It took over 10 years to get a mental health parity bill through the Oregon legislature.  But it happened. 

In 2005, Gov. Kulongoski signed into law Senate Bill 1, which said that beginning on January 1, 2007 state-regulated group health insurance policies must cover mental health and chemical dependency treatment at the same level as physical health services.  

In the years leading up to the parity law, private insurers and business interests insisted that it would cause insurance rates to skyrocket, leaving business owners no choice but to drop all insurance coverage for their employees. Advocates countered that parity would in fact save money. 

How so? Because untreated mental illness and addictions result in physical health ailments, parity advocates predicted that providing treatment in a timely manner, before costly hospitalization became necessary, would be cost-effective.

Who was right?  Although it might be too soon to say for sure, a recent report from the Oregon Department of Consumer and Business Services is making the advocates look pretty good.

The report compares claims from 2006 (before parity) and 2008.  The data show that claims for outpatient mental health visits went up 17.9% while claims for inpatient mental health treatment went down 6.2% and claims for residential mental health went down 30%.  Claims for both outpatient and residential chemical dependency treatment went up but had very little impact on the overall cost of health insurance. 

According to the report, “there appears to be relatively little impact to total healthcare claims costs.  Mental health costs remained at a little over 3.1% of insurers’ total healthcare claims costs, and insureds actually saw a small decrease in the relative percentage of overall costs attributable to mental health claims.”

So the data show more outpatient visits, fewer hospitalizations and cost neutrality.  Yay, advocates!  The fears promoted by businesses and the insurance industry have, so far, proved baseless.  This is a good example for us as the broader health insurance reform debate rages on.

The 2009 version of the Oregon legislature finished business last night with a flurry of activity.  It was a characteristic end to a hard-working and productive session.  However, a quick glance at the newspapers reaffirmed my expectation that the big story would be increased taxes.  Despite the fact that the legislature made $2 billion in cuts from projected service levels, the lead stories in the Oregonian only mentioned the last-minute reduction of $11.5 million from higher education. 

The fact is, we will see significant cuts in services that Oregonians with disabilities and their families depend upon.  But it will be hard to tell that story amid the tumult of the tax debate and the inevitable ballot measures designed to wipe out the new revenue and bolster the political fortunes of their proponents.

Back in 2003, the legislature took a different approach.  It decided to decimate human services budgets in order to avoid tax reform or tax increases.  About 100,000 Oregonians lost their health insurance, the infrastructure for delivering mental health and addictions services was severely damaged, thousands of seniors lost their support services, schools went begging.  But there were no ballot measures to challenge the legislature back then. 

Although touted as the "people's voice," ballot measures cost money.  Instead, some organizations like Legal Aid and DRO filed law suits on behalf of vulnerable Oregonians to attempt to stop or slow some of the worst cuts.  While we had some small, technical victories, we were not able to stop the cuts.  Judges were hesitant to substitute their judgment for that of the legislature.  Close calls went to the elected officials.

This time around, we have three major tax increases.  They target corporations, high earners and hospitals/health insurers.  The first two are most likely to be challenged by ballot measure.  The other is really a fancy way to leverage more federal Medicaid funds and should not have a significant fiscal impact on those taxed.  You may hear differently when health insurers cite the tax as a reason to increase premiums and decrease reimbursement rates for providers.  My advice is to keep your eye on their profit margins rather than their justifications.

Overall, the legislature deserves high marks for its labors. Despite the difficult financial times, some excellent bills were sent on to the Governor and budgets were constructed in a fair and open manner.  DRO is particularly pleased that a bill to bring Oregon law up to date with the federal ADA Amendments Act has been signed into law.  We worked with the Bureau of Labor and Industries to craft and promote this legislation and received invaluable assistance from Senator Floyd Prozanski to get it through the process.

Now that the session is complete, we here at DRO are writing a summary of legislation passed this year that particularly affects Oregonians with disabilities.  We'll let you know when it is complete and is posted here on the Disability Rights Oregon website.

The auditorium at Portland Community College was full by 5 PM for the 6 PM Ways and Means Committee forum.  By the time the forum began, the overflow room was overflowing.

Co-Chair Margaret Carter was absent due to illness, but 21 other members of the committee were present.

Our orange "No DD Cuts" stickers seemed to be just as numerous and obvious as the purple t-shirts - yeah for us!  We heard a full hour of testimony before anyone from the DD community spoke - that being Jeanne Farr (thanks to Bernie for being there early to sign her up, distribute stickers, etc). Following on Jeanne's heels was Bud Thoune.  Both Jeanne and Bud represented our interests very eloquently and persuasively.

Parents and self advocates were also well represented in the crowd.  I saw Arlene and Roberta from FACT; Steve, Hannah and Sherry from SAAL, and several other familiar faces.  Everyone who could get their hands on a copy of the committee's survey was filling one out.  Most of those wearing our orange stickers were new to me - a good sign that our grassroots are reaching beyond the usual suspects.

We're on a roll...so keep on rollin'!

Bill

Bill Lynch, Executive Director
Oregon Council on Developmental Disabilities

Thanks to the miracle of WIFI, I am sitting in the gallery of a state legislative hearing that is discussing whether the state mental health delivery system needs some fundamental changes.  The Oregon system has been criticized for being "fragmented" and "inefficient."  Senator Bates and Representative Kotek have raised the question of whether the state system should be "regionalized" and "integrated" with physical health services. 

For over a century, publicly-funded mental health services in Oregon have been county-based.  By state law, each of the 36 counties must have a mental health authority that provides an array of services.  In recent years, many small rural counties have combined forces to provide services regionally.  During the 1990s, the Oregon Health Plan (OHP) spurred the creation of regional managed care organizations that administer OHP money for mental health services.  Non-OHP money from the state continues to go directly to counties.

The state Department of Human Services has weighed in, suggesting that three major pilot projects be established to test whether regionally-administered and funded services would save administrative costs and deliver better services.  It also wants to test whether health outcomes for individuals needed public mental health services can be improved.

Having heard some of the testimony, it seems that folks that run community mental health services are supportive of the goals but skeptical about the approach of regionalization.  Hospitals and managed care entities seem to welcome carefully-implemented change.  Advocates seem to be eager for change.  Counties are feeling threatened.

There can be no doubt that in this time of fiscal austerity, efficiencies are welcome.  Treatment approaches that keep people in their homes and support healthier lifestyles are welcome.  But people involved with mental health services have good reason to be wary.  Years of chronic underfunding have been punctuated by periods of serious racheting back of support.  Will efficiencies merely result in loss of local control and a loss of financial support that is never returned?  Or will changes result in more uniform access to quality services across the state and elimination of the 25 year life-expectency gap for people with mental illness?  The conversation ensues.

While looking over a list of proposed cuts to the state budget last week, I noticed that $6.5 million were slated to be removed from the Community Housing Trust Fund. That is half of the entire Fund.  This was not good.

Back in 1999, a Community Housing Trust Fund was set up by law.  The proceeds of the sale of Dammasch State Hospital property (minus sale costs) was directed to be placed into the Trust for investment.  Earnings of the account and no more that 5% of the principal were to be available to the state to use for community housing and institutional housing for people with mental illness.  Other moneys could be added to the Trust by the legislature or through other sources.  The proceeds amounted to about $13 million.

The statute that creates the Trust (ORS 426.506) specifically says that "At least 95 percent of the sale proceeds shall remain in the account in perpetuity."  It also says that "all moneys in the fund are continuously appropriated to the Department of Human Services to carry out” the purpose of the trust.

I alerted our partners on the Community Mental Health Coalition that we needed to take action.  We learned that the final decision about the Trust would be made this week.   NAMI Oregon sent an alert to its members and many organizations and individuals sent messages to Ways and Means Committee Members asking that the Trust Fund be held harmless. 

Today, we received official word that only $400,000 in unspent interest would be taken from the Trust.  While not protecting all of the money, this keeps the principal of the Trust intact.

In this budget environment,  we have achieved a great victory for the mental health community.  A key component to recovery is stable housing.  Without it, people are often rendered homeless and are at high risk to experience crisis and institutionalization.  We have preserved both the principal and the principles of community housing and trust in government.

Yay Advocates!

Understanding how state government and its budgets work is never an easy task.  But it is a critical component of effective advocacy.

At this moment, advocates, law makers and state officials are all scrambling to make sense of not only the needs of government operations, social service clients, families and delivery systems, but they are also faced with the moving targets of a plummeting tax base, two state funding cycles, two federal funding cycles and a complex federal stimulus package.

The state Ways and Means Committee has almost finished its work in reconfiguring the state budget that will end on June 30 of this year.  Thanks to the federal stimulus package, cuts were tough ($311M) but not drastic.  But there may need to be further cuts in May if fiscal projections get worse.  And then there is the next budget cycle (2009-2011) in which the state will be billions of dollars short of being able to maintain current service levels.

Are there opportunities for new state revenues?  Are there chances to change inefficient or ineffective policies and services?  What should be our priorities?  We're all trying to figure it out.