Long-term care facility complaints
In November, the Star Tribune ran a series of stories about the state Department of Health mishandling reports of neglect and abuse in Minnesota’s long-term care facilities. Former DHS Commissioner Dr. Ed Ehlinger resigned as a response to the stories. Governor Dayton instituted an Elder Abuse Work Group led by AARP, which has just begun meeting. The Senate Committee on Aging and Long-Term Care also is reviewing the topic, and the Office of the Legislative Auditor will be issuing a report in February. Solutions, including more funding for MDH to pursue these reports, likely will be discussed this session.
Opiate abuse has continued to have broad and devastating effects on families, law enforcement and health care providers throughout Minnesota. In October, a bipartisan group of lawmakers and Governor Dayton renewed support for an Opioid Stewardship Program that they will again be pushing in 2018. This program would require opioid manufacturers to pay a “penny a pill” fee, which would generate $42 million every two years.
These funds would be dedicated to opiate abuse prevention and treatment in Minnesota. The proposal was included in Governor Dayton’s 2017 Supplemental Budget proposal and supported by lawmakers of both parties, but it could not receive a hearing in the House.
Community health centers
Congress chose not to renew funding for Community Health Centers across the nation in the temporary funding bill passed in January. For Minnesota, that means a loss of $27 million in federal funds for 70 health centers across the state that provide sliding-scale fees to uninsured, low-income individuals. Many community health centers have said they will close or lay off significant numbers of staff without funding. Without the safety-net centers to rely on, this population will either go without care or place a strain on other providers in the area. This has typically been a bipartisan issue and likely will be part of the conversation in 2018. Some DFLers have suggested the Health Care Access Fund could be used to provide state funding for these centers.
Despite an enrollment period that was two weeks shorter than last year, MNsure announced a record 116,000 Minnesotans enrolled in coverage for 2018. No major glitches in enrollment processing were reported, either. Recent federal action may reignite the conversation about the future of MNsure, however, as the federal tax reform package eliminated the requirement that taxpayers carry health insurance or suffer a tax consequence. That is effective for Tax Year 2019, meaning people could make a decision to not enroll beginning this fall. At least one Republican senator notably commented that he is open to investigating a state-based individual mandate and other states also are looking into this option. That could be a topic of conversation in 2018.
Individual market premiums also were relatively steady this year, although many consumers do not believe that. The one-year, 25% premium relief subsidy the Legislature passed in 2017 disappeared for 2018, meaning some consumers whose rates did not change for 2018 still will be paying 33% more now that the subsidy has disappeared. Some constituents have asked their senators to support another premium relief subsidy this year, but that would likely cost at least another $300 million. It also would be added to the $543 million the Legislature approved for a reinsurance program, which is the main reason rates were stable this year.
In 2017, the Legislature approved $543 million for a reinsurance program to compensate insurance companies for high-risk individuals on the individual market. The bill became law without the Governor’s signature; DFLers believed there were better ways to help consumers and stabilize the market without approving a giveaway to insurance companies. Health plans cited reinsurance as one reason the individual market rates remained relatively stable this year, but there is no guarantee written into the law that providers maintain stable rates next year. Additionally, the money runs out after 2019.
In October 2017, lawmakers learned reinsurance would come at a much steeper cost than originally anticipated. In approving the waiver needed to implement the program, the federal government also went back on its promise to hold harmless Basic Health Plan funding and revoked up to $369 million in federal funds that are used to fund MinnesotaCare. Reluctantly, the Governor accepted the deal. It is expected there is currently enough revenue to sustain MinnesotaCare for about two years, but this as well as other federal decisions mean lawmakers now must plan for a significant loss of federal funds to maintain the future of this low-cost health care program.
DFLers and the Governor have been advocating for a MinnesotaCare buy-in option for all consumers on the individual marketplace, and those efforts could continue in 2018. The option would allow anyone purchasing insurance through the individual marketplace to access MinnesotaCare at full cost, meaning they would not receive the subsidy available to the program’s lower-income enrollees, but they would be able to access the broader network of quality, affordable care already established under MinnesotaCare.
As noted above, MinnesotaCare funding is under threat because of the reinsurance deal accepted last fall. This funding problem will be part of any conversation about expanding MinnesotaCare’s reach. Though, again, the buy-in would be unsubsidized and not place a financial strain on the program.
Medicaid work requirements
The Trump Administration announced in January that it would offer a path for states desiring to set work requirements for Medicaid recipients. At this point, at least ten states have applied for waivers involving work requirements for the program. Minnesota is not among them, but Republicans could make it a point of conversation in 2018. Many Medicaid enrollees are working and most of those who are not are unable due to illness, disability, family commitments, or seeking education.
Children’s Health Insurance Program (CHIP)
Since September, there has been much concern over Congress not reauthorizing funding for the Children’s Health Insurance Program. The November forecast actually booked a $178 million loss to Minnesota’s budget to compensate for the state picking up the federal government’s share of funding for this program, which covers 125,000 low-income children and 1,700 mothers. A six-year extension in CHIP funding was included in the government funding bill that Congress passed in January, meaning the $178 million loss will be removed from the February forecast estimate.
Fingerprints for children of care providers
The Human Services Reform Committee held a hearing last fall regarding a state law requiring teenage minors living in homes that also are childcare facilities to be fingerprinted and photographed. The requirement is part of a broader set of standards approved by lawmakers in recent years, which are aimed at improving background checks on those involved with vulnerable populations, such as children. Republicans and some DFLers voiced concern at this hearing that the requirements go too far. Some senators have promised a bill in 2018 to remove this requirement.
Oregon recently became the fifth state to raise its legal age to purchase tobacco products to 21. Several municipalities in Minnesota have passed similar ordinances, including Edina, Duluth, and Plymouth, and several more are considering similar policies. Other cities, such as Minneapolis and Saint Paul, have restricted the sale of flavored tobacco. Sen. Nelson introduced a bill late last session to raise the smoking age to 21 so it is possible this issue could be discussed this year.
Access to contraception
The Trump Administration issued a rule in October that eliminated the Affordable Care Act’s requirement that all insurance plans cover birth control without a co-pay or otherwise ensure access to birth control coverage for women whose employers or schools can legally opt out of providing coverage. In response, Planned Parenthood called on Minnesota lawmakers to enact legislation that will bar employers from denying birth control coverage to their employees an ensure access to contraception at no out-of-pocket cost. This could be discussed in 2018, although the prospects of a Republican Legislature accepting the change is unlikely.