By SCOTT JORGENSEN

SALEM, Ore. -Oregon legislative leaders hope to transform the state’s health care system into a model to be emulated nationally. But as with any issue as complicated as health care, one point has become increasingly obvious to all involved: The devil is in the details.

Nobody knows this better than State Senator Alan Bates, D-Ashland. Bates, a doctor, is among the handful of legislators who have spent much of the last decade working on expanding access to health care coverage. He describes the process as an “eight-year walk,” but one he is determined to see through to completion.

Health care issues are near and dear to Bates, who for years has seen patients on weekends in his district while the legislature is in session.

All of the states are facing rising Medicare and Medicaid costs, and most have chosen to solve the imbalance by dropping the number of people covered under their programs, Bates said. Oregon seeks to go in the opposite direction, he said, and plans to get there through the creation of Coordinated Care Organizations (CCOs).

CCOs were created by House Bill 3650, which passed during the state’s 2011 legislative session. The timeline set forth in the process calls for the first CCOs to be certified in June and to begin enrolling Medicaid members the next month.

Under HB 3650, each CCO is required to have a Community Advisory Council (CAC) with consumers making up a majority of the membership. At least one CAC member must serve on the CCO’s governing board.

That’s where it starts to get tricky.

On Friday, Feb. 3, the Senate Health Care, Human Services and Rural Health Policy Committee approved Senate Bill 1580 with a do-pass recommendation on a 3-2 party-line vote following a packed public hearing. SB 1580, which now heads to the budget-writing Ways and Means Committee, would provide legislative approval of the Oregon Health Authority proposals for CCOs.

During the two-hour public hearing, SB 1580 received near-unanimous support from the many diverse groups whose representatives testified before the committee. Despite that, several concerns were still raised about the bill’s governance component. Also, the question of who gets to be on the boards of the various CCOs to be formed throughout the state remains to be answered.

Sen. Jeff Kruse, R-Roseburg, sits on the Senate Health Care, Human Services and Rural Health Policy Committee, along with Bates. Kruse is among those who have been working long and hard on health care issues, and he said there are still any number of variables that could jeopardize the attempts to reform the state’s system.

In an interview conducted a few hours before the public hearing on SB 1580, Kruse listed some of his concerns about the bill and the process being used to push it through to passage.

Kruse said he doesn’t want to force health care providers into a CCO structure that isn’t properly vetted by lawmakers. Also troubling to Kruse is the information technology component of the reform efforts. Such a system must be developed by Jan. 1 for an insurance exchange, Kruse said, but the state has a very poor track record of completing those kinds of projects on time and on budget.

Further complicating matters is the fact that the U.S. Supreme Court has agreed to hear the legal challenge brought by 26 states against certain aspects of the federal health care legislation.

“That will be a major dynamic in what direction we go,” Kruse said.

The shortened timeline of the 2012 session has helped prompt some of Kruse’s most vehement objections to passing SB 1580 in its current form.

Lawmakers are shooting for a Feb. 29 completion date. In order to meet that deadline, the state’s budget must be approved by Friday, Feb. 17, Kruse said.

However, Kruse said that sending SB 1580 to Ways and Means for budgetary approval is premature because it still needs more work.

“I want to send them a finished product,” Kruse said. “To say it’s a finished product is ridiculous, because it’s not.”

Kruse was adamant that Ways and Means should deal strictly with budget issues and that matters of policy should be dealt with elsewhere, such as the Health Care Committee.

“It should be our job to do it,” he said.

The final, amended version of SB 1580, Kruse said, will bear little resemblance to the one that was passed out of committee last Friday.

“That’s wrong,” Kruse said.

Kruse made several of the same points during the work session on SB 1580, minutes before its approval by the committee.

Sen. Laurie Monnes Anderson, D-Gresham, co-chair of the committee, responded by stating that SB 1580 needed to go to Ways and Means due to its overall importance in balancing the state’s budget, as hundreds of millions of federal dollars are depending on it.

Monnes Anderson said that the legislative process involving SB 1580 has been going on for months and has involved much public input, so it is not being fast tracked.

She added that another piece of legislation, SB 1509, has a “huge” relating-to clause involving health care. Therefore, she said, suggested amendments to SB 1580 can be included in SB 1509.

In response, Kruse stated that for much of the process, committee members have had access to mere concepts, and not to actual legislation. He reiterated his contention that putting policy issues before Ways and Means is a “violation of the way the process is supposed to work.”

Kruse expressed skepticism about the possibility of issues pertaining to SB 1580 being resolved through SB 1509.

“I seriously doubt that is going to happen,” he said.

The notion that the committee doesn’t have time to complete its work on SB 1580 was characterized by Kruse as “absurd.”

“We could take another week,” Kruse said, and send a finished product to Ways and Means instead of a “blank slate.”

Monnes Anderson insisted that amendments still can be properly vetted. She added that similar bills are being worked on in the House and will have to be reconciled with any legislation coming out of the Senate.

Bates said that while sending SB 1580 to Ways and Means in its current form is “not the cleanest process,” committee members need to get it to a joint committee “as soon as possible.”

Describing the bill as a “major step in health care reform,” Monnes Anderson said it will help the state’s middle class and most vulnerable, save tax dollars in the long term and take a better, smarter and more efficient approach to health care.

Aside from that, Monnes Anderson said, the bill is “significant to balance our budget.”

SB 1580 was then passed, with Kruse and Sen. Frank Morse, R-Albany, opposed.

Bates was among those voting to move the bill out of the committee. Hours prior to the public hearing, Bates said that legislators are receiving more information every day about what the federal government will require from the state in order to receive funding to implement health care transformation.

Oregon’s model, using CCOs as the delivery method for health care services, is essentially a pilot program, Bates said. As such, the federal government is willing to help the state financially in order to make it work.

“We couldn’t do it without the federal money,” Bates said. “They look at it as an investment.”

Transforming the state’s entire health care system will be a two- to three-year process, Bates said, and mistakes will be made along the way. However, he added that mistakes can be learned from and remains optimistic about the long-term prospects of the transformation efforts.

“I think it’s going to work great,” Bates said. “We just need time to get there.”

Bates points out that many groups and institutions initially skeptical of the health care reform are now very supportive of the concepts being worked on.

As it turns out, some of the most vocal support could come from around Kruse’s own legislative district.

Robert Dannenhoffer, a doctor from Roseburg, testified on behalf of SB 1580 during the Feb. 3 public hearing. He stated that nine different groups in Douglas County have formed a 501(c)3 organization in hopes of becoming the first CCO in the state.

Kruse acknowledges that the legislative timelines involved in the current session are compressed, but he insists that lawmakers must be more deliberate if they want to replace the existing health care system with something better.

“I’d rather do the status quo than make bad change,” Kruse said.

Bates said that reform ultimately will make it easier for doctors to do what they need to do and will improve efficiency. He describes it as an “opportunity to turn this all around.”

In fact, Bates said his own patients will benefit from the reforms presently being deliberated by lawmakers.

“I can’t wait to join a CCO,” he said. “I’m looking forward to it.”