Legislative Update: 2/4/11


Peds Day at the Capitol Set for February 15

Building relationships with elected officials has never been more important.  With a state budget deficit of $6.2 billion and 60 new legislators, communicating with those who will be making the decisions at the Legislature is critical to promoting children’s health and well being. The MN-AAP’s annual “Day at the Capitol” is a terrific way to do just that.  We’ve invited key legislators and opinion makers to address the group and we’ll arrange for you to meet with your own legislators, too. This is a terrific way to add your voice to the MN-AAP chorus at the Capitol.

We’ve also invited some key leaders to address our group as a whole.  As of this writing, Representatives Jim Abeler (GOP – Anoka, Chair of the House HHS Finance Committee) and Erin Murphy (DFL – St. Paul), as well as Senator Linda Higgins (DFL – Minneapolis), have confirmed their availability.

It’s easy to be a part of Peds Day at the Capitol, too. To take advantage of the schedules of many area resident pediatricians, we’ve arranged for two sessions, the first orientated towards residents, the second geared toward community and faculty pediatricians. Both will present excellent opportunities to learn about the issues we’re following and to add your voice. Join us for either one… or both!

REGISTER today for this important event!

Budget Cutting Begins in Legislature

After a highly contentious debate on both floors, both 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 originally found in former Governor Pawlenty’s unallottments of 2009 and passed by the Legislature in 2010.

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, as the two versions of the bill differ.  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 year’s federal health care reform package received two hearings in the Senate.  The bill, SF 33, is being carried by Senator David Hann (GOP – 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.

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 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 10th Amendment Center spoke in support of the bill, arguing that the federal reforms passed last year infringed on Minnesota’s sovereign rights 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 U.S. 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 Thursday, 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.

SF 33’s House companion, HF 199, is being carried by Rep. Steve Gottwalt (GOP – St. Cloud), chair of the House Human Services Reform Committee, though it 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 (GOP – Saint Cloud) to move a number of MinnesotaCare enrollees into private health insurance advanced earlier this week when it was passed by the House Commerce Committee. The bill’s next step is to be considered by 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 with incomes above 133% of the federal poverty level to purchase individual, private insurance in place of 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.  The bill’s proponents argue that the bill would save the state money while opponents raised concerns about the poor being able to navigate the private market.

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 freshman GOP members about the newborn screening program.  The newborn screening program is a Minnesota initiative in which all babies born in Minnesota are screened for more than 40 disorders.  Several parents brought suit against MDH, claiming that the way the department operated the program ran counter to the authorizing statute.  The MN-AAP has long been a supporter of the program.

The legislators, Reps. Mary Franson (GOP – Alexandria), Kathy Lohmer (GOP – Lake Elmo), and Carolyn McElfatrick (GOP – 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.

Committees Continue Issue Overviews

The pace of committee hearings remained relatively sluggish with many committees continuing their work to bring members “up to speed” on the issues before them.  One month into the legislative session, very few bills have been heard by committees and even fewer have been considered by the full House or Senate.

On Tuesday the Health and Human Services Reform Committee heard two presentations on the federal Patient Protection and Affordable Care Act.  The first was from Dr. Stephen Parente of the U of M’s Carlson School of Management and the second was from Peter Nelson of the Center for the American Experiment.  Both presenters talked about the positives and negatives of the legislation and suggested alternatives including med mal reform, expanded high-risk pools and long-term care insurance.

On Thursday, the committee heard from each of the Coordinated Care Delivery System (CCDS) hospitals (HCMC, Fairview/University, North Memorial)about the lessons learned from the changes made after the termination of the GAMC program. The final portion of the hearing was devoted to an overview of Minnesota’s Community Health Centers.  Witnesses from the Minnesota Association of Community Health Centers told the committee about their successes and challenges in working with low-income and uninsured patients.

Dr. Doug Wood, the Mayo Clinic’s leading health policy spokesman, testified before the Senate HHS Committee and the House HHS Reform Committee on Wednesday.  Wood outlined the challenges facing health care consumers, employers and the state in paying for health care.  His recommendations for reform included bundled payments for major acute episodes, a single statewide insurance exchange, using the federal employee benefit plan as the basic benefit set and promoting public health spending to reduce obesity and tobacco use.

“State of the State” Scheduled for Wednesday

Governor Mark Dayton will appear before a joint session of the Minnesota Legislature on Wednesday, February 9 to present his “State of the State” address.  Dayton will outline his budget and policy priorities.  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.

Federal Court Rules Federal Reform Unconstitutional

In a significant opinion, a federal court in Florida ruled that the entirety of the federal health care reform bill (aka the “Patient Protection and Affordable Care Act,” or PPACA) passed in March 2010 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.  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 U.S. Supreme Court.

Here in Minnesota, a senior DHS official stated that the administration and department will be moving forward with state-centered changes that the ACA offers or mandates, regardless of the lower court federal ruling.  Officials in other states, including Wisconsin, have stated that they will be stopping all activity around the federal bill given the ruling.

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 than in prior sessions.  Many believe it is because of the severe budget deficit and many new legislators waiting for the Governor’s budget recommendations to be released.  Click on the HF number to link to the text of the bill’s language.

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.

Bills introduced:
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.

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