health services.

“While Oregon’s CCO system has been touted as a model, there’s still a lot of work to be done,” she said. “The Oregon Health Authority will require some changes. It will look at improving access to behavioral healthcare. That’s at the top of the list.”

Meieran spearheaded a sweeping examination of Multnomah County’s mental health services, and its place in a larger $333 million healthcare system that serves 70,000 patients a year through its primary care clinics alone. She said access to timely mental health services is hindered in part by an imbalance of reimbursement rates between primary care providers and mental health and substance abuse providers.

“People doing the hardest work are paid the least and have the poorest benefits,” Meieran said. “That’s hard when you need continuity of care, which results in the best outcomes for our patients.”

The resulting report led to recommendations, which Meieran plans to review with the help of an implementation team.

Cee Carver, a program director with the Mental Health & Addiction Association of Oregon asked Meieran if she plans on including people with lived experience in that group.

“Absolutely there will be a person with lived experience,” Meieran said.