The Oregonian reports that Senator Betsy Johnson, D-Scappoose, has joined all fourteen Senate Republicans in signing a letter threatening to scuttle the Coordinated Care Organization (CCO) portion of Oregon health care reform, at least for the 2012 legislative session, unless CCOs are brought under a liability cap that is part of a broader Republican agenda for tort reform.
This is essentially hostage-taking. CCOs are one of Governor Kitzhaber's key priorities. Their innovative features have attracted a great deal of interest from the Obama administration as way to leverage the Accountable Care Organization provisions of the Patient Protection and Affordable Care Act to improve health, creating a potential to bring up to $2.5 billion in federal revenue to Oregon over five years.
The CCO bill, SB 1580 would approve the business plan for CCOs put forward by the Oregon Health Authority, and allow the OHA to go ahead with rule-making regarding criteria for choosing or establishing CCOs within parameters established by the bill.
SB 1580 is currently in the Joint Ways and Means Committee, of which Senator Johnson is co-chair. Fourteen Republicans plus Senator Johnson could also block the bill on the Senate floor.
What the Republicans seek, joined by Senator Johnson, is to bring the CCOs under the provisions of the Oregon Tort Claims Act of 2009, which limits the tort liability of public agencies in Oregon.
This effort is a form of class warfare against low income people, since the CCOs in the first instance will serve people on the Oregon Health Plan. If the Republican + Johnson effort succeeds, CCO patients will have inferior protection to everyone else against medical malpractice including CCO maladministration that might lead to poor care.
Including the CCOs under Oregon Tort Claims Act would only save the state about $20 million per year, according to a recent OHA-commissioned study (downloads a pdf). Pretty clearly the aim here is not related to OHP or CCO costs, but to advance a broader liability limitation agenda, even at the expense of improved health for low income people and health care cost savings.
Since the governor hopes at some point to bring public employees into the CCOs, it might also be an attack on public workers. Alternatively it is likely to raise the level of resistance from public workers to being included in CCOs, or to choosing to join them if the CCOs were opened on a voluntary basis.
According to The Oregonian "Sen. Alan Bates, D-Medford, said he supports limiting medical malpractice awards, but given the potential funding, the letter 'is like playing with nuclear weapons. If they hold, they'll kill this thing, and we'll all pay the consequences.'" Bates is a physician from Medford and one of the Senate Democratic leaders on health care reform matters.
The CCOs are the core of the "Transformation" piece of health care reform, as distinct from the Exchange part required by PPACA. Transformation is dearest to Governor Kitzhaber's heart, because it addresses not just insurance-related financial access elements of reform, but the actual delivery of care, which is Kitzhaber's longstanding main interest. The OHA's proposal aims especially to shift the OHP to "upstream" care that focuses on health promotion, prevention, primary care, and early stage chronic disease management. Such care is widely understood in medical and health policy circles to be the central element of any serious efforts to improve population health and thereby control overall health care costs.