by Ben Botkin, Oregon Capital Chronicle
October 4, 2024
Oregon lawmakers plan to address myriad challenges on the state’s health care landscape next year.
The behavioral health system lacks thousands of residential care beds. Hospitals are burdened with mental health patients they’re not equipped to serve. And rural pharmacies are struggling to stay open.
Those issues – and others – will emerge in bills during the 2025 legislative session, a panel of six state legislators told a health care conference on Wednesday. They’ll have time next session to dig into those issues. In odd-numbered years, sessions can last up to 160 days, allowing more time for deeper policy dives and to set the budget for the next two years.
Lawmakers were among the 400 people at CCO Oregon’s annual conference in Salem. The organization’s members include regional Medicaid insurers – also called coordinated care organizations – and other health care providers.
Rep. Rob Nosse, D-Portland, and Sen. Deb Patterson, D-Salem, each chair of their chamber’s health care committee, participated on the panel.
State lawmakers who also are health care providers joined them: Reps. Travis Nelson, D-Portland and a registered nurse; Hai Pham, D-Hillsboro and a pediatric dentist; Lisa Reynolds, D-Beaverton and a pediatrician; and Cyrus Javadi, R-Tillamook and a dentist.
Behavioral health work planned
Lawmakers offered a variety of ideas for what Oregon should do next to improve its behavioral health system.
Oregon’s opioid overdoses soared to about 1,400 in 2023 as people continue to struggle to access addiction treatment and mental health care.
Patterson said the state needs to do more to fund prevention efforts in schools, including adding counselors and other providers in school-based health centers, which can provide primary care and counseling for mental health and addiction.
This session, a bill died that would have provided nearly $18 million for the centers to expand. They’re in about 7% of Oregon public schools now.
Oregon Legislature allocates millions for adult addiction, stumbles on funding for children
Nosse said he’s looking forward to working on the ideas that emerge from the state’s task force on hospital discharges that’s been meeting for months. The state needs to address the problem of how to help behavioral health patients who are “stuck boarding in hospitals” when they need residential care, Nosse said.
He said he’s planning bills that will be “focused on more” That means more money for beds, higher salaries to pay people and adding workforce programs to encourage people to enter the field.
Nosse said Oregon’s Medicaid and health care system is strong, but not strong enough in behavioral health.
“We have a lot of work to do to improve our behavioral health system,” he said.
Javadi said the state needs to look more closely at raising provider reimbursements to attract more providers and look for ways to integrate behavioral health care with primary care to reach more people.
Nelson said the state needs to do more to show appreciation for health care workers in the behavioral health field – both through increased rates and respect.
“The folks who do the work are not recognized nearly enough, and oftentimes they leave their positions not because of the way they’re treated by the patients, but because of how they’re treated by their employers,” he said. “And so I’d love to see more done on that side, so that we can keep people and make our system as great as it should be.”
Legislative priorities
Reynolds said the maternity care system needs to do more to support parents during and after pregnancy. Serious health problems and deaths during and shortly after pregnancy are linked to behavioral health, she said.
“A big chunk of the cause for maternal morbidity and mortality, half of which is postpartum, is mental health problems and substance use disorder,” Reynolds said. “I have not seen the providers of maternity care retool their offices like we have in pediatrics.”
That’s also linked to other problems, like children entering the child welfare system.
“We know when that bridge gets crossed, it’s very hard for that young person to have a great outcome,” Reynolds said. “So I will keep ringing this bell. We need to do better.”
Reynolds said she’s looking at ways to provide more support for new parents, such as ensuring they have stable housing for the first year of the child’s life and community health workers who can help parents.
Nosse said he’s planning a bill that would help pharmacies cover costs and stay open, especially in rural Oregon communities.
At the heart of the problem is a complex system of pharmacy benefit managers that serve as a middleman between drug companies and pharmacists and inflate costs.
The current business model has led to independent pharmacists and even chain pharmacies in rural areas closing or struggling to fill prescriptions, Nosse said, something that also worries Oregon’s U.S. Sen. Ron Wyden. Just this week, Wyden and another Democratic U.S. senator, Sherrod Brown of Ohio, urged the Federal Trade Commission to investigate practices that pharmacy benefit managers might be using to block competition and jack up profits.
In tackling the issue in Oregon, Nosse said he anticipates bipartisan support from his Republican colleagues.
“They understand how lousy it is to have a business model where you lose money every single time you fill a prescription,” Nosse said.
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