In just 31 days, the legislature made historic investments in healthcare, homelessness, our workforce, working families, and small businesses. 

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Friends and neighbors,

The last two years have been extremely challenging for so many Oregonians, and the 2022 legislative session provided an important opportunity to meet the moment and address the critical issues facing our state. As KGW Political Analyst Len Bergstein said ([link removed]) , “It was a surprisingly successful and productive session, given the fact that the public has demonstrated in public opinion polls a general frustration with the way the government has handled the current crises. I think [lawmakers] delivered on a broad range of very important measures significantly improving people's lives.”

In just 31 days, Oregon’s 81st Legislative Assembly passed legislation that makes historic investments in healthcare, housing affordability, homelessness, childcare, education, our workforce, working families, small businesses, equity, and the environment. There is still more work to be done, but the legislation passed this session will help Oregon on its path toward a more equitable recovery for all. As Chair of the House Healthcare Committee I led on two very important committee policies: HB 4003 ([link removed]) and HB 4035 ([link removed]) and my personal priorities: HB 4083 ([link removed]) (amended into SB 1529 ([link removed]) ) and HB 4081 ([link removed]) .
2022 Session Accomplishments

HB 4003 ([link removed]) : Supporting Oregon’s Nurses

I care deeply about our state and the nurses who provide the care we rely on. They’ve experienced a lot of trauma over the last two years and this bill makes important changes to support them.

The current nursing crisis is the result of longstanding workforce issues that have only been exacerbated by the pandemic. Many of you have heard me speak on this floor about my experience as a nurse practitioner. I have seen firsthand the stress this pandemic has placed on our already overburdened healthcare system and I knew the legislature had to take action to avoid further depleting our healthcare workers.

Over the interim, I convened a workgroup to discuss Oregon’s nursing workforce shortage and consider possible solutions. The coalition was purposely broad and consisted of representatives from nursing advocacy groups, nursing education, hospitals and long-term care organizations, as well as policy experts. Over the course of several meetings, we identified multiple challenges contributing to our nursing shortage. Specifically, burnout and wellness; education and faculty support; care models and documentation; and infrastructure.

The workgroup identified potential short-and long-term solutions and the product of those conversations is what you see before you today. HB 4003 was written to address the immediate concerns Oregon’s nurses are facing. It is not the end of the conversation, but provides a bridge to both address some immediate needs and get us to a place where we can do more.

Hear me speak about HB 4003 and how we must support nurses here ([link removed]) and read more about this bill here ([link removed]) .


HB 4035 ([link removed]) : Continuing Health Care Coverage for Medicaid Recipients After the Federal Public Health Emergency Ends

At the beginning of the pandemic, the federal government passed the Family First Coronavirus Recovery Act providing additional Medicaid funding to states to ensure beneficiaries would retain their health insurance benefits throughout the emergency regardless of eligibility changes during the PHE. Once the emergency ends, however, states will have 12 months to complete eligibility redeterminations and disenroll members who are no longer eligible.

Many low-income Oregonians struggle to maintain health insurance coverage when their income fluctuates above and below the eligibility level for OHP. During the public health emergency we have seen the uninsured rate drop to a record low of 4.6% with more Oregonians reporting they were enrolled in health insurance than ever before.

OHA must conduct the redetermination process for all 1.4 million Oregonians on the Oregon Health Plan, the state Medicaid program, within twelve months after the federal PHE expires. OHA’s latest projections suggest as many as 300,000 Oregonians could lose OHP eligibility due to income changes.

I ran for office in 2018 to protect Medicaid coverage for the vulnerable populations that depend on it to access care. It did not escape me how poetic it was that HB 4035, which will protect continuity of care for the same vulnerable Oregonians, was the last bill I carried on the House floor.

Being a primary care provider, you learn a lot about what’s important to people - listening to their dreams and fears, sharing their faith, and giving them hope. I see the emotional toll lack of health insurance has on people. They lose sleep. They are constantly stressed. They worry about seeking care because they are terrified of costs. They ration their medication. On any day, our lives can be flipped upside down by a diagnosis or accident, whoever you are, however important you are. Our healthcare system should support us when it does.

I look forward to continuing working to make sure every Oregonian can access healthcare.

See me speak about HB 4035 and the importance of this work here ([link removed]) .

Read more:
* [link removed]
* [link removed]

SB 1529 ([link removed]) : Increasing Access to Primary Care and Behavioral Healthcare

In 2019, I led on a bold policy to increase access to primary care. As a new legislator, I hadn't yet built the coalition or spent the time needed for such a heavy lift. But I persisted.

In 2020 I Co-Chaired the Universal Access to Primary Care work group, which met monthly at the start of the pandemic. The members were a diverse group of primary care stakeholders, including practitioners, behavioral health providers, specialty providers, health system representatives, payers, health economists, a rural health expert and a consumer advocate. Even though many of the members were healthcare clinicians working on the frontlines, they knew how important this work was.

Together we built a clearer understanding of barriers to accessing comprehensive primary care and brought forward a policy in 2021 representing the work group's top policy recommendations, with broad stakeholder support. HB 3108 passed out of the House Healthcare Committee with bipartisan support, but with so many big bills in the Joint Ways and Means Committee this small but mighty policy died at the close of the 2021 session. But I persisted because research consistently demonstrates that access to primary care reduces disparities in health outcomes, improves health system efficiency, and reduces overall health system costs.

Unfortunately, primary care is incredibly under-utilized in our state. A quarter of Oregonians report not having a personal provider, which is higher than the national average. While the benefits of comprehensive primary care are clear, over a third of Oregonians report being underinsured, foregoing preventive care visits which leads to worsening illness and more severe, expensive treatments.

Oregon also ranks as one of the worst states in the nation for adults who report lack of mental health treatment within the past year. Mental and physical health are inseparable. We must no longer accept behavioral healthcare as anything else but primary care. We must create a system that reflects this reality, and minimizes the many barriers to accessing mental health care.

This short session the policy, HB 4083 once again made it out of the House Healthcare Committee and once again got stuck in Joint Ways and Means. When I learned the policy was dying again, I knew I had to do whatever I could to make sure it got passed this session. I had one more committee meeting that afternoon so I scrambled and worked with legal counsel, the Legislative Fiscal Office and the Legislative Policy and Research office and we were able to amend HB 4083 into SB 1529. It was an amazing moment in our committee and one I’ll remember forever!

The policy will require insurers to provide reimbursement for three primary care visits annually, removing the often prohibitive point-of-service cost-sharing for patients for these three visits. These visits can be with a primary care provider or behavioral health care provider.

House Healthcare Committee celebrating SB 1529

2022 Short Session Legislative Recap
Addressing Homelessness & Housing Stability

I supported a $400 million homelessness and housing package ([link removed]) , which will help connect unhoused people with shelter and critical services, build on past investments to increase the supply of affordable housing, and keep Oregonians in affordable homes. I also supported investments to help our youth experiencing homelessness, as well as House Bill 4123 ([link removed]) , which creates a coordinated and regional response to homelessness across the state.

Supporting Working Families & Small Businesses

Working families and small businesses are the backbone of our economy. That’s why I voted to expand infrastructure supporting broadband internet access ([link removed]) and increase access to loans for small businesses ([link removed]) from $100,000 to $1 million. I also supported over $200 million in investments ([link removed]) in career pathways and programs to retain and attract workers in critical sectors, including healthcare,
behavioral health, education, manufacturing, technology, and construction.

Driving Down the Cost of Living

For too many working Oregonians, covering monthly expenses has become a challenge. That’s why I led on a policy that will send $600 one-time payments ([link removed]) to a quarter of a million low-wage households who qualify for and utilize the Earned Income Tax Credit. This will help cover the cost of daily essentials like prescriptions, diapers, and groceries.

We also made targeted investments to drive down the cost of necessities that drain the largest portion of Oregonians’ paychecks, like child care and health care. I also voted for a $100 million investment that will help us ([link removed]) stabilize our childcare workforce, ([link removed]) responding to the growing need for affordable childcare for families.

Investing in Community Safety & Violence Prevention
I believe we need to invest in proven solutions that prevent violence, while fostering safe communities built on trust. I supported targeted investments in community-based violence prevention programs that will help address the root of the problem and reduce crime. I voted yes on HB 4075 ([link removed]) , making it easier for victims of crime, including small businesses, to seek restitution and be repaid for economic damages.

Stronger Schools
Students learn best in safe, healthy classrooms five days a week, which is why I’m committed to keeping our schools open. To do that, we must make sure our teachers, school staff, and students have the resources and support they need to succeed. This session I supported a $300 million investment ([link removed]) funding summer learning programs and activities for K-12 students to keep them engaged and learning; addressing the workforce shortage to retain educators, school counselors, substitute teachers, mental health professionals and nurses; and supporting school districts impacted by the wildfires.

The work that's left to do

HB 4081 ([link removed]) : Opioid Overdose Prevention

HB 4081 would have increased distribution of naloxone to prevent opioid overdose deaths by ensuring that patients who are filling a high-risk opioid prescription are offered naloxone at the pharmacy counter. Sadly this policy died in Ways and Means at sine die.

The opioid epidemic in Oregon continues to worsen. In 2020, 472 Oregonians died of an accidental opioid overdose, a 40% increase over the previous year. 2021 saw another 45% increase in overdose deaths – in the first half of that year, 350 Oregonians had already died of an opioid overdose.

While heroin and fentanyl are a huge part of the problem, the latest data from 2018 shows nearly half of accidental overdose deaths were caused by prescription opioids. And in Oregon, only 5% of high-risk opioid prescriptions are accompanied by naloxone. In a state like New Mexico that requires high-risk opioid prescriptions be co-prescribed with naloxone, 30% of patients are taking naloxone home with them. Fourteen other states have passed co-prescription laws, and they have seen distribution of naloxone increase, and deaths decrease.

Pharmacists are currently allowed to prescribe naloxone in Oregon, and the CDC encourages all providers to offer naloxone to patients at a high-risk of overdose. This is something some providers and health care systems have implemented on their own – still, not enough patients are taking naloxone home with them. Opioid overdose deaths are preventable, but naloxone needs to be present to save lives.

HB 4081 would have ensured that patients with high-risk opioid prescriptions are offered naloxone by requiring pharmacists to offer a prescription of an opioid antagonist with any opioid prescription over 90 morphine milligram equivalents per day, or any opioid that is prescribed to a patient with an active prescription of benzodiazepine, both of which increase the risk of overdose.

Recognizing the current burden on pharmacies with workforce shortages and pandemic workload, we worked with pharmacists to craft a narrow, easily implemented requirement that still ensures the most at-risk patients receive education about opioid overdose and an offer for an opioid antagonist.

We know this bill will not solve the opioid crisis on its own, and that there will still be gaps for patients who use multiple pharmacies or receive mail order prescriptions, but this is one of many solid public health policies that will result in more patients understanding that their opioid prescription presents a high risk for overdose and receiving an offer of a life-saving overdose reversal medicine.

Why did the bill have a fiscal on it? The bill was assigned to Joint Ways and Means because the Oregon Health Authority and the Board of Pharmacy indicated a fiscal impact. Other states consider cost savings in their fiscal analysis. For example, when Colorado passed this legislation, they were able to consider things like prevention of ER visits and hospital admittance from overdose; acknowledging an offset to the fiscal cost and providing a more complete picture of actual costs. Here in Oregon we look only at the cost of implementation, and don't take into consideration the possible savings of policies. This prevents us from accurately reflecting the real fiscal impact of those policies. Asking agencies to only identify actual program costs without identifying potential savings as a result of policy implementation does not serve Oregonians well and I hope it is something we will address in future sessions.

I will draft this policy again for the 2023 session and have another representative lead on it.

Read more here: [link removed]

What is naloxone? Watch to see how naloxone, an opioid overdose-reversal medication, works in the body [link removed]

The Need To Professionalize The Legislature

I co-wrote an opinion piece for the Sunday Oregonian alongside my colleaguesRepresentative Karin Power ([link removed][0]=AZWH_FUTa4kIGHbzYM0s2wtL-7e72_ndYAA4MAdgvVOglRWIFaAI0MJt_8ebYIGOGg00CGYbxFlHgO6Ywd9-GnB5_--aEwH6Xr7jRJajcXZhVpNt4oAjBg4munNVae0oVVY1ganSgRIbIALtW7FdOu_D&__tn__=-]K-R) &State Representative Anna Williams ([link removed][0]=AZWH_FUTa4kIGHbzYM0s2wtL-7e72_ndYAA4MAdgvVOglRWIFaAI0MJt_8ebYIGOGg00CGYbxFlHgO6Ywd9-GnB5_--aEwH6Xr7jRJajcXZhVpNt4oAjBg4munNVae0oVVY1ganSgRIbIALtW7FdOu_D&__tn__=-]K-R) .

What should be a citizen legislature has historically been a legislature of wealthy or retired applicants. The reality is that most Oregonians cannot afford to even consider this job. The current structure ensures a power imbalance that excludes candidates who are talented and passionate but cannot survive on a legislator’s salary.

A system built for the financially well-off or the retired will never work for all of its citizens. Though Oregon has elected a historic number of diverse lawmakers over the last few years, we have not changed the underlying systems that will inevitably push them out over the coming years. We must professionalize the legislature so it works for those that are not independently wealthy or retired.
Read the full opinion piece here ([link removed]) .

TIME SENSITIVE: Task Force and Board Membership Opportunities

Exciting news: HB 4035 established a Task Force to develop a proposal for a bridge program to provide affordable health insurance coverage and improve the continuity of coverage for individuals who regularly enroll and disenroll in the medical assistance program or other health care coverage due to frequent fluctuations in income. It was important to me that the Task Force membership include a low-income person who will likely be eligible for the bridge plan, so if that includes you I especially encourage you to apply.

The portal to apply for appointment to the Task Force is now open. If you are interested, use the following links to submit application materials:

New Applicants (External Candidates):
* Go to the Boards and Commissions Workday webpage – HERE
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* If helpful, use the instructions starting at step 2, outlined – HERE
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Applicants who are Current State Employees or Current Board Members who already have an OR number (Internal Candidates):
* Log in to Workday – HERE
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* If helpful, use the instructions outlined – HERE
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Please note that only completed applications will be processed and considered for appointment. A complete application includes the following:
* Uploaded Resume (PDF only)
* Uploaded Short Personal Bio (PDF only)
* Responses to the three General Application Questions
* Responses to Background Questions
* Responses to the subsequent Gender Identity, Personal Information, and Public Records Disclosure tasks that come up directly after you submit your application

Drug Affordability Board Opportunities

In the 2021 session I, alongside Senator Patterson, led on the Senate Bill 844, creating a Prescription Drug Affordability Board to research and identify drugs with excessive price increases, and impose payment limits on those drugs if necessary. An Executive Director has been hired, but there are currently staff positions available and there is still time to apply to be a board member.

Drug Affordability Board Applications Accepted through March 18th

Applications are being accepted through March 18th for the Governor appointed Prescription Drug Affordability Board. Applicants must be Oregon residents with expertise in health care economics and clinical medicine. More information on the opportunity and how to apply are available here:[link removed] ([link removed]) .

DFR Career Opportunities In Support of the Drug Affordability Board

In support of the PDAB, the Division of Financial Regulation is recruiting for five professional staff positions also created under SB 844 of the 2021 Regular Session. The positions close on Monday, March 21, 2022 and applications must be submitted through Workday.
* Board Data Analyst ([link removed])
* Board Policy & Program Analyst ([link removed])
* Board Administrative Specialist ([link removed])
* Project Manager ([link removed])
* Board Research Analyst ([link removed])

News Clips
* I spoke with the Lund Report ([link removed]) and the Portland Business Journal ([link removed]) to reflect on my legislative career and the work we still have left to do.
* This session we made huge investments in access to physical, behavioral, and dental healthcare. The Legislative Clinician’s Caucus, a bipartisan group of legislators who are also healthcare providers, highlighted some of those investments ([link removed]) .
* Earlier this year I signed onto a letter to support the unionization effort of Lines for Life employees. Lines for Life is a local non-profit dedicated to preventing subtance abuse and suicide, and has provided critical behavioral health supports throughout the state. I am so happy their effort was successful! ([link removed])

Sincerely,
Rachel Prusak

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Your support of Rachel Prusak for State Representative is important, as is your privacy!

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West Linn, Or 97068
USA
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