HCA-MN legislative update

As presented at the last HCA-MN Quarterly Meeting in late March, here is the status of various health reform bills making their way through the Minnesota Legislature.

SF 1125 & HF 1200

Senate SF 1125 (John Marty), SF 1128 (Carolyn Laine) 15 co-authors.
House HF 1200, HF 1769 (Alice Mann). 37 co-authors.

  • Single state-wide plan that covers all Minnesotans for all medical needs.
  • No MNSure exchange.
  • Governed by a democratically-selected board legally bound to principles that serve the public interest.
  • Funded by all Minnesotans, based on ability to pay, which replaces premiums, deductibles, and co-pays.
  • Payments to providers made by the MHP, not multiple insurance companies, reducing bureaucracy and saving money.
  • Short and simple application form.
  • Prohibited from denying, delaying, or restricting care, or reducing quality to save money.
  • No insurance company interference between doctor and patient.
  • Choice of medical providers and coverage doesn’t end with job loss or new employer.
  • Choice of using the same doctors, medical services, hospitals, and clinics, which remain under existing ownership, whether public or private.
  • Primary and preventive care, dental, vision and hearing, mental health, chemical dependency treatment, prescription drugs, medical equipment and supplies, long-term care, and home care.

MHP study bill

Introduced 3-7-19.  Referred to Health & Human Services Policy & Finance
Senate SF 2128 (John Marty, Melissa Wiklund, Chris Eaton, Jim Carlson, Foung Hawj)

Commissioner of Department of Health contracts with the University of Minnesota to conduct an analysis of the benefits and costs of the MN Health Plan and the current system to contrast the impact on:

  • number of insured people versus those without access to health care due to financial and other barriers;
  • completeness and adequacy of coverage;
  • total public and private health care spending under the current system versus the MN Health Plan to include savings from
    reduced insurance, billing, marketing, underwriting, and other overhead
    reduced prices on pharmaceuticals and medical services due to price negotiations;
    reduced administrative costs to businesses and government.

MNCare expansion HF 3 established OneCare Buy-In 3-11-19

House HF 3 (Liebling), 35 authors: Heard in Health & Human Services Finance Division 3-29.
Senate SF 1080 (Klein, Marty, Hayden, Eaton, Wiklund) Referred: Health & Human Services 2-14.

  • Allows enrollment of any Minnesota resident.
  • Leverages the state’s volume purchasing power for lower prices.
  • Offers lower-cost dental care through a common administrator.
  • Commissioner of Department of Human Services (DHS) establishes a OneCare Buy-In option through the MNSure exchange in accordance with the federal Affordable Care Act (ACA).
  • Offers the following insurance products with coverage and deductible levels: Platinum coverage at 90% of full actuarial value, Gold coverage at 80%, and Silver coverage at 70%.
  • Contracting with these plans that require government subsidies is not cost containing, as Minnesota’s health spending will double to $94 billion by 2026, according to the Minnesota Department of Health.

Repeal 2019 sunset of 2% provider tax

Funds 40% of MNCare; goes to Health Care Access Fund.
SF 399 (Jeff Hayden) (Rep. Jennifer Schultz not introduced). Referred to Senate Taxes 1-14.

  • Repeals the Dec. 31, 2019 sunset of the Provider Tax.  In 2019, the tax will generate more than $690 million. The MN Medical Association proposes replacing the Provider Tax with a Claims Assessment Expenditure (Sen. Jim Abler) to be applied to claims processed by health plans and third-party admin.

Anti-price gouging for prescription drugs

Introduced during the week of February 5:
HF 4 (John Lesch) 35 authors.  Referred to Health & Human Services Finance Division 3-4.
SF 1518 (Matt Klein, Rich Draheim [R], Melissa Wiklund, Scott Jensen [R], Matt Little) Referred to Health & Human Services Finance & Policy 2-21

  • Drug manufacturer or wholesale distributor prohibited from charging unconscionable prescription drug prices;
  • civil penalties imposed against violating companies to ensure prices are kept at the bulk-purchased  level;
  • health plan companies required to notify attorney general of drug price increases;
  • attorney general authorized to take action against drug companies and wholesalers regarding price

Re-insurance of health insurance companies with government subsidies introduced

HF 629 (Laurie Halverson): 23 authors.  Referred to Health & Human Services Finance Division 3-18.  Passed to the House.
SF 761 (Dahms [R], Gazelka [R], Benson [R], Jensen [R], Tomassoni [DFL]):  Referred to Finance Committee 3-4.

  • “Premium security plan funding” of $271 million for 2018- 2019.
  • Uses existing state government funds to subsidize insurance companies to stabilize rising premiums of individual plans, but doesn’t contain costs.

Other prescription drug bills related to costs

  • HF 149 relates to price transparency.
  • HF 182 establishes a repository for safe leftover prescriptions for low-income people.

Bills related to the pharmaceutical industry’s practices are popular as they appear as potentially bipartisan.  Not necessarily bad, but not a real solution.  Dr. Stephen Schondelmeyer, U of M pharmaceutical industry economist, testified on the industry’s dysfunction.

Senate Republicans’ package of ‘bold measures’ aimed at reducing health care costs:

  • Direct Primary Care to eliminate the insurance company middle-man for primary care physicians.
  • Right to Shop to allow patients to shop for doctors and clinics out of their network.
  • Pre-existing Conditions Coverage to assure coverage.
  • Pharmacy Benefits Manager Reform to increase transparency and accountability of pricing prescription drugs.  This is a layer of bureaucracy that we think could be eliminated.

National legislation

Medicare-for-All, U.S. House

HR 1384, introduced by Rep. Pramila Jayapal (Washington State) on February 27.

Has the main components of a single-payer system:

    • one payer pays providers directly,
    • contains costs by prohibiting commercial ACOs, HMOs, and other insurance companies,
    • a uniform fee schedule for doctors,
    • budgets for hospitals and nursing homes, and
    • price limits on drugs and equipment.