All Minnesotans should have the care they need.
Minnesotans believe every person should have high-quality, affordable health care, no matter their gender, age, where they live, or what they look like. DFLers in the House and Senate worked with Gov. Walz to secure health care access for 1.2 million Minnesotans last year. Unfortunately, Senate Republicans refused to expand access to affordable health care and blocked provisions to ban traumatic conversion “therapy” procedures and ensure Minnesotans have access to life-saving insulin. Protecting and expanding health care coverage will help ensure people at all age levels get the physical and mental health services they need.
The biggest health care-related success of the 2019 session was preventing arbitrary and irresponsible cuts proposed by Senate Republicans, including cuts to disability services, eliminating the entire Child Care Assistance Program, and risking health care for thousands of Minnesotans by allowing the provider tax to expire. However, Republicans did secure another two years of reinsurance and stopped any of the governor’s health care reforms, displaying a continued willingness to kick the can down the road on health care even as the Trump Administration continues efforts to dismantle the Affordable Care Act.
Republicans also refused to respond to critical issues, such as the need for an emergency insulin program.
Ongoing management issues at DHS will be a focus of Republican efforts this year; the DFL will be working toward meaningful reform rather than knee-jerk reactions that jeopardizes care for the thousands of Minnesotans served through the agency. In addition, the DFL will continue working to convince Republicans that consumers need relief from prescription drug prices and access to emergency insulin.
Last session, DFL members and insulin advocates led by the mother of Alec Smith, a young man who died rationing his insulin, made repeated efforts to get Senate Republicans to move on a program to provide low-cost emergency insulin funded through fees on insulin manufacturers. The bill was never heard in the Senate, and Republicans claimed the proposal had somehow gotten “lost” during the budget negotiations. Discussions about holding another special session for insulin continued well into the interim but ultimately failed as Republicans dragged their heels and ran out the clock.
As of January 30, 2020:
- The cost of insulin has tripled in the last 10 years, raking in profits for pharmaceutical companies while leaving Minneostans with diabetes scrambling to afford the drug they need to survive.
- This issue should have been dealt with last session, but DFL amendments to establish an emergency insulin program were shot down by Republicans. This should have been dealt with during a special session, but Republicans refused to budge– and blew through their own self-imposed deadline to find a deal.
- The DFL Senate, House and Governor have a bill that takes the best from oth Democrat and Republican proposals to increase access to affordable insulin and hold Big Pharma accountable. We are ready to complete this work as soon as possible.
- We need to act now because people’s lives are at stake. The DFL proposal is ready and can be implemented immediately. The Republican position lets big insulin manufacturers off the hook, creates barriers for patients and can’t actually be implemented.
- The DFL plan puts patients first and ensures Minnesotans can get the insulin they need at a price they can afford.
- Three insulin manufacturers control over 90% of the insulin market in the United States. In the last twelve months, those three companies have reported $84.1 billion in revenue and $18.5 billion in profits. Republicans may be concerned for these companies, but the DFL is concerned for the diabetics and their families.
The rising costs of prescription drugs will again be a focus. No one should go broke to get the medicine they need. As Big Pharma continues to shamelessly place profits over people, Republicans have continued to stand with them and protect them from accountability.
Among Senate Republicans’ misguided priorities this session is a plan to reimport drugs from Canada to lower prices. This comes after the federal government announced they would allow such programs. This may sound like a good idea, but new information on feasibility suggests many of the most expensive drugs cannot be included, including insulin, and Canada has serious concerns about states buying up the medications they need for their own residents.
Department of Human Services
There have been a series of media reports and legislative hearings since the end of the 2019 session outlining high-profile resignations at DHS and various payment and process issues within the agency. Some stories highlight actual concerns while others are the result of manufactured outrage from Republicans. None of the stories are related to the unsubstantiated allegations of fraud in the child care assistance program (CCAP) discussed last session, although Republicans continue to push their false narrative of “rampant” fraud in public programs and “turmoil” at DHS by invoking CCAP.
As a result, lawmakers can expect an extended discussion about whether DHS should be divided into several smaller agencies moving forward. Governor Walz recently announced that he would bring in an outside consultant to make recommendations on the future of DHS, including whether breaking up the agency would improve efficiency and accountability. Throughout the discussion, DFL lawmakers will be prioritizing continued access for Minnesotans to the vital programs administered by DHS and protecting taxpayer dollars.
- DHS is an agency of about 7,000 employees serving over 1 million Minnesotans. No organization of this magnitude, private or public, is immune to the kinds of challenges they are facing, but it requires a swift and unflinching response when they occur in Minnesota’s public institutions.
- These types of challenges do not develop overnight, but likely have been present and festering for some time across multiple administrations. There are also no overnight fixes, and the Legislature cannot leap toward reactive solutions that may make things worse.
- The DFL prioritizes protecting taxpayer dollars and ensuring Minnesotans can continue to access the vital services administered by the department. Senate DFLers are committed to partnering with the administration to address every issue in a way that restores public confidence and maintains and strengthens the integrity of every program within DHS.
Minnesota’s childcare costs consistently rank near the top of national lists. The Senate DFL is commited to a comprehensive solution that makes quality care more affordable and recognizes the true value of caregivers working in this field. Ensuring a younger generation is able to step into their full potential and contribute to our workforce is critical to Minnesota’s future economy.
Child care access and affordability has been a focus of the Legislature for the last few years. However, Republicans spent most of their time last session fixated on inflammatory and unsubstantiated allegations of fraud in the state’s Child Care Assistance Program (CCAP), trying to cut the entire program and refusing to make needed investments that help families find affordable child care. Their actions obscured the fact that the state’s child care program is out of compliance with the federal government, risking millions in future federal program dollars and keeping costs higher for families and pay rates too low for many child care providers. Although it is not a budget year, there are looming budget questions in child care that must be urgently addressed.
While DFLers stopped a separate, but no less drastic, effort by Senate Republicans to deregulate all child care in the state last session, a new Family Child Care Task Force was created to review and make recommendations on the current regulatory landscape and the Parent Aware program. Recommendations will be delivered in a report to the Legislature in March, so lawmakers can expect related legislation to come shortly after.
Conversion “Therapy” ban
The United Nations has classified conversion “therapy” practices as torture. Conversion therapy, often referred to as reparative therapy, ex-gay therapy, or sexual orientation change efforts, includes a range of dangerous and discredited practices aimed at changing a person’s sexual orientation or gender identity or expression. These harmful practices are based on the false claim that being lesbian, gay, bisexual, transgender, or queer (LGBTQ+) is a mental illness that should be cured.
Despite the proven, long-lasting damage caused by this practice, every single Republican in the Minnesota Senate voted against a ban on conversion therapy in 2019, even after some of them spoke up in support of the ban.
Since last session, more of our young people have been subjected to this harmful and discredited practice. The Minneapolis City Council recently took matters into their own hands and banned the practice within city limits. Hopefully the municipal action will convince Republicans to stand up for Minnesota’s kids, but recent comments by Majority Leader Gazelka to a national outlet suggest Republicans are once again prepared to allow children to endure this abusive practice.
Other Health Care Issues
Overpayments to Tribes and Counties
Among the concerns about DHS financial controls highlighted over the summer, two issues involving overpayments may require legislative action and additional state funding this year.
First, DHS made overpayments to two tribal governments for their substance use disorder treatment programs totaling about $29 million. While the tribes assert that they were acting based on incorrect guidance from DHS, current state law requires DHS to recoup the money regardless of who is at fault. According to the most recent information available, there are several paths to resolution including scenarios in which the Legislature is not required to act.
Second, errors DHS made in paying for certain mental health facilities, called IMDs, resulted in an increase in the counties’ shares of these costs, totaling about $9 million. Many counties have publicly stated they do not plan to pay when they get a bill from the state.
The governor has expressed support for holding both the counties and the tribes harmless for the errors. DHS is working on resolutions, but various legislative proposals may be forthcoming.
Opioid Response Grants
The first report from the new Opioid Epidemic Response Advisory Council will be delivered to lawmakers in March. The report will include a list of proposed grants to be funded by new fees imposed on opioid manufacturers. While the Legislature does not have to take action on the grants, the list of potential grantees may be a subject of discussion.
Republicans have stood in the way of many changes to the medical cannabis program out of fear it will lead to full legalization for personal use. This has resulted in a very restrictive program with high costs that price out many patients. A handful of changes to improve access passed last session after much debate, including doubling the number of distribution sites to 16, but other elements that would have made a much bigger impact on affordability were considered too controversial. Lawmakers can expect a renewed push in this area in 2020.
Additionally, the OLA released a January 2020 report on the medical cannabis program and found several issues with internal program controls. The Department of Health has already been working to correct some of the issues raised but new legislation, and new funding may be necessary to address all the recommendations.
Medical Assistance Waivers for Disability Services
In addition to their plan to eliminate the provider tax last session, Republicans pushed for cuts to medical assistance for people with disabilities, despite a growing need for services across the state. A series published in the Star Tribune over the interim took a deeper look at existing programs and highlighted several areas of concern, including inconsistencies across counties that lead to arbitrary denials for services and a high-stakes assessment tool developed by DHS that may not be delivering on all of its promises. DHS is already engaged in a multi-year effort to streamline services, but lawmakers are expected to apply new pressure and scrutiny to the programs and seek out ways to ensure people with disabilities are getting the care they regardless of where they live.
Legislation raising the legal age to purchase tobacco products to 21 failed to pass the Legislature last session, but 56 cities and counties across Minnesota have decided act in the meantime. This year, the decision is no longer up to the Minnesota Legislature after Congress passed a law raising the age to 21 nationwide. State lawmakers may still be looking to expand on the federal law, including limiting criminal penalties for minors and banning flavored tobacco.
The popularity of electronic cigarettes, or e-cigarettes, has exploded in recent years, erasing the gains made to reduce tobacco use in youth and adults. Youth tobacco use in Minnesota is on the rise for the first time in years, and one in five high school students report using e-cigarettes. A virtually unregulated market for vaping products resulted in an urgent public health crisis in 2019, taking the lives of three Minnesotans and sickening dozens more. Without meaningful regulatory action from the federal government, lawmakers may be looking for ways the state can protect public health and keep e-cigarettes out of the hands of children and teens.
How the products are taxed will continue to be part of this conversation, since increasing the price has proven to be one of the most effective tools in stemming youth cigarette and traditional tobacco use. The DFL Senate successfully offered an amendment to last year’s tax bill that would have added a $2 surcharge on the retail sale of each closed-system vapor cartridge sold in the state. That tax bill failed to pass, but similar proposals to ensure electronic nicotine delivery systems are treated the same as traditional tobacco will be part of the discussion this year.
Rural Mental Health Access
Last session legislators invested additional resources in farmer mental health resources. It is likely the Legislature will take another look at mental health in rural areas, especially as it relates to agricultural issues. The Minnesota Department of Agriculture indicated in late 2019 that their mental health counselors have been receiving several calls a day from farmers and their loved ones. While many resources are available, the Department of Agriculture has counselors ready to help (Ted Matthews: 320-266-2390 and Monica McConkey: 218-280-7785). There is no cost or paperwork. Additional resources can be found at: https://www.mda.state.mn.us/about/mnfarmerstress/copingstress.