Monday, January 12, 2015
Legislative Updates for MAFP Members
Once again the MAFP Is providing regularly scheduled legislative updates to keep members apprised of what is happening in St. Paul. These updates will be sent out every two weeks to provide you with a brief summary of the actions related to health care legislation that impacts family physicians and the patients your care for. If there are any issues in these updates for which you have questions or want to provide feedback, please feel free to let MAFP staff know or contact me directly at firstname.lastname@example.org.
And they’re off…
With the crack of the gavel and calls for cooperation and bipartisanship, the 2015 legislative session began shortly after noon on Tuesday, January 6, 2015. All 201 legislators in the DFL-controlled Senate and GOP-controlled House gathered in St. Paul to officially begin the 2015 legislative session amidst the construction dust and debris of the ongoing Capitol renovation project.
First and foremost on the minds of legislative leaders will be their constitutionally-mandated job to pass a balanced biennial budget. That task was made somewhat easier with the announcement of a budget surplus going into the 2016-2017 biennium. While the $1.037 billion surplus is certainly good news, in the scope of a nearly $42 biennial budget it won’t completely remove disagreements among legislators and the Governor. Between now and the end of session – set this year for no later than May 18, 2015 – legislators must come to an agreement on the state’s budget for the next two years.
An added challenge this year is the fact that the Capitol is in the midst of a comprehensive, three year, $272 million renovation. During the 2015 Legislative Session, two-thirds of the Capitol building is closed to the public. This has resulted in the Governor and dozens of Senators and staff being relocated to temporary offices, and over half of the Senate hearing rooms being unavailable this year. The construction will add an interesting dynamic to the session. Of some horror to Capitol denizens, portable toilets have been brought in to make up for the closed bathrooms. Quarters are close, creating new challenges that will likely lead to more impatience than understanding. A terrific video that documents the project is available here.
The Key Players
The November 2014 elections saw the nationwide Republican wave hit Minnesota, though in a somewhat smaller form. Two statewide DFL leaders who first came to office via the narrowest of margins – Senator Franken and Governor Dayton – were handily reelected in 2014, though the Republicans regained control of the Minnesota House of Representatives. The House has now shifted from one party to the other in the last four elections.
With the new House majority comes new names in key positions of leadership. Often considered the second most influential political position in the state behind only the Governor, the new Speaker of the House is Rep. Kurt Daudt (R – Crown). The Republicans have elected Rep. Joyce Peppin (R – Rogers) as their new Majority Leader, while the DFL House Caucus elected former Speaker Rep. Paul Thissen (DFL – Minneapolis) as the Minority Leader. The Chair of the House HHS Finance Committee is Rep. Matt Dean (R – Dellwood) while Rep. Tara Mack (R – Apple Valley) is the Chair of the HHS Reform Committee. Reps. Tina Liebling (DFL – Rochester), Dianne Loeffler (DFL – Minneapolis), and Joe Mullery (DFL – Minneapolis) will be the lead Democrats on these two committees. A link to the entire list of committee assignments is available here.
Members of the Senate were not on the ballot in November and there have been no changes in leadership or committee chairs. The Chair of the Senate HHS Finance remains Sen. Tony Lourey (DFL – Kerrick) while the Chair of the Senate HHS Policy Committee remains Sen. Kathy Sheran (DFL – Mankato). Lead Republicans on the two committees remain Sen. Julie Rosen (R – Fairmont) and Sen. Michelle Benson (R – Ham Lake) respectively. The Senate Majority Leader remains Sen. Tom Bakk (DFL – Cook) while the Senate Republicans will still be led by Sen. David Hann (R – Eden Prairie).
Budget Picture Rosier, But Concerns Loom
As noted above, the fiscal forecast announced in early December shows a surplus for the state in both the current period and the 2016-2017 biennium. Much of the $556 million surplus in the current biennium has been deposited in the state’s reserve account – known as the “rainy day fund” to many – due to a change in state law adopted in 2013. Analysis of the forecast by officials at Minnesota Management and Budget (MMB) show that the surplus came about because of both higher-than-anticipated tax receipts and lower-than-expected state spending, particularly in health care. MMB also projects that revenue in the 2016-2017 biennium will exceed spending by $1 billion which, when combined with the remainder from the current biennium, puts the surplus at $1.037 billion.
The good budget news will make legislator’s budget-setting task easier. DFLers will likely be successful in their push for more spending in key areas and the Republican-controlled House will likely be able to move forward some targeted tax relief. But the budget numbers are not as rosy as they might seem. Should the economy take a turn for the worse, the next budget forecast – due in March – may show a smaller number. And in the scope of an almost $42 billion budget, a surplus of $1 billion is a relatively small number.
It’s also worth noting that the budget forecast paints a more troubling picture for the area of the budget that is of special significance to health care interests. The Health Care Access Fund, the budget fund that is funded mostly by the state's 2% provider tax, shows a deficit beginning in 2017 and growing in subsequent years. That deficit will grow quickly in the future as the state’s provider tax is repealed at the end of 2019. Those deficits will put tremendous pressure on legislators to find new funding, cut programming or eligibility for health care, or rescind the repeal of the provider tax.
MAFP Begins Work Setting 2015 Session Agenda
The MAFP Legislative Committee, chaired by Will Nicholson, MD, has begun identifying priority issues for 2015. Some of the priority issues the MAFP will be promoting include continuing the “primary care bump” in Medical Assistance payments for primary care services. This increase was included in the Affordable Care Act but sunset on December 31, 2014. We will be working to reinstate that increase with a mix of state and federal money.
There are also efforts to increase funding for physician loan forgiveness programs for primary care physicians willing to serve in under-served areas. This initiative comes from the MMA’s Primary Care Physician Workforce Task Force.
The MAFP will be active in tobacco prevention efforts. The MAFP House of Delegates passed a resolution asking that the minimum age to purchase tobacco products be raised to 21. In addition, a large coalition of anti-tobacco advocates is pursuing adding e-cigarettes to the Freedom to Breathe Act and limiting the sale of flavored tobacco to tobacco shops where kids are not allowed.
Finally, the MAFP is supporting the Minnesota Medical Association's (MMA's) efforts to better regulate the use (and at times abuse) of prior authorization requirements for medications. MAFP Past President Dr. Randy Rice is serving on an MMA task force that is developing a legislative package that will reduce the burdens on prescribing physicians and improve access for patients to needed drugs. It will include more transparency on the process, potential limits on the use for generics, and a focus on providing high quality drugs to patients.
MMA Agenda Complements MAFP
In addition to the work on prior authorization, much of the agenda MMA's other legislative priorities are in-line with the MAFP's priorities. The following issues have been identified as priorities the MMA will spend time and resources to advance:
- Reducing Burdens for Physicians and Patients. To allow physicians to best serve their patients, the MMA will advocate for reform of the prior authorization process. Excessive prior authorization hurdles hurt patients by delaying care while adding significant costs to the health care system.
The MMA will also promote passage of a new system to expedite licensure for physicians who wish to practice in multiple states. The Interstate Compact for Physician Licensure legislation will authorize Minnesota’s participation in a national framework that will expedite licensure for physicians who practice in multiple states while maintaining.
- Keeping Primary Care Viable. The Affordable Care Act increased Medicaid payments for certain primary care services by about 20 percent. That increase ended on Dec. 31, 2014. The MMA will advocate for extending the primary care payment bump into the future.
- Ensuring Fair Financing of Health Care. The 2 percent tax often called “the sick tax” is scheduled for repeal at the end of 2019. The MMA remains committed to its repeal and will be working in 2015 to ask legislators to keep their commitment that the provider tax repeal goes forward as scheduled.
- Investing in the Future of Health Care Workforce. Minnesota has loan-forgiveness programs for physicians willing to practice in rural and underserved urban areas. The MMA will urge legislators to invest in the next generation of physicians by expanding loan forgiveness programs for primary care physicians.
- Protecting Public Health. Tobacco and nicotine dependence remain a problem in Minnesota. Although the Legislature increased regulations on e-cigarettes last year, more needs to be done. The MMA will advocate for clean indoor air by prohibiting vaping in bars and restaurants, pushing to limit the sale of flavored tobacco products to minors, and working to preserve the state’s tobacco tax.
MAFP Partners with MMA Day at the Capitol, Set for March 11
Make plans to join your physician colleagues for the annual MMA Day at the Capitol set for March 11, 2015. Once again this year, the MAFP will partner to co-sponsor the event. 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 presentations from key legislative leaders, individual meetings will be scheduled for you and your local colleagues with your Senator and Representative.
With most of the Capitol closed to the public due to construction, the 2015 Day at the Capitol will be a little different than years past. This year we’ll start our day with a noon lunch at the DoubleTree by Hilton in downtown St. Paul where we’ll hear from key legislative leaders and MMA advocacy staff. From there we’ll take the light-rail Green Line to the Capitol for meetings with your own elected officials before returning to the DoubleTree for a late afternoon reception and debriefing.
The “White Coats Day” at the Capitol is a key piece of the MMA’s and MAFP'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.