Last session, several of the session’s biggest bipartisan priorities- addressing elder abuse, stopping the opioid epidemic, and preventing a significant cut to providers serving people with disabilities- were stymied when Republicans pushed through inadequate provisions on elder abuse and opioids and then wrapped them into the supplemental budget bill despite the Governor’s requests to send them separately.
Absent from the agenda was any meaningful discussion on the future of MinnesotaCare and the Provider Tax or the state’s individual market, kicking the can down the road and increasing the urgency to act in 2019. Lawmakers were successful in passing legislation to combat sex trafficking in the hospitality industry and making some improvements to the child care regulatory system.
What has happened in this issue area since last session?
The federal government has continued to feel like an unreliable partner in helping Minnesota ensure access to quality, affordable health care through their efforts to undermine the ACA over the summer, and Minnesota has recently learned that the reinsurance program will be even more costly to the state budget than originally anticipated. The news will likely impact what options are on the table now that reinsurance is ending after 2019. Meanwhile, Minnesota’s uninsured rate has ticked up from 4.3% to 6.3%, leaving about 350,000 Minnesotans without health insurance.
The Minnesota Department of Health has continued efforts to tackle elder abuse by convening informal working groups to find and build consensus around possible policy proposals. A final product and proposed legislation from the working groups is expected around the start of the 2019 Session.
What is expected to happen this session?
With a DFL-controlled House, it is likely that prospects for passing legislation like the Opioid Stewardship Program and reforms in elder care have improved, given the difficulties both pieces of legislation faced in the House last year.
Lawmakers can expect extensive discussions on health care, including what should be done to continue to shore up the individual market. The relationship between available federal funding for MinnesotaCare, the Provider Tax sunset, and reforms that may require federal approval amidst alarming uncertainty will dominate the discussion.
Long-term care facility complaints
In late 2017, the Star Tribune ran a series of stories about the Minnesota Department of Health failing to respond to reports of neglect and abuse in long-term care facilities. A working group on elder abuse instituted by Governor Dayton issued a report to the Legislature in advance of the 2018 Session, sparking a series of bills aimed at addressing elder abuse in Minnesota. Bipartisan legislation backed by the working group was ignored by Republican leaders in favor of a deeply flawed approach that was ultimately wrapped into the supplemental budget bill. Governor Dayton cited the legislation’s inclusion as a primary reason for vetoing the spending bill, and the result was a 2018 session without any urgently-needed reforms in long-term care. During the interim, the Minnesota Department of Health has been convening stakeholders in a new series of working groups that will provide analysis and policy proposals for legislators to consider this year.
Opiate abuse has continued to have broad and devastating effects on families, law enforcement and health care providers throughout Minnesota. For the third year in a row, a bipartisan group of lawmakers will likely be looking for renewed support for an Opioid Stewardship Program that raises revenue from the pharmaceutical industry to pay for a statewide response to the opioid epidemic. These funds would be dedicated to opiate abuse prevention and treatment and county child protection programs. The legislation passed the Senate on a 60-6 margin in 2018 only to stall in the House under intense pressure from the industry. With a DFL-led House, this legislation could have new life in 2019.
The reinsurance program is heading into its second and final year. This $542 million program compensates insurance companies for high-risk individuals on the individual market with the goal of reducing premiums across the market. While premiums have been lower than they otherwise would have been, reinsurance has failed to provide adequate relief for many Minnesotans who still feel the cost of their health care is unaffordable.
Minnesota has faced some negative effects as a result of implementing the program, including a lower-than-expected federal contribution and unanticipated cuts in federal funding for MinnesotaCare. While there is currently enough revenue to sustain MinnesotaCare for a few more years, this as well as other federal decisions mean lawmakers now must plan for a significant loss of federal funds when considering the future of this low-cost health care program and any further interventions to improve the individual market.
Provider Tax Sunset
On the short list of urgent policy decisions facing lawmakers is addressing the impending sunset of the Provider Tax on December 31, 2019. The provider tax is a significant source of revenue for the Health Care Access Fund (HCAF). The HCAF has historically funded MinnesotaCare, but when MinnesotaCare became a Basic Health Plan under the Affordable Care Act, the federal government began providing a significant portion of funding for MinnesotaCare. The HCAF is still used to fund certain MinnesotaCare and Medical Assistance expenses for low income Minnesotans. Without extending the provider tax, the HCAF will run a deficit after Fiscal Year 2021. The 2019 session will likely include discussions about whether to continue this tax or implement an alternative solution.
DFLers have been advocating for a MinnesotaCare Buy-In option for consumers on the individual market, and those efforts are likely to continue in 2018 with the support of Governor-elect Walz. The option would allow those purchasing insurance on the individual market to access quality coverage through MinnesotaCare, along with its broad network of health care providers, at a lower cost than other comparable plans on the market. The program would require no ongoing cost to taxpayers because premiums would be set to cover the cost of care just like traditional insurance.
Disability Waiver Rate System
The supplemental budget bill in 2018 appropriated new funding to increase the reimbursement rates paid to providers of services for people with disabilities after the federal government declined to match the state’s previous investments as expected. Without the additional funding after the bill was vetoed, the Department of Human Services ceased paying increased rates beginning in July of 2018. Advocates sued the Department over the summer to prevent the funding cut, but the lawsuit was not successful. Another push to increase provider rates will likely appear in 2019.
Six states have raised the legal age to purchase tobacco products to 21, and well over a dozen municipalities in Minnesota have passed similar ordinances, including Excelsior, Duluth, Plymouth, and Minneapolis. Cities like Minneapolis and St. Paul have also restricted the sale of flavored tobacco. Legislation was introduced during the last biennium to raise the age to 21 across the entire state, and as more cities are considering this change, it may be introduced again in 2019.
In 2020, Minnesota will become the only state that does not offer a smoking cessation program when funding sunsets for QUITPLAN Services. Legislation in 2018 would have diverted funding from existing public health prevention dollars under the Statewide Health Improvement Partnership (SHIP) despite calls for the funding to be allocated from tobacco settlement fees; it was however vetoed as part of the supplemental budget bill. Funding for a tobacco cessation program is expected to be reintroduced in 2019, but the funding source may still be a point of contention.
The popularity of electronic cigarettes, or e-cigarettes, has exploded in recent years. Youth tobacco use in Minnesota has increased for the first time since 2002, and one in five high school students are using e-cigarettes. In the fall of 2018, the FDA proposed significant regulatory action to curb the use of e-cigarettes among youth and the agency has been cracking down on manufacturers like JUUL for marketing their products to children through enticing flavors. Renewed efforts at the state level are expected this year to build on steps taken in 2014 to regulate e-cigarettes and keep addictive nicotine out of the hands of Minnesota’s youth.
A prominent theme during the 2018 session was improving access to quality, affordable child care. Republicans focused their efforts solely on finding ways to reduce regulation for child care providers; however, those efforts were simply not enough to combat a decline in child care providers and rising prices that mirror national trends. Committees in the Senate and House have been hearing from child care providers and families during hearings held all over the state this fall, and Governor-elect Walz has declared child care to be one of his top priorities, so lawmakers can expect renewed energy behind finding solutions this session.
Skyrocketing prices for insulin have received increased attention in the last few years as heartbreaking stories surface about people who have lost their lives or face impossible financial decisions because they are unable to afford this life-sustaining medication. While there has been little progress at the federal level to reign in the pharmaceutical industry, the responsibility has ostensibly fallen to states to find solutions. A round table discussion led by the DFL in December has kick-started momentum in Minnesota to confront this moral and economic imperative.
See the Commerce section for more information on this topic.
DHS Program Integrity
Lawmakers can expect Republicans to continue discussions from 2018 on improving program integrity in human services programs. Allegations of fraud surfaced during the 2018 session in the state’s child care program based on a Fox 9 investigative report and in the Medical Assistance program after evaluations done by the Office of the Legislative Auditor showed the Department of Human Services had made some errors in determining eligibility for the program, despite some of the allegations being based on unsubstantiated evidence. Lawmakers might see some of the related proposals that were vetoed in the supplemental budget bill from 2018 resurface in 2019.