Legislative Update

May 2, 2011

Three Weeks ‘til Adjournment?
Members of the Legislature returned to the Capitol on April 25 following a week long break for Easter and Passover, and begin a sprint to finish by the constitutionally-mandated adjournment of May 23.  With only one budget bill signed into law thus far into the session, the vast majority of work remains.  How the Governor and Legislature will reach agreement in the next weeks is deeply unclear.

That said, both legislative leaders and the Governor continue to insist a special session can be avoided.   For that to happen, both sides need to first need to decide that they want to reach agreement.  This will require compromise on crucial points from both sides.  Gov. Dayton continues to insist that the final solution must include an increase in the income tax for top earners, as a way to make our tax system more progressive.  Legislative leaders continue to insist that we do not need any new revenues and that the deficit can be solved through spending cuts alone.  Agreement needs to be reached on the amount of overall cuts and new revenues before any significant negotiations between the two can begin.
 

Bill to “Right-Size” Provider Tax Receives Hearing
A bill that would lower the provider tax as Health Care Access Fund (HCAF) surpluses grow was introduced in the House and received its first hearing on April 28.  The proposal, HF 1584, authored by Majority Leader Rep. Matt Dean (R - Dellwood) would require the state's budgeting department, Minnesota Management and Budget, to determine the estimated need for spending from the HCAF for the year and, if a surplus exists, lower the provider tax levied during the next year so that the HCAF does not exceed 125% of projected outlays.  In addition to reducing the provider tax, this approach also reduces the likelihood that the HCAF surpluses will be used for non-health care purposes.  As surpluses have accrued in years past, all too often those dollars have been raided to balance the state's budget. 

The bill has bipartisan support with several DFL members of the committee noting that once the federal health care reforms passed in 2010 are fully implemented in 2014, those individuals currently covered by MinnesotaCare will be covered by federal subsidies to purchase health care insurance.  At that point, many would argue, the need for the provider tax disappears.

The bill passed unanimously and has been referred to the House Tax Committee where it will be heard today, May 2.  No Senate companion has yet been introduced.
 

Budget Conference Committees Continue
The conference committee tasked with reconciling two very different HHS budget proposals continued to meet this week.  While no decisions have been made, the ten members of the committee continued their study of the two proposals.  Each body has been presenting further explanation of the rationale for various elements of their respective bills.  The committee has been meeting regularly for nearly three weeks and has yet to make any substantive decisions.  Until decisions on the overall spending have been decided as part of the global budget negotiations, the committee cannot make much progress.

Governor Dayton has continued to insist that he would not begin negotiations until the House and Senate agree on a single legislative position.  His Commissioner of Human Services, Lucinda Jesson, has weighed in with a letter listing a number of concerns present in either or both of the proposals.  Among the objections is the legislature's repeal of the state's adoption of "early Medicaid," as well as the move of many low-income individuals from MinnesotaCare into defined contribution health insurance plans.  Commissioner Jesson also noted the department's belief that the overall target for cuts - $1.6 billion - is too high to not create significant problems for the state's most vulnerable.

View Commissioner Jesson’s letter to the HHS Budget Conference Committee here.
 

Chiropractor Bill Tabled for the Remainder of Session
In a late night House hearing, the HHS Reform Committee took up HF 1334, a bill to amend the chiropractic practice act.  The bill, promoted by the Minnesota Chiropractic Association, seemed to go beyond a simple update of their statute by using language that significantly expanded their scope of practice. 

A coalition of primary care and specialty physicians, physical therapists, occupational therapists, dietitians, and health plans came together to oppose various elements of the bill.  Of particular concern were provisions authorizing the use of "any type" of diagnostic imaging, allowing the use of the term "chiropractic physician," and a repeal of statutory language that states that "the practice of chiropractic is not the practice of medicine, surgery, or osteopathy."  Although the MAFP was able to reach some agreement with the chiropractors to remove most of the objectionable language in the weeks and days prior to the hearing, issues of concern remained.

Following testimony both in support and opposition to the proposal, the author moved to table the bill, noting that many issues remain unresolved.  Discussions will continue this summer, and the proposal is likely to be back next legislative session. 
 

House Committee Holds Vaccine Safety Hearing
The House HHS Reform heard testimony surrounding vaccine safety issues on April 28.  Dr. Theresa Deisher, a Stanford-trained genetic researcher and President of Sound Choice Pharmaceutical Institute, offered testimony about her research into the link between the presence of "fetal stem cell DNA" in the MMR vaccine and growing rates of autism.  A press release noting her appearance before the committee states that her research focuses on the "likely adverse affects of human DNA residuals in many widely utilized vaccines.”

Offering an opposing view were a number of researchers and public health experts, including Kristen Ehresmann, the Director of the Infectious Disease Epidemiology Division at the Minnesota Department of Health and two researchers from the Department of Genetics at the University of Minnesota, Dr. Brian Van Ness and Dr. Perry Hackett.  These testifiers noted that Dr. Deisher's research has yet to be published in peer reviewed scientific journals, and that is widely discredited in the scientific community. 

Even though the hearing was “informational” only, and no legislation has resulted from it, many public health advocates are worried that scientifically-suspect pronouncements such as Dr. Deisher's are very dangerous and may be the cause of the rising numbers of reported cases of measles as parents have unsubstantiated fear of vaccines.
 

MinnesotaCare Defined Contribution Bill Passes the House
The bill to change MinnesotaCare from a defined benefit plan to a defined contribution plan passed the House floor on April 28 on a nearly party-line vote of 70-62.  HF 8 (Gottwalt—R, St. Cloud) would provide a state voucher to adults without children earning more than 133% of the federal poverty level.  The voucher would be used to purchase coverage through the private, individual market.  The size of the voucher is based on the cost of a $3,000 deductable product.

The supporters of the bill have argued that this will benefit providers because there will no longer be a $10,000 cap on inpatient hospital coverage and that providers will be paid at commercial rates and not the artificially low Medicaid rates.  The MAFP opposes the bill as drafted because for a person earning as little as $14,500, a $3,000 to $5,000 deductible will be unaffordable.  These individuals will put off care, present at the office as uncompensated care, or get their care at the emergency room.  This approach goes counter to the health reforms adopted just two years ago designed to encourage patients to get outpatient care through a health care home and reward chronic disease management.

The Senate version on HF 8 is still awaiting final action on the Senate floor.  At this point, Gov. Dayton has indicated that he does not support the bill in its current form so it is unclear whether the Senate will act on the bill.  Most likely, this will be a part of the final budget negotiations in which we will be working to ensure appropriate coverage for needed outpatient care.

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