Minnesota Academy of Family Physicians (MAFP) lobbyist Dave Renner, CAE, shares what to expect in the remaining weeks of the legislative session and provides an update on actions around the MAFP’s legislative priority areas.
Five Weeks Remaining—Focus on Budget Bills
The focus of the time remaining in this legislative session will be to finalize plans for the state’s $17.5 billion budget surplus and pass the state’s budget for the next two years.
The Minnesota Legislature intends to increase the state’s biennial budget to $69.9 billion, an increase of nearly $10 billion over the last two-year period. According to the budget targets announced in March 2023, the legislature intends to dedicate most of the surplus to items related to children, families and education. This includes $668 million for a paid family and medical leave program and about $400 million for free school breakfasts and lunches for Minnesota students.
In addition to the budget, there are several high-profile items that may also be acted on in the remaining weeks:
- Firearm safety measures are included in both the Senate and the House judiciary omnibus bills. Specifically, language to expand criminal background check requirements for all firearm sales/transfers and to implement extreme risk protection orders to allow law enforcement to temporarily remove guns from people who have been found to be dangerous to themselves or others are included in both bills. The House bill also includes new safe storage requirements for firearms and a new requirement to report to law enforcement if your firearm is lost or stolen.
- The bill legalizing adult-use cannabis has been making its way through multiple committees for months now and could still go to a floor vote before the May 22, 2023, adjournment deadline. The effort would legalize recreational use for anyone older than 21. It includes limitations on where it can be sold and on marketing and establishes a sales tax and dedicates revenues to addiction treatment programs. The legislation also includes a label requirement outlining the effects the drug could have on brain development up to the age of 25.
- Additional bills relating to reproductive health care are anticipated to pass this year. Governor Walz has already signed the Protect Reproductive Options (PRO) Act, legalizing the right to an abortion in Minnesota law. Awaiting action in the Senate is the Reproductive Freedom Defense Act, which would prevent state courts or officials from complying with extraditions, arrests or subpoenas related to care received in Minnesota. Additionally, both the House and Senate omnibus health budget bills include the repeal of Minnesota statutes intended to obstruct or delay access to reproductive health services, including abortion.
Omnibus Health Budget Bill
Many of the MAFP’s legislative priorities are included in the omnibus health budget bills that are expected to be heard in their final committees this week and proceed to the floor. From there, the two bills will be sent to a conference committee to work out the differences between the House and Senate versions before returning to chambers for a final floor vote.
Summary of key issues included in the health budget that the MAFP is following:
- All-Payer Claims Database: This language updates the All-Payer Claims Database (APCD) to ensure the state is collecting a more complete picture of health care spending by including payment data that is not currently included in an insurance claim. It also requires the Commissioner of Health to study the amount of health care spending directed at primary care services. This language is in both the House and Senate bills.
- Limits on Mid-year Formulary Changes: This bill prohibits insurers and pharmacy benefit managers from forcing a patient to change drugs during the middle of a patient’s contract year. This language is included in the Senate bill, but not in the House bill.
- Rural and Primary Care Workforce Grants: This involves increasing funding to address the health care workforce shortages in underserved areas through loan forgiveness, clinical training grants and primary care residency training programs. The House bill includes the Governor’s recommendations for a new rural primary care residency program, new loan forgiveness money for physicians and other health care providers and new clinical training grants for rural sites. The Senate bill includes some new funding, but not the rural residency program (and the loan forgiveness funding is only for nurses).
- Public Option: This bill creates an option for Minnesotans of any income to buy coverage through MinnesotaCare. The bill also includes continuous eligibility for children up to the age of 6, and 12-month eligibility for kids under the age of 21; it eliminates all cost-sharing for Medical Assistance (MA) and MinnesotaCare coverage; and it provides subsidies to those earning below 250% of the poverty level to purchase gold-level products with smaller deductibles. The House bill extends eligibility to all undocumented Minnesotans, while the Senate bill only extends that coverage to undocumented kids. The language directs the Commissioner of Health to provide an actuarial analysis on the public option and to expand the coverage starting in 2027.
- Audio-only Telehealth Extension: This bill includes language to continue coverage of audio-only telehealth until July 1, 2025, and to continue the study of audio-only telehealth services for one year. It is included in both the House and Senate bills.
- Long-acting Reversible Contraception: This language provides Medical Assistance (MA) coverage and reimbursement of postpartum use of long-acting reversible contraception (LARC) immediately following a delivery. It is in both the House and Senate bills.
- Family Planning: This language increases Medical Assistance (MA) reimbursement rates for family planning services and is in both the House and Senate bills.
- Repeal of Barriers to Reproductive Health Services: This language removes multiple items from Minnesota statute intended to obstruct access to reproductive services, including abortion, and is in both the House and Senate bills.
- Recuperative Care: This language extends MA coverage for recuperative care services for enrollees experiencing homelessness. Funding will cover care coordination services but not housing costs. This coverage is critical to address the health care challenges related to homelessness, a significant social driver of health. It is included in both the House and Senate bills.
Other Important Bills
- No-cost Primary Care Study: This directs the Commissioner of Commerce to study providing all primary care services with no cost-sharing for patients. This idea is based on how we provided COVID testing and vaccines free-of-charge for patients and to remove all barriers for patients to receive all primary care services without cost-sharing. This is included in both the Senate and House omnibus commerce budget bills.
- Psychiatric Collaborative Care: Included in the omnibus commerce budget bill is the requirement for health plans to cover psychiatric collaborative care. This model promotes provision of mental health services with a team that includes a primary care physician or other provider, a care manager and a psychiatric consultant.
- Firearm Universal Criminal Background Checks: This language expands the required criminal background checks to apply to all sales and transfers of firearms, including private loans and gifts of firearms, and is in both the House and Senate omnibus judiciary bills.
- Firearm Extreme Risk Protection Orders: This language, also known as a “red flag law,” allows family members to petition law enforcement or the courts to temporarily remove firearms from someone who is deemed to be a danger to themselves or others. This is found in both the House and Senate omnibus judiciary bills.
- Paid Family and Medical Leave: This bill is moving independently in both bodies. It requires employers to offer 12 weeks of paid family leave and 12 weeks of paid medical leave to employees. It caps the total to 20 weeks annually. It is funded primarily by a new payroll tax.