Oregon lawmakers have wrapped up this year’s legislative  session, dedicating millions to patch a big budget gap and giving wins to immigrant advocates, Planned Parenthood, rural hospitals and managed care organizations that serve lower-income Oregonians.

But few new programs were created in the six-week session, and most bills requiring state funding were either trimmed or killed by budget writers.

For patients, providers and health care systems, the session was mixed. Lawmakers passed bills to shore up the Bay Area Hospital in Coos Bay and help other struggling rural hospitals survive. They also approved proposals to expand the behavioral health workforce, give a state health care official more authority over vaccines and establish new rules to protect young people using chatbots from harming themselves.

But other proposals on curbing patient costs, protecting provider revenue and enhancing consumer safety died — along with a proposal requiring reports from pharmaceutical companies on their patient assistance programs.

“This was not a session that was dominated by health care,” Rep. Rob Nosse, chair of the House Health Care Committee, told The Lund Report.

A multi-million dollar budget gap loomed over the session, which meant that few big spending items got through. There were a few exceptions — with lawmakers agreeing to spend nearly $9 million more to keep Planned Parenthood clinics open — but several health care bills requiring state spending were downsized to get through. 

Here are some highlights from the session:

Bills affecting care

Democrats headed into the six-week session determined to pass more than a handful of bills protecting immigrants. They included Senate Bill 1570 on patients under arrest or threat of arrest by immigration authorities. It aims to protect the privacy of both their medical information and residency status while establishing guidelines for the way administrators manage immigration agents and keep them out of clinical areas. 

Under the bill, health care facilities are to designate restricted private areas for patient care, prevent administrators from divulging a patient’s immigration status unless required to do so by a court order and prohibit hospitals from retaliating against employees for giving patients state-backed information about their rights. 

The bill was a priority for the Oregon Nurses Association, following months of complaints by nurses at Legacy Emanuel Medical Center saying masked agents were roaming the halls, refusing to identify themselves and interfering in patient care. The bill was also prompted by the shooting and detention of people, including a 7-year-old girl, by immigration authorities in a Portland hospital parking lot.

But it initially faced stiff opposition from hospitals and safety net clinics, with the Oregon Primary Care Association that represents 33 safety net clinics arguing it was too broad. It also had a provision that would have allowed the state to revoke the licenses of hospitals found in violation of the provisions.

The chief sponsors and opponents reworked the bill, taking out the sanction and limiting what legal information can be given to patients.

“The way the bill landed, I don’t have any problem with it,” Marty Carty, government affairs director of the Oregon Primary Care Association, told The Lund Report. “I think it's going to protect workers. I think it's going to make sure we get the right information into the hands of the patient. So I think it's a win for the state.”

Oregon Nurses Association officials were also pleased. Tamie Cline, ONA president, told The Lund Report in a statement that it will ensure people can access services without fear.. 

“Mothers and fathers should be able to take their children to the emergency room without fearing for their safety,” Cline said. “Everyone deserves to be treated with dignity, humanity and compassion.”  

The bill awaits the signature of Gov. Tina Kotek and so does one that aims to enhance protections in Oregon for reproductive and gender-affirming health care. House Bill 4088 would build on the state’s existing “shield laws” that protect providers who perform abortions and gender-affirming care from out-of-state prosecution, investigations or extradition. The bill also expands protections that currently prevent the disclosure of their names and addresses to include their photo and home phone number. And it adds mid-wives to the list of protected providers.

The bill was championed by Democratic Rep. Lisa Fragala and passed by Democrats, with Republicans voting against it.

“The bill really aims to protect patients' ability to receive lawful, evidence-based, safe health care and providers' ability to safely provide care without fear of retaliation or punishment,” Fragala told The Lund Report. 

She said the bill has been needed since the U.S. Supreme Court reversed constitutionally guaranteed abortion rights in 2022, leading to federal attacks on abortions and gender-affirming care under the Trump administration. 

Several other states, including California, Connecticut, Colorado, Illinois, Maine, Massachusetts, New York, Vermont, Washington and New Jersey have also strengthened their shield laws since the court overturned Roe v. Wade. 

“This bill is about living up to Oregon’s values when those values are being tested by growing federal threats and out of state interference,” Fragala said in a statement. “It is about protecting providers’ ability to safely provide care, and it is about protecting patients’ ability to receive legal evidence-based health care.”

Hospitals, clinic and provider bills

Planned Parenthood took home a big win this session, with lawmakers approving an award of nearly $9 million to fill a gap created by the big congressional tax and spending bill passed last summer. The federal law stripped federal funding from Planned Parenthood for a year, including its 11 clinics in Oregon.

In response, the legislative Emergency Board approved an initial $7.5 million last year to shore up Planned Parenthood, and House Bill 4127, which was passed along party lines, adds nearly $9 million more to keep clinic doors open until July, when the federal funding ban ends. Planned Parenthood’s 11 clinics in Oregon serve tens of thousands of people, and a majority are low-income who depend on the organization’s clinics for a range of reproductive health care services.

Christopher Coburn, executive director of Planned Parenthood Action Oregon, the organization’s political arm, hailed passage of the bill. 

“This is a win for Oregon and everyone in our communities who depend on Planned Parenthood health centers for affordable, essential health care services, including cancer screenings, birth control, vaccines and STI treatment," Coburn said.

Planned Parenthood is not the only health care entity that’s faced financial difficulties. Oregon hospitals have also been struggling, especially those in rural areas. They tend to serve a higher percentage of low-income patients on the Oregon Health Plan, the state’s version of Medicaid, which usually pays less than commercial insurers.

But they play a crucial role in areas that often lack health care providers.

The 172-bed Bay Area Hospital in Coos Bay is the largest hospital on Oregon’s coast and a major regional employer. In January, for the first time in two years, it posted a profit. But hospital leaders said the repayment terms on the facility’s debt were untenable, and they sought the state’s help to refinance. 

House Bill 4075, which barely slipped through the Legislature, aims to patch up the hospital’s finances by using Treasury money from an unclaimed property fund — that helps fund state schools — guarantee a $44 million loan. 

The bill was backed by Rep. Boomer Wright, a Republican who represents the area, and drew strong support from other rural Republicans. But a slew of Democrats, who control the Legislature, voted against it, including the two top budget writers.

Many Democrats didn’t like the financing mechanism, Nosse said.

He said he pushed it through, working behind the scenes to pull the bill together and getting just enough Democrats to support it.

It passed the Senate on Friday by four votes.

“This is probably my best accomplishment this session,” Nosse said. “I’m keeping this hospital fully open.”

In her end-of-session comments to the media, Kotek noted the Democratic opposition to the funding mechanism behind the bill, saying it can always be revisited.

“Most importantly, the hospital has some certainty right now around their fiscal situation, and I think that's a win for southern Oregon,” Kotek said.

That bill awaits Kotek’s signature and so does House Bill 4047, another bill for rural hospitals. Championed by Stayton Republican Rep. Ed Diehl, it would allow a rural hospital at risk of closing to convert to an emergency hospital under a new state license. The designation was created by Congress in 2021 to keep vulnerable rural hospitals open by letting them downsize, shifting to only offering emergency and outpatient services. Though sanctioned by Congress, each state has to establish the license.

The bill drew support from the Hospital Association of Oregon and the Oregon Society of Health-System Pharmacists.

“This bill is essential to ensure that rural communities retain access to safe, reliable and clinically appropriate medication services,” the pharmacy association said in written testimony.

And another bill also rural patients is focused on pharmacies. House Bill 4131 would make medications more accessible to people in rural areas by allowing the use of mobile pharmacies. Under current regulations, pharmacies can only operate in a brick-and-mortar setting unless there is a public health emergency. This bill changes that, allowing safety net clinics, hospitals, county governments and certain pharmacies to run mobile pharmacies on an ongoing basis. 

The bill was backed by the Oregon Primary Care Association, the Hospital Association of Oregon, the Oregon Medical Association and the Oregon Primary Care Association, which represents 33 safety net clinics that serve a largely low-income population, including in areas that lack health care facilities. 

More than half of those clinics have mobile health care units that offer primary health care and dental care to farmworkers, tribes and to unhoused people in urban areas. But without the bill, they can’t provide medications. 

Carty of the Oregon Primary Care Association said the proposal is needed to prevent situations like a recent one involving a woman with a urinary tract infection. A mobile unit operated by Virginia Garcia Medical Center in Washington and Yamhill counties gave her a prescription but she didn’t have a car to drive to a pharmacy.

“She couldn't get it filled for four days and it turned into a kidney infection that required her to be hospitalized,” Carty said. “That's lost productivity for her employer and lost wages for her.”

Consumer and safety bills pass

Several health care bills that passed aim to support consumer access to health care.

Senate Bill 1598, which had a divisive ride through the session, is directed at easing access to vaccines. The bill, if signed by Kotek, will give the state health officer the authority to ensure consumers have access to specific vaccines while requiring insurance companies to cover them.

Nosse said it marks an incremental, but important change.

“Is it going to be earth shattering? No,” Nosse said. “But does it make government more responsive? Absolutely.”

The bill is a reaction to the Trump administration’s moves to restrict access to certain vaccines under Health Secretary Robert F. Kennedy Jr., a vaccine skeptic.

Another consumer bill aims to protect young people who interact with artificial intelligence chatbots, which have been linked to teen suicides. Championed by Reynolds, Senate Bill 1546 will require AI companies to inform users that they are interacting with artificial content and not a human. Chatbots would have to be programmed to be able to detect when a user is thinking of hurting themselves and send them to a crisis service, like 988 or a youthline.

The bill won unanimous support in the House and all but two Republicans in the Senate supported it. It awaits Kotek’s signature.

Another health care leader in the Legislature, Sen. Deb Patterson, who chairs the Senate Health Care Committee, also championed consumer bills. 

Senate Bill 1527, already signed by Kotek, will require insurance companies starting next January to pay for follow-up care after an abnormal Pap smear or testing for the human papilloma virus. That follow-up can cost $1,200 and is needed to determine whether the woman is at risk of developing cervical cancer.

Another bill championed by Patterson, Senate Bill 1575, aims to protect hospice patients from operators with a history of fraud or neglect in other states. The Oregon Health Authority will be in charge of stepping up oversight by reviewing new and renewing applications. 

The bill awaits Kotek’s signature along with House Bill 4107 on urgent care centers. That bill, from Eugene Rep. Nancy Nathanson, is designed to help patients needing urgent care by requiring clinics to list information about their services on their websites. The bill would mark the first move in Oregon to regulate urgent care clinics.

And another bill for consumers, Senate Bill 1571 from Reynolds, will close a loophole in Oregon’s tobacco laws by classifying any oral nicotine product as a tobacco product. The proposal targets nicotine pouches, which are popular among youth, barring their sale to young people. 

Reynolds also championed a bill this session to tighten regulations on cannabis edibles. Senate Bill 1548 would have required cannabis manufacturers to individually wrap edibles, limiting each portion to 10 milligrams of THC, or tetrahydrocannabinol, the psychoactive substance in marijuana. Portions now can contain up to 100 milligrams of THC.

The bill was aimed to prevent children from accidentally ingesting a high dose of THC and would have put Oregon in line with regulations in Washington state.

In hearings in a House committee, industry leaders opposed the bill, with one small owner saying he would have to spend $2 million on new equipment and would be put out of business.

And so it died.

Mental health bills adopted

Besides Reynolds’ bill on chatbots, lawmakers also tackled other issues related to mental health.

Aimee Kotek Wilson, the governor’s wife and chair of the Governor’s Behavioral Health Talent Council, played a leading role in a bill streamlining the credentialing process for therapists who need a license to practice. Right now, that process is lengthy and involves a lot of red tape. 

House Bill 4083 will create a centralized platform, curtail administrative work and allow more professionals to supervise those trying to enter the field.

“This is an important win for health care providers and for Oregonians waiting for care,” Kotek said in a statement announcing she had signed it.

Kotek has also signed Senate Bill 1547, which will create a new mental health license. The bill, from Sen. Lisa Reynolds, a pediatrician and chair of the Senate Committee on Early Childhood and Behavioral Health, will benefit graduates of the Ballmer Institute at the University of Oregon. After completing their training, they’ll be able to serve in the workforce as behavioral health and wellness practitioners, helping in classrooms and clinics.

House Bill 4069 also passed, requiring mental health clinics to develop and implement written safety plans, provided it’s signed by the governor.

Bills affect of Medicaid-funded Oregon Health Plan

The state’s 16 care organizations that manage the Oregon Health Plan notched a win with a bill backed by Nosse. House Bill 4039 was written to make the state’s funding process more transparent. The state’s insurer-like regional managed care entities, known as coordinated care organizations or CCOs, are paid a per-member fee each month to cover the physical, mental and dental benefits offered free to the one in three Oregonians on the Oregon Health Plan. Leaders of the care organizations have complained about that process, and one of them pulled out of Lane County earlier this year over complaints that the state’s rates announced for this year were too low, creating hassles and uncertainty for thousands of people.

Nosse worries that unless the rate process is more “palatable” for the managed care organizations, more of them will leave the system and create a crisis. 

The bill will require the Oregon Health Authority to be transparent about the data it uses in developing rates and obtain an independent review of its process. The bill also bans the agency  from adopting any major new initiatives that cost health care entities more than $1 million over the two-year budget cycle.

Nosse expects the bill, which would take effect immediately after being signed by the governor, will ease the coordinated care organizations’ concerns about the rate-making process..

“Hopefully that goes better this summer and fall and we don’t have another CCO pull out of a region,” Nosse said.

State moves against primary care continues

In raising rates to coordinated care organizations for this year, the Oregon Health Authority decided to pull money out of funds used to pay primary care providers, pediatricians and OB-GYN’s for improving the health of Oregon Health Plan patients by controlling measures such as blood pressure or diabetes. 

Some lawmakers raised concerns about that decision, which will take $170 million out of the pockets of providers who serve low-income people. It also has raised concerns about the viability of clinics and their ability to continue serving people in need.

The Legislature signed off on the plan despite the criticism.

“This quality incentive program was one way where we could drive towards better health outcomes,” said Marty Carty, government affairs director for the Oregon Primary Care Association, which represents 33 safety net clinics. “Without those resources, providers are left scratching their heads saying, ‘Well, we have a nurse practitioner or a nurse who's dedicated to our hypertension program or smoking cessation program and now how do we pay for that person?’”

In a hearing about the rate-setting bill, Reynolds, a pediatrician who cares for many low-income families when she’s not in Salem, spoke passionately about the effect of low Medicaid rates on her clinic. She said her clinic recently had to lay off several people and is currently facing an “existential threat,” she said.

“All feels a little rich to me right now,” she said.”Poor CCOs don't feel comfortable with how your rates are being administered or being figured out by OHA when the providers are left out, high and dry.”

Other losses and dead bills 

Another bill backed by Nosse concerning the management of the Oregon Health Plan didn’t pass. House Bill 4003 would have eliminated the prioritized list of approved services that determines what state and federal dollars can cover under Medicaid. Oregon is the only state with such a list, and state officials were concerned that it excluded coverage of some services that the federal government considers mandatory.

“I want our statutes to conform to federal regulation,” Nosse said.

The bill faced opposition from coordinated care organizations that manage Medicaid in the state. Former Gov. John Kitzhaber, an architect of the Oregon Health Plan, joined those testifying against it.

When it became clear the bill would fail, the agency’s director, Dr. Sejal Hathi, indicated to the committee in a letter that the Oregon Health Authority could ensure the Oregon Health Plan conforms to federal regulations through the rule-making process.

“The bill wasn't even necessary on some level,” Nosse said.

Others weren’t happy with Nosse’s umbrella package, House Bill 4040, which will make several dozen changes if signed by Kotek. It includes a provision that will reduce the number of people likely to benefit from hospital charity care.

That bill also includes a measure that will repeal a requirement that commercial insurers assign patients to a primary care provider. Industry leaders categorized the requirement as an administrative burden that doesn’t help patients access care.

But opponents worry it marks a move away from bolstering primary and preventive care. 

“I don't think it's going to be disruptive in the short term, but it's a concern,” Betsy Boyd-Flynn, director of the Oregon Academy of Family Physicians, told The Lund Report in an email.

Another insurance-related bill but one opposed by industry also died. House Bill 4054 would have required insurers to alert providers anytime they’ve used an automated program like artificial intelligence to downgrade billing codes, leading to a smaller reimbursement for the service. Providers and hospital executives said they lose substantial amounts of money when insurers “downcode” bills, and they said some appear to do it systematically.

Despite support from numerous providers and the Oregon Medical Association, the bill ran into a wall of opposition from the insurance industry.

Another bill that died was introduced to shed light on companies that have a lot of employees on the Oregon Health Plan. House Bill 4147 would have directed the Oregon Health Authority to investigate companies with more than 50 staff members that have employees getting their health care thanks to state and federal funds. The bill directed the agency to write a report about them, showing the number of people insured under the Oregon Health Plan or Healthier Oregon, which is for immigrants, by employer size, industry and region. 

The bill came in response to looming cuts to Medicaid rolls under a congressional tax and spending bill that will take effect next year. That bill will drive up state costs to administer the Oregon Health Plan, requiring members to reapply every six months instead of every two years, and likely lead to a cut in benefits.

The bill had strong union support.

“When workers and their families lack access to affordable employer-sponsored health coverage, Medicaid often becomes the coverage source that fills the gap,” said a letter from nine unions and health care organizations submitted by Matt Swanson, Oregon State Council of the Service Employees International Union, SEIU. “Policymakers cannot effectively manage a system if they do not understand the drivers of cost and coverage within it.”

But businesses said the bill went too far. Written testimony from Oregon Business & Industry, a trade group representing 1,600 companies, said the bill would unfairly target companies.

“Medical assistance enrollment is often driven by household size, family circumstances or life events, not solely by wages or employer benefits,” its testimony said. “Publicly tying Medicaid enrollment to specific employers creates reputational risk based on factors that employers do not control. If the goal of this bill is to provide legislative insight, aggregated and contextualized analysis would be more accurate and less likely to mislead the public.”

With Democratic support, the bill passed the House and was approved by the Senate Rules Committee and was poised to go to the full Senate, championed by Sen. Sara Gelser Blouin.

She told The Lund Report that because of Republican opposition, it ran out of time, but she hopes it comes back next year.

“This was one of the bills I was most excited about this session,” she said. “The data seems so important to inform policy decisions moving forward.”

Another bill that didn’t make it would have placed limits on state audits of mental health therapists and counselors. House Bill 4028 won unanimous support from the eight-member House Behavioral Health Care Committee and passed the House but died in the Senate amid potential conflicts with federal Medicaid policy and concerns from Medicaid managed care organizations about shortened timelines for audits.

“We have competing theories from different lawyers about what Medicaid requires with regard to audits and record keeping,” Nosse said. “We ran out of time to reconcile the competing theories.”

He said it’s likely to be reintroduced next year.

And finally, a proposal targeting the pharmaceutical industry, Senate Bill 1528, also died. It would have required reports from pharmaceutical companies on their patient assistant programs. These programs are designed to cut the cost of expensive drugs for low-income people though critics say they are part of a strategy by manufacturers to keep prices high.

The bill, from Oregon’s Prescription Drug Affordability Board, would have required pharmaceutical companies to report on the number of Oregon consumers served by programs, eligibility criteria and the total value of the assistance.

Lobbyists voiced strong opposition to the proposal, saying it would require them to divulge “confidential and proprietary information” and verge into areas being litigated.

It passed the Senate Health Care Committee and full Senate on a party-line vote but then died in the House Rules Committee where it was never called up for a vote.