By William Street, HD 40 Co-Leader
In what appears to be a clear violation of the standards of the office of secretary of state, the Oregon official charged with overseeing all elections in Oregon, Secretary Richardson has mastered the Trump administration’s “conflict of interest” ethos.
In a newsletter issued November 29, 2017 he writes:
Soon Oregon voters will be considering whether or not to approve tax increases intended to provide additional funding to the OHA. With such abysmal examples of OHA misfeasance and obfuscation, OHA faces tough questions about its credibility and its ability to appropriately spend the money it is provided.
This is clearly an appeal to voters to vote NO on Measure 101, a bipartisan health care bill designed to protect more than 60,000 Oregon children and stabilize insurance markets for millions more.
This raises an interesting question: Is the situation so bad as to warrant the secretary of state violating his oath of office, or is this pure politics? The Democratic Party of Oregon has filed an election complaint against Secretary Richardson for misusing public funds to electioneer.
The secretary would have voters believe that the Oregon Health Authority (OHA) is wasting huge percentages of money, thus justifying his entry into politics with official state communications. A review of the actual audit provides a very different picture.
What the audit acknowledges but the secretary of state’s newsletter fails to is:
- Medicaid eligibility in Oregon grew from approximately 600,000 individuals in 2013 to more than 1 million by the end of 2014, where it has remained.
- In 2015, Oregon’s PERM FFS error rate was estimated to be about 9 percent, which is lower (emphasis added) than the national average.
- CCOs (Coordinated Care Organizations, i.e. network of private providers) are required to develop their own policies and procedures for detecting fraud, waste, and abuse. These policies vary considerably between the CCOs, with some having strong written documentation and reported procedures, while others lacked sufficient detail.
- If OHA had requested additional information about each individual’s state of residency and each individual was deemed ineligible as a result of that process, this data match could have potentially yielded approximately $645,000 in savings ($150,000 state funds). These estimates do not account for staff costs, but the costs to investigate the eight matches per week would likely be less than the potential savings.
In summary, the Oregon Health Plan grew by double digits in a very short time yet has an error rate BELOW the national average. Private providers for whom fraud is not a priority are expected to do better, and even if all out-of-state fraud was caught, it is likely that it would cost almost as much as it would save.
The out-of-state cases could be truly misleading. The audit documents several cases where those in need of health care received it, but then it was discovered that they were from another state, defined as having a driver’s license from another state. The audit spends much time documenting how out-of-state driver’s license holders received health care in Oregon.
Here’s just one of a number of problems with this line of accusations. Think about your child going to college in another state. After their car has been in that state for a few months, they are issued a ticket. In response to the ticket, they change their registration, which in some bureaucracy someplace changes their legal residence. Yet they are still Oregonians. Their primary residence with their parents is still in Oregon. So they are home on summer vacation, get sick and go to their family doctor. The doctor’s office asks if they still live at home. They reply they do. Service is provided and, Oops, the Oregon Health Plan has now violated the regulations by giving medical services to a nonresident.
Thus, what the secretary of state’s newsletter could just as easily and perhaps more accurately have said is:
- Despite a growth of more than 60+ percent, the Oregon Health Plan has a LOWER error rate than the national average.
- The main problem appears to be with private providers putting medical care as a higher priority than accounting procedures, and,
- Even though hiring more staff to monitor the program will just barely cover the costs of the audits, we recommend placing accounting procedures ahead of providing medical care.
What wasn’t said in the audit or by the secretary of state’s newsletter are the most important observations. Private for-profit health care is inefficient. It costs more to monitor abuse than to simply provide care to those who need care. Funding Measure 101 will save lives and stabilize insurance markets, which is important for millions of Oregonians. But it is not the solution. The solution is single payer health care or a national health service. Not because it’s more efficient (it is), not because it provides superior care (it does), but rather because it is the moral and ethical way for the richest country in the world to treat its citizens.