Friday, March 4, 2016
The Start of Session and the Return of Legislative Updates
With Legislators from around the state returning to St. Paul on March 8 for the 2016 legislative session the MAFP will again be providing you biweekly updates on the key issues for family physicians. Lead by Dr. Sam Hanson Willis, the MAFP Legislative Committee has been meeting to prepare for what is expected to be a shore but hectic session. The Constitution requires the session conclude no later than May 23, resulting in a 10 week session.
One of the reasons session is starting later than usual this year is the ongoing Capitol restoration has left almost the entire Capitol building off-limits to legislators, staff, and the public. Only the House floor will be open once the session commences, and a strict limit on capacity has been set. The Senate will hold its floor proceedings in the recently opened Minnesota Senate Office Building. The construction of the new building was the source of significant controversy in 2014 as Republican legislators attacked the building as both too expensive and unnecessary. And while DFL members have moved into their offices in the new building, the Senate Republican Caucus remains in their old offices in the State Office Building.
With the late start, the deadlines set by legislative leaders to help guide the work of the House and Senate also point to a furious pace of committee hearings. The first deadline, set for April 1, is the date by which bills must have passed all policy committees in one body or the other. The second deadline falls on April 8, and is the date that those same bills must have cleared all policy committees other legislative body. April 21 is the third deadline and is the date by which all spending or tax proposals must have reached the floor of the House and Senate. The aggressive timeline will make for a very speedy start to the session.
Casting a shadow on the entire session is the looming election season. All 201 legislative seats will be up before voters in November 2016. While many observers believe both the GOP in the House and DFL in the Senate are in good positions to retain their majorities, a strong national election tide in either party’s favor could tip the scales.
MAFP Sets Legislative Priorities
The MAFP Legislative Committee has set our priorities for the 2016 session.The committee met on November 24, 2015 and again on February 2, 2016 to develop the priorities.Because of the short session we have limited our priorities to three for the 2016 legislative session:
Fix medication prior authorization. The MAFP is strongly supporting the MMA lead effort begun in 2015 to pass significant reforms to the medication prior authorization PA processes. PA often delays and disrupts care and, in some cases, harms patients. PA is inconsistent from insurer to insurer, and it is complex and inefficient. The MAFP supports legislation – HF 1060 (Rep. Tony Albright, GOP – Prior Lake) and SF 934 (Sen. Melisa Franzen, DFL - Edina) – 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 last year but did not receive a hearing in the House of Representatives. MAFP is working with the Fix PA Now Coalition to ensure the House hears the bill in 2016.
Stronger Tobacco Laws. Tobacco and nicotine products continue to be a leading cause of death and disease that is completely preventable. The MAFP is working on a number of fronts to reduce the use of these products. A major initiative of the MAFP is to raise the age to purchase tobacco to 21. This will reduce the availability of tobacco products to those in their teens, when many smokers first begin.
The MAFP is also working through a larger coalition to address expand the Freedom to Breathe law to include e-cigarettes and prohibit their use in all public places, including bars and restaurants, and to restrict the availability of flavored tobacco that is marketed to kids.
Advocate for stronger immunization laws. Minnesota’s vaccine exemption law is widely considered one of the weakest in the nation as it allows a parent to exempt their children from required vaccines for both religious reasons and for "conscientiously held beliefs.” The MAFP is working with many partners to support a bill to remove all exemptions from childhood immunizations except for medical contraindications, an approach similar to one successfully passed in California last year in response to the Disneyland measles outbreak.
Budget Picture a Bit less Rosy
Officials from the state’s fiscal agency, Minnesota Management and Budget (MMB), announced an updated picture of the state’s budget health on February 26. The new figures represented a slight weakening of the state’s budget forecast compared to the estimate released in December.MMB’s latest projection estimates that the state will have a $900 million budget surplus for the 2016-2017 biennium, down from an estimated $1.2 billion surplus that had been forecast in December.The lower estimate MMB reported is due to a somewhat weakened economic outlook and slower than previously projected revenues coming into state coffers.Estimates for the 2018-2019 fiscal years are even more impacted by the slowdown, with the projected surplus down from more than $2 billion to $1.1 billion.The lower General Fund surplus figure will likely further complicate plans by the Governor and legislative leaders to make new investments in transportation and education, as well as paying for broad tax cuts.
Estimates for the fiscal health of the Health Care Access Fund (HCAF), however, took a positive turn in the new forecast. Thanks to lower expenditures, the forecast for the HCAF improved to a surplus of $610 million in fiscal year 2016 and $1.166 billion in fiscal year 2019. The surpluses in the HCAF are positive news, though legislators of both parties have too often used surplus funds to pay for purposes outside of the original intent of the provider tax, the source of funding for the HCAF.
Senate Committee Studies Prescription Drug Pricing
The Senate Health, Human Services & Housing Committee held a hearing on February 29 to consider the rising costs of pharmaceutical drugs.The hearing featured testimony from Stephan Gildemeister, the Minnesota Department of Health’s (MDH) health care economist who presented early results from an analysis of medical and retail prescription drug spending.The study was largely derived from data from the state’s All Payer Claims Database (APCD).
Not surprisingly, the study found that prescription drug prices are rising rapidly and consuming a growing portion of overall health care spending. Of note, the study found that spending on prescription drugs administered in a medical setting – in a clinic or hospital – is growing markedly faster than spending drugs dispensed at a pharmacy. Also presenting at the hearing was University of Minnesota professor Steven Schondelmeyer, Phar.D., PhD. Schondelmeyer discussed a number of examples of spikes in drug pricing, including the high profile case of Turing Pharmaceuticals and its recent action to increase by 5,000% the price of Daraprim, a drug used to treat a parasitic infection.
A number of bills related to prescription drug pricing are likely to be introduced at the legislature in 2016. One proposal, authored by Rep. Joe Atkins (DFL – Inver Grove Heights) has already been pre-filed. Rep. Atkins’ bill would establish a program that would make drugs reimported from Canada available to Minnesotans. Another pre-filed bill would require greater reporting by drug manufacturers around "ultra-high priced pharmaceuticals,” defined under the bill as those with a wholesale cost of more than $10,000 per year or per treatment. The intent of the proposal is to bring about greater public transparency of high cost drugs. The likelihood of any of these proposals gaining traction in a short session with split partisan control remains to be seen.
Many New Faces at the Capitol
With the legislature returning to session next week a number of new legislators will be taking their first official acts as legislators.Since the end of session in May 2015 four special elections have been held to fill seats vacated by retiring legislators or, in one case, the death of a legislator.
House Republicans had a surprising win in early February when they picked up a usually reliable DFL district. Rep.-Elect Chad Anderson (GOP – Bloomington) will replace Rep. Ann Lenczewski (DFL – Bloomington), who retired in late 2014 to take a job as a lobbyist.
Rep. Elect Rob Ecklund (DFL – International Falls) will take the seat of Rep. David Dill (DFL – Crane Lake), a long-serving representative who passed away in August 2015. Rep. Ryan Winkler (DFL – Golden Valley) left the legislature last summer to move with his family to Belgium for a career opportunity and was replaced in his reliably DFL district by Peggy Flanagan (DFL – St. Louis Park). Rep.-Elect Flanagan had previously served as the executive director of the Minnesota Children’s Defense Fund.
One familiar face is among the new legislators. Former Rep. Jim Abeler won election in the race to succeed former Sen. Brandon Petersen (GOP – Andover). A chiropractor and past chair of the House HHS Finance Committee, Sen. Abeler had retired from the House in 2014.
Also new at the Capitol this year is Emily Johnson Piper, the new Commissioner of the Department of Human Services. Commissioner Piper replaces former Commissioner Lucinda Jesson, who was appointed by Governor Dayton to a seat on the Minnesota Court of Appeals. Piper had previously served as Dayton’s general counsel and deputy chief of staff.
MAFP Partners with MMA for 2016 Day at the Capitol: March 23
Make plans to join your physician colleagues for the annual MMA Day at the Capitol set for March 23, 2016.The MAFP is once again a partner of this important event and all family physicians are encouraged to attend.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 most of the Capitol closed to the public due to ongoing construction, our 2016 Day at the Capitol will begin away from the Capitol building. Like last year, we’ll start our day with a noon lunch at the DoubleTree by Hilton St. Paul Downtown 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 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.