New partisanship challenges Oregon health reforms
Apr 6, 2014
By JONATHAN J. COOPER
Of the Associated Press
SALEM — Gov. John Kitzhaber has spent at least a decade trying to drive politics out of health care reform, and he successfully drew bipartisan support for an ambitious plan to redesign the system serving poor people on Medicaid.
The failure of Cover Oregon's website, however, has unraveled that bipartisan spirit and brought a piece of the bitter national health care debate to Oregon. Kitzhaber, if he's re-elected, faces the daunting task of keeping his vision on track after a divisive election season that's likely to focus on health care.
Health care executives, lawmakers, state officials and others involved in remaking Oregon's system insist the rising partisanship surrounding the state's troubled insurance exchange will fade after the election and won't derail Kitzhaber's other efforts to remake the health care system. Still, they acknowledge the impending fight.
The GOP nationally is trying to create a political opportunity out of the problems associated with President Barack Obama's health care law. One of the party's sharpest weapons has been Oregon's failure to launch an online system for enrolling in health coverage, despite more than $130 million paid to the primary technology contractor, Oracle Corp.
“It does create some noise out there,” said Tina Edlund, the acting director of the Oregon Health Authority. “But I do think, whenever we talk about the delivery system reforms, that people relate to that, they understand the need to make a more coordinated, integrated system.”
To Kitzhaber and his allies, Cover Oregon's problem is merely a technology failure. They point out that it hasn't prevented them from using a backup enrollment process to sign up more than 200,000 people for health coverage, about a third of them with private insurers.
But the fiasco at Cover Oregon took out one of the chief architects and champions of Kitzhaber's health reforms. Dr. Bruce Goldberg, director of the Oregon Health Authority, resigned last month after a scathing independent review highlighted the OHA's lax oversight.
Goldberg played a central role in pitching and transitioning to Oregon's new system of administering Medicaid, which was approved by lawmakers in 2011 and 2012. As part of a plan to improve health care and lower costs, lawmakers created coordinated care organizations responsible for integrating physical, mental and dental care while working within a budget that grows at a fixed rate.
“We're going to miss his hard work and his steady hand,” said Democratic Sen. Alan Bates of Medford, a physician who has helped craft Oregon's health care legislation. “But the things he's set up and rolling, because of efforts he made, will continue.”
Kitzhaber has been working aggressively to expand his coordinated care model to the private health insurance market in Oregon, and Cover Oregon was central to that goal. He also met with governors of other states, explaining his efforts in Oregon and trying to persuade them to pursue similar reforms.
Kitzhaber has long complained that the politicization of health care stymied efforts to reform the system. That was one reason he created the Archimedes Movement, a Portland nonprofit now called We Can Do Better, to work on health reform after he finished his first two-terms as governor in 2003.
He often boasts that Oregon's been able to avoid the partisan rhetoric that has characterized health care debates in Washington and in many other states. The legislation approving both Cover Oregon and Kitzhaber's Medicaid reforms passed the Legislature with overwhelming bipartisan support.
But much of the bipartisan goodwill has faded.
“It was bipartisan because we were told one thing that turned into something else,” said Sen. Jeff Kruse, R-Roseburg. “To a degree, I'm a little disappointed in my Democrat colleagues for still carrying the banner.”
Rep. Dennis Richardson of Central Point, who is likely to get the Republican gubernatorial nomination, has made Cover Oregon a centerpiece of his campaign against Kitzhaber. The Republicans seeking to challenge Democratic U.S. Sen. Jeff Merkley are also talking extensively about health care, which is likely to be the subject of advertisements attacking Democrats come fall.
Health care may be a big issue in the election, but lawmakers can turn off the partisan politics when they come back to Salem next year, said Jeff Heatherington, chief executive of FamilyCare Inc., a Portland-based coordinated care organization.
“What I would expect is that after everybody's done that, all of the heads that reside in the Legislature will come together and still work for the good of the whole state, which is what we have done in health care for a good long time,” Heatherington said.
Kitzhaber was not available for an interview, said Nkenge Harmon Johnson, his communications director.
Edlund, the Oregon Health Authority chief, said she's doesn't foresee coordinated care organizations getting caught up in the politics surrounding Cover Oregon because they're run by local doctors and hospitals, not the state.
“If you're talking about legislators, it means a lot to them that what's going on in their community is different and is changing,” Edlund said. “So I think that's where you get the countervailing forces.”
Follow AP reporter Jonathan J. Cooper at http://twitter.com/jjcooper .
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