Why has health care been one of your top priorities?
Health care is not only a fundamental right, it contributes to strong communities and a strong economy. When children are healthy, they can go to school. When workers are healthy, there is less absenteeism and lower insurance costs for employers. When families have access to health insurance, they are less likely to face crushing medical bills and turn to social services.
One of your main goals this session was getting early passage of HB 2010, which provides a big chunk of the funding for Oregon’s Medicaid budget for the next six years. Why was that so important?
It is critical that we find a long-term, sustainable funding source for Medicaid. Medicaid expansion has opened access to coverage for thousands of Oregonians and supported economic growth throughout the state, particularly in rural Oregon. Much of the funding for the Oregon Health Plan has been one-time revenue no longer available, and the federal matching for the ACA expansion has been declining slightly each year (it will reach 90 percent in 2020 and remain there).
HB 2010 is the first part of my proposal to fund the Oregon Health Plan. It was important to pass this legislation quickly so that we could turn our focus to the remainder of the funding package–including a tobacco tax increase– which we expect will take more time to move forward.
Why did you propose a tobacco tax increase as a key part of the Medicaid funding package?
Raising the tobacco tax is the most effective and proven way to reduce tobacco use. Quitting tobacco use has immediate health benefits and will provide long-term health care cost savings. About 31 percent of adults on OHP currently smoke. The cost of tobacco-related illness among the OHP population was $374 million in 2010, or nine percent of OHP expenditures. When OHP members can quit using tobacco, all Oregonians benefit, and increasing cigarette taxes is a critical component of a comprehensive public health tobacco strategy.
We have compiled data showing a big increase in behavioral health related visits to hospitals. What is your reaction?
Unfortunately, this data point is not surprising to me. Mental health is a huge challenge in Oregon and across the country. While we have made some progress, we have much work to do to ensure timely access to mental health and substance use disorder treatment and to ensure patients are treated in more appropriate settings than emergency rooms. This requires having the same kind of access to mental health and substance use disorder treatment as we have for physical health care.
My 2019-21 budget includes resources to expand community mental health treatment, provide in-home, intensive behavioral health services for children and youth with special needs and reduce risk factors for suicide.
You are in a great position to get things done with a supermajority in both houses of the legislature. How do you think that is going so far?
My goal for this legislative session is to prepare Oregon for the future by addressing the challenges of affordability, educating our kids, mitigating the effects of climate change and maintaining a strong democracy. The Legislature already has made significant progress on many of these issues.
The rising cost of prescription drugs is an issue not just in Oregon but across the country. Are you satisfied with the progress?
We passed a pharmaceutical transparency bill in 2018, but need to look at other tools. We are looking at increasing opportunities in bulk purchasing (partnering with neighboring states if we can). We are looking at importing drugs from Canada. All options are on the table. When we see costs doubling and tripling for common but lifesaving drugs like insulin, it threatens people’s lives and the sustainability of our health care system overall.
Oregon has been using the word “transformation” for several years to describe health care. Have we really transformed the system?
Transformation is a journey, and we are still in the early stages of that journey. Oregon has long been an innovator in health reform with a triple aim goal of lower costs, better health care and improved health. Our transformation goal has been to change the health care delivery system by reducing waste, improving outcomes, and creating accountability. Evidence shows it is working: Oregon’s Medicaid CCOs have seen a 50 percent reduction in avoidable emergency department use and increased utilization of preventive care. The CCOs have saved taxpayers more than $1.9 billion over the first five years, but we are not done. This is a path that we will always be on as we face increasing cost pressures and changing demographics. The next stage of transformation must address issues of equity and health disparities in our state and the critical need for increased access to behavioral health services. We also must increase our adoption of value-based payment systems. Finally, we now recognize that social factors such as housing, education and jobs have a greater impact on long-term health outcomes than medical care. The next stage of our journey will require that health systems engage with communities to address social determinants of health.
What can the state do to improve health care in the rural parts of Oregon?
The Affordable Care Act, including Medicaid expansion, has had a tremendous impact on rural communities. In some rural counties, close to 40 percent of residents are on the Oregon Health Plan.
We need to continue to improve access to quality care for rural Oregonians, and develop the capacity and diversity of the health care workforce, with a focus on the unique needs of workers in rural Oregon.
Creating good jobs throughout the state also can improve health outcomes. My Future Ready Oregon initiative is providing skills and job training to students and adults, helping to close the gap between the skills that Oregon’s workers have and the skills that Oregon’s growing businesses and rural communities need.
There is now broad agreement that access to clean, safe housing is critical to health. Does that help in the push to create more affordable housing in Oregon?
Chronic homelessness and rising rents have created a housing crisis in Oregon, and there is a lot of support this legislative session to invest in affordable housing. Housing plays a key factor in the health of communities. Recognizing the importance of this connection, the Oregon Health Authority and Oregon Housing and Community Services (OHCS) are collaborating to invest in permanent supportive housing to create at least 200 new units of housing with supportive services across Oregon.
Tell us something people don’t know about you.
I regularly practice yoga for the benefits it has on my mental and physical well-being.