Greg Walden | AHCA | Kate Othus

This is a big week in American health care with the vote on the AHCA tomorrow night. The consequences will be far reaching, including the possible collapse of the individual market in at least one state (Alaska). Oregon will likely fare better than the 49th State up north, but how much?  Ask Greg Walden.

Those and other things are on our radar screen for Oregon health care in March, 2017.

1.  Greg Walden and ballot consequences

Greg Walden has been a driving force of the American Health Care Act, moving the bill through the Energy and Commerce Committee he chairs. That has earned him favor with House leadership. However, Walden also has 129,200 Medicaid expansion beneficiaries in his district, more than any other Republican member of Congress. Medicaid is a central target of his bill, of course.

Walden’s total 2016 vote count of 267,000 suggests he was more popular than Trump on election day, who garnered about 200,000 votes or 56% in Walden’s district. Walden won a number of independents, since there were 189,000 Republicans registered for the general election. Many of those independents didn’t vote for Trump, and many more likely more unhappy with the President now.

It would be extremely unlikely for Greg Walden to lose his seat in a normal election year.  But, 2018 may be far from a normal election cycle.

2.  Video:  Kate Othus, Aldrich Advisors

Kate Othus knows the demands of clinical administration as well as anyone. She’s built clinics, managed providers, and run operations. Kate and her team at Aldrich Advisors are also some of the smartest consultants in Oregon on the topic of MACRA, reimbursement, and plan-provider contracting.

In this issue of “What They’re Watching,” Kate talks through the cultural challenges facing providers as they have to learn to grapple with changing demands to support payment. “Only 20% of physicians even know what MACRA is. So, from a baseline perspective, they don’t know what they don’t know…  There is a lot of data out there that will be used against them (docs) if they don’t prepare their own data.”

3.  CCO contingency planning ahead of 2018

There is an increasing amount of dialog starting among CCO stakeholders outside of Portland about what the 2018 procurement might look like. It’s too early to think about that, according to the OHA, but some executives think it’s possible the OHA may want fewer CCOs in the next round of procurement than the current 16 contracted entities. Legislators have already started the conversation.

For some organizations, this is an existential threat. For all CCOs, it’s a delicate conversation. Yet, some are exploring how an integrated administration would work, how to pool reserves, and what governance might look like with a different model than exists now for rural Oregon. Some think it might be a “HealthShare” model, or informed by it. Others think it might be an entirely new organization.

4. Republican bill up for vote Thursday

Thursday is the 7th anniversary of the signing of the ACA. It’s also the day the US House is set to vote on their reform bill, the American Health Care Act. The bill is set to be amended in the Rules Committee on Wednesday.  You can read the Congressional Budget Office memo here.  It’s perhaps the most important read you’ll find for an objective analysis of the bill.

Ironically, a million more people may become uninsured under the AHCA than if Republicans simply repealed Obamacare, according to the CBO. It’s a bill that even Trump began to pan a bit in his Monday night rally in Kentucky where he asked “Hey Mitch, are we going to be ok?”

McConnell said Tuesday he wants a vote on the bill next week.

5. Launching the State of Reform podcast

State of Reform tries to bridge the gap between the world of health care and that of health policy. We do this in part by providing a platform for the voices of senior executives and health policy leaders. The content generated by them is then shared across multiple discreet information channels, providing insights wherever consumers access their information most easily: web, email, social, video, small-run book publishing, and conferences.

Today, we add a podcast to that list of channels where you can learn directly from senior members of the health care and health policy world. This is content in their voice, reflective of their thinking. Expect to hear stories ranging from Honolulu to Baton Rouge – and of course Oregon.

In our first podcast episode, we go to Texas, perhaps the staunchest state-opponent to the Affordable Care Act. We wondered: Is a Trump presidency good news for Texas health care?  What we heard was a range of answers – but some acute anxiety.