Its chief sponsor says he is optimistic that state lawmakers will succeed next year in reinforcing Oregon’s limits on corporate ownership of medical practices, after his bill cleared the House but died in the Senate this year.
Rep. Ben Bowman of Tigard said that a work group already has met three times to discuss various aspects of a new bill for the 2025 session, which opens Jan. 13.
“We’ve had over a hundred stakeholders involved in these meetings,” he said in response to a recent inquiry. “I’m optimistic that we will pass a strong bill in 2025 that keeps providers in charge of medical care.”
Among the aspects discussed, he said, are the relationship between professional corporations and management service organizations — the latter normally carry out non-medical functions, such as scheduling and billing — the regulation of medical providers through the use of noncompetition agreements, and direct employment of physicians by corporations.
Assuming he is re-elected to a second term and Democrats retain their majority in the House, Bowman also will bring something else to the table in 2025. After the 2024 session he became leader of the Democratic majority, which now numbers 35.
Bowman took part in a discussion about the potential legislation at a May 10 forum sponsored by the Salem City Club. He was joined by Hayden Rooke-Lee, senior health care fellow for the American Economic Liberties Project who is based in Eugene, and state Sen. Deb Patterson, D-Salem, who led the Senate Health Care Committee.
Origins of the limits
The day before that forum, Dr. Bruce Goldberg touched on the topic during an appearance at Willamette Women Democrats in Lake Oswego. He said there was a reason that states instituted limits on corporate control of medical practices nearly a century ago.
“They realized there was a clear conflict of interest in terms of having coal miners cared for by doctors who were paid for by the coal companies,” Goldberg said. “States decided that practices should be owned by the people who provided care.”
Goldberg led the Oregon Department of Human Services from November 2005 to January 2011, and when it was made a separate agency, the Oregon Health Authority from 2011 to 2014, when he resigned. Since 2016 he has been a professor in the School of Public Health run jointly by Oregon Health & Science University and Portland State University.
Goldberg joined Bowman and former Gov. John Kitzhaber, a physician who continues to speak out about health policy, during a Feb. 7 House hearing on Bowman’s original bill.
Goldberg said a series of events in recent years led to the erosion of those limits, often by corporations and private equity firms recruiting physicians to serve as fronts for ownership. He said the change has led to an emphasis on generating more money and reducing costs by raising fees and cutting staff.
“Quality suffers,” he said. “We have to figure out how to do something about that.”
“I want to go into a clinic that is run efficiently and effectively – but also one that delivers good-quality care and has the right ratios of doctors and nurses to patients,” he added. “We need to pay attention to this. It is happening at speeds none of us imagined even a year ago.”
Oregon events
Among those events:
• In 2020, Optum — a subsidiary of UnitedHealth Group, a for-profit company — purchased Oregon Medical Group in Eugene and Springfield.
• In 2021, Optum purchased GreenField Health clinic in the West Haven-Sylvan section of Portland.
• In 2022, Amazon bought One Medical — a primary care provider with metro area clinics in Cedar Hills, downtown Portland, North Williams Avenue and the Pearl District — for $3.9 billion.
• Earlier this year, Optum won emergency approval from the Oregon Health Authority for a takeover of Corvallis Clinic.
• The agency has just started a review of UnitedHealth’s acquisition of Amedisys, a home health and hospice caregiver.
“What we have now is a tangible example of the status quo that is restricting access to care,” Bowman said during the Salem City Club discussion. “It means in Eugene that more than 10,000 people do not have a primary care doctor. That is what is restricting access to care — not our reforms, which are trying to reassert our existing law that says physicians need to be in charge.”
Bowman’s 2024 legislation (House Bill 4130) cleared the House on Feb. 22 on a 42-12 vote, including nine Republicans in support. The bill would have set seven years, until 2031, for compliance. It exempted hospitals and telehealth. Bowman said he’s looking at a much shorter deadline for compliance, no more than four years, in any new bill.
The 2024 bill stalled in the Senate Health Care Committee after opponents got employees to testify in person or in writing. (Neither UnitedHealth Group nor Amazon testified directly, but CVS, one of the nation’s largest pharmacies, did so through a lobbyist.)
Patterson, the Senate committee chair, said during the discussion she was approached by some employees afterward who told her they could not speak out publicly for fear of losing their jobs.
“I want you to know I support this work to try to protect the doctrine that is already in law, which says health care providers get to be in charge of health care decisions and treatment,” she said.
‘A lot of work’
Bowman said it was Rooke-Lee who brought the issue of increased corporate ownership to his attention — and that he sought advice from Kitzhaber, who Bowman interned for during Kitzhaber’s successful comeback for governor in 2010.
Rooke-Lee said that even if Oregon passes legislation in 2025, it’s not the only challenge for independent medical clinics.
“It is recognized that it is increasingly difficult for physician practices to survive in this complicated regulatory environment,” he said, given the increasing demands by insurance companies and government agencies. “Wrapping our arms around the health care system and trying to bring it back into the hands of patients, communities and physicians requires a lot of work.”
But the two major federal health insurance programs account for almost half of Oregon’s population. Medicare, which serves people 65 and older and some people with disabilities, has under 1 million recipients. Medicaid, in the form of the Oregon Health Plan for low-income people, has about 1 million recipients. (Some will lose coverage as a result of a federally required review, which started after pandemic restrictions on enrollment charges were lifted, but lawmakers have set up an alternative for basic coverage.)
“Fundamentally, it’s our money paying for this system,” Rooke-Lee said. “The question is not whether government is getting more involved in it, but how we want to structure it.”
pwong@pamplinmedia.com
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