(This article has been updated and expanded to incorporate additional reporting.)

After election night in Oregon left several races undecided, it’s now clear that Democrat Tina Kotek will be the state’s next governor, her party apparently lost its supermajorities in the Legislature,  and the ballot measure that would make health care a right in the state constitution, Measure 111, appears to have won.

As of the morning of Nov. 12, the health care measure crafted by Democratic lawmakers had built lead of about 24,000 votes after trailing by about 12,500 early on Nov. 9. 

In the state Senate, Democrats lost the three-fifths supermajority needed to pass revenue measures without votes from non-party members. In the state House, as of Nov. 12, they appeared to have the lost their supermajority as well.

Delayed outcomes in several races were driven by a new state law allowing ballots to be counted if they are postmarked on election day, contributing to the unknowns that lingered for days after the election, said Salem lobbyist Tom Holt, likening it to “uncharted territory.”

What’s clear is a slew of rookie lawmakers will go to work in Salem in January, driving significant turnover in the makeup of the health care committees in both chambers in Salem.

The more even split in both houses could complicate lawmakers’ response to Measure 111, said Jim Moore, a government professor at Pacific University. Republicans had opposed the measure, and so had prominent health care activists such as single-payer advocate Samuel Metz and former Gov. John Kitzhaber.

The measure could have an influence on potential reform legislation as well as spending on health care, complicated by the fact that the Legislature’s lawyers think its language gives individuals a right to sue the state over their coverage or lack thereof.

“This will be fascinating because it’s not clear what it directs the government to do,” Moore said. “I think a strongly Democratic legislature would say ‘okay, here’s what it means, we need to move forward, let’s define it.’ But … I don’t know that there will be a big enough majority to move this forward, and especially because there were splits within the healthcare advocacy community on whether this was a good idea or not.”

Before the election, through a campaign spokesperson, Kotek told The Lund Report she was optimistic about lawmakers’ ability to implement it. “The text of Measure 111 gives the legislature substantial deference to define how it meets its obligation. If voters approve Measure 111, my job as Governor will be to uphold the will of the voters and ensure our budgets adequately reflect the values of Oregonians and balances them appropriately.”

Kotek Plans To Boost Behavioral Health Spending

Kotek’s victory is expected to result in a general continuation of key health care policies in the state — ranging from abortion access to health care merger oversight — since she oversaw many of those policies’ passage into law as House Speaker in Salem.

Her victory also could have implications for the labor strife raging between health systems and their workers. She received backing from the Oregon Nurses Association as well as the Service Employees International Union, which represents many health care workers in Oregon. Meanwhile the Oregon Association of Hospitals and Health Systems contributed to her opponents in the primary and general elections.

She is also expected to replace Pat Allen, director of the Oregon Health Authority, which could be accompanied by other departures of top managers there.

During the campaign, a spokesperson told The Lund Report that Kotek would take a hands-on approach to OHA. “Too often the Health Authority leadership has interjected unnecessary bureaucratic procedures and screening requirements. They have not been transparent about the lack of progress, prioritization, or plans to strategically invest the funding to take pressure off the state hospital and local communities, and did not engage strategically with stakeholders to get the money out efficiently. My goal as governor is to take a hands-on approach to these strategic initiatives and ensure the agency shares my expectations and meets clear benchmarks of success.”

Her campaign representative also said Kotek does not support a wholesale revamp of the Oregon Health Plan structure spearheaded by Kitzhaber a decade ago, which created coordinated care organizations, or CCOs. Kitzhaber recently told a CCO Oregon conference the experiment has not worked out as planned.

“Before we pursue further major CCO reforms, we need to successfully implement several other significant projects including: redetermining Oregonians’ eligibility for the Oregon Health Plan, potentially implementing a new basic health plan, managing untenable rates of growth, and the staggering workforce crisis that is impacting all of our health care systems,” the Kotek campaign representative wrote. “Without collaborative and decisive leadership, the next few years will be whack-a-mole for a health care industry that is exhausted by the pandemic, workers who have had enough, and patients who rightfully demand better outcomes regardless of external factors. The next iteration of CCO contracts and how we manage these big challenges ahead of us are linked and must be approached collaboratively with a unified vision.”

According to Kotek’s responses, she plans to cut red tape, but “This flexibility will be paired with active oversight and accountability. If a CCO is failing to perform, I will not hesitate to explore the levers and tools available to me.” 

She vowed to vastly increase funding for behavioral health programs as well: “After years of agency shoulder-shrugging, the House directed an inventory and gaps analysis of Oregon’s services for substance use disorder prevention, harm reduction, treatment and recovery. The OHSU-PSU School of Public Health recently released their findings, showing that Oregon needs to double our level of services to adequately address the current addiction health needs of Oregonians … In addition to delivering on the promises of the Measure 110 funding, I will also make sure we are targeting funds from the opioid settlement and Medicaid to expand withdrawal management and residential treatment programs.”

Outcomes Mixed In Other Races

In Oregon’s Fifth Congressional District, Republican ​Lori Chavez-Deremer was victorious over Jamie McLeod-Skinner. In the primary the progressive Democrat had ousted longtime incumbent moderate Kurt Schrader in a push centered largely around his positions on Medicare drug-pricing reform.

Some had attributed a victory by Republicans to liberals’ ouster of Schrader. But Moore, the government professor believes Schrader contributed to the final margin, whatever that may be.

“Schrader was the most powerful voice in the distract, and he just sat out totally,” Moore said, adding that he’s heard from some of the former Congressman’s centrist supporters, “Well, you know, maybe Republican isn’t a bad option now.”

In the Sixth District, Democrat Andrea Salinas — who had played a major role in health care legislation in the Oregon Legislature —beat out Republican, Mike Erickson.

In Multnomah County, where two county commissioners had clashed to lead the board, former state lawmaker Jessica Vega Pederson won against emergency room physician Sharon Meieran.

You can reach Nick Budnick at [email protected] or at @NickBudnick on Twitter