February 5, 2010
Minnesota Legislature Back in Session;
Return of the MAFP Legislative Update
Thursday, February 4, 2010, marked the return of the Minnesota
Legislature for the second year of the Eighty-Sixth biennial
session. While this is considered the “non-budget” year of the
biennium, budget issues will dominate this session.
Minnesota is once again facing a budget
shortfall. Projections released in December show a deficit of $1.2
billion for the period ending June 30, 2011. The Minnesota
Constitution requires that we end the biennium with a balanced
budget, so the focus will be on finding program cuts, budget shifts,
or new revenues to fill the hole.
In
addition, the even-numbered session is historically dedicated to
passing a bonding bill for state capital projects. Governor
Pawlenty released his version of a bonding bill that funded projects
totaling $685 million. The Senate Democrats passed their bonding
bill out of committee on opening day that totals $1 billion.
With the return of the Minnesota Legislature,
we are again providing the MAFP Legislative Update. This biweekly
electronic update is provided to MAFP members as a way to keep you
up to date on what is happening at the Capitol. We will try to
focus on issues of importance to family physicians as identified by
the MAFP Legislative Committee and Board of Directors. We hope you
find this update interesting and useful.
GAMC Reforms Fast-Tracked This Session
Because of actions taken by
Governor Pawlenty at the end of the 2009 Legislative Session, the
state’s General Assistance Medical Care (GAMC) program is scheduled
to end on April 1, 2010. GAMC is a state-only funded program that
provides health care coverage for adults without children earning
less than $7,800 per year. It currently covers 35,000 Minnesotans,
many of whom have chronic conditions such as mental illness or
chemical dependency.
Pawlenty has proposed shifting this
population into the MinnesotaCare program for their continued
coverage. (HF
2736--Dean) The trouble with this is that many of the GAMC
population will not fit well into the MinnnesotaCare program. It is
a premium-based program which many GAMC recipients will not be able
to afford. The fear is these people will join the ranks of the
uninsured and become uncompensated care.
The
DFL is proposing legislation to maintain GAMC in a slightly scaled
back version (HF
2680--Murphy, E.). Under this proposal, hospitals, physicians,
and other providers will still receiving reimbursement; however, the
bill cuts GAMC reimbursements by 50 percent. These cuts are to
payments that are already absurdly low. Current fee-for-service
payments are based on the median charges from 1989. For primary
care codes, they are 35 percent of the average payment made by
private insurers and they are 47 percent of what Medicare pays.
MAFP Past President Dave Thorson Testifies
on GAMC Cuts
Dave Thorson, MD, testified on February 3 before the joint
hearing of the Senate Health, Housing, & Family Security Committee
and the Senate Health & Human Services Budget Division raising
concerns with the size of the proposed GAMC payment cuts. He was
testifying on behalf of the MMA, where he currently serves as Chair
of the Board of Trustees.
Thorson encouraged the Legislature to find a
solution that will maintain coverage for the GAMC enrollees, but
cautioned the committee that 50 percent payment cuts to physicians
and other providers will create large financial strains on clinics
that serve this population.
The MAFP Board decided in January that seeking
a solution to the loss of GAMC funding would be a high priority for
the MAFP in the 2010 Legislative Session. We must find a way to
maintain coverage for the lowest income members of our society.
Failing to do so will result in them forgoing needed care and
finally receiving care in the hospital, which is the most costly way
of caring for them.
Federal Reform Stalls; Impacts State Budget
Problems
With all of the work that Congress
has done to promote comprehensive health system reform, it all seems
to have come to a standstill with the recent election of a
Republican senator from Massachusetts. The reform effort had been
supported by the AAFP and included a number of reforms that were
similar to what Minnesota adopted in 2008.
Included in the federal reform bill is a
continuation of the federal stimulus money that increased the
federal matching amounts for the Medicaid program. This would bring
in approximately $500-$600 million this year to Minnesota. This
would have addressed nearly one-half of the state’s deficit.
In addition, the Senate bill will allow states
to begin enrolling adults without children in Medicaid starting
April 1, 2010. This would solve the GAMC problem. We could
eliminate GAMC, enroll them in MA, and receive 50 percent federal
matching money. This would cut the cost of this program in half.
With the Congressional leadership reassessing
where they go with health system reform, all of this is now unclear.
Lyme Disease Treatments
Based on concerns raised by some
physicians that they may be disciplined for the way they treat Lyme
disease, legislation has been introduced to limit the Board of
Medical Practice’s authority in these cases (SF
1631--Marty). The bill says a physician shall not be subject to
disciplinary action by the Board of Medical Practice (BMP) solely on
the basis of prescribing, administering, or dispensing long-term
antibiotic therapy for a therapeutic purpose to a patient who has
been clinically diagnosed with chronic Lyme disease.
This bill comes out of a disagreement among
different physician groups about whether long-term antibiotic
therapy is appropriate for treating Lyme Disease. Two other states
have passed similar legislation.
The MAFP Legislative Committee reviewed the
bill and heard from supporters of it. Following that discussion,
the committee was concerned that this kind of legislation was
creating the wrong precedent for the future. The BMP is authorized
to review cases of physician practice and establish the standard of
care based on the science and the facts of the case. For the
Legislature to step in and limit the BMP from acting on one specific
type of treatment is not good overall policy.
The bill is scheduled to be heard in both
Senate and House committees during the week of February 8.
Disposal of Unused Pharmaceuticals
Rep. Paul Gardner (DFL-Shoreview) is proposing legislation to
establish a program to take back unused pharmaceuticals. The goal
of the bill is to address the environmental concerns caused by drugs
being flushed into the sewer systems and to reduce the number of
unused drugs by changing prescribing behaviors.
The bill would require the establishment of
“stewardship programs” to create take-back programs for unused
drugs. The programs would be paid for by the drug manufacturers.
The bill would also clarify conflicting regulations where the
Minnesota Health Department requires health care facilities to flush
certain drugs, but the Minnesota Pollution Control Agency says it is
unlawful to do so.
A part of the bill would try to change
prescriber behavior by prohibiting samples and instead use vouchers
for free drugs at pharmacies, and by limiting the initial
prescription for new therapy to no more than 15 days. In meeting
with Rep. Gardner, we told him that these two provisions will have
unintended consequences of creating access barriers for certain
patients receiving needed therapies. He is in the process of
rewriting portions of the bill and it is our hope that these
provisions will be removed.
Pharmaceutical Marketing
There have been three bills introduced this year to limit the
marketing practices by pharmaceutical and device manufacturers. The
proponents of the bills argue that these practices inappropriately
influence the prescribing decisions of physicians.
The first bill prohibits
manufacturers from using physician prescribing data for marketing
purposes (HF
491--Liebling). The process, some times referred to as data
mining, is used by drug companies to review physicians’ prescribing
patterns and provide that to the manufacturers’ sales forces.
Physicians and patient advocates have raised concerns that this data
may somehow disclose patient information and patients may be
reluctant to disclose information to physicians if they think it may
be used for marketing. The MAFP Legislative Committee recommends
that the MAFP support this legislation. The Board will decide on
that recommendation on February 27.
The
second bill would create an unbiased resource to whom physicians
could turn to learn about new drugs and appropriate therapies (HF
1640--Liebling). This is referred to as academic detailing and
it designed to move that educational function away from the specific
manufacturers who some believe have a bias. The bill would direct
the Board of Pharmacy and the UM Medical School to develop an
evidence-based prescription drug education program designed to
provide information and education on the therapeutic and
cost-effective utilization of prescription drugs to physicians,
pharmacists, and other health care professionals authorized to
prescribe and dispense prescription drugs. There would be an
outreach component that would work to get this information to
practitioners.
The
third bill would prohibit manufacturers from giving and physicians
from receiving gifts and would increase the public disclosure
requirements for all payments made from manufacturers (HF
1641--Liebling). The bill would exempt samples from the gift
definition if they were used for low-income patients or for initial
trials, honoraria for speaking if it did not exceed the standard
hourly billing rate of the practitioner, and educational materials
that were published and produced by the manufacturer.
Follow the Legislative Process
If you would like to follow the legislature more closely, there
are a number of resources available to you. The Minnesota
Legislature website is a great place to start. -
http://www.leg.state.mn.us/. You can track bills, see committee
schedules, find your legislator and more.
From there you can go to the Senate site and
the House site. Both have weekly newsletters you can sign up for.
The Senate Briefly can be found at
http://www.senate.leg.state.mn.us/briefly/index.php?ls=#header
The House Weekly can be found at
http://www.house.leg.state.mn.us/sessionweekly/
