Rep. Mitch Greenlick, D-Portland, has drafted a ballot referendum that would limit political donations to $500 from any organization that gets more than half of its funding from public sources.
The chairman of the House Health Committee is aiming his ire at a group of Medicaid providers that have profited from the Oregon Health Plan while bankrolling political campaigns to the tune of $700,000 a year.
He unveiled the bill the same day that Rep. Nancy Nathanson, D-Eugene, the top recipient of campaign finance cash from the Medicaid providers, pulled his CCO reform bill, House Bill 2122, from the floor. Nathanson received $13,000 from these groups in 2016.
Medicaid providers, together with the Oregon Association of Hospitals and Health Systems and the Oregon Health Care Association, are some of the biggest spenders on state elections, yet rely on state and federal money for their livelihood.
All of them could be impacted by House Joint Resolution 32, which, if approved by the Legislature, could encapsulate other non-healthcare businesses that rely on federal, state and local tax dollars as well.
“I intend it to cover any entity in Oregon in any sector,” Greenlick told The Lund Report. “If they have more than 50 percent of the revenue directly from a state or federal tax source a candidate cannot accept a contribution greater than $500. That means directly or indirectly.”
Greenlick immediately attracted the support of four Democratic co-sponsors: Rep. Dan Rayfield of Corvallis, Rep. Phil Barnhart of Eugene, Rep. Rob Nosse of Portland, and Rep. Alissa Keny-Guyer of Portland. HJR 32 adds the campaign finance reform language to Article II, Section 8 of the Oregon Constitution, which currently decrees:
“The Legislative Assembly shall enact laws to support the privilege of free suffrage, prescribing the manner of regulating, and conducting elections, and prohibiting under adequate penalties, all undue influence therein, from power, bribery, tumult, and other improper conduct.”
Flow of Money
But House Joint Resolution 32 would still face a tough road. A sales tax gets called the the third rail of Oregon politics, but that distinction also goes to another Oregon public policy — unlimited campaign finance donations.
Democratic leaders, including Senate President Peter Courtney of Salem, have repeatedly killed attempts to cut off the gravy train that funds their campaigns and keeps them in power.
Oregon legislative elections are among the most expensive in the United States, with contested races routinely costing more than $1 million for a job that pays a stipend of about $21,000 a year.
Under the radar, healthcare players including hospitals, senior care providers and groups affiliated with the Medicaid program are some of the biggest contributors to non-competitive races. This allows legislators to increase their power by redistributing the funds they raise to colleagues in competitive races. Donors spend in order to exert their influence on almost every piece of healthcare legislation that passes out of Salem.
Legislators are currently contemplating a $575 million increase in the hospital assessment tax to fund the Oregon Health Plan, while knowing that Medicaid providers will likely kick back more than $1 million a biennium to those same legislators for their campaigns.
Greenlick has run into a buzzsaw of Oregon’s pay-to-play politics with House Bill 2122, his effort to increase transparency and protect the public investment in the Medicaid system. He has been repeatedly hamstrung by Republicans and his fellow Democrats, who have deferred to the lobbying of the Coalition of a Healthy Oregon, a conglomerate of eight mostly for-profit groups that help manage coordinated care organizations.
On Monday, Nathanson once again pulled HB 2122 from the floor and sent it down to the Committee on Ways & Means, which she chairs.
“There is a lot of public money involved in CCO organizations, and this needs additional analysis, review and discussion,” she told her colleagues.
However, House Bill 2122 has already had three public hearings in the House Health Committee, followed by two more hearings in the House Rules Committee, where it was stripped of transparency requirements that would have opened CCO governing boards to the public. That compromise won it the support of six non-profit CCOs, but that still evidently wasn’t enough to assure passage.
According to the Oregon Secretary of State database, Nathanson is one of the top recipients of campaign money from COHO, receiving $5,500 in 2016. Only two recipients exceeded her take, both Coos Bay Democrats, Rep. Caddy McKeown with $10,000 and Sen. Arnie Roblan with $12,500.
Gov. Kate Brown and Secretary of State Dennis Richardson received $5,000 each from COHO in December.
Nathanson took another $5,500 from an affiliated group, the Douglas County Physicians PAC, whose contributers help run the Umpqua Health Alliance in Roseburg. Rep. Bill Kennemer, R-Canby, who has led opposition to HB 2122, also took $5,500 from this group; Roblan took $5,000. House Minority Leader Mike McLane, R-Prineville raised $4,000, while House Speaker Tina Kotek, D-Portland; Sen. Richard Devlin, D-Tualatin; and Rep. Duane Stark, R-Grants Pass, each raised $2,500.
Doctors for Healthy Communities, which partners with the Salem CCO, spent $50,000 on local physician-candidate Bud Pierce in his failed 2016 gubernatorial campaign. After the election, it gave $10,000 to Gov. Brown. The group also gave $5,000 to Richardson. Roblan received $7,750 while Sen. Alan DeBoer, R-Ashland, took in $3,000 and Kotek accepted $2,500. Nathanson received $2,000.
Protecting Public Assets
HB 2122 protects public assets by requiring all CCOs by 2023 to either become non-profit companies, like the Portland CCOs Health Share and FamilyCare, or become benefit corporations, like All-Care Health in Medford.
The Coalition for a Healthy Oregon appears to oppose this because it would prevent their member organizations from following the course of Trillium Community Health Plan, in which shareholders cashed in on the Medicaid program for Lane County for $109 million in a sale to the St. Louis healthcare corporation, Centene.
Under HB 2122, the CCOs would lose much of their investment value for Centene since any profits from the companies must be donated to a public good upon dissolution. The bill also requires any excess reserves to be put back into the community for upstream health investments.
Central to Oregon’s coordinated care system are the locally run companies, both for-profit and nonprofit, in which physician organizations and hospitals take responsibility for the Medicaid system and humanely administer care for their low-income and disabled neighbors.
If the remaining CCOs sell out, it would effectively end Oregon’s experiment in coordinated care reform and leave the state with a Medicaid system similar to other states, such as Washington, where managed care organization contracts are bid out to large out-of-state corporations that underpay providers and leave Medicaid members with health care insurance that does not provide good access.
Reach Chris Gray at firstname.lastname@example.org.