Staying Ahead of the Curve in Health Policy

State Sen. Elizabeth Steiner Hayward shares her thoughts Oregon’s next steps forward in health

"File:Doernbecher Children's Hospital front - Portland, Oregon.JPG" by M.O. Stevens is licensed under CC BY-SA 3.0.

Oregon has long led the nation in health care and health systems innovation and should continue to do so through a range of policies. In fact, in 1991 I chose Oregon Health and Science University (OHSU) for my family medicine residency in part because as far back as the late 1980’s, then Senate President John Kitzhaber led efforts to develop and implement what is now known at the Oregon Health Plan (OHP), Oregon’s Medicaid program. Since 2003, first as an advocate and then, beginning in late 2011, as a legislator, I’ve participated in a range of initiatives to continue Oregon’s leadership in health care, including, among many initiatives:

-        2007: Insurance coverage for contraception;

-        2009: Healthy Kids, ensuring children up to 300% of federal poverty level have health insurance;

-        2012: Coordinated Care Organizations, providing regionalized system-based coverage for OHP members;

-        2017: Cover All Kids, offering state-funded insurance coverage for undocumented children;

-        2017: Primary Care investment, requiring that all insurers spend a certain percent of revenues on primary care services;

-        2018: Prescription Drug Price Transparency program, providing transparency into increases in some prescription drug prices;

-        2019: Statewide Health Care Cost Containment (SB 889);

-        2021: Cover All People, offering state-funded insurance coverage for undocumented adults; and

-        2021: Prescription Drug Affordability Board.

Despite all of these accomplishments, we have a long way to go toward Oregon being the healthiest state in the nation, the goal that motivated my run for the legislature and much of my work since then. We know that only about 10% of “health” comes from traditional health settings; the rest depends on social determinants of health such as education, housing, nutrition, etc. While the state has made extensive investments in these core areas, we have not yet explicitly established the necessity of providing these social determinants of health to those historically disenfranchised and disadvantaged by decades of racism and intergenerational poverty.

Additionally, while it’s critical to maintain health insurance coverage, coverage does not guarantee access. We must ensure that we’re paying for health care in ways that incentivize the “rights”:  the right kinds of health care delivered at the right times by the right providers in the right ways and right locations. Incentivizing the “rights” of health care will increase access as we maintain (and hopefully increase) insurance coverage while further integrating provision of social determinants of health into our health care systems and our state’s thinking about overall individual, family, and community well-being.

Oregon now has two important opportunities to advance health systems innovation. First, we are in the process of renewing our federal 1115 waiver which allows us to administer our Medicaid program in a range of ways that differ from traditional Medicaid. The new waiver proposes some important initiatives to address equity, social determinants of health, and improved insurance coverage including:

-        maximizing continuous & equitable access to coverage – 2 year eligibility for adults, 5 year continuous enrollment for children under 6;

-        streamlining life & coverage transitions such as re-entry after incarceration or time at state hospital by facilitating housing, insurance, care coordination, etc.;

-        implementing value-based population payment by moving away from fee-for-service payment models and rewarding investments in population health, health equity, and social determinants of health;

-        incentivizing equitable care via new metrics focused on equity, giving communities funds to make the best investments for their needs, and alignment with Tribal priorities;

-        leveraging federal funds to support provision of social determinants of health.

All of these proposals will help advance true health by reducing gaps in coverage and better addressing social determinants of health, the impacts of systemic racism, and disparities in health care experienced by BIPOC, rural, and low-income Oregonians.

At this moment we have another exciting opportunity to advance health insurance coverage and increase access to care. In 2022, the legislature passed House Bill 4035 which set up a Task Force to develop a Bridge Health Plan for people at 138%-200% of the federal poverty level (FPL). During the pandemic, changes in the federal Medicaid program resulted in significant increases in insurance coverage for people in this income range, and a drop in Oregon’s uninsured rate that was particularly beneficial for BIPOC Oregonians. However, after the federal Public Health Emergency (PHE) ends, Oregon will go through a twelve-month process of redetermining OHP eligibility. Since only adults under 138% FPL are automatically eligible, we must take advantage of several different paths to create a Basic Health Plan that will ensure affordable, comprehensive insurance coverage for people who have historically experienced “churn” off and on OHP coverage and thus had care disrupted. I am honored to co-chair this Task Force with Rep. Rachel Prusak and am excited to work with the dedicated Oregonians who have stepped up to lend expertise to this critically important work.

State Sen. Steiner Hayward. Photo furnished by Hayward campaign.