Relating to health care; declaring an emergency.
SB 28 establishes a new reimbursement standard for primary care in Oregon’s commercial health insurance market. The bill requires certain health insurers to pay primary care providers practicing in independent practices at the same contracted rate for the same services as primary care providers working in hospital-based or hospital-affiliated systems. It defines key terms such as independent practice, hospital-affiliated provider, primary care provider, and primary care services, and it directs the Department of Consumer and Business Services (DCBS) to adopt rules implementing the measure.
The bill also requires DCBS to create and publish a benchmark called the Primary Care Fairness Rate. That rate must be based on current reimbursement rates reported by hospital systems in Oregon and set at the highest primary care reimbursement rate reported in the relevant geographic market. DCBS must publish the applicable CPT codes and benchmark rates annually by March 1, and finalize the requirements by January 1, 2026. The measure applies to health insurance policies, health care service contracts, and multiple employer welfare arrangements issued, renewed, or extended on or after January 1, 2026. It excludes coverage offered through the Public Employees’ Benefit Board and the Oregon Educators Benefit Board, and it declares an emergency so it takes effect on passage.
In terms of state law, SB 28 amends ORS 750.055 and 750.333 to incorporate the new primary care reimbursement requirements into Oregon’s insurance code framework. It expands the regulatory obligations of insurers, health care service contractors, and multiple employer welfare arrangements by making them subject to the new parity and benchmark-rate provisions. The bill also authorizes DCBS to adopt additional rules needed for administration and prohibits insurers from lowering hospital-based or hospital-affiliated provider reimbursement to offset compliance with the new standard.
The general sentiment reflected in the bill text and committee action is supportive of independent primary care and concerned about access, affordability, and market power in health care. The legislative findings emphasize that independent practices are disappearing, that hospital systems can command much higher reimbursement for identical services, and that the bill is intended to improve access to primary care in Oregon’s reported primary care crisis. The committee vote shown was 3-2 for do pass with amendments and referral to Ways and Means, suggesting support but not unanimity.
The main point of contention is the effect of mandated payment parity on insurers and hospital-affiliated systems. Supporters frame the bill as correcting unfair reimbursement disparities and helping independent practices survive, while the structure of the measure suggests concerns about cost impacts, rate-setting authority, and how insurers will absorb the new benchmark without reducing hospital-system payments. The exclusion of OEBB and PEBB coverage also indicates a policy choice to limit the bill’s reach, likely reflecting fiscal or administrative considerations.
SB 28 would add a new insurance-code requirement that certain health plans, health care service contractors, and multiple employer welfare arrangements reimburse independent primary care practices at the same contracted rate as hospital-based or hospital-affiliated providers for the same services. It directs DCBS to define applicable CPT codes, establish the Primary Care Fairness Rate, publish annual benchmark rates, and enforce the rule beginning with policies issued, renewed, or extended on or after January 1, 2026. The bill amends ORS 750.055 and 750.333 to make these entities subject to the new provisions, while exempting PEBB and OEBB coverage.
The overall sentiment appears favorable toward strengthening independent primary care and addressing reimbursement inequities. The bill’s findings and structure present the measure as a response to a primary care access crisis and as a way to counter hospital-system market power. The recorded committee vote of 3-2 for do pass with amendments indicates the proposal had enough support to advance, but also that there was meaningful hesitation or disagreement.
The central contention is whether requiring payment parity and a benchmark rate will improve access without creating unintended cost pressures for insurers, employers, or hospital-affiliated systems. Opponents or skeptics would likely focus on the administrative burden of annual rate-setting, the possibility of higher premiums, and the impact on existing negotiated rates. Supporters, by contrast, emphasize fairness, transparency, and the survival of independent primary care practices. The carve-out for PEBB and OEBB suggests additional sensitivity around public employee and educator coverage.