Legislative Update
January 23, 2012

As we start off a new year, we are preparing for the start of the 2012 Legislative Session.  Again this year, I look forward to representing the MAFP at the Capitol.  You are also well served by a very active MAFP Legislative Committee chaired by Dr. Philip Stoyke.

During the session I will be providing bi-weekly summaries of the Legislature’s actions.  They will be delivered via email as part of the MAFP’s News Flashes.  I will try to provide you with an up-to-date progress report of the bills of interest to family physicians.

I hope you’ll find these updates interesting and helpful.  Should you have any questions about news from the Capitol, please don’t hesitate to contact me.

Dave Renner
MAFP Legislative Representative
drenner@mnmed.org
612-362-3750

Legislature Back to Work on January 24
Even though it seems like the Legislature just finished, following a government shutdown in July and special session in late-July, legislators are set to return to Saint Paul for the 2012 Legislative Session on January 24.  This is the second year of the state’s biennium so there is no budget that has to be adopted.  Couple that with legislators who are eager to return home to begin their reelection campaigns in earnest, watch for a short session.  The House has announced that it plans to adjourn no later than April 30, and many legislative leaders are suggesting an early April exit remains possible.

A number of significant issues are likely to take up much of the energy at the Capitol, notably the question of public financing of a new Vikings stadium.   Also, the second year of the biennium is often considered “the bonding year,” and this year is no exception.  Governor Dayton has unveiled a $775 million bonding plan for capital improvement programs, though Republicans were initially lukewarm to such a large proposal.  The Republican majorities in the House and Senate have spent much of the interim planning for their “Reform 2.0” agenda, though much of the details remain hidden. 

Adding to the interest to get done soon is that every legislative district’s boundaries will be redrawn this year to account for population shifts to make all districts of equal population.  Because the Governor and Legislature failed to reach agreement on new maps during the last legislative session, the final lines will be drawn by the courts and won’t be released until February 21.  With all 201 legislators running for reelection in neighborhoods and communities that may be new to them, they want to get home to begin to introduce themselves to new voters. 

A Rosier Budget Picture
For the first time in many years, the state got a bit of good news in early December when the November budget forecast was announced showing a surplus of $876 million going into 2012.  This minimizes the risk of more cuts to our state health care programs.  According to existing law, the surplus dollars are already accounted for, as state statute requires that they be used to repay the state’s cash flow and reserve accounts. 

The good news is tempered by the fact that the surplus remains only a projection; legislators will wait until the next forecast in February before making spending plans.  Also, the agreement that ended the last two budget stalemates in 2010 and 2011 also contained a “shift” of over $2 billion from the state’s school fund to the state’s general fund.  This is money that the state “borrowed” from the school districts that must be paid back.  On top of that, the November forecast predicts that deficits of $1.3 billion return for the 2014-15 biennium.

Health Insurance Exchange
The question of a Minnesota health insurance exchange is certainly on the minds of many legislators and the Dayton Administration.  Health insurance exchanges are intended to be a “one-stop shop” for consumers and small employers to purchase health insurance.  Under the Affordable Care Act (ACA), states are given the option of designing and implementing their own state-based health insurance exchanges.  Should they not do so prior to 2013, the federal government would run a national exchange in Minnesota.  Many groups, including the MMA, the Minnesota Hospital Association, the Chamber of Commerce, and labor groups have strongly encouraged legislators and Governor Dayton to begin work in earnest on a plan for a Minnesota-based exchange. 

A task force led by the Minnesota Department of Commerce has convened a working group to begin the task of designing an exchange.  They are addressing issues related to governance and funding of the exchange, measurement and reporting, and ways to ensure that it is user-friendly.  MAFP President Alan Olson, M.D., sent task force members a copy of the AAFP’s Family Medicine Principles for State Health Insurance Exchanges and offered MAFP assistance.  

Because of the highly political issues related to the ACA, it remains to be seen whether the Legislature will take up any exchange proposals this year.   While everyone agrees that a state-based exchange is preferred to an federal one, many do not want to support anything related to the ACA because of their strong opposition to it.

Provider Tax Repeal
As part of the budget agreement that ended the government shutdown and closed the budget deficit in 2011, the Legislature passed and Governor Dayton signed, a gradual phasing out and eventual repeal of the provider tax.  This has been an issue the MAFP and other provider groups have been working on since the provider tax was first adopted in 1992. 

According to the law, the Commission of Management & Budget will annually determine the amount of revenues raised by the provider tax and the amount needed each year.  If it is determined that the revenues are greater than 25% over the need, the provider tax will be reduced.  According to current projections, the provider tax should begin a gradual reduction in 2013.  The ultimate repeal in scheduled for 2020.

For the phase-out to proceed, we must ensure that the provider tax is not targeted to fund new programs.  The MAFP will continue its work to preserve the repeal and will, in fact, advocate for hastening its demise.  There are already reports of some who are interested in dedicating the provider tax dollars for other purposes.  The MAFP will actively oppose such efforts.

MERC Funding
A growing coalition of health care advocates, including the MAFP, is beginning work to revisit the 2011 cuts to the Medical Education and Research Costs (MERC) program.  The program helps teaching hospitals and clinics to offset the costs of providing training and education to medical residents.  MERC suffered a nearly 50% reduction in state support last year, and the cut threatens to cause severe reductions to residency slots in hospitals and clinics across the state. 

While it will be difficult to obtain new money in this non-budget year with very little new money to go around, it is a crucial time for residency programs.  At a time when policymakers agree that we need more primary care physicians, we are seeing a lack of commitment to fund the needed training programs.

Other Potential Issues
While we are expecting a short session without a lot of new laws passing, there are many issues that potentially may arise.  Here is a brief listing of those issues.

• An effort to prohibit all minors from using artificial tanning facilities.  Current law allows anyone under 16 to use the facilities with parental consent, and unregulated access for those older than 16. 
• Efforts to raise the tobacco tax.  The MAFP is a member of the “Raise it for Health” coalition that is promoting an increase as a way to reduce smoking rates.
• A “gag bill” that would prohibit physicians from asking their patients about the presence of firearms in the home.  This is not an issue about guns.  Instead it is an issue about interference between the patient-physician relationship.
• An expansion of the chiropractic scope of practice to allow chiropractors to use “all types” of imaging, as well as permitting them to use the term “chiropractic physician.”  Negotiations are continuing to eliminate all controversy with this bill.
• Additional requirements of health plans to provide transparency on their accounting and rate-setting procedures.  The goal is to ensure that the money health plans receive from the state is being used to provide health care services to low-income Minnesotans.
• A proposal that is moving across the country known as “The Health Care Compact.”  This effort, led by state’s rights advocates, would change all incoming federal dollars for health care programs to block grants, thus removing all federal regulations on how the dollars are used. 
• Changes affecting the state’s Health Care Home designation, possibly including efforts to broaden the eligibility of patients as well as efforts to simplify the certification and recertification process. 
• Changes to the state’s Provider Peer Grouping law to ensure that any data that is released is accurate, verifiable, and helpful to providers and consumers.  The focus of this data must be on quality improvement and not product development by the health plans.

New Legislators, New Leaders
In a development that shocked Minnesota’s political world, Senator Amy Koch (R – Buffalo) stepped down as Majority Leader in mid-December.  It was later learned that she had been engaged in a relationship with a Senate staffer.  After several weeks of speculation and a day-long meeting of the Senate Republican Caucus, Senator David Senjem (R – Rochester) was elected by his colleagues as the new Majority Leader.

The legislative session will see a number of new faces on the floor of the House and Senate.  Following the death of Senator Linda Scheid (DFL – Brooklyn Center) after a long battle with cancer, Chris Eaton, a Brooklyn Center nurse, was elected to represent Senate District 46. 

Long-serving Senator Linda Berglin (DFL – Minneapolis), a fixture of health care debates for many years, has also resigned her Senate seat to pursue other opportunities.  Berglin was replaced in the Senate by Jeff Hayden (DFL – Minneapolis), formerly a member of the House of Representatives.  Filling Hayden’s Minneapolis seat is attorney Susan Allen (DFL – Minneapolis), who is the first American Indian female to serve in the Legislature.

Elsewhere in Minneapolis, Kari Dziedzic (DFL) will fill the seat left open when DFL Sen. Larry Pogemiller resigned from the Senate to head the Office of Higher Education.  The district includes the east part of Minneapolis and the University of Minnesota.

MMA Day at the Capitol—MAFP Co-Sponsor
Plan to join you fellow family physicians from around the state at the MMA’s “Healthiest State Day at the Capitol,” set for February 16.  Our day of advocacy will focus on driving Minnesota to the top of US health rankings.  The day will include a white coat rally at the Capitol, meetings with lawmakers, networking, and a reception.  Minnesota Commissioner of Health Ed Ehlinger, M.D., will speak at the event.

You'll learn about the key legislative issues impacting physicians and their patients, and we'll schedule appointments for you to meet your lawmakers.  After the event, you are invited to a reception at the University Club (free valet parking) to network with colleagues and enjoy hors d'oeuvres.  

Registration is required.  Click here to join us for this important event!
 

Important Links
Stay on top of the latest news from the Capitol via the following helpful sources:

Minnesota State Senate

Minnesota House of Representatives

Bill Search

Find My Legislator

Session Weekly (A non-partisan journal of news from the House)
 

- Dave Renner, MAFP Legislative Representative
(drenner@mnmed.org, 612-362-3750, 1-800-342-5662)