5 Things Oregon: Q&A w/Lori Coyner, Hospital finances, Health disparities

This may be the calm before the storm.

Thursday is the last published day on the US Supreme Court calendar to release opinions from its current term (though they have a few more weeks for orders). It’s a term that saw a meaningful challenge to the ACA last November. It was a case many in the media thought could not be overturned, based on the line of questioning from the justices. But for that to happen, Justices Roberts and Kavanaugh both will need to break from the 6-3 conservative majority to craft a majority opinion with the three more liberal justices. That seems a tough reach.

Anyone who tells you they know what’s coming should probably not be listened to, including me. But, for what it’s worth, I’d offer this is not a binary moment. The range of options which I think may be on the table for the justices to land a majority with is wide. Like the first NFIB case, expect the unexpected. You can read my break down of the Texas case from 2019 here, or my incorrect prediction of the 2012 NFIB case (and subsequent explanation of Roberts’ creative opinion here).





With help from Emily Boerger

1. Q&A with Medicaid Director Lori Coyner

State Medicaid Director Lori Coyner oversees Oregon’s Medicaid program which now covers over 1.3 million enrollees – an over 20% increase since the beginning of the pandemic. In this Q&A with State of Reform Reporter Patrick Jones, Coyner offers insights into changes to the Oregon Health Plan during the pandemic, OHA’s discussions around health equity, and the issues she is spending her mental energy on.

Looking toward the future behavioral needs of Oregonians, Coyner says OHA is continuing to collaborate with a broad range of community partners and stakeholders to identify ways to overcome barriers to receiving services. Coyner says the agency is also engaged in preparation for the 988 crisis line and is researching modalities to improve the way services are offered to individuals.

2. Hospital finances still precarious

After operating margins plunged in the second quarter of 2020, a new report finds Oregon acute care hospitals ended 2020 with a 3.3% statewide operating margin. In response, OAHHS President and CEO Becky Hultberg, warned that improvements in hospital finances are heavily reliant on CARES Act funds. “Without that infusion, the median operating margin in 2020 was -2.1 percent. One in three hospitals in Oregon lost money in 2020.”

Dr. Jeff Absalon, Executive Vice President at St. Charles Health System in Central Oregon, says it’s important to note that recovery is also not uniform across the state. Central Oregon represents 5.9% of the state population but accounted for 13.6% of the state’s occupied COVID beds at the end of May. Absalon says their hospitals are still struggling with capacity challenges and continue to have to limit elective surgeries due to workforce shortages.


3. New studies on health disparities

An OHSU study published last week found people of color are twice as likely to die after a traumatic brain injury than white people. This was the first study to review racial and ethnic disparities in neurosurgical trauma, according to OHSU, and it is one of several recent publications that point to the varied and persistent ways health disparities show up in health data.

Another study, found that over 40% of white neighborhoods in Portland are considered pharmacy deserts. In diverse neighborhoods, over 95% are considered pharmacy deserts. This represents the highest percent of pharmacy deserts found in any of the 30 most populous cities evaluated in the report.


4. Strengthening the BH system

According to a Kaiser Family Foundation report, 32.4% of adults in Oregon report symptoms of anxiety or depressive disorder. As part of Mental Health Awareness month, we recently hosted a “5 Slides We’re Discussing” conversation on strengthening Oregon’s behavioral health system. The panelists, which included Dr. Mike Franz of PacificSource, Maree Wacker of De Paul Treatment Centers, and Dr. Paul Giger of Providence Health Plan, discussed telehealth’s effectiveness and efforts to keep patients away from emergency rooms.

Behavioral health bills are also on the move in Salem. HB 2469, which requires state medical assistance programs to provide mental health wellness appointments, was recently signed by Gov. Brown. Other bills – like SB 563 and HB 3139 – aim to reduce youth suicide in the state.

5. Major health reforms absent in Biden’s budget

President Biden’s first budget submission is surprising in what it omits, says State of Reform Columnist Jim Capretta. Several of the high-profile health proposals from the 2020 campaign – like the public option and Medicare eligibility at age 60 – are mentioned in the budget’s text, but are not tied to specific funding proposals or plans in the budget.

“Perhaps the most glaring omission in the budget,” says Capretta, “is the absence of any proposals to change what Medicare pays hospitals, physicians, and other medical service providers.” Without this, he says Congress will find it difficult to advance cuts as potential offsets for legislation that adds spending elsewhere. Capretta reasons that the lack of detail in the budget for major health policy changes are a signal that Biden has “made the political calculation that it is not possible to get most of them enacted in this Congress.”