Monthly Archives: January 2017

Legislative Update 1/20/2017

MAO Legislative Update
January 20, 2017
Eric Dick, MAO Lobbyist

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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.

 

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2017 Legislative Session Kicks Off

MAO Legislative Update
1/6/2017
Eric Dick, MAO Lobbyist

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Legislative Session Kicks Off
The 2017 legislative staff kicked off with the wrap of a gavel in both the Minnesota State Senate and Minnesota House of Representatives at noon on January 3, 2017.  Legislators, staff, lobbyists, and the public at large returned to a Capitol building open again for the first time in several years, as the three-year renovation project has been largely completed.  The newly refurbished building is beautiful and much brighter, and it contains significantly more space for the public.

The elections of November 2016 brought a big change to the Capitol, as the Senate flipped from DFL to Republican control.  The fall elections also saw the House remain in GOP control, and with a bigger margin.  While the two legislative bodies are now in control, passing bills into law will require the signature of DFL Governor Mark Dayton.

It will be interesting to watch the tone in which the legislative leaders and Governor Dayton interact.  Much of the summer and fall of 2016 saw on-again, off-again negotiations about scheduling a special session to address unfinished business from the ’16 session, notably relief for increased health care insurance premiums.  Efforts to reach agreement failed, and the rhetoric became quite heated.

Given that there are more than 40 new legislators and new committee chairs, the session will start slowly as most committee meeting will feature briefings on issues from state agencies and advocates.  In the next weeks legislative leaders will announce the deadlines by which legislation must pass certain waypoints to be considered viable.  The deadlines – likely in March – serve to help winnow the volume of bills under serious consideration.  The Minnesota Constitution requires that the session end no later than midnight on May 22, 2017.

Budget, Health Insurance Likely to Dominate Session
Leaders in the House and Senate, as well as Governor Dayton, have made relief for consumers facing steep increases in their health care insurance premiums a priority. Legislators have heard from constituents of enormous increases in the their premiums for 2017, and there is universal support for helping these individuals.

While few details have been announced, most proposals would offer a one-time rebate to those consumers who purchase health insurance products in the individual market and are not eligible for federal tax subsidies. Earlier proposals from House Republicans have used the Health Care Access Fund to fund the rebates, while others - Governor Dayton, notably - have insisted on using the state's reserve account or general fund dollars. Only about 5% of Minnesotans would qualify; the vast majority of Minnesotans receive their health coverage from either their employer or government payers (e.g. Medicare, Medical Assistance, MinnesotaCare).  In addition to one-time, short term relief for 2017, legislators and the Governor have committed to passing more substantial reforms to address future cost increases.

The primary task in front of legislators in 2017 is the crafting of a biennial budget that funds all operations of state government.  Minnesota, unlike the US Congress, budgets in two year increments. The state’s budget is in a strong position, with a budget surplus of more than $1 billion.  Passing a budget is the one item that must be completed.  Should the Legislature and Governor fail to reach agreement on a budget by summer, a government shutdown could occur.

Also likely to see significant attention by legislators are tax cut packages, as well as investments in transportation. Legislators had hoped to pass these measures in 2016, but agreement could not be reached. As such, these priorities remain at the top of many elected officials agendas.

Key Issues for the MAO to Watch
While it is always difficult to predict exactly which issues will garner attention at the Capitol, the MAO will be carefully monitoring action at the Legislature for a number of specific issues.

Thanks to a bipartisan agreement reached in 2011, the state’s provider tax is set for repeal on December 31, 2019.  With the GOP in control of the Legislature, an extension of the tax is unlikely.  The MAO will partner with other physician and provider groups to strongly oppose any effort to extend the provider tax.

The MAO will also continue the partnership with the Minnesota Medical Association and others to pass medication prior authorization reform.  The “Fix PA Now” coalition, of which the MAO is a member, will continue to press for passage legislation to simplify medication PA and ensure patients get the medications they need in a timely manner.  The bill passed all necessary committees in the Senate in both 2015 and 2016, but did not receive a hearing in the House of Representatives. Advocates for the bill have held multiple meetings with key legislators in the House in an effort to ensure hearings in 2017.

There have been some rumors that audiologists will be pursuing legislation in 2017, though the intent of any potential legislation remains unknown.  The MAO will carefully watch for bills that would change or broaden the scope of practice for audiologists at the risk of patient safety.

Many New Names in Key Positions
The work of the legislature begins with the committee process, and with the change in partisan control of the Senate many legislators will be taking on new leadership roles.  Chairing the Health and Human Services Finance and Policy committee is Sen. Michelle Benson (R – Ham Lake), while Sen. Jim Abeler (R – Anoka) will chair the Senate’s Human Services Reform Finance and Policy committee.  Abeler, a chiropractor, held the House HHS Finance Division gavel during the 2011-2012 legislative session prior to his election to the Senate in 2016.  Taking over as Senate Majority Leader is Sen. Paul Gazelka (R – Nisswa), an insurance agent, while Sen. Tom Bakk returns to lead the now-minority DFL Senate Caucus.

The House will see some leaders returning to their position.  Rep. Matt Dean (R – Dellwood) retains the gavel of the House HHS Finance division.  Rep. Dean’s spouse is Laura Dean, MD, an OB/GYN who practices in Stillwater.  With the retirement of the previous chair, the HHS Policy committee will now be helmed by Rep. Joe Schomacker (R – Luverne).   Rep. Kurt Daudt (R – Crown) returns as Speaker of the House, while the House DFLers have elected Rep. Melissa Hortman (DFL – Brooklyn Park) to lead their caucus.

Two Physicians Elected to Minnesota Senate
For the first time since 2002, there are not one, but two physicians serving in the Minnesota Legislature.  Representing Mendota Heights, Inver Grove Heights, and South St. Paul, Sen. Matt Klein (DFL) is a hospitalist who practices at HCMC.  Also elected in November was Sen. Scott Jenson, a Chaska Republican.  Sen. Jensen is a family physician.  Both were elected by wide margins to fill Senate seats left open by retirements of incumbent legislators.

The last physician to serve in the legislature was Rep. Dick Mulder, a Republican from Ivanhoe, who served from 1995 to 2002.

Physician’s 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.

Read more →

 
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