Legislative Update

February 19, 2010

Pawlenty Releases Budget Changes—Cuts All Around
Gov. Tim Pawlenty presented his supplemental budget Monday that outlines how he would erase a $1.2 billion state budget deficit.  Keeping with his ongoing pledge to not raise taxes, his budget recommendations rely on cuts to his familiar targets of health care and local government aid. He also relies on $387 million in federal money that has not yet been approved by Congress.

For details on the Governor’s budget recommendations, click on the following link to the Department of Budget and Management: http://www.mmb.state.mn.us/

The budget proposal cuts $347 million from health and human services programs. About one-third of those savings would come from reducing MinnesotaCare eligibility for single adults from 250 percent of poverty ($27,084 a year) to 75 percent of poverty ($8,124 a year). Another big cut is a 2.5 percent reduction in payments to long-term care workers.

The proposed change would result in about 21,500 low-income workers losing their health care. MinnesotaCare is a premium-based program for working Minnesotans that provides subsidies on a sliding scale.  If passed, the only adults without children who would qualify for MinnesotaCare would be those who in past years qualified for the General Assistance Medical Care program.  What is disappointing with these cuts is that MinnesotaCare originally passed as a bipartisan effort designed to help people move from welfare to work.

The proposal also undercuts Minnesota’s efforts to achieve universal coverage and health care reform. The budget proposal includes cutting $10 million from the State Health Improvement Program – a statewide effort to reduce tobacco use and obesity by making communities healthier – that was passed as part of Minnesota’s 2008 Health Care Reform Act.

GAMC Passes the Legislature—Vetoed by Governor
What looked like a bipartisan effort to save the GAMC program was abruptly halted by Governor Pawlenty with his veto of a bill to continue coverage Thursday night.

Efforts to maintain coverage for recipients of General Assistance Medical Care (GAMC) continues to move quickly through the Legislature.  Governor Pawlenty has proposed transferring these individuals into the MinnesotaCare program beginning April 1, 2010.  The DFL legislative leaders are proposing maintaining a scaled back GAMC program with a 50 percent cut to physician payments.

The Senate passed an amended proposal on February 11 to continue the GAMC program. The Senate dropped a funding source that would have assessed a surcharge on hospitals and HMOs designed to draw down more federal Medicaid money, but kept steep reimbursement cuts.  The bill passed on a party-line vote of 45 to 20, with DFL lawmakers supporting it. 

Before passing the bill, the Senate dropped the surcharge on hospitals and HMOs in response to indications that Gov. Tim Pawlenty would veto a GAMC fix that included the surcharge.  To pay for the bill, the bill’s author Sen. Linda Berglin, DFL-Minneapolis, proposed using $110 million that was scheduled to be transferred from the General Fund to the Health Care Access Fund in 2011. The $110 million transfer had been scheduled to cover the additional costs expected to occur as a result of the governor's plan to transfer GAMC enrollees to MinnesotaCare. 

The House version of the bill, authored by Rep. Erin Murphy, DFL-St. Paul, was passed on February 18 with a bipartisan vote of 125-9.  Many looked at this vote as a sign that the Republican Governor would sign the bill.  Surprisingly, Thursday night he announced that he had vetoed the bill because it “does not represent meaningful reform and does not address fundamental cost issues.”  Here’s a link to the Governor’s veto message.  Veto message

Legislative leaders said they will attempt to override the Governor’s veto as early as February 22.  In order to be successful, they will have to convince at least three House Republicans to vote for the override in order to get the two-thirds vote needed.

Amended Dental Caries Bill Moves with MAFP Support
Legislation encouraging physicians to provide basic dental screenings for children as part of their child and teen check up is moving forward.  HF 984 (Norton-DFL, Rochester) was amended last year in response to MAFP concerns, from language that mandated that these services be provided by physicians to language that says the Commissioner of Human Services shall encourage physicians to provide these services.  The services would include a general visual exam of the child's mouth without using probes or other dental equipment, a risk assessment using the factors established by the American Academies of Pediatrics and Pediatric Dentistry, and application of fluoride varnish beginning at age 1 to those children assessed by the provider as being high risk.

The bill passed the House Finance Committee on February 16 and is awaiting final action on the House Floor.

The Senate companion bill SF 633 (Berglin-DFL, Minneapolis) is in the Senate Finance Committee.  It still has the old language mandating the service, but the expectation is that Senator Berglin will adopt the House language.

Lyme Bill Compromise Reached with BMP
Legislation to limit the Board of Medical Practice’s (BMP) ability to take action against a physician solely on the basis of prescribing, administering, or dispensing long-term antibiotic therapy to a patient who has been clinically diagnosed with chronic Lyme disease was withdrawn for consideration in the House Health Care & Human Services Policy and Oversight Committee on February 17 following a compromise agreement with the BMP.

The bill SF 1631 (Marty-DFL, Roseville) and HF 2597 (Ward-DFL, Brainerd), would have put the BMP limitation in statute, creating a very bad precedent of having the Legislature tell the BMP how to regulate medical practice and how to define the standard of care.  The MAFP testified against the bill in the Senate.

Under the compromise, no legislation will move forward and the BMP will voluntarily agree to a moratorium on taking action related to Lyme disease for up to five years while more study is done on the efficacy of long-term antibiotic therapy for Lyme.

Disposal of Unused Pharmaceuticals
Rep Paul Gardner’s (DFL-Shoreview) bill HF 1217  to establish “stewardship programs” for unused drugs has passed two committees in the House.  It has passed the Environment Policy & Oversight Committee and the Health Care and Human Service Policy & Oversight Committee.  It still has to go through the Crime Prevention Committee and the Finance Committee before getting to the House Floor.

The programs would require wholesalers to develop and fund drug take-back programs for unused drugs in order to eliminate these drugs from being disposed in the sewer systems.  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.

The bill is being opposed by the drug manufacturers, Life Science Alley, and the Minnesota Pharmacists Association.

Chiropractic Practice Act Changes
The Minnesota Chiropractic Association is proposing legislation to rewrite portions of the chiropractic practice act.  The bill would change the definition of chiropractic from “the science of adjusting any abnormal articulations of the human body…” to “the health care discipline which emphasizes the inherent recuperative power of the body to heal itself without the use of prescription drugs or surgery.  Chiropractic focuses on the relationship between structure, primarily the spine, and function, as coordinated by the nervous system, and how that relationship affects the preservation and restoration of health.”  The bill would also authorize chiropractors to use the term “Chiropractic Physician” with patients.

This bill has not yet been introduced.  The MAFP is reviewing it and would appreciate member input on it.  Input may be e-mailed to drenner@mnmed.org.

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