MAO Legislative Update
January 20, 2017
Eric Dick, MAO Lobbyist
Premium Relief Bill Headed to Conference Committee
Legislators raced to pass bills to provide relief for those consumers who have seen skyrocketing premium increases in the health plans they purchase in the individual market. The bills passed both the House and Senate, though in different versions. A conference committee is expected to begin the work of negotiating a single bill as early as next week. The Governor and his staff are likely to be heavily involved so that the legislature can vote on a final bill that can be quickly signed into law.
While both the House and Senate provide premium relief, they contain a number of different provisions. The House bill (Rep. Joe Hoppe, R – Chaska) contains language purported to address the phenomenon of “surprise billing,” those instances where a patient receives care in a hospital or surgery center that is in the patient’s network, but some ancillary services – often anesthesia, radiology, or pathology – is provided by a non-network provider. In these cases, patients are often surprised to receive bills from those providers that are not covered under their health plan. Under this House provision, non-participating providers would be reimbursed at the level on in-network providers. Physician groups have opposed these provisions, arguing that they would effectively strengthen the health plan’s negotiating power. The language would also incentive health plans creating even more narrow networks.
In addition, the House bill was amended to include provisions that would repeal all of Minnesota’s mandated health coverage. Gone, for instance, would be a requirement that all health plan products cover mental health treatments, cancer treatment, autism services, and dozens of other conditions and treatments. Opponents argued that patients don’t plan or schedule a cancer diagnosis or mental health episode, and that a patient’s coverage must anticipate many possible medical needs.
The Senate bill, authored by Sen. Michelle Benson ( R – Ham Lake) does not contain the “surprise billing” language, nor does it include the repeal of mandated coverage of specific conditions and treatments. It does include a section that would establish a reinsurance pool for those individuals and families with very high health care spending. The provision would create an entity very similar to Minnesota Comprehensive Health Association, the state’s high risk pool that was dismantled when the Affordable Care Act established guarantee issue and precluded the use of preexisting conditions as disqualifying for coverage.
Both bills focus exclusively on the individual market, a relatively small part of Minnesota’s health insurance landscape. None of the bills proposed would impact employee-provided health care plans.
The Governor has also proposed relief, though via a different mechanism. While the House and Senate Republicans’ proposal would use Minnesota Management and Budget (MMB) to administer rebates for those paying high premiums, the Governor’s plan would “buy down” a consumer’s premium via direct payments to the health plans. Dayton’s proposal is also not means tested, meaning all Minnesotans purchasing in the individual market would be eligible, while the Republicans’ plan uses a sliding scale based upon an individual or family’s income.
Cigar Taxes Cut Under Proposal; Other Tobacco Legislation Likely
The House Tax Committee considered a bill to lower the tax paid on “premium” cigars, those cigar which have a wholesale cost of more than $2. Current law applies a tax of $3.50 on each of these premium cigars, though the bill would reduce that tax to $.50. Unsurprisingly, the bill is supported by the tobacco industry, as well as cigar retailers. Opposition to the bill was led by Minnesotans for a Smoke-Free Generation, a tobacco control coalition on which many physician groups participate.
The proposal was laid over for possible inclusion in a larger tax omnibus bill that will be released later in the legislative session. No Senate companion has yet been introduced.
Other action on tobacco-related items may yet be considered in 2017. Tobacco control proponents remain on guard for efforts by the Legislature to preempt local tobacco control efforts. In recent years many Minnesota cities have enacted local ordinances to restrict the sale of candy and fruit flavored tobacco products to adult-only stores; such products are currently widely available at convenience stores and gas stations. It’s also likely that tobacco interests will once again seek to lower the tax rate on the most commonly available e-cigarette devices that failed to pass in 2016.
More than 600 Bills Already Introduced in Young Session
While the 2017 session is only three weeks old, more than X bills have already been introduced in both the House and Senate. Very few of these bills will receive a committee hearing, and even fewer will become law. By the close of the session in May, it's likely that more than 4,000 bills will have been introduced.
Some notable bills already introduced include:
- HF 142 (Thissen, DFL – Minneapolis). Rep. Thissen’s bill would require the state’s finance agency, Minnesota Management & Budget (MMB), to upon request by a legislator compile an estimate of a bill’s potential impact on the state’s disparities, including health disparities. The model for the proposal is the fiscal note process, the means by which MMB estimates the fiscal impact of legislation. The bill does note yet have a Senate companion.
- SF 112 & HF 345 (Housely, R – Stillwater & Zerwas, R – Elk Creek). These bill would establish the Palliative Care Advisory Committee. The 20 member group, on which at least three physicians will serve, is tasked with consulting and advise the commissioner of the Minnesota Department of Health on matters related to the establishment, maintenance, operation, and outcomes evaluation of palliative care initiatives in the state.
- SF 143 & HF 96 (Freiberg, DFL – Golden Valley & Eaton, DFL – Brooklyn Center). Introduced but not acted upon in recent years, these bills intend to strengthen Minnesota’s very weak school immunization law by requiring that parent & guardians who wish to not vaccinate their school-age children have a conversation with a physician about the risks of not vaccinating.
- SF 160 (Clausen, DFL – Apple Valley). Under this bill, the Minnesota Health Care Workforce Council would be established. The council would be tasked with providing ongoing policy and program monitoring and coordination, analyzing trends and changes in health care delivery, practice, and financing, and would recommend appropriate public and private sector efforts to address identified workforce needs. No House companion has yet been introduced.
White Coat Day at the Capitol Set for February 15
Make plans to join your physician colleagues for the annual Minnesota Medical Association’s Day at the Capitol set for February 15. This day of advocacy and fellowship is an important effort in advancing policies that help physicians and patients, and is a great opportunity for you to directly engage with your legislators on the issues facing organized medicine. Following presentation from key legislative leaders, individual meetings will be scheduled for you and your local colleagues with your Senator and Representative. With the extensive three year-long renovation of the Capitol largely finished, it’s a great time to visit the Capitol.
The “White Coats Day” at the Capitol is a key piece of the organized medicine’s advocacy strategy, and your participation is important to our efforts. Please make plans to join us for this fun and enjoyable day. More information and registration details are available here.