Category: Healthcare

That's it, we're going on a hunger strike

Fresh Spinach for Indifferent Students: Oregon’s Costly Farm-to-School Program

By Helen Cook

When did you last hear a child profess his love for spinach?

Oregon’s Farm-to-School program awards grants to school districts across Oregon to give them the funds needed to purchase fresh foods from local farms and vendors. Advocates hope that by using the words “fresh” and “local,” K-12 students will nurture a healthier taste for fruits and veggies. This hope prompted legislators to budget almost $15 million for the program at the end of the 2019 session.

This is a significant increase from the program’s $200,000 budget in 2012, largely because legislators rephrased the bill to allow entities separate from Oregon school districts to accept grants. This technical rewording allows for summer meal programs, nonprofits, and even the local vendors selling food to the districts to accept grant money.

But frozen foods benefit students more than local produce does. Frozen fruits and veggies have equal or superior nutritional value and lower costs. This is important for school districts who prepare meals by the thousands.

Since the program’s main benefit is not Oregon’s students, I suggest the state reevaluate the expensive Farm-to-School program to be more cost-effective and call this current grant program what it is: a subsidy for local vendors.

Helen Cook is a Research Associate at Cascade Policy Institute, Oregon’s free market public policy research organization.

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Reform of Oregon’s Foster Care System Is Long Overdue

By Justus Armstrong

Are we failing Oregon’s foster kids? A January audit from the Secretary of State uncovered serious shortcomings in how Oregon’s Department of Human Services has handled foster care, including chronic mismanagement and irresponsibility, overburdened caseworkers, and a common practice of children with nowhere else to stay having to sleep in hotels or their caseworker’s office.

Oregon’s child welfare system is deeply flawed and in need of reform. Many internal reforms to Oregon’s DHS have been recommended, but Oregon could take additional steps to improve the situation by contracting out child welfare services to private agencies. Doing so would relieve the overburdening of the state agency and allow other organizations and members of the community to assume responsibilities that the state has failed to fulfill.

Other states have already implemented privatization with promising results. After shifting to a privatized child welfare system, Kansas saw a decrease in the average length of stay in foster care and an increase in adoptions; and Michigan was able to relieve their overburdened caseworkers while saving taxpayers’ money.

It will take careful effort to implement a similar system in Oregon, but making our state a safer place for foster kids is long overdue. Privatization provides an opportunity for substantial change in the right direction, and we need change now more than ever.

Justus Armstrong is a Research Associate at Cascade Policy Institute, Oregon’s free market public policy research organization.

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Direct Primary Care Puts Patients First, Lowers Health Care Costs

By Justus Armstrong

Could forgoing health insurance make health care more affordable? That’s the approach taken by many physicians practicing direct primary care, or DPC, an emerging medical movement that seeks to cut out the middleman and put patients first. Instead of billing insurance for individual services, physicians charge a regular fee as low as $60 a month directly to patients, increasing patient access and letting doctors focus on quality of office visits over quantity. Under a direct primary care model, your doctor is more available, with easier appointment scheduling and direct access to medical advice via phone, text, or email. A better doctor-patient relationship allows more personalized care, and research into DPC has yet to find a single instance of malpractice.

Health care without a third party brings entrepreneurship to medicine and saves patients money. While most direct primary care providers recommend patients carry a high-deductible insurance plan to protect against emergencies, taking insurance out of the equation for regular medical expenses allows physicians to reduce their overhead and provide better quality at a lower price.

Oregon is home to many direct care facilities; but current law requires direct providers to obtain a separate license through the state insurance agency, making direct primary care unnecessarily difficult. Let’s get rid of the red tape and take health care in a new direction.

Justus Armstrong is a Research Associate at Cascade Policy Institute, Oregon’s free market public policy research organization.

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Right to Try Goes National

By Steve Buckstein

Last week President Trump signed a national Right to Try law, allowing terminally ill patients the right to try drugs that have gone through part of the FDA testing process but are not yet approved.

In 2015 Cascade Policy Institute helped craft Oregon’s Right to Try law, but with two troubling restrictions. First, patients must be 18 years of age or older; and second, “in a physician’s reasonable medical judgment” patients will die within six months.

Neither of these restrictions is in the new federal law. One of the witnesses at the bill signing was Diego Morris of Arizona. Diagnosed with a deadly form of cancer when he was just 11 years old, Diego was denied a possible treatment because it was not approved in the U.S. It was, however, approved in other countries; so his family spent months in England where Diego was treated. Years later, he is still cancer-free.

Diego came to Oregon in 2015 to help us pass Oregon’s law. When someone asked him whether such laws offer false hope to desperate patients, this then-fourteen-year-old teenager answered: “There is no false hope, only hope.”

We hope that as legal issues are clarified, the new national law will “trump” Oregon’s law and offer all terminally ill Oregonians real hope for a better future.

Steve Buckstein is Senior Policy Analyst and Founder of Cascade Policy Institute, Oregon’s free market public policy research organization.

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If Health Care Becomes a “Fundamental Right,” Who Pays for It?

By Steve Buckstein

The Oregon House of Representatives has voted for HJR 203, which would add a section to the Oregon Constitution making health care a “fundamental right.” If passed by the Senate, voters will be asked in November to put this language in our Constitution:

“It is the obligation of the state to ensure that every resident of Oregon has access to cost-effective, medically appropriate and affordable health care as a fundamental right.” 

I object to defining health care as a right on a philosophical level, because in America rights don’t come from government; government protects our natural or God-given rights. But on a political level, I understand that government tries to grant such rights all the time.

A key argument against this proposal is the recognition that a “fundamental right” to health care would seem to trump everything else, since the Oregon Constitution doesn’t currently recognize any other “fundamental rights.” If the legislature tries to make good on this “fundamental right,” what happens when voters reject the new taxes needed to pay for it?

The unintended consequences of codifying health care as a “fundamental right” are almost endless. But that’s the way the game is played for now, and the next inning will play out in the Oregon Senate before the end of this short legislative session.

Steve Buckstein is Senior Policy Analyst and Founder of Cascade Policy Institute, Oregon’s free market public policy research organization.

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Why Health Care Should Not Be Defined as a “Fundamental Right”

By Steve Buckstein

The Oregon House of Representatives has voted for HJR 203, which would add a section to the Oregon Constitution making health care a “fundamental right” of every Oregonian. If passed by the Senate, Oregon voters will be asked in November to put this language in our Constitution:

“It is the obligation of the state to ensure that every resident of Oregon has access to cost-effective, medically appropriate and affordable health care as a fundamental right.”

Cascade Policy Institute board member Michael Barton, Ph.D. and I testified in opposition to earlier versions of this legislation. Dr. Barton gave us a history and philosophy lesson, explaining how the American government was founded on the principle that government does not grant rights, it simply protects our inalienable rights such as those to life, liberty and the pursuit of happiness. He explained that our rights define what we are free to do without interference; they are not goods or services that others must provide for us. He expounded on these concepts in his 2006 Cascade Commentary, “Right to Health Care Violates Individual Rights.”

While I object to defining health care as a right on a philosophical level, on a political level I understand that government tries to grant such positive rights all the time. In this case, passing this constitutional amendment will make some people feel good. It may say that we care deeply about the uninsured; but it only gives intellectual lip service, if that, to the matter of future costs.

More and more people will say, “I have a right to not care about the costs, because I have an unqualified right to health care.”

Define health care as a fundamental right, and cost control will go out the window. Witness Oregon’s public school system, where education is supposedly “free” and yet taxpayers are asked to pay more and more for little (if any) improvement in real quality. As in education, health care innovation will become mired in bureaucratic process.

And who will have the task of controlling the economics? Is the Oregon legislature going to assume responsibility for that? An elegantly composed commission? A superhuman future governor? Or do we assume private insurance companies will simply figure it out?

A key argument against this proposal is the recognition that a “fundamental right” to health care would seem to trump everything else in the Oregon Constitution. If the legislature comes up with a plan to make good on this “fundamental right,” what happens when voters reject the new taxes needed to pay for it?

Since neither education, transportation, criminal justice, nor any other state government service is defined as a “fundamental right” in our Constitution, then funding for these services might be cannibalized to fund the one “fundamental right” in that document, health care. But voters won’t be presented with this reality when marking their ballots in November. This potential clash of essential services may make for strange bedfellows in future election battles. Will the teachers union, for example, want to lose funding to the health care providers?

The unintended consequences of this proposal are almost endless. But that’s the way the game is played for now, and the next inning will play out in the Oregon Senate before the end of this short legislative session. Stay tuned….

(This article is an update on a legislative post, published here, regarding an earlier version of this legislation which was considered in 2008.)

Steve Buckstein is Senior Policy Analyst and Founder at Cascade Policy Institute, Oregon’s free market public policy research organization.

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Measure 101 Deserves Your No Vote

By Steve Buckstein

By now you should have your ballot for the January 23rd statewide election asking you to vote Yes or No on Measure 101. It would let Oregon state government raise some additional $300 million this biennium on health care after it has already misspent several times that amount in recent years.

In addition to wasting $300 million on the Cover Oregon website that failed to sign up one person for health insurance, the state has been paying $280 million a year for nearly 55,000 Medicaid recipients recently found to no longer qualify or who failed to respond to an eligibility check. The state also overpaid health care organizations some $74 million over three years to provide expanded Medicaid coverage to some Oregonians.

More recently we learned that the state may have “erroneously paid, allocated, inaccurately recorded or over-claimed $112.4 million in health care funds.”

Measure 101 will tax some hospitals and add a tax to the health care premiums of many Oregonians. It will raise the cost of health care as these taxes are passed on to consumers and patients. These taxes are unfair, hitting some while exempting others. Furthermore, based on the recent failures of the state to spend health care monies properly, there is no assurance that this new money will be spent properly, either.

Measure 101 deserves your No vote.

Steve Buckstein is Senior Policy Analyst and Founder of Cascade Policy Institute, Oregon’s free market public policy research organization.

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dont allow skimming of medicaid funds for unions

Don’t Allow the Skimming of Medicaid Funds for Unions

By Aaron Withe and Steve Buckstein

Each year, hundreds of millions of dollars are skimmed off the top of Medicaid payments intended for some of society’s most vulnerable citizens and used for purposes never envisioned by the program’s supporters. Most of us can agree this is wrong.

After all, the whole point of Medicaid is to help low-income individuals—particularly the elderly and disabled—whose lives, dignity and comfort all benefit from the program.

Unfortunately, many politicians don’t see it this way. Oregon is one of nine states that allow labor unions to get a slice of the Medicaid pie by skimming union dues from the Medicaid paychecks of home-based caregivers.

The home-care program allows Medicaid-eligible individuals to avoid institutionalization by receiving daily living assistance in their own homes. In Oregon, Medicaid clients employ approximately 30,000 home-care and personal-support workers (HC/PSWs)—often their own family members—who are compensated through the program for providing basic assistance.

In 2000, however, the Service Employees International Union (SEIU) successfully inserted itself into that arrangement.

It funded a ballot measure that allowed HC/PSWs to be unionized on the shaky logic that their Medicaid payments made them “public employees.” As a result, the state deducts an average of $500 per year in SEIU dues from each caregiver’s Medicaid payments and sends it to SEIU before the assistance money ever reaches the caregiver.

In states where this is happening, caregivers and their clients are understandably upset. Because unions have a limited role to play between family members in a home-based setting, many feel the idea of paying for traditional union services just doesn’t make sense.

Some have pursued legal action to prevent the worst of the dues-skimming abuses. In 2014, the U.S. Supreme Court took up the Harris family’s case and ruled that “partial-public employees” like HC/PSWs could no longer be forced to pay a union against their will.

But it hasn’t been enough. Although the Harris decision technically allows HC/PSWs to make their own choice about whether to pay union dues, Gov. Kate Brown’s complicit administration has continued skimming dues from the Medicaid payments, making it easy for SEIU to keep thousands of caregivers paying dues against their will.

Kyle Osburn, a Portland resident who cares for his disabled son, was one such caregiver. Kyle never signed up for SEIU membership, but the state confiscated dues from his Medicaid checks anyway. Others, like Diana Berman, tried to cancel their union payments after Harris but were told they weren’t allowed to resign until an arbitrary 15-day annual window.

Thousands of caregivers in Oregon remain victimized by the SEIU’s dues-skimming scheme.

And Oregon isn’t alone. At least eight other states deduct dues from Medicaid checks and divert the money into union bank accounts. This practice inevitably goes hand-in-hand with shocking reports of what unions will do to obtain “authorization” for such payments, including forging caregivers’ signatures and pressuring them to sign union cards.

It’s clear federal action is needed to protect the integrity of Medicaid, its beneficiaries and caregivers nationwide.

The U.S. Department of Health and Human Services should immediately adopt administrative rules to ensure that Medicaid dollars are not misdirected toward union dues. Congress could also make it illegal to skim Medicaid funds in this way.

Either move would protect caregivers’ freedom to join a union if they chose to. Preventing state governments from deducting dues from Medicaid checks would make it far easier for caregivers to exercise their rights under Harris, but would in no way prevent caregivers from joining a union and paying dues on their own.

Medicaid dollars should be preserved for improving the lives of disabled, elderly and other Americans in need. They shouldn’t be diverted to special interest groups that often use those dollars for political gain, like propping up the politicians who skim dues for them in the first place.

Federal policymakers should take action now.

Aaron Withe is the Oregon director of the Freedom Foundation, a think and action tank in Salem. Steve Buckstein is Senior Policy Analyst and Founder of Cascade Policy Institute, Oregon’s Portland-based free market public policy research organization. This article originally appeared in The Bend Bulletin on December 8, 2017.

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Vote NO on Health Care Tax Measure 101

Vote NO on Health Care Tax Measure 101

By Steve Buckstein

Oregonians will have the opportunity in January to vote No on Ballot Measure 101, thus rejecting new taxes that the state legislature and the governor tried to impose on health insurance premiums and hospital services. While these and other taxes are meant to shore up state funding of Medicaid services to low-income Oregonians, it has become clear that the state has been misspending such funds for years.

Voters’ Pamphlet statements for and against Measure 101 were due by November 13, and Cascade Policy Institute submitted an Argument in Opposition which you can read below. In it, we noted three ways that the state has mismanaged over $650 million in health care funds entrusted to it by state and federal taxpayers. But, that may be far from the final number.

On November 17, four days after the Voters’ Pamphlet deadline, Oregonians learned that the state may have “erroneously paid, allocated, inaccurately recorded or over-claimed $112.4 million in health care funds, according to a letter Oregon Health Authority (OHA) Director Pat Allen sent to Oregon Gov. Kate Brown. Allen also told state legislators that “the state was likely to see more processing problems come out of the state’s health agency.”

These revelations were too late for Cascade, or anyone else, to include in our Voters’ Pamphlet statements. So voters will need to keep up with all the reasons to vote No on Measure 101. More reasons may emerge when the Secretary of State releases an expected audit of the OHA by early December.

An early version of the Voters’ Pamphlet for Measure 101, including the full text of the Measure and Arguments in Favor and in Opposition can be found at the Secretary of State’s website.

Here is Cascade’s Argument in Opposition:

STOP NEW SALES TAXES ON HEALTH INSURANCE PREMIUMS
AND HOSPITAL SERVICES

Vote No on Measure 101.

Oregon state government has a long history of mismanaging “other people’s health care dollars,” including:

  • Wasting $300 million federal tax dollars building a website, Cover Oregon, that wasn’t able to sign up a single person for health insurance.
  • Paying $280 million a year for nearly 55,000 Medicaid recipients recently found to no longer qualify or who failed to respond to an eligibility check.
  • Overpaying health care organizations $74 million over three years to provide expanded Medicaid coverage to some Oregonians. The state initially only asked for $10 million of those overpayments back, and under political pressure eventually asked for the rest.

As one Oregon economist notes about the taxes in Measure 101:

“The law explicitly allows the new taxes on health insurance providers to be passed on to consumers. With these new taxes, that Silver ACA plan will cost about $625 more in 2019 than in 2018. It’s not just 40-year-olds who will get hit with the insurance tax. Nearly 12,000 college students…will pay the tax. Small group employers…will pay the new tax.

“Taxes on hospitals will raise the costs of care across the board….The cost of these taxes also will be passed on in the form of higher deductibles and premiums. Even if you don’t go to the hospital, you will be paying the hospital tax through higher insurance prices.”*

The cost of health care is already too expensive for many Oregonians. Don’t let the state add even more taxes onto services that are expensive enough already, especially when it has such a poor track record spending the health care tax money it already gets from us.

Say No to these new health care sales taxes.

Vote No on Measure 101.

*source: Health Care Tax Would Hurt Middle Class
at: CascadePolicy.org/Health-Care

(This information furnished by Steve Buckstein, Cascade Policy Institute.)

Steve Buckstein is Senior Policy Analyst and Founder of Cascade Policy Institute, Oregon’s free market public policy research organization.

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When Is a Health Care Tax Not a Tax?

When Is a Health Care Tax Not a Tax?

By Steve Buckstein

Oregon state legislators who voted for you to pay higher health insurance premiums and higher hospital costs don’t want you to think you’ll be paying more because they raised taxes. In their words, they aren’t raising taxes at all; they’re simply putting assessments on these services and letting insurers and hospitals pass on the extra costs to you.

Three legislators who don’t want you to pay these higher costs collected more than enough voter signatures to place Referendum 301 on the ballot in January, so you can vote No and stop these new taxes from going into effect.*

The problem is, when you see your Voters Pamphlet and ballot, you won’t see the words “tax” or “taxes” anywhere in the official statements. You’ll only read about “assessments.” Apparently, tax supporters think you’re more likely to approve them if you don’t believe they’re taxes at all.  Assessments sound so much more palatable, don’t they?

Referendum supporters have asked the Oregon Supreme Court to require that the official statements refer to taxes, not just assessments. Whether this happens or not, hopefully enough voters will understand that they’re being asked to impose new taxes on services that are expensive enough already, and vote No. Learn more at StopHealthCareTaxes.com.

*Referendum 301 is now known as Measure 101 on the January 23, 2018 Oregon ballot.

Steve Buckstein is Senior Policy Analyst and Founder of Cascade Policy Institute, Oregon’s free market public policy research organization.

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