A bill curtailing the influence of private equity on Oregon medical practices appeared poised this week to claw its way past the legislative finish line.
House Bill 4130 would prevent private equity firms from controlling medical practices and dictating patient treatment or making hiring decisions, though clinics could hire outside administrators to handle paperwork and the bill would exclude telemedicine providers, hospitals and long-term care facilities.
Democrats passed it out of the House last month, and they approved it in the Senate Health Care Committee. Normally, it would have gone to the Senate floor but it was referred to the Rules Committee for more discussion, and Rep. Ben Bowman, D-Tigard and its chief sponsor, made a few clarifications in response to various comments.
Sen. Kate Lieber, D-Beaverton, who presided over a hearing this week as chair of the Senate Rules Committee, gave the 45 people signed up to testify about 90 seconds to speak and then called for a vote.
“I think the process in many ways has worked,” Lieber said. “We slowed it down. We took it into the Rules Committee and Representative Bowman made some significant changes.”
The bill was approved, 3-2, along partisan lines. From there it should have moved on, but it’s stuck, with Republicans saying they will file a minority report to advance their version of the bill.
A minority report stalls the process, forcing at least one day to pass before the bill is read on the floor and receives a vote. With the deadline for minority reports at 5 p.m. Thursday, that means it wouldn’t be able to be read in the Senate until Friday, and, unless Republicans agreed to have the rules suspended, a vote couldn’t take place until Saturday.
Lawmakers might be done by then, which means the bill would die.
Bowman said in an email he won’t give up.
“This bill maintains Oregon’s tradition of local control, and both Democrats and Republicans are joining the medical community to support this bill,” Bowman said. “It passed the House with 42 members voting in favor and I hope my colleagues in the Senate have an opportunity to vote for it, too. If that doesn’t happen this session, I’ll bring it back because no corporation or private equity firm should be able to get between a patient and their doctor.”
The bill has plenty of support among physicians in Oregon, including former Gov. John Kitzhaber, a former emergency physician, and Dr. Bruce Goldberg, former head of the Oregon Health Authority. It also drew support from groups including the Oregon Medical Association and the Oregon Nurses Association and from outside the state, with a letter from the Federal Trade Commission supporting the bill’s ban on non-compete agreements which can force a physician to have to move to practice medicine.
Dr. John Moorhead, an Oregon emergency physician who testified this week on behalf of the Oregon Chapter of the American College of Emergency Physicians, said he’s been in practice in Oregon for 46 years.
“I’ve seen a lot of changes, and the involvement of private equity and venture capital is amongst the most concerning changes that I’ve seen during my career,” Moorhead said. “They purchase equity with the sole intent of increasing profits, controlling hiring practices, substituting non-physicians for physicians, implementing performance metrics that are impossible to meet and increasing burnout in physicians.”
Rep. Maxine Dexter, D-Portland and a physician, also testified in favor of the bill.
“This is about the longstanding commitment to physicians,” Dexter said. “Oregon cannot afford to miss this opportunity this session.”
But others were opposed, like Sen. Cedric Hayden, a dentist and R-Fall Creek, who proposed that the bill be gutted and turned into a study.
“Let’s put on the brakes; let’s study this a little bit,” Hayden said. “Medicine is expensive. We need partners.”
If passed, the bill would be a landmark. Researchers at the Commonwealth Fund, which promotes equitable health care, told the Capital Chronice they know of no other state that limits private equity in health care.
At stake are millions of dollars in profit and the state of health care in Oregon. The state has not been swept by private equity buyouts of medical practices, though Amazon bought One Medical, a primary care practice with five offices in Oregon, for $3.9 billion two years ago. And Optum, a subsidiary of United Healthcare and the largest employer of physicians in the U.S., bought Oregon Medical Group in Eugene and GreenField Health in Portland and is trying to purchase the Corvallis Clinic, an 11-clinic physician-owned system in the mid-Willamette Valley.
Opponents of the bill say Oregon needs big capital to pay for expensive equipment and procedures, though studies show that when private equity moves in, patients suffer worse outcomes. Patients also face higher prices. An Oregon Health & Science University researcher found that when private equity firms buy a medical practice, prices go up as much as 30%. Analysts said private equity firms often borrow to purchase practices, then lean on the practices to generate enough profit to pay down the debt and pad their bottom line.
When they don’t, sometimes they simply pull out, which is the case with a Tillamook dialysis center. The Tillamook Headlight Herald reported last month that a Texas company, U.S. Renal Care, decided to close its dialysis center in Tillamook earlier this year because Medicare wasn’t paying enough. That left 11 patients in need of the life-saving treatments that usually require three dialysis sessions a week, lasting several hours each.
So far, 430 people have filed written testimony on the bill, with fewer than 10% opposed. They included a representative for Amazon, who said the bill would “have unintended consequences that would unnecessarily leave Oregon patients and employers with higher costs, reduced access to care and fewer choices for care.”
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