Finance Committee May 2025 update
The Finance and Revenue Committee of the UHPGB met on May 20, 202
Summary by Sandra Coyner, HCAO/HCAO-Action (SandraCoyner@hcao.org)
The main business of the meeting was to hear and respond to a presentation from Morgan Shook, one of the consultants from ECONorthwest, hired to work with this committee and others. This exercise included several parts
Several slides reviewed and somewhat reorganized and reformatted the tasks ahead, including translating them into research questions that ECONorthwest would pursue.
Shook proposed pursuing these issues in eight meetings of the committee. Discussion however, revealed that most committee members believe much of the work planned for meetings 2-4 had already been done by Charlie Swanson (on current costs and on revenue options) and separate committee meetings should not be required to review again. Morgan Shook said he will look at this work that had been done and rework the meeting list. MaryLou Hennrich later said that the collaborative tone in this exchange had alleviated her prior anxiety that there would be too much duplication of work already done. Committee discussed meeting twice a month instead of only once a month, setting the main meeting so its results can be presented to the Governing Board soon after.
During discussion (earlier in the meeting) of the Governing board meeting of May 15 , a number of important points were raised by committee members.
Envisioning the future was more difficult than describing the current situation and identifying “stepping stones” to the future.
A cost calculator is needed for individuals who will ask “what will it cost me?” This task has been described as “ easy” but almost certainly is not easy.
What is the decision level? What work will be done by board and what by committees? Many issues were assigned to the Board that should be committee-level work. Decision level should be seen as a draft only. (Mimi agreed.)
Timeline–it will be pushed forward in time for almost every group and task.
Committee sunsetting – F&R should not end its work in Dec. 2025, for various reasons of things that could come up later.
Public feedback is needed for the work of F&R, with interaction, not just somebody taking notes on what people say. [sc: Remember the limits the CECC has placed on its own ability to do forms of public interaction.]
These points came up in discussion of the presentation by Morgan Shook of ECONorthwest.
What does it mean to “develop a model”? It should be able to identify responses to unforeseen situations.
“Reserves” includes structures and equipment and it is not clear how these will be covered.
Will local governments be allowed to spend less on health care?
A “worst case” contingency plan is needed (e.g. if Medicaid is cut drastically).
Medicare is not resolved. Should there be a Medicare Trust?
What about reserves of current health plans? Are they on the table? Even leaving reserves to cover costs already incurred by health financers, much will be left available. Shook will look into it; reserves were not formerly on his radar.
The principle of not privileging any type of income must be incorporated. (ie, wage vs. capital gains income)
How can committee members share information to review between meetings, while still obeying the public meetings law? Mimi reviewed some complexities. Comment: this is a good reason for meeting twice a month, not just once.
How to avoid the kicker? E.D. Mimi McDonell said this is an Ops issue, not F&R
If an employer payroll tax is exempt from income tax and FICA, would an employee payroll tax also be exempt? Morgan Shook said he’d look into it.
Studies of differential coding have shown clearly that because more risk means higher payment, there is pressure for upcoding. John Santa named this as incredible corruption, and wants a payment system that eliminates this corruption. Although Bethany Stairs noted the provider must have risk adjustments because their patients are so diverse, several committee members noted that not dividing the risk pool and using fee-for-service payments (as opposed to per capita) would alleviate the problem.
There was no oral public comment. Many written comments were submitted and their existence was briefly briefly noted at the start of the meeting.
The next meeting is expected to include a report from HMA consultants on a literature review about provider savings.
