At its meeting today the PSU-AAUP adopted an OPPOSE position on HB 3428, which has its first hearing in the House Committee on Health Care tomorrow, April 14, 2017.
HB 3428 abolishes the Oregon Educator Benefit Board (OEBB), the public school counterpart to PEBB, and has all the administrative functions currently performed by OEBB transferred to PEBB. PEBB would become an administrative agency that is no longer obligated for providing health benefits to anyone. Virtually all public employees in Oregon would be of enrolled in coordinated care organizations (CCOs) that contract with the Oregon Health Authority, the agency responsible for administering medicaid through CCOs on Oregon through the Oregon Health Plan (OHP). This is basis health insurance coverage.
Members would be restricted to medical and dental services provided in the Oregon Health Plan by members of their coordinated care organization. As the CCOs are oriented toward medicaid delivery and not active employees, the CCO model may not be able to provide medical services when members are traveling outside the service area. This alone would be particularly problematic for AAUP members who spend time away from Portland for their scholarship.
It is not clear whether current health care plan levels would be maintained, or if members who have good health plans (platinum, gold and bronze level) would experience a reduction in covered conditions and events. OHP has a limited formulary for prescription drugs. Vision benefits are provided only if there is an underlying medical condition. Physical, occupational and speech therapy are not covered benefits.
The Oregon Health Evidence Review Commission (HERC), the board in the Oregon Health Plan that is responsible for maintaining the "prioritized list," ranks health care condition and treatment pairs in order of clinical effecitveness and cost effectiveness. In general, the prioritized list ranks treatments that help prevent illness higher than services that treat illness after it occurs. The OHP covers treatments in this ranked order, with prevention at the top of the list. It is not clear whether members would face a reduction of access to health care, and only be given options to the highest ranked services on the list and not all services that could potentially treat an illness or condition.
If current plan levels are not maintained, having all members move into basic medicaid health coverage in a CCO represents a significant benefit reduction for AAUP members. This will cause retention and recruitment issues for Universities and all public employers, and the personal costs for public employees seeking health care from providers will increase.
Further, the CCO model is new, and there have been a steady stream of reports about CCO financial issues. It might be the right solution for the delivery of medicaid, but it is not the right delivery for the delivery of health benefits to a competitive marketplace where basic medicaid insurance could be an incentive for highly educated faculty members to seek employment elsewhere.