Ballot Measure 101: Situational Analysis 2/18/2016 Ballot Measure 101: Situational Analysis November 2017

What is the issue with BM 101? 2/18/2016 What is the issue with BM 101? PROBLEM: The legislatively-approved Provider Assessment—which helps fund the Medicaid system in Oregon—has been referred to voters. IMPLICATIONS: If the referendum is rejected by voters in January 2018, the financial impact—both short and long term—will be substantial. WITH FAILURE: No choice but to cut payments to providers, limit or eliminate services to those most in need, and fundamentally change the CCO delivery model.

Balancing the Medicaid Budget 2/18/2016 Balancing the Medicaid Budget Oregon’s Medicaid budget was balanced through a slate of industry-approved assessments and spending reductions. Increased the hospital assessment to 6 percent Expanded the hospital assessment to include rural hospitals Created a new 1.5 percent assessment on state-regulated insurers Reduction in non-essential agency spending Combined, this plan added $2.5B in Medicaid funds. $937M in state funds leveraged $1.8B in new federal investment. These assessments provide more than 17 percent of all Medicaid funds. The healthcare industry supported the assessment package and is promoting the passage of the referendum.

Effort to Refer Plan to Voters 2/18/2016 Effort to Refer Plan to Voters Reps. Julie Parrish, Sal Esquivel and Cedric Hayden submitted 84,367 signatures for their petition on Oct. 5. State law requires only 58,789 to qualify – they qualified. This is on the ballot (ballots mailed Dec. 26 for election on Jan. 23). The Supreme Court is reviewing the ballot language in November. Who supported their effort? A strange array of political action groups with no connection to health care (pro-gun, anti-immigration, anti-tax) Three wealthy business people without healthcare links Oregon’s healthcare community is now engaged in the battle to protect coverage and the CCO system.

2/18/2016 Failure = Budget Cuts Legislature will need to re-balance the Medicaid budget in the short February Session if the referendum fails in January. Directly eliminates $320M in state funds and risks carefully negotiated plan Opponents of the funding plan say the budget could be balanced using existing resources, tobacco taxes and raiding CCO incentive funds. They have also stated that they want to reduce costs and “new” taxes without identifying which services they would eliminate Balancing the Medicaid budget without these funds would result in significant spending cuts. Rebalancing the budget would require all cuts in the second year of the current two-year state budget cycle.

Cutting the Medicaid Budget 2/18/2016 Cutting the Medicaid Budget Legislature would have no option but to reduce eligibility and services, including the expansion population. Oregon could lose more than $5.2 billion in enhanced federal funding if the expansion population is cut. These cuts would be directly felt by the CCOs, providers and patients. Rate reductions for CCOs Cuts to provider reimbursement rates Elimination of key services such as dental services Return to 15-20 percent of state population being uninsured Returning to emergency room healthcare delivery services “The biggest option is to cut the expanded population.” – Senator Richard Devlin (D-Tualatin) Co-Chair of the Ways & Means Committee Oregon’s recognized expert on the budget

2/18/2016 The Campaign Opposition campaign is focusing on the issue of “new” taxes, not services—the provider assessment has been in law since 2003. Attacking organized labor for their support Attacking the CCOs as “profiteers” The YES campaign is all about the provider-patient relationship, not about unions and taxes. Our messages are all about health care services: Protecting healthcare for children, seniors and people with disabilities Lowers rates for people who by their own insurance Maintaining affordable healthcare in rural Oregon Health care as a right, not a privilege “For $5 a month the assessment is able to fund a reinsurance program [that saves] about $25-$30, on average, per person,” explained Jake Sunderland, spokesman for the DCBS.

2/18/2016 The Campaign Proponents have organized under the name “Yes for Healthcare” Currently onboarding spokespeople from all walks of healthcare Physicians & Specialists Nurses Mental Health Providers Patients or their parents Yes for Healthcare has hired a team of the most successful consultants Consultants are already building an arsenal of campaign materials to deploy in only a matter of weeks, including mail, digital and TV.

Campaign Timeline Voters’ Pamphlets Mailed – December 27-29 2/18/2016 Campaign Timeline Voters’ Pamphlets Mailed – December 27-29 Voter Registration Deadline – January 2 Ballots Mailed – January 3 Last Day to Mail-In Ballots – January 18 Election Day – January 23

Your Role in the Campaign 2/18/2016 Your Role in the Campaign Voting YES when you receive your ballots Raising money – Experts have said the campaign may cost upwards of $3 million, given the election date and opposition focus on taxes Spreading the word among providers, patients, vendors, community leaders, media, etc. Making sure everyone knows this is a YES vote

2/18/2016 Thank you! For specific questions regarding the Measure, contact Courtney Johnston and Jeff Newgard. Johnston@pacwestcom.com Newgard@pacwestcom.com 503-685-9400