Fall Winter 2017

The Oregon Caregiver Fall/Winter 2017 www.ohca.com 12 PUBLIC POLICY T his was a dramatic year in health care and long term care public policy at both the state and federal levels. The Oregon State Legislature and Congress pursued significant initiatives impacting Medicaid funding, and those initiatives were largely in contradiction with each other. To date, the Congressional efforts to “repeal and replace” the Affordable Care Act have proven unsuccessful, while the state’s plan to fund the next phase of Medicaid expansion under the ACA remains in question pending the outcome of a potential referendum. In terms of long term care regulatory policy, 2017 ushered in new requirements at the state level, particularly for community based care. While at the federal level, the new leadership at CMS has pulled back on the implementation of several regulatory requirements approved by the Obama Administration. While Congress was attempting to “repeal and replace” the Affordable Care Act, the Oregon State Legislature was approving a comprehensive funding package to implement the next phase of Medicaid expansion under the ACA. This funding package includes an increase in the state general fund, an increase in the hospital provider assessment, the addition of a hospital provider assessment on rural hospitals, a new 1.5% insurer tax, and reductions in expenditures for innovation programs for hospitals. These additional funds generate hundreds of millions of dollars in additional revenues to be matched by the Federal government at the stepped- up match rate under Medicaid expansion. Potential Referendum Challenges Provider Taxes; Medicaid Expansion Funding This comprehensive state Medicaid funding package is now being challenged by three state legislators who are spearheading a signature gathering campaign to refer portions of the funding package to voters, known as Referendum 301. One of the legislators spearheading this campaign actually provided the decisive vote to pass the measure during the legislative session. In Medicaid long term care services, Congressional attempts to impose per capita cost caps have stalled for now. On the state level, the legislature made positive steps by approving full rebasing of skilled nursing facility rates and increases to reimbursement rates for home and community based. In a typical year, we would now be turning our focus to the short legislative session in 2018. However, with this year being anything but typical, we first must wait to see if Referendum 301 qualifies for the ballot. If the proponents of the referendum are successful in submitting the nearly 60,000 valid signatures required (which has not been completed at time of print), then there will be a special election in January. If the funding package is overturned by voters in January, the legislature will be required to make budget reductions in the 2018 session to bring the state budget back into balance. A successful referendum would also set a precedent for challenging provider taxes in the future, potentially destabilizing a significant funding tool for Medicaid long term care services. The Race for Governor to Heat Up in 2018 In addition to the referendum issue, the political landscape in Oregon is proving atypical in other ways. Governor Kate Brown will be the first person to run for governor in Oregon twice in two years. Her 2016 election victory was to fill the remainder of the vacancy left by Governor Kitzhaber’s resignation. She will now run again in 2018 to serve a full four-year term. Challenging Governor Brown in the upcoming election is State Representative Knute Buehler, an orthopedic surgeon from Bend. He is seeking the Republican nomination and is already garnering significant financial support. As with the other interesting and atypical activities going on, Rep. Buehler could prove to be a significant electoral challenger for Governor Brown even though early predictions would suggest 2018 will be a down year for the Republican party nationally.  Phil Bentley, J.D., is the Senior Vice President of Government Relations at OHCA. Federal and State Legislatures Moving in Opposite Directions By Phil Bentley, Oregon Health Care Association The Oregon State Senate (pictured) and the Oregon House of Representatives adjourned on July 10.