Novick backs needle exchange as path to new Medicaid patients

Novick backs needle exchange as path to new Medicaid patients
City Commissioner Steve Novick meets with the people who run Outside In's needle exchange program. Novick supports the program and sees it as a means to bring uninsured patients into Oregon's soon-to-expand Medicaid program. Photo courtesy Cathy Cheney, Portland Business Journal.

PORTLAND, Ore. - When Steve Novick walked across downtown Portland the other day to meet with the leaders of Outside In about their free needle exchange program for IV drug users, he wasn’t just showing his liberal support for a hot-button issue.

As usual, the newest addition to Portland’s city council had bigger ideas on the subject.

Dressed in a pinstriped navy shirt with an extra-wide, orange tie, Novick listened closely and nodded his head often as Outside In Director Kathy Oliver explained the importance of the needle exchange program: a half a million needles each year to 3,676 IV drug-users (60.5 percent of whom are homeless), with an exchange rate of over 100 percent, meaning more dirty needles coming in for safe disposal than there are clean needles handed out in exchange.

Oliver explained that the program gets $126,000 per year from Multnomah County. The additional $65,000 it gets from the city is in danger because of Portland’s $25 million budget shortfall.

Novick made it clear that he would support the program. Then he asked a question with large implications:

“Do you tell your clients that they will be eligible for Medicaid starting in 2014?”

He was referring to a huge shift that will take place at the start of next year, as health care reform takes hold. Millions of formerly uninsured Americans will be brought into the Medicaid system for low-income patients as income requirements change. That will bring a major influx of low-income people into the Oregon Health Plan, which is being transformed under an ambitious program overseen by Gov. John Kitzhaber and the Oregon Health Authority that could become a model for the country — or a flop, depending on how things go.

Novick knows more than a little about this complicated shift, because his previous job involved making it simple and seamless for people who will be eligible under the new income requirements to sign up for the Oregon Health Plan.

“I’ve spent the last two years working for OHA (the Oregon Health Authority) and preparing for 2014,” he said. “It should be much easier to sign people up, and I believe opiate recovery treatment will be covered.”

Those facts carry large implications. The faster Oregon’s Medicaid system expands and the more new patients come into the system, the more pressure gets put on the state to do it right and prove that Oregon health care providers can deliver more efficient care without sacrificing quality. The pressure builds further if a significant number of those new patients are inherently challenging and expensive, as IV drug users often are.

In fact, one of the biggest priorities for the 15 Coordinated Care Organizations across Oregon that are scrambling to prepare for 2014 is something called “hot-spotting:” identifying the individual patients who use up the most health care resources, and trying to work with them to improve their health without relying on emergency room visits and other costly events.

Novick knows about this subject as well. He is thinking of trying something similar to “hot-spotting” to bring down health insurance costs for city employees. It’s an approach that has worked with casino workers in New Jersey and is being implemented with transit drivers in Lane County.

After listening to Outside In’s leadership and offering his own suggestions, Novick walked over to meet Haven Wheelock, the staffer who runs the needle exchange program. He didn’t just ask her about the program; he asked her what she thought about the War on Drugs in general and the funding for the Police Bureau’s Drugs and Vice division in particular.

Offered a platform to speak on a subject dear to her heart in the presence of a City Commissioner, two journalists and her bosses, Wheelock took it.

She described the War on Drugs as “racist” and “wasteful” and lamented, “We waste a lot of money fighting the War on Drugs when we could be spending money on treatment.”

Novick smiled and asked, “How long do you think you’ll keep doing this?”

“Until I become drug Czar,” answered Wheelock. “My heart is in it. I believe in the mission and the communities we serve.”