Updated September 11, 2024

Policy and Regulatory Update Call Invite

OPCA’s Policy Team is inviting you to join them as they kick off OPCA’s Policy and Advocacy Update Call where they will provide monthly updates on important policy and regulatory issues that matter to health centers.

Attendees will have direct access to federal and state-level policy and regulatory updates from OPCA staff and national experts.

When: Every second Wednesday of the month at 12:00 PM Pacific Time (US and Canada)

Register in advance for this meeting.

After registering, you will receive a confirmation email (check spam/junk) containing information about adding the calendar invite and joining the meeting

State Update

Workgroups Wrap-up – OPCA’s Policy Team has been engaged in two high-profile legislative workgroups – CCO 3.0 Salon and Pharmacy Benefit Manager (PBM) reform – hosted by State Rep. Rob Nosse (D-Portland).

The last of three six-hour CCO 3.0 Salon meetings wrapped up with Rep. Nosse giving advocates marching orders to get their legislative concepts in order before September 20. These Salon meetings served as a venue for advocates, provider groups, and CCOs to surface pain points they experience with the current CCO model and examine where they shared common ground.

PBM reform wraps up later this month on September 18 after six intensive meetings. Similar to CCO discussions this working group provided a space for pharmacists, advocates, payers, and PBMs to discuss the PBM model and seek areas of agreement. Oregon has passed two PBM reform bills over the past five years and advocates seek to further regulate PBMs in the upcoming 2025 legislative session.

Quarterly Legislative Days – Just around the corner are September Legislative Days (Sept. 23 – 25). The Senate Committee on Health Care invited OPCA in partnership with the Hospital Association of Oregon to brief lawmakers on the 340B program. We see this as an opportunity to both ground lawmakers’ in how 340B works and to lift up the value of FQHCs as critical providers within Oregon’s health care delivery system.

Quarterly Revenue & Economic Forecast – August 28 saw legislators from both chambers’ revenue committees gathered for Oregon’s third revenue forecast of the year. There is one more forecast in late November before the 2025 Legislative Session kicks off in mid-January.

Economic outlook

In the last forecast in April, state economists spoke to inflationary concerns, stating “While we’re on the right path, we aren’t there yet.” Economists doubled down on their sentiment in August, noting that several economic indicators are heading in the right direction (such as cooling inflation, low unemployment, steady income growth, and increased job growth), but with interest rates still relatively high, the likelihood of a recession is not out of the question yet. They noted that the Federal Reserve has signaled a lowering of those rates next month, which is sooner than was anticipated during the last forecast.

That’s not to say that the picture is rosy across the state. For example, wildfires are currently taking a toll on agricultural centers within the state. Economists drew attention to a correlation between where the fires are burning this season and what the agricultural output is like in those regions. They shared that this could negatively impact this economic industry, depending on how the fire season closes out.

Despite wildfires, as well as layoffs being announced recently by Intel, Nike, and within the timber industry, economists underscored, “These green shoots of stronger gains indicate there is more potential upside than believed in some time.”

Revenue forecast

State economists previously announced that we are on track for a $583 million kicker. Today, that amount has adjusted up significantly, to $987 million. It is important to note that this amount can change many times over before it is finalized, including going away entirely, depending on what happens during the next tax season.

The General Fund has yet again increased as well. Lawmakers learned they have an additional $676 million from the last forecast, bringing up the total increase since the end of the last session to $1.9 billion.

Federal Update

Capitol Hill

Congress Returns – Members of Congress returned to Washington, DC this week. The most pressing business this work period is passing a Continuing Resolution to keep government open after the end of the fiscal year on September 30th before adjourning for October to focus on their campaigns. House Speaker Mike Johnson (R-LA) introduced a Continuing Resolution (CR) this week that would both:

  • Provide stopgap funding for the Federal government through some point in early 2025 (presumably to prevent Democrats from pushing through a major “omnibus” bill during the Lame Duck session), and
  • Include the Safeguard American Voter Eligibility (SAVE) Act, a bill sought by the Freedom Caucus that would require proof of citizenship to register to vote.

While the proposed CR is seen as a win for the House GOP’s conservative wing, it has already alienated six Republicans and has teed up a showdown with the Democratic-controlled Senate and White House, which both object to the voting bill.

SUSTAIN 340B – Last month we told you that the comprehensive 340B reform bill that the Group of Six bipartisan Senators have been working on for two years and was supposed to be introduced before the August recess would instead come out in early September. However, it seems to have stalled for the time being due to complicating factors which are likely minor relative to the size and scope of the proposal. We do not have a new estimate for when it will be released. More information will be coming soon.

Sen. Welch (D-VT) to introduce Senate companion to House bill banning contract pharmacy restrictions – Sen. Peter Welch (D-VT) is planning to introduce a Senate companion to HR 7635, the 340B PATIENTS Act, which was introduced in the House in March by Rep. Doris Matsui (D-CA). The PATIENTS Act would require drug manufacturers to ship 340B drugs to an unlimited number of contract pharmacies, without restrictions. HR 7635 currently has 10 cosponsors, all of whom are Democrats.

Several Oregon FQHCs have been contacted by Senator Merkley’s team asking them if they support the 340B PATIENTS Act. OPCA sees no harm in endorsing it, as the bill would be very beneficial for CHCs. However, be aware that it is considered politically “DOA”, due to opposition from drug manufacturers.

Workforce Innovation Act – Last month we told you that Sens. Wyden (D-OR) and Blackburn (R-TN) introduced the Health Care Workforce Innovation Act which would provide funding for health centers to create their own workforce training programs. In a recent blog post, NACHC highlighted Virginia Garcia’s Maria Loredo Workforce Development Program saying, [the Program] supports staff [in] pursuing education and certificate-level training that could directly benefit their organization.

This is just one example of why health center advocacy is so important and what can happen when we engage with decision-makers. Mark your calendars for Hill Day February 6, 2025

Policy & Regulatory

340B Rebate Model:  Drug maker Johnson & Johnson is plowing ahead with plans to convert 340B pricing for some drugs from an upfront discount to a rebate for some drugs — and doesn’t seem to be deterred by potential legal issues. Many 340B experts consider it a threat on par with contract pharmacy restrictions. To date, HRSA has prohibited manufacturers from implementing a rebate model, and a lawsuit seeking to override HRSA’s position has not succeeded.

Under the current discount model, CHCs pay a discounted amount for 340B drugs at the time of purchase.  Under the rebate model, CHCs and other covered entities would be required to pay regular market prices for their drugs upfront. After dispensing the drug, they would need to submit a rebate request to the manufacturer, including any data that the manufacturer demands.  Then they would need to wait for the manufacturer to approve the rebate request and send them the savings.  A rebate model would create enormous cash flow and administrative challenges for CHCs, and most CHC pharmacists report that it could end their 340B programs entirely.

Election Update

  • Senate – Before President Biden decided to withdraw from the race, the GOP stood to gain widely in November, since then, many Democratic seats are now more secure (e.g., OH, NV, AZ, MI, PA). However, MT and WV are still expected to switch from D to R.
  • House – Current polling has the public in favor of a Democratic House by nearly 3%. Like the Presidential race, however, national polling helps only a little in predicting the outcome of individual districts as each House district is unique and, combined with the GOP’s successes in the State legislatures to draw favorable lines, the GOP has a strong defense.

Contact OPCA’s Policy and Advocacy team

Policy & Governmental
Affairs Sr. Director
Danielle Sobel
503-228-8852, x248
dsobel@orpca.org

Governmental
Affairs Director
Marty Carty
503-228-8852, x239
mcarty@orpca.org

Health Policy Analyst
Erin Woods
ewoods@orpca.org