Friday, April 29, 2016
Three Weeks Left, No Global Agreement
With three weeks left until the Constitutional deadline to adjourn both the Republican controlled House and the Democratic controlled Senate have passed their bills laying out how to spend the state’s $900 million budget surplus, but they are drastically different.
Coming into session in March leaders of both bodies identified three major issues that needed to be addressed this year—passing a transportation funding bill for roads and bridges, passing a bonding bill to fund state building projects, and agreeing on how much of the surplus should be used for new spending and how much for tax cuts. The approach for each of these items, however, remain very different. If the Legislature hopes to complete its work on these and other issues before the May 23 adjournment date there will need to be some significant compromise by both sides.
Currently both sides are very far apart with little time left, but if there is a willingness to compromise, agreements can still be reached. The sticking issue on a transportation bill is whether it can be funded with the existing surplus (the House position) vs. whether an increase in the gas tax is needed for long-term funding (the Senate position). On the bonding bill it is a question of size, with the House recommending approximately $600 million in projects and the Senate recommending $1.4 billion in projects. And, the differences on the use of the surplus have the House wanting to use it for transportation and tax cuts and the Senate wanting to use it for new investments in needed programs.
The next step in the process is for House and Senate leadership to meet, along with Gov. Dayton, to agree on global spending levels that both sides can live with. If they are able to reach agreement on these numbers soon there is a good chance of them passing the budget bills. If not, we may be heading to the proverbial "train wreck.”
Since the even-numbered years are the second year of the state’s biennial budget, there is no need to pass budget bills to keep the state running. That removes some pressure to compromise. However, with 2016 being an election year for all 201 seats in the Legislature, and with the majority in both bodies at stake, there is pressure to show voters that the party in control can get their work done.
House & Senate Craft Very Different Budget Proposals
House and Senate legislators took two very different approaches to crafting their budget supplemental bills, and the differences in the Health & Human Services budget are stark. Both bodies considered and passed their HHS budget pieces this week, though the differences will require a conference committee to reconcile the dramatic differences.
The different approaches began with very different budget targets set by House and Senate leaders. While the House Republicans gave the HHS committee a budget target of zero new dollars, Senate Democratic leaders allocated additional spending of $43 million in 2017 and $140 million for the 2018-2019 biennium. The House does shift some dollars within its jurisdiction to fund some new programming while cutting spending on other health care programs.
Importantly, the Senate’s version of the HHS budget bill includes the language to reform the medication prior authorization (PA) processes, a top priority for the MAFP. The goal now is to convince the House to accept this language in conference committee. The Senate bill also includes a 5 percent increase in reimbursement for primary care and mental health services provided for MinnesotaCare and Medical Assistance patients, as well as $1 million of new money for rural family medicine residency programs. It also includes and increase in the eligibility for MinnesotaCare to 275percent of the federal poverty level, from the current 200 percent. Other provisions in the bill would allow physicians limited access to the state’s medical cannabis registry to see if patients are participating in the cannabis program, extend the sunset for use of the All Payer Claims Database (APCD) to better study regional differences in health care utilization, and expand specialty asthma care services under MA for children with difficult-to-treat asthma.
While there had been some speculation that the Senate bill might include language to rescind the sunset of the provider tax, that provision was not included in the package. The provider tax remains set for repeal on December 31, 2019.
The full Senate considered the bill on April 28 and passed largely on a party line vote. Senators considered a number of amendments related to MNsure and other issues. An effort to strip the bill of $500,000 in funding from the Health Care Access Fund for a study of single-payer health care systems was unsuccessful.
Given its neutral budget target, the House bill contains far fewer provisions. Central to the House HHS bill is language to move Minnesota from the existing state-based insurance exchange MNsure to the federal insurance exchange. Included in the bill is $1 million in each of the next three years funding for greater Minnesota family medicine residency programs, and over $3 million of new money for MERC. The HHS omnibus bill also includes language instructing the Department of Human Services to apply for new federal grants to promote awareness and treatment of maternal depression and chemical dependency in pregnant and postpartum women.
The House also debated the HHS finance bill on the floor on April 28th in an occasionally fiercely partisan debate that stretched past 1:00 am. Dozens of amendments were considered, including amendments related to firearm licensing, MNsure, the licensing of facilities that perform abortions, and other hot-button issues. Unlike the Senate bill which was a single bill funding numerous segments of the state budget, the House has assembled three smaller omnibus bills. The HHS bill was packaged with bills financing public safety and state agency operations.
House Takes Aim at Fetal Tissue Research
Continuing the focus on fetal tissue research that garnered national headlines in the summer and fall of 2015, the Minnesota House of Representatives included provisions that seek to restrict the use of aborted fetal tissue in research at the University in a higher education finance bill. The bill passed the House on April 25.
Under the provisions, the Dean of the Medical School is required to "attempt to identify sources for procurement of fetal tissues that are available due to the natural death of the fetus and are suitable for use in academic research” and – when identified – the use of such tissue is to be encouraged. During committee hearings earlier in the session University President Eric Kaler and Brian Herman, PhD, the university’s Vice President for Research, and Brooks Jackson, MD, the Dean of the University of Minnesota's Medical School presented a strong defense of the University’s use of the tissue in research into spinal injuries, Alzheimer’s disease, and many other conditions. Tissue derived from miscarriage, they argued, often have genetic abnormalities that make them unsuitable for research.
In addition, the bill requires that all research using fetal tissue be approved by the University’s institutional review board, which is required to explore if the research can be conducted using non-human tissue. The language in the House bill further requests that the Office of the Legislative Auditor (OLA) conduct an investigation into the University’s use of fetal tissue in research activities, including the number, type, and cost of fetal research being conducted. The OLA is widely respected by both parties at the Capitol.
The same bill also contains language that attempts to address continued fallout from the suicide of a man enrolled in a University clinical psychiatric drug. The state’s Ombudsman for Mental Health and Developmental Disabilities is tasked with monitoring any drug trials being conducted by the University’s Department of Psychiatry. The Ombudsman is granted additional oversight authority by serving as a receiver of complaints from drug trial enrollees and is authorized to make recommendations to the University on means of corrective action.
These provisions have not received hearings in the Senate, nor have they been included in the Senate’s higher education finance package.
Senate Holds Informational Hearing on Firearms
A hearing on several firearm-related bills led to an emotional hearing in the Senate Judiciary Committee on April 26. With the House having no interest in pursuing similar measures and the deadline for policy bills passed, the bills were considered on an informational basis only. No votes were recorded and the bills will not receive further consideration this year.
Under SF 2493, authored by Senator Ron Latz (DFL – Golden Valley), background checks for firearm sales would be expanded to include those conducted online and at gun shows. Closing the "gun show loophole,” advocates argued, would help prevent guns from falling into the hands or dangerous or criminal hands. Also authored by Sen. Latz, SF 2980would allow individuals to voluntarily add themselves to a DHS-maintained database of individuals prohibited from purchasing a firearm. The bill further allows an individual to voluntarily turn in firearms to local law enforcement for storage or destruction.
The bills were supported by Everytown for Gun Safety and Moms Demand Action, two pro-gun control groups involved in Minnesota, as well as a number of law enforcement groups. The National Rifle Association (NRA) and other pro-firearm groups opposed the measures.