Q&A: Rep. Andrea Salinas on legislative priorities and universal coverage in Oregon

Representative Andrea Salinas represents Oregon’s House District 38, which covers most of Lake Oswego. Salinas has served in the legislature since 2017 and currently serves on the House Health Care Committee, the Energy and Environment Committee, and on the Ways and Means Subcommittee on Human Services. She was also the Chair of the Universal Access to Healthcare Workgroup during the 2018 interim.

In this Q&A, Salinas discusses how the 2019 legislative session is shaping up for healthcare, legislation to watch, and the bills we can expect to see related to universal coverage this year.

Emily Boerger: To start off broadly, what issues have emerged as priorities this year in the House Committee on Health Care?

Andrea Salinas: “Obviously, the Medicaid spending package — that’s been the first kind of big thing that we worked on and that passed out of our health care committee… It went down to the Human Services Subcommittee on Tuesday, I believe it was, and we passed it out to the full Ways and Committee. So, obviously that Medicaid funding package is going to be critical to making sure that we have the needed state funds to match the federal funds.

Then, I think, kind of teeing off what the legislature did in 2018 with HB 4005, the pharmaceutical transparency bill. On Tuesday we will be hearing some additional pharmaceutical drug bills and trying to figure out how we actually get any kind of savings or the benefits of price transparency to consumers directly.

And I think, looking a little further out, Representative Greenlick will have a vaccination bill that we’re getting a lot of feedback on from our constituents and folks around the state. And for me it’s kind of both sides – I have a lot of physicians in my district so we’re hearing from those who really want vaccinations and those who really don’t want what they would consider mandatory vaccinations.

And then I think later on we will probably be addressing some of the bigger issues, like some of the universal access to care ideas. So I know Representative Greenlick has one that he’s calling EPHCOT… it’s essentially trying to move the integrated systems, like a Providence and a Kaiser, to a true non-profit system that would look more like universal access to care.

And then on my side, I’m trying to develop the Medicaid buy-in, and a “shared responsibility” which is essentially an individual mandate.

So that’s kind of the broader idea around where Oregon is headed. And I think SB 770 kind of feeds into that discussion too.”

EB: Jumping back a little bit, can you tell me about some of the drug pricing transparency bills that will be heard in committee?

AS: “I have one that would require a 60-day notice for drug manufacturers who increase their brand name drugs 10 percent or more over the year and where the prescription is $100 or more a month. They would be required to give DCBS a 60-day notice and this would help at least insurers move their formularies around a little bit so that ultimately the costs of that increase in the manufactured drug doesn’t get passed on to the consumer.

Also, I know Representative Nosse will have one bill that will essentially allow us to import drugs from Canada using an Oregon warehouse up there essentially, and then bringing them in for drugs that we purchase.”

EB: What are your thoughts on that bill?

AS: “I love it. I think it would be great. I don’t know how much it will ultimately save the state, and how much it will save overall, but I think it’s a great idea. If we can figure out any ways to lower the costs directly to consumers, I’m willing to take a look at it.

EB: You also mentioned SB 770, which has been described as “setting the stage” for universal health care in Oregon. Can you tell me about the bill and what it entails?

AS: “Yeah, I mean it sets up the [Health Care for All Board] and it sets parameters for that the board is required to do. You know, to be honest, while I think it’s a great idea (I’m a chief sponsor), and I think ultimately getting to some kind of single payer system is the best thing we could do for Oregonians and really all people in the US, I do think trying to figure out how we do this as a nation would be more helpful.

And I think we have some things in place that this bill actually asks for, so I don’t think it would be necessarily a huge lift. I think that the biggest piece though, is it calls for this board to provide a plan, so a roadmap, for getting to comprehensive coverage, including replacing private and state employee insurance with one universal type of health care plan. So, while that all sounds amazing, and I think in theory it is amazing if we could get there, but we have some pretty big hurdles in terms of being able to really take the proceeds and the revenues that we’re spending right now on Medicaid, Medicare and private insurance and pull them into a state-based, kind of, delivery system.

So yeah, we don’t have those waivers yet. But this board would be setting us up to be able to move into something should the federal government open up the ability to get those waivers. Because right now, under ERISA, Congress would essentially have to change their laws in order for us to be able to capture those ERISA dollars and require private insurance to become part of a public/state insurance or health care plan.

EB: So, if the bill moves forward and passes, it essentially says, we’ve set up this board and it is going to work on this roadmap?

AS: “That’s right, exactly.”

EB: What other bills might we see related to universal access this session?

AS: “I’m planning to offer a Medicaid-like buy in… we learned [in the Universal Access to Healthcare Workgroup] that there are about 200,000 individuals in Oregon who are likely eligible for Medicaid, but they churn on and off of the Medicaid system, and/or they don’t know they’re eligible. So that’s a big group of those who are still uninsured. We also learned that a lot of the reason that people are uninsured is because of employment. So whether their hours were reduced, or they changed jobs, or their employer plans are just too expensive, they don’t have insurance.

What [this bill] essentially would do is offer the Medicaid benefit plan to anybody who is above 138 percent of poverty level, but below 400 percent of the federal poverty level, and allow them to purchase it at the current premium price for the plan. None of the proceeds would come out of the state budget. You know, I think the question is, is that Medicaid plan and that premium affordable enough? Because from what I understand from OHA and some of the insurers, is that it would still be somewhere between $500 and $600 monthly. But, recognizing that there are no costs at transaction times – so there’d be no co-pays, no deductibles — you know, for some people that could be really beneficial.

The other folks I’d like to include in it too are those who have to pay full freight through their employers; they have to pay for their entire health insurance. So for those who are between 400 and 600 percent of federal poverty level and pay the entire amount of their health insurance, they too could buy in.

It would be administered through the CCOs and so I think the other question is, how are those networks going to stay standing? Essentially, they would get the same reimbursement rate under the buy-in option that the current Medicaid plan does. So would the networks stay in place and would we have providers? Because that’s kind of the idea — to expand access — and if you don’t have those providers because they don’t like the reimbursement rates, then it does no good. So those were a couple of outstanding questions that I have as I start to roll this thing out and I don’t know that I’m going to have an answer to that.

EB: Any other bills?

AS: “So that’s one bill, and then like I said, the shared responsibility bill would essentially require everybody to either have some kind of health care coverage or pay a penalty. And then with any proceeds from that penalty, we would help folks buy down. Essentially it would be a premium assistance kind-of offer to folks who maybe can’t afford the full premium on the Medicaid buy in, but could afford part of it.”


This interview has been edited for length and clarity.