5 Things Oregon: Budget proposal, Biden era health policy, Vaccine science

This is indeed a “dark winter,” as was predicted. But, I’m hopeful that we are perhaps at our nadir. We are 11 days away from the days getting longer. We are four days away from the likely first vaccines to distributed in the US. And, of course we are zero days away from the magic of Christmastime, Hanukah and the winter holidays.

It’s easy to get down. It’s hard to stay upbeat. It takes intention. It takes discipline. And, an optimism that can sometimes seem unfounded.

Do hard things.

Merry Christmas and Happy Holidays to you and your family! May they be warm, wonderful, and bright!





With help from Emily Boerger

1. Gov. Brown’s budget proposal

Gov. Brown released her 2021-23 budget proposal last week, calling for “strong cost controls” in Oregon’s health care system while also placing an emphasis on supporting behavioral health services and health equity. Of the $25.6 billion general fund spending included in the proposal, $7.7 billion (30%) is slated for human services agencies – representing a 16.3% increase compared to the 2019-21 budget approved by the legislature.

Notable health investments include: $10 million to create a pilot program to expand coverage for undocumented and uninsured Oregonians, $27.7 million in incentives to diversify Oregon’s medical and behavioral health workforces, and $30 million to modernize the state’s public health system. Proposed cost controls include reduced hospital reimbursement rates, reduced inflation built into CCO rates from 3.4% to 2.9%, and elimination of the Graduate Medical Education Program.

2. OHA details provider and payer finances

OHA recently released an analysis of COVID’s financial impact on hospitals, CCOs, providers, and commercial insurers during the first 6 months of 2020.  After a steep decline in utilization during spring, and a corresponding decrease in revenue, the latest data indicates finances have rebounded, thanks in part to aid from the federal government.

Overall, the report states that hospitals received 38% less revenue and 75% fewer outpatient surgery visits in April 2020 compared to December 2019. “By June 2020, both hospital revenues and operating margins climbed back up to normal levels, due mostly to the federal CARES Act, which infused an estimated $436 million into Oregon’s hospitals,” reads the report. “The median hospital’s operating margin fell to -2.5% in in January-March 2020, but then rebounded to +2.4% in April-June 2020.”


3. Appreciate this week for what it is

We are on the cusp of a tremendous leap forward in vaccine science, which is something that our gratification-now culture doesn’t fully appreciate. It took 5 days from sequencing the virus genome to the vaccine design. Just 5 days! Today, initial emergency use authorization is expected for Pfizer’s vaccine. First vaccinations are expected across the country next week.

It took four years for the mumps vaccine to be developed, which was previously the fastest development of a vaccine ever. This moment is equivalent to landing on the moon for vaccine science. But with no images, no historic quote upon landing, and no visionary call from a martyred president (Kennedy), it’s not a moment likely to be fully appreciated or seared into our collective memory.

But, in the perhaps unpolished word choice of President-Elect Joe Biden, upon the passage of the ACA in 2010, this is a big deal.


4. Hospitalizations continue to surge

Even with a vaccine around the corner, it’s important to not forget about the situation we are in now. As of Tuesday, there are 553 COVID-positive patients in Oregon hospitals – the previous bump in hospitalizations, which occurred over the summer, peaked at 168. On Tuesday, the state broke a record with 36 recorded deaths.

With these numbers in mind, hospitals have started making staffing adjustments and postponing non-urgent surgeries to free up space. Providence and Legacy Health have brought in temporary morgues “to prepare for an expected increase in deaths and related delays in pick-ups from funeral homes and mortuaries that are also busy right now.”

5. A view from inside the beltway

With a new administration and a closely divided Congress, DC-based State of Reform columnist Jim Capretta reasons it will be difficult to pass controversial measures on a partisan basis. In his latest column for State of Reform, Capretta outlines what the current political landscape might mean for health care policy in the Biden era.

He says drug pricing and surprise billing may be areas for bipartisan progress, but he doesn’t expect to see legislation lowering Medicare’s age of eligibility to 60, despite what was outlined in the Biden-Sanders unity agenda. Capretta also anticipates Biden will make a push for a public option starting in January, but that he may need to rely on state initiated plans, like Washington’s, to develop a “quasi-public option” that would have a better chance of surviving political scrutiny.