Q&A: Rachel Prusak wraps up the legislative session
Rep. Rachel Prusak is the chair of the House Health Care Committee in the 2021 General Session. First elected to the Oregon House in 2018, Prusak is also a nurse practitioner and clinician.
In this Q&A, Prusak discusses the passage of Cover All People, telehealth access and other health care legislation from this session. She also discusses some of her bills that did not make it through and her interim plans.
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Patrick Jones: How do you think the session went? How would you summarize the session?
Rachel Prusak: “In regards to the health care committee I chaired, I am really thankful. The Ways and Means Committee supported the policies that we wanted to move. I think we were really successful. I think that COVID-19 highlighted the strengths and weaknesses of our health care system by pulling the curtain back and exposing the existing disparities, which I have seen for decades as a clinician. It brought [disparities] to the forefront for everyone to see. We started with over 150 bills referred to the committee and I prioritized as much as possible, using the themes equity, access, cost and public health. I think that we did a really good job.”
PJ: What are some of your biggest wins when it comes to health care legislation this session?
RP: “First thing that comes to mind is Cover All People. This was huge, and started as work from lots of community advocates and the governor’s racial justice committee. They came to the session with what they believed was the biggest thing that we could pass, which was a pilot project to cover all people and to expand health care coverage to those beyond what Cover All Kids covers — so those up to age 26 and their parents. We had several legislators who wanted to think bigger and bolder. We were able to build off of all of the work that the coalition had done and end up passing Cover all People in the form of House Bill 3352. We invested $100 million into this program. We had Rep. Salinas, Rep. Alonso Leon and Rep. Campos leading on that within the Health Care Committee and lifting up all the work that the governor’s team had done prior to the session.
[Another bill] that [was] my priority bill really looks at increasing access to telehealth across the state in House Bill 2508. We are going to make sure that everybody can access health care. We need to make sure those with transportation barriers, geographic barriers and mobility barriers can access it. I think that COVID really showed us that telehealth can do that. This will allow us to not go back to pre-COVID and allow for reimbursement rates to be the same as in-person.
Another big one would be House Bill 2362, making health care more affordable and making mergers and acquisitions more transparent. Senate Bill 844 was a big one, which is creating a prescription drug affordability board within the Department of Consumer Business Services (DCBS). That was championed by Senator Patterson, as chair of health care, and myself [which] is looking at the entire system of pharmaceuticals and how we can improve the more immediate cost of medications and the cap on the cost of insulin in House Bill 2623.
Investments that came not out of my committee but out of the behavioral health committee chaired by Representative Sanchez [were big], and that would be the establishing the 988 suicide prevention hotline in House Bill 3069, as well as allocating $6 million for peer respite centers in need of behavioral health treatment in House Bill 2980.”
PJ: Were there any bills that you wanted to see get through that didn’t make it? What are those?
RP: “One of them was mine unfortunately, and that was House Bill 3108 which was co-chiefed by my Republican colleague in the health care committee, Rep Moore-Green. It was almost a year-long work group that had 23 members including hospitals, payers, patient advocacy groups and clinicians ranging from nurses, pharmacists, nurse practitioners and naturopathic surgeons. I wanted to make sure that [the bill] wasn’t just physician-centric like a lot of workgroups are. It was going to do three things. It was going to remove the copay for three primary care visits because we know that delaying primary care increases costs and suffering by not addressing some of the things that community members want to seek care for. They can’t afford their [for example] $20 copay. It was going to allow for behavioral health visits and your primary care visits on the same day because sometimes payers don’t allow that. It was going to provide for our primary care provider assignment.
There wasn’t opposition but because of the amount of bills that we passed and the amount of bills that were in Ways and Means and [we] just didn’t get it out. So in February I will be back with that. I think the other one that died on the floor was House Bill 2044. Ultimately, it was addressing transparency in our prescription drugs. It was attempting to ensure that our transparency program with DCBS could also look at how using patient assistant programs and coupons impact the cost.”
PJ: How do you think the bills passed in this session will impact the health of all Oregonians and the health care system in general?
RP: “I think that it’s going to do exactly what we set out for which was to make it more accessible, make it more affordable and make it more equitable. That’s really what the committee set out to do.”
PJ: How will the passage of Cover All People reduce the 6% uninsured rate in Oregon?
RP: “Well, the amount [of the uninsured rate] that are undocumented [contains] those that would qualify for Medicaid if it wasn’t for their immigration status. And we know these are the community members that are often on our frontline in this pandemic, or often really needing access to health care and can’t get it because of immigration status, despite being really active participants in our community. So, this is going to make a much more just health care system. I think there isn’t a clinician across the state that wouldn’t say the injustice of not being able to access care when you’re a productive member of our society isn’t the right thing to do. I think that will end up not just increasing access but decreasing costs because these are the same community members that wait until something gets really really bad and they end up in our emergency room.”
PJ: What are you looking forward to working on in the next legislative session?
RP: “In the interim, I am going to work on some of the pieces of legislation that talked a lot about increasing emergency medical services to our community members. We also talked about increasing access to community birthing in our health care committee. So those are two of the things that I’m going to look at.
I’ve [also] been appointed as a board member to the State Hospital Advisory Board. I really want to get engaged and involved with that and listen to the workers and ensure that we’re doing the best that we can for those with the most severe mental illness and supporting the workers that care for them. So one of the things that I’ve been talking to OHSU about, and even SEIU, is how we make sure that we are seeing the data of where our patients with the most severe mental illness are, because I know from hearing from the hospitals that they’re being boarded in emergency rooms. With the investment that we passed out of this session, hopefully we’ll see more increased access and community care to prevent it before things get more severe.”
This interview was edited for clarity and length.