5 Things Oregon: Proposed insurance rates, big movement from Medicare, health care’s social contract

Good afternoon. Lots of news for you in this issue, including some breaking news about 2019 proposed insurance rates released this afternoon.  Thanks as always for reading our stuff.

By the way, our 2018 Oregon State of Reform Health Policy Conference is stated for October 16th.  Thanks to some of our early sponsors this year:  Beacon Health Options, Physicians Insurance, and PhRMA.  More on that event soon.


1.  Commercial rates out; PacificSource now lowest cost plan in individual market

This afternoon, the Oregon Division of Financial Regulation released the proposed rates for the 2019 individual and small group market.  PacificSource proposed a 9.6% decrease in rates which will make it the lowest cost plan on the individual market.  Each of Oregon’s 36 counties will have an individual plan on the exchange, though two counties – Lincoln and Douglas – will only have one plan.

On average, proposed rates among the seven plans seeking to sell individual market coverage is 7.9%. PacificSource’s decrease is definitely an outlier. The average of the other six plans, excluding PacificSource, is 10.8%. In the small group market, the average proposed increase among the nine plans is 2.5%. Starting on May 23rd, public comments can be submitted via oregonhealthrates.org.


2.  The four elements of health care’s social contract

I believe you can view our politics and our policy discussions through the lens of our social contract we have with one another, and the social capital we have built together to support it. I’ve talked a bit about social capital before.  One of the country’s first efforts to measure social capital was just released in late April. Oregon was 13th on the social capital index of states.

Our social contract is the set of responsibilities we owe to one another as Americans. I would argue many, and perhaps most challenges we face in health care today result from a perceived violation of our social contract by one group or another.

I outline the idea of this social contract in a two part series:  connecting the decline of public opinion of health care to our social contract, and the four tenets that make up the contract and which have broad acceptance by a majority of Americans.


3.  Two big moves in Medicare

The Bi-Partisan Budget Act passed by Congress allows for the inclusion of non-health care services to be covered supplemental benefits for MA plans starting in 2020.  I detail some of the background on this here.  This means that strategies related to the social determinants, for example, can be funded in Medicare, if a plan chooses to cover them – and has a provider partner willing to do the work.

CMS also proposed several updates to Medicare payment policies and rates. Among them is a requirement to have hospitals publish a list of “their standard charges” online in an effort to “empower consumers.” This is an incremental step, but a good one and one we’re likely to get more of from Seema Verma’s shop.


4.  Video: Dr. Lynnea Lindsey, Legacy Health

Lynnea Lindsey, PhD, is the Director of Behavioral Health Services at Legacy Health. Legacy was one of the four health systems that worked to establish the Unity Center for Behavioral Heath. Now that Unity is up and running, Lynnea joins us in this episode of “What They’re Watching” to discuss how Legacy continues to address behavioral health.

“And now that Unity is up and running, I have now come to the system and we’re looking at behavioral health not only in the specialty space, but also how behavioral health and health behavior permeate all of health care. And making sure that we honor and support multidisciplinary teams that include physical health and behavioral health clinicians.”


5.  Novartis, Michael Cohen, and Senate probe

In case you missed it, last week Novartis announced it had paid Michael Cohen $100,000 per month for twelve months. It only took one meeting with him before the company realized Cohen, President Trump’s adviser, had no depth of knowledge in health policy (something usually confirmed before contracts are signed).  That amount is high, even by DC standards, and is apparently more than Novartis pays its lobbyists already on contract.

When Novartis considered terminating the contract, it chose not to saying it didn’t want to “anger” Cohen.

This follows Novartis’s payment of hundreds of millions in fines for bribery of public officials and “kickbacks” in foreign countries. US. Sen. Ron Wyden (D-OR) and Sen. Patty Murray (D-WA) have started a probe into the contract, with Wyden saying it “raises the specter of corruption.”