Legislative Update

February 4, 2011

Budget Cutting Begins in Legislature
After highly contentious debate on both floors, the House and Senate passed what they are calling “Phase One” in their work to craft a balanced budget.  The bills, passed on strict party lines, make permanent over $800 million in cuts that were originally proposed by former Governor Tim Pawlenty in his 2009 unallottments.  The 2010 Legislature passed these last year but only as one-time cuts. 

The majority of the cuts contained within the bill are to local government aid programs, the university system, and various human service programming though, notably, not to physician reimbursement.  HHS programs for low income Minnesotans such as General Assistance and Supplemental Aid Grants, as well as Child Support Enforcement Grants to counties would see cuts.

Republicans argue that beginning the work of cutting the budget now will make the next set of budget cuts more manageable, and note that the DFL legislature supported these very same cuts in 2010.  DFLers counter that the 2010 cuts were largely ‘backfilled’ with federal stimulus dollars, so that the damage to programs and recipients was muted.  These cuts, they argue, will disproportionately hurt the neediest Minnesotans. 

The House and Senate bills will now be referred to a conference committee to work out the differences between the two versions of the bill.  Governor Dayton, while not specifically stating his intent to veto the bill, has repeatedly called for a single, comprehensive budget solution, rather than the ’piecemeal’ approach that the Legislature has begun.  The Governor is due to present his budget proposal to the Legislature on February 15. 

“Freedom of Choice in Health Care” Bill Gets Hearing
A bill that would roll back Governor Dayton’s executive order enrolling Minnesota in the “early Medicaid” program made possible by last years’ federal health care reform package received two hearings in the Senate.  The bill, SF 33, is being carried by Senator David Hann (R – Eden Prairie), the chair of the Senate HHS Committee.  In addition to ending Minnesota’s enrollment in early Medicaid, the bill contains a “public policy statement” that declares that every resident of Minnesota has the “freedom of choice” in health care.   Click HERE to view the text of the bill.

Very clearly the supporters of this bill strongly believe that health care policy should be decided at the state level and not be dictated by the federal government.  This clearly directs the state of Minnesota to oppose a federal insurance mandate and for our Attorney General to enter into lawsuits challenging the constitutionality of the federal individual mandate to purchase health insurance.

The bill received its first hearing on January 26 in Senator Hann’s HHS Committee. 

A number of individuals testified in opposition to the bill, including MAFP Past President and current Minnesota Medical Association President Patricia Lindholm, a family physician from Fergus Falls.  Dr. Lindholm noted that passage of this legislation would serve to shift the costs of health care of those covered by public programs onto physicians, hospitals, employers who provide coverage for their employees, and all rate payers.

Several individuals, including representatives from the Citizens Council on Health Care and the 10^th Amendment Center spoke in support of the bill, arguing that the federal reforms passed last year infringed on Minnesota’s sovereign rites as a state.

Testimony on the bill was followed by contentious debate within the HHS Committee, with DFL members lamenting the lack of significant discussion on the state’s finances.  Much of the discussion focused on the US Constitution, and the relative wisdom of a committee of the Minnesota Senate debating constitutional law.  A fiscal note prepared for the bill stated that the cost to Minnesota would total $45 million for the next biennium. 

On February 3, the bill received its second hearing in the Senate Judiciary Committee, where debate once again focused on issues such as the state’s rights and sovereignty.  The bill passed on a voice vote and was referred to the Finance Committee.

The House companion bill, HF 199, carried by Rep. Steve Gottwalt (R – St. Cloud), chair of the House Human Services Reform Committee, has yet to receive a hearing.  Governor Dayton has stated his intention to veto any legislation that attempts to undo the state’s participation in early Medicaid. 

MinnesotaCare Changes Move Forward
A proposal by Rep. Steve Gottwalt (R – Saint Cloud) to move MinnesotaCare enrollees who are adults without children with incomes above 133% of the federal poverty level into private health insurance advanced earlier this week when it was passed by the House Commerce Committee.  The bill’s next stop is the House Human Services Finance Committee.  The text of the bill, HF 8, is available HERE.  The bill’s Senate companion, SF 32, carried by Senator David Hann (GOP – Eden Prairie) also took its first step, as it was passed from the Senate HHS Committee to the Senate Commerce Committee. 

The Gottwalt and Hann proposals would provide subsidies to eligible adults without children to purchase individual, private insurance in place of receiving coverage through MinnesotaCare.  Subsidy levels are determined on a sliding scale based on age and income.  Those individuals denied care in the private market would receive a slightly higher subsidy to seek coverage from the Minnesota Comprehensive Health Association (MCHA), Minnesota’s high-risk insurance pool. 

From a physician and clinic point of view, there are pros and cons with this proposal.  Clearly the reimbursement levels would be much better because they would be market rates as opposed to the artificially capped MinnesotaCare rates.  The concern, however, is that many of those purchasing individual coverage will purchase plans with $1,000, $3,000 or $5,000 deductibles.  Will this result in low-income patients avoiding needed care or being unable to pay the deductible?  The bill also creates a new exposure for the Health Care Access Fund to pay for the costs of the MCHA program.

Community Paramedics
A proposal from the Minnesota Ambulance Association would promote a new level of health care provider known as Community Paramedics.  The bill would allow a paramedic who completes additional training to be reimbursed under the Medical Assistance program as a community health worker.  The text of SF 119 is available HERE.   

Community health workers provide care coordination and patient education services to MA recipients.  They do not provide direct patient care.  The bill would still require the community paramedic to work under the direction of the ambulance medical director.

The MAFP has not taken a position on the legislation yet.  There are some family physicians who believe this is a wonderful program that utilizes trained paramedics to address some of the workforce shortage issues.  Others are worried that this is the type care that should be provided as part of the health care home and it should not be segregated from what family physicians do. 

Federal Court Rules Federal Reform Unconstitutional
In a court opinion related to the federal health reform act, a federal court in Florida ruled the entirety of the Patient Protection and Affordable Care Act (PPACA) passed in March 2010 to be unconstitutional.  While noting that many elements of the bill contained no constitutional question, Federal District Judge Roger Vinson ruled the individual mandate to buy health insurance to be unconstitutional.  Because the bill lacks a “severability clause,” he ruled the entirety of the bill to be in violation of the Constitution.  Severability clauses are a way in which the author of legislation can keep the remainder of a bill intact should a particular element be ruled unconstitutional. 

This is another of many federal rulings on this issue.  To date, two federal courts have ruled that PPACA passes constitutional muster, while two courts have ruled parts of the bill to be in violation of the US Constitution.  The issue is certain to ultimately end up before the US Supreme Court.

Here in Minnesota, a senior DHS official stated that the Dayton administration will be moving forward with implementation of the ACA at the state level, regardless of the lower court federal ruling until there is a final decision by the US Supreme Court.  Officials in other states, including Wisconsin, have stated that they will be stopping all activity around the federal bill, given the ruling.

Rumblings Around Newborn Screening?
In an otherwise mundane and dry House HHS Finance hearing regarding the internal finances of the Department of Health, questions arose from several first-term Republican House members about the newborn screening program.  The newborn screening program is a Minnesota initiative in which all babies born in Minnesota receive a dried blood spot test.  It has become controversial with some parents related to patient privacy concerns.  Several parents brought suit against MDH, claiming that the way the department operated the program ran counter to the authorizing statute. 

The legislators, Reps. Mary Franson (R – Alexandria), Kathy Lohmer (R – Lake Elmo), and Carolyn McElfatrick (R – Deer River), asked several MDH officials about the cost of the newborn screening program – the cost of the lawsuit defending the Department and the cost of storing the samples.  While the MDH officials didn’t have ready answers, they promised to provide those details to the committee.  While these legislators didn’t directly speak to a bias against the program, it seems likely that they are critical. 

After these questions, Rep. Tina Liebling (DFL – Rochester) stated that any financial assessments should also attempt to put a figure on the savings from treating newborns from the conditions that are diagnosed via the screen.  Rep. Tom Huntley (DFL – Duluth) noted that one legislator had a child whose condition was successfully treated because of the early diagnosis the screen provided.

While no legislation has yet been introduced that would repeal or modify the newborn screening program, this line of questioning in committee clearly signals continued interest in the program.  The MN-AAP continues to monitor closely both the pending Supreme Court case and the Legislature for developments. 

“State of the State” Scheduled for Wednesday
Governor Mark Dayton will appear before a joint session of the Minnesota Senate and House on Wednesday, February 9 to present his “State of the State” address.  Dayton will outline his budget and policy priorities.  This is an annual speech for the governor similar to the President’s State of the Union address.  During the gubernatorial campaign, Dayton identified jobs and education funding as top priorities.  To address the budget deficit, he said he would raise taxes on upper income households, which will meet strong resistance from the Republican legislature. The Governor’s budget will be released on February 15. 

House Bills Introduced in First Month
Below is a listing of House bills related to health care that have been introduced during the first month of session.  There are a similar number of Senate bills introduced as well.  Compared to years past the total number of bills (364 in the House) is significantly lower this year.  Many believe it is because of the severe budget deficit and many new legislators waiting for the Governor’s budget recommendations to be released.  If you click on the HF number, the link will take you to the legislature’s website and copies of the bills.

Bills introduced:

Gottwalt; Anderson, S.; Quam and Woodard introduced:
H. F. 8, A bill for an act relating to human services; establishing the healthy Minnesota contribution program; requiring plan to redesign service delivery for lower-income MinnesotaCare enrollees; amending Minnesota Statutes 2010, section 256L.05, by adding a subdivision; proposing coding for new law in Minnesota Statutes, chapter 256L.
H. F. 11, A bill for an act relating to taxation; increasing the research credit; amending Minnesota Statutes 2010, section 290.068, subdivision 1.

Hayden; Greiling; Scalze; Murphy, M.; Laine; Paymar; Ward; Hausman; Murphy, E.; Liebling; Moran and Greene introduced:
H. F. 51, A bill for an act relating to health; guaranteeing that all necessary health care is available and affordable for every Minnesotan; establishing the Minnesota Health Plan, Minnesota Health Board, Minnesota Health Fund, Office of Health Quality and Planning, ombudsman for patient advocacy, and inspector general for the Minnesota Health Plan; authorizing rulemaking; appropriating money; amending Minnesota Statutes 2010, sections 13.3806, by adding a subdivision; 14.03, subdivisions 2, 3; 15A.0815, subdivision 2; proposing coding for new law as Minnesota Statutes, chapter 62V.

Lanning, Abeler and Hayden introduced:
H. F. 77, A bill for an act relating to human services; establishing grant programs to promote healthy communities and the development of circles of support initiatives; appropriating money.

Clark, Hayden, Huntley and Champion introduced:
H. F. 167, A bill for an act relating to public health; requiring the commissioner of health to research and report on autism; requiring the Department of Human Services to train autism service providers; requiring notification of autism service options for medical assistance and MinnesotaCare recipients; proposing coding for new law in Minnesota Statutes, chapter 256.

Hackbarth; Howes; Rukavina; Anderson, B., and Buesgens introduced:
H. F. 188, A bill for an act relating to health; providing an exemption from smoking prohibition in public places; amending Minnesota Statutes 2010, section 144.414, by adding a subdivision.

Gottwalt, Abeler, Holberg, Lohmer, Dean, Shimanski, Sanders and Banaian introduced:
H. F. 199, A bill for an act relating to health; providing a statement of public policy declaring that every resident of Minnesota has the freedom of choice in health care; amending Minnesota Statutes 2010, section 8.31, subdivision 1; proposing coding for new law in Minnesota Statutes, chapter 1; repealing Minnesota Statutes 2010, sections 256B.055, subdivision 15; 256B.0756; Laws 2010, First Special Session chapter 1, article 16, sections 6; 7; 18; 46; 47.

Gottwalt, Abeler, Lohmer, Fritz, Norton, Hayden and Brynaert introduced:
H. F. 200, A bill for an act relating to health; requiring collection and reporting of certain data related to Alzheimer's disease; proposing coding for new law in Minnesota Statutes, chapter 144.

Gottwalt, Abeler, Mack, Torkelson and Vogel introduced:
H. F. 222, A bill for an act relating to health insurance; requiring guaranteed issue in the individual market; requiring MCHA to reinsure ceded risk on certain health plans; ending additional enrollment in MCHA; amending Minnesota Statutes 2010, sections 62A.65, subdivision 2, by adding a subdivision; 62E.10, subdivision 7; 62E.11, subdivision 1; 62E.14, subdivision 1; repealing Minnesota Statutes 2010, section 62A.65, subdivision 6.

Mack, Hayden, Gruenhagen, Quam, Davids, Gottwalt, Abeler, Huntley, Eken, Kiffmeyer, Dean, Zellers, Ward, Persell, McElfatrick, Lohmer, Barrett and McDonald introduced:
H. F. 262, A bill for an act relating to human services; adding community paramedics to the list of community health workers; amending Minnesota Statutes 2010, section 256B.0625, subdivision 49.

Urdahl; Hamilton; Gruenhagen; McElfatrick; Gunther; Westrom; Murdock; Anderson, B.; Franson; Kiel; Swedzinski; Anderson, P.; Schomacker; Vogel; Koenen; Eken; Gottwalt; Lohmer; LeMieur; Scott; Dettmer and Shimanski introduced:
H. F. 264, A bill for an act relating to civil actions; prohibiting actions against certain persons for weight gain as a result of consuming certain foods; proposing coding for new law in Minnesota Statutes, chapter 604.

Hayden and Clark introduced:
H. F. 278, A bill for an act relating to health; creating medical homes for children with autism spectrum disorders.

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