Hospital Tax | Gov. Kitzhaber | Medicaid Waiver

The cutoff for policy bills in the legislature is next week.  If a bill hasn’t moved out of a committee by then, it’s likely dead for the session.  That makes this a bit of an anxious time for stakeholders as they anxiously track where their legislation may be headed.  Which bills are moving and which aren’t – it’s part of what we’re watching this month.

DJ 5 Things Signature

1. Hospital tax to fund public health

HB 1946 “obligates” Washington State hospitals to pay 6% of their revenue, less charitable care, into a something called the “Washington Wellness Trust.”  The trust would fund public health and county-based behavioral health services.

At a hearing on the bill yesterday, Rep. Jinkins, the bill’s prime sponsor, argued that the reduction in hospital charity care resulting from the ACA allows improved hospital revenue to fund health care outside of a hospital’s four walls.  WSHA has said “hospitals cannot be the funding source for public health activities or mental health services” though responded under questioning that hospital net revenues were up under the ACA.  The bill is scheduled to move out of the House Health Care and Wellness committee next week.

2. Video: “What They’re Watching”: Susan Johnson

Our latest in the series “What They’re Watching” features Susan Johnson, Regional Director of HHS Region X.  With so much anxiety in healthcare these days, her message is a positive one that’s good for our industry to be reminded of sometimes.

“Healthcare is one thing that can enhance lives, save lives, so let’s not backtrack on that.  Let’s keep going ahead…  Keep going forward.”


3. Gov. Kitzhaber to resign? Yes. Then, no.

We’ve been glued to the unfolding drama related to Gov. Kitzhaber.  It turns out his fiancee was being paid by stakeholders to be an advocate on issues she was also tasked to lead in her capacity as First Lady. This has led to an Ethics Commission review, an investigation by the Attorney General (with this interesting correspondence) and a call from The Oregonian for Gov. Kitzhaber to resign.

Yesterday, word got out that the Governor had decided Tuesday to resign and had called Oregon’s Secretary of State back early from a conference in Washington DC.  Apparently, Gov. Kitzhaber then changed his mind in what is today front page news in Portland.  It is a stunning set of news stories eroding the legacy of one of the most impactful health policy leaders of the modern era.

4. Medicaid waiver for new provider payments

The HCA has been thinking through what new payment methodologies in Medicaid might look like moving forward.  Now, HB 1967 would codify that effort, directing the state to have a waiver application in by the end of 2015.  Specifically, the bill directs the waiver to “authorize alternative structures for enrollee eligibility, provider payment, and plan design” in Medicaid.  The bill is set to move out of the House Health Care and Wellness Committee next week.

In a hearing this week, Rep. Cody called the effort to determine the scope of a waiver “a work in progress” with the committee leaders from both parties and both chambers engaged in what a wavier should accomplish.


5. Low exchange enrollment will likely hit consumers

At a Tuesday Policy Committee, the Exchange said they had enrolled 139,000 individuals in QHPs on their platform.  That’s up from 120,000 last year but below expectations for 2015. The Exchange was initially planning on over 300,000 members enrolled for FY 2015, though that number was recently dropped to 213,000.

The pinch will come in the budget, already projected at a $12m shortfall (down from $20m by cutting premium aggregation).  Without adequate enrollment, projected premium tax collections will fall.  Assessments on the plans will likely rise to sustain the Exchange infrastructure, which will increase the per product price paid by consumers.  Without adequate enrollment, a central value proposition of the Exchange – lower costs for consumers – will be threatened.