Lockridge Grindal Nauen hosted a Health Care Policy Luncheon at the University Club in St. Paul. The event gave some of the firm’s clients, health care providers and other guests an opportunity to learn more about the challenges facing Minnesota in the health care arena as well as some of the reform initiatives that are in the works.

The luncheon featured a legislative forum consisting of Minnesota Representatives Paul Thissen (DFL-63A), Chair of the House Health and Human Services Committee, and Laura Brod (DFL-25A), the Committee’s Ranking Member. Both Representatives gave their perspectives on issues and challenges facing the legislature in the next year. They also offered some insight into how their respective caucuses plan to address those challenges.

Guests and legislators discussed a variety of issues, including the appropriate usage of the Health Care Access Fund; a proposed amendment to the Minnesota Constitution giving every citizen the right to affordable health care; identity theft protection as it applies to medical information; and, the integration of electronic medical records into health care practices across the state.

Lockridge Grindal Nauen holds a variety of policy luncheons throughout the year featuring key legislators as speakers. These forums give our clients the opportunity to ask questions and express their concerns regarding state policy matters.

Health Care Update

September 18, 2007

Legislative Commission on Health Care Access Continues Deliberations:

The Legislative Commission on Health Care Access and its eight work groups continued to debate various proposals for reforming the health care industry. Panel members have received multiple presentations from various entities detailing the current status of existing programs. The group is searching for places where the legislature can act.

Throughout the meetings, a desire to enact legislation authorizing universal health care remains a goal shared by many panel members; but, the question remains what such a proposal would look like. Some cost containment work group members have conveyed a desire to pass a sustainable measure that elected officials on both sides of the aisle will look upon in future years as a legislative success.

The key to this, according to Rep. Erin Murphy (DFL-64A), is to ensure that future proposals don’t rely exclusively on the public sector, and do not focus exclusively on providing coverage to Minnesotans without health insurance. Murphy stated that a sustainable solution will be one that looks at the entire population, and includes measures for containing the rising cost of health premiums that the insured population is currently wrestling with.

The work group is also looking at existing initiatives and trying to gauge their current or projected success. In a recent meeting held by the full Commission, Brian Osberg, Assistant Commissioner of the Department of Human Services, gave an overview of current efforts being implemented by the state to advance value-driven health care in Minnesota.

Osberg touched upon health information technology networks and explained the state’s grant program that seeks to encourage and help fund interoperability between different systems. Commission co-chair Sen. Linda Berglin (DFL-61) noted that promoting expanded usage of electronic health records with increased compatibility between different networks are goals that the Senator and the Governor share. Osberg also discussed projects seeking to measure quality of care such as the Minnesota Community Measurement project.

The commission also received an overview on federal legislation that affects Minnesota. Not surprisingly, much of the overview focused on the Children’s Health and Medicare Protection (CHAMP) Act. The U.S. House and Senate have each passed respective versions of the bill, which is due to be reviewed in conference committee. The House version halts a 9.9 percent cut in Medicare reimbursement rates. Multiple concerns have been raised about a number of the offsets used to fund this provision, including monies originally allocated toward the Medicare Advantage program. Staff from the Minnesota Department of Health also voiced concern about a number of rule changes proposed by Centers for Medicare and Medicaid Services (CMS) that could put some federal funds the state relies on to aid in running various public programs in jeopardy.

What is Affordability?

The Health Care Access Commission’s work group entitled “Cost Containment: Restructure the Health Care System through the Identified Savings” has been working actively to define “affordability” as it relates to health insurance. In doing so, the work group looked at how affordability is defined in Massachusetts and Vermont’s comprehensive health reform proposals, and some of the flaws within those definitions.

In Massachusetts, anyone with a family income level at or above 300 percent of the Federal Poverty Guidelines (FPG) without health insurance will be penalized for not having coverage unless the Commonwealth Health Insurance Connector Authority determines that affordable coverage is not available.

According to a memo released by Julie Sonier, Director of the Health Economics Program with the Minnesota Department of Health, the Connector Authority has determined that an individual with income at 300 percent of FPG can afford coverage at $105 per month. The monthly cost of the lowest premium policy available to a 50 year old in Massachusetts varied from $232 to $356 per month. To put this in perspective, a family of four with an annual gross income of $61,950 and an individual who makes $30,630 are both considered 300 percent above the FPG.

According to Katie Cavanor, Senate Counsel and Research, the goal of the Massachusetts plan is to provide coverage to 95 percent of the population. Sen. Linda Berglin (DFL-61) speculated that the people in Massachusetts who will fall through the cracks will likely be people in their 40s and 50s with income levels slightly over 300 percent of the FPG.

Vermont offers a number of different health plans targeted to different cross sections of the uninsured community, and premium levels are determined largely by the beneficiaries’ income levels. The Vermont Health Access Plan is an insurance plan for individuals over 18 at income levels below 150 percent of FPG, and parents below 185 percent are eligible.

The Catamount Health Plan is a privately run health plan available to uninsured Vermonters who had insurance, but lost coverage for a number of reasons, and who do not have access to employer sponsored insurance. The estimated premium for the Catamount Plan’s least expensive plan will cost about $390 per month. Individuals with income levels below 300 percent of the FPG may also be eligible for state assistance. Similar to Massachusetts, the Vermont plan seemingly leaves few options for persons over 50 with income levels just above 300 percent of the FPG.

Senate Fiscal Analyst David Godfrey informed the work group that expanding eligibility for MinnesotaCare to all citizens whose income is at or below 300 percent above the FPG has the potential to increase the cost of premiums, particularly if the new population is less healthy than the current policyholders.

Berglin added that such an expansion might also prompt Minnesota Comprehensive Health Association (MCHA) beneficiaries and MCHA candidates to enroll into MinnesotaCare. This trend would drastically increase premiums and overhead, unless there was language inserted into statute specifically prohibiting MCHA enrollees from moving to MinnesotaCare.

With respect to affordability, Berglin observed that the number of uninsured Minnesotans eligible for Medicaid is much higher than the number of uninsured persons eligible for MinnesotaCare, and the primary reason cited for not enrolling is cost. Holly Rodin with the Service Employees International Union (SEIU) said the commission should look at ways to identify people who are currently paying for health insurance they can’t afford. Peter Benner with AFSCME, however, expressed concern about political pressure to increase the amount of money that is identified as the benchmark for defining affordability.

Mary Edwards with Fairview Health Services said another crucial piece of the puzzle consists of asking whether consumers know what their health care premium dollars are paying for. As an example, some consumers may opt for high deductible plans because of the lower premiums, but this decision has to beg the question whether or not these consumers can realistically afford the high deductibles.

There is no shortage of challenges for the Commission and work groups, but panelists remain undeterred as they move toward defining comprehensive coverage and looking for ways to make such a package affordable to all Minnesotans.

Upcoming Meetings:

Governor’s Health Care Transformation Task Force
Monday, September 17th , 2007 - 9:30 a.m. to 4:00 p.m.
Location: Revenue Building - Skjegstad Room, 600 Robert St. N., St. Paul

HCAC Working Group: Single Payer Approach to Health Care
Tuesday, September 18, 2007 - 11:00 a.m.
Room: 200 State Office Building
Chair: Rep. Ken Tschumper
Agenda: Possible financing mechanisms for a single payer system

HCAC Working Group: Development of New Cost Containment Strategies
Tuesday, September 25, 2007 - 1:00 p.m.
200 State Office Building
Chair: Rep. Jim Abeler and Sen. Ann Lynch
Agenda: TBA

HCAC Working Group: Identifying Health Care Costs/Savings
Tuesday, September 18, 2007 - 2:00 p.m.
200 State Office Building
Chairs: Rep. Erin Murphy, Sen. Tony Lourey
Agenda: Discussion on regulatory and licensing law changes Increasing the variety of providers providing care to rural and underserved populations. Continue previous discussion on recommendations. Written testimony can be submitted to Jenn Holcomb (jenn.holcomb@house.mn) before noon Sept. 14.

HCAC Working Group: Insurance Market Reform
Wednesday, September 19, 2007 - 10:00 a.m.
200 State Office Building
Chairs: Rep. Diane Loeffler, Sen. Mary Olson
Agenda: Discussion of risk adjustment Written testimony can be submitted to Jenn Holcomb (jenn.holcomb@house.mn) by noon Sept. 13.

HCAC Working Group: Public Health
Monday, September 24, 2007 - 10:00 a.m.
200 State Office Building
Chairs: Rep. Steve Gottwalt, Sen. Patricia Torres Ray
Agenda: Discussion on non-financial barriers to receiving health care

HCAC Working Group: Bridging the Health Care Continuum
Tuesday, September 25, 2007 - 10:00 a.m.
G-15 State Capitol
Chairs: Sen. Kathy Sheran
Agenda: TBA

HCAC Working Group: Identifying Health Care Costs/Savings
Tuesday, September 25, 2007 - 2:00 p.m.
200 State Office Building
Chairs: Rep. Erin Murphy, Sen. Tony Lourey
Agenda: Continue discussion on recommendations

HCAC Working Group: Insurance Market Reform
Wednesday, September 26, 2007 - 10:00 a.m.
200 State Office Building
Chairs: Rep. Diane Loeffler, Sen. Mary Olson
Agenda: TBA

Governor’s Health Care Transformation Task Force
Monday, October 22, 2007 - 9:30 a.m. to 4:00 p.m.
Location: Revenue Building - Skjegstad Room, 600 Robert St. N., St. Paul, MN 55164-0975

Governor’s Health Care Transformation Task Force
Monday, November 19, 2007 - 9:30 a.m. to 4:00 p.m.
Location: To Be Determined

Governor’s Health Care Transformation Task Force
Monday, December 3, 2007 - 9:30 a.m. to 4:00 p.m.
Location: To Be Determined

Governor’s Health Care Transformation Task Force
Monday, December 10, 2007 - 9:30 a.m. to 4:00 p.m.
Location: To Be Determined

Governor’s Health Care Transformation Task Force
Monday, January 7, 2007 - 9:30 a.m. to 4:00 p.m.
Location: Snelling Office Park - Mississippi Room, 1645 Energy Park Drive, St. Paul

Health Care Update
August 20, 2007

The Governor’s Health Care Transformation Task Force and a number of the work groups reporting to the Legislative Commission on Health Care Access met last week to discuss various measures and proposals seeking to potentially reform the health care industry.

The Governor’s Task Force held a round table discussion on ways the state could save money on the management of chronic diseases, which makes up a significant portion of the expenses in the health care industry. Task Force members specifically discussed how the state could review existing successful programs such as the Park Nicollet Health Services’ cardiac rehabilitation program and St. Mary’s Hospital’s heart failure management program, and use their successes to benefit the rest of the state.

Sen. Linda Berglin (DFL-61) noted that if health providers in one part of the state have discovered a way to treat patients more efficiently while maintaining quality, they need to share that information with the rest of the state to ensure other Minnesotans are receiving that quality care.

Rep. Tom Huntley (DFL-7A) informed task force members that some of these innovative groups, such as St. Mary’s, are actually losing money on their programs because the reimbursement structure currently used by health plans around the state discourages preventative care.

In identifying programs and proposals to improve the health delivery system and streamline cost, task force members identified the following four questions that would need to be answered before moving forward on any given strategy:

“Is it a good idea?
Who is going to implement the proposal?
Where do the savings from the idea go?
How do we rake in those savings?”

During the discussion, Task Force member Scott Wright observed that the group should keep in mind that some concepts which prove successful in the metropolitan areas of the state may provide little value in rural Minnesota. Charles Fazio, Medica’s senior vice president and medical officer, also pointed out that great steps have already been taken both by industry professionals and the legislature to contain health care costs, and these entities are still measuring the benefits these changes will have on the community.

Along those lines, Sen. Berglin cited health plans’ recent new program requiring prior authorization for any imaging procedure as an example, saying the plans are currently boasting record savings from this practice. She noted, however, that the legislature should pay close attention to what the plans do with the savings they have achieved.

In future meetings, the Task Force will heed Fazio’s advice and review current initiatives that are underway to rein in health care costs and their current and projected savings. Additionally, the group will look at initiatives that other states have launched.

The task force will meet again on September 17th and October 22nd from 9:30 a.m. to 4:30 p.m. on both days. The location has yet to be determined, but we will provide more information as it becomes available. The task force also has a web site that can be viewed at http://www.health.state.mn.us/divs/hpsc/hep/transform/.

Legislative Commission on Health Care Access Work Group Meetings:

The Legislative Commission on Health Care Access and a number of its work groups also met this week at the Capitol. All of the work groups are still in the information gathering state, and to that tone, heard a number of presentations from various groups on cost savings initiatives.

Carolyn Pare with the Buyers Health Care Action Group testified before the Cost Containment Work Group focused on restructuring the health care system through savings identified by its sister work groups, giving a presentation on assumptions on cost savings in the private sector due to pay for performance. David Godfrey, fiscal analyst with the Minnesota Senate, provided the work group with a presentation comparing enrollee premiums for state subsidized insurance programs in other states.

Dr. Jeff Schiff, medical director with the Minnesota Department of Health, gave a presentation on the elimination of unnecessary services. During Schiff’s presentation, Rep. Jim Abeler (R-48B) asked about the implementation of a law passed in 2005 requiring providers to seek prior authorization from a payer for any imaging procedure for public program enrollees. Schiff conceded that the Department did not implement the law in part because some private plans had just rolled out their programs requiring preauthorization for imaging procedures.

Abeler promptly responded, saying, “When the legislature passes a bill, it is generally not a suggestion. We expect the [Department of Health] to act.”

The Cost Containment Work Group focused on Identifying Health Care Costs and Savings received a presentation from Doctors George Schoephoerster and Douglas Wood on a “medical home” approach to caring for patients. The physicians’ presentation closed with recommending that legislators look at ways to attract and retain providers in underserved areas and consider regulatory or legislative changes increasing reimbursement for preventative services.

The Cost Containment Work Group focused on identifying new cost savings mechanisms heard presentations on a number of legislative proposals introduced in the 2007 legislative session. Work Group members also discussed the need to continue moving toward integrating mental health services into the services a patient is receiving when applicable.

The Public Health Work Group met to continue its discussions on seeing what role the legislature can play in addressing the current obesity epidemic in Minnesota. Work group members heard presentations on current actions the Governor and the Minnesota Department of Health are already taking as well as an overview on some of the federal programs that are currently underway. Rep. Mary Ellen Otremba (DFL-11A), who chairs the Agriculture, Rural Economies and Veteran Affairs Committee, noted that all policy items regulating the food industry fall under the jurisdiction of her committee, and it might be appropriate for work group members to hear a presentation from the Department of Agriculture.

Work Group chair Rep. Steve Gottwalt (R-15A) questioned whether parents are doing their part on preventing the obesity epidemic especially in light of multiple actions schools have taken, and expressed an interest in knowing what could be done to help educate parents. Otremba noted that some low income families don’t even know how to prepare healthy meals, and there might be a need to educate parents.

Rep. Kim Norton (DFL-29B) expressed concern that the work group was going to focus exclusively on child obesity while the entire public health system might be in need for review and potential reform as well. However, most other work group members expressed support for sticking with obesity. As deliberations continue, it will be interesting to observe whether the purview of the work group evolves.

The Insurance Reform work group also met for the first time, during which group members received overviews on the insurance market in Minnesota from Tom Pender with the House Research Office and Deputy Commissioner of the Commerce Department Patrick Nelson. Pender’s overview focused on the types of insurance available in Minnesota and detailed the percentages of people on public versus private programs.

Nelson’s presentation focused on the regulatory aspect of insurance, explaining the jurisdictions between the health and commerce departments with respect to who is responsible for regulating which aspects of the health insurance industry. It is unclear when the work group will meet again as work group co-chair Rep. Diane Loeffler (DFL-59A) will be serving on jury duty for a portion of the month.

"Portions of the information contained herein was provided by the Minnesota House of Representatives and Senate websites, found at http://www.house.leg.state.mn.us/ http://www.senate.leg.state.mn.us/, for additional materials on the topics discussed above please consult these sources."

Health Care Update

August 2, 2007

Governor’s Health care Transformation Task Force Holds Initial Meeting:

The Governor’s Health Care Transformation Task Force held its first meeting this week during which task force members went through introductions and reviewed the group's legislative goals. Gov. Tim Pawlenty addressed the task force, and outlined what he hopes the task force will accomplish. More significantly, Pawlenty made it clear that he would not support any legislative proposal authorizing a single payer health system in Minnesota.

The task force has been assigned with delivering a report to the legislature by February 1, 2008, with specific and measurable goals and deadlines for each:

Actions that will reduce health care expenditures by 20 percent by January 2011 and limit the rate of growth in health care spending to no greater than the percentage increase in the Consumer Price Index for all urban consumers plus two percentage points each year thereafter.
Actions that will increase the affordable health coverage options for all Minnesotans and other strategies that will ensure all Minnesotans will have health coverage by January 2011.
Actions to improve the quality and safety of health care and reduce racial and ethnic disparities in access and quality.
Actions that will improve the health status of Minnesotans and reduce the rate of preventable chronic illness.
Proposed changes to state health care purchasing and payment strategies that will promote higher quality lower cost health care.
Actions that will promote the appropriate and cost-effective investment in new facilities, technologies and drugs.
Options for serving small employers and their employees as well as self-employed individuals.
Actions to reduce administrative costs.

Co-chaired by Rep. Tom Huntley (DFL-Duluth) and Human Services Commissioner Cal Ludeman, who also serves as the chair of Governor Pawlenty’s Health Cabinet, the task force heard testimony from Julie Sonier, Director of the Health Economics Program, Minnesota Department of Health. Sonier spoke about some of the recent trends of health coverage in Minnesota, the cost trends for private and public health insurance programs and some private and public cost containment strategies that have been implemented thus far.

Sonier spoke about how an increasing number of employers are encouraging and rewarding healthier lifestyles by implementing benefits such as reimbursement for fitness club monthly memberships and lower premiums for non-smokers. Sonier concluded by emphasizing that all stakeholders – health plans, providers, employers, consumers and government – need to play a role in reining in the rising costs of health care.

The task force will be meeting through the fall and winter seasons to identify ways to meet the aforementioned objectives. Because of the bipartisan and diverse membership of the task force, it is likely that some of its findings may very well become public policy.

Single Payer Work Group:

The Single Payer work group met this week to continue its mission to craft legislation authorizing a single payer health delivery system in Minnesota. Absent from the meeting was the acknowledgement that Gov. Tim Pawlenty stated on Monday during the Governor’s Health Care Transformation Task Force meeting that he would not support any such legislation.

The work group heard testimony from Deputy Commissioner of the Commerce Department Patrick Nelson, who discussed the current minimum benefits required for selling health benefits in Minnesota and costs that would be eliminated under a single payer system. Much of the conversation during Nelson’s presentation focused on a statistic that mandates for coverage imposed on insurance companies accounted for 13 percent of the insurance costs. Nelson asserted that this money could be saved if such mandates were repealed.

Work group members, however, argued that such mandates were likely authorized because plans did not cover such services that were deemed as medically necessary, and ultimately, someone is paying for services not covered. Work group members also expressed dismay at the amount of money allotted to the administrative aspect of the health care delivery system, chastising health plans for their inefficiencies.

Insurance agencies, however, were not the only organizations to come under fire. Dr. Jim Hart with the Minnesota Universal Health Care Coalition blamed imaging centers and ambulatory surgical centers for the rising costs of health care, stating that physicians must order an excessively high volume of scans to justify the purchase of expensive medical equipment. This charge sparked the ire of Sen. Linda Higgins (DFL-58), who expressed strong support for resurrecting a certificate of need (CON) process to ensure that health care providers build new facilities in underserved communities. Higgins also argued that a CON process would help prevent providers from purchasing unnecessary and expensive medical equipment.

Sen. Kathy Sheran (DFL-23) stated, however, that work groups must recognize that health care is not free, and it is not unreasonable to expect people to pay for care. Sheran asserted that the work group, as well as the commission, should keep that in mind as deliberations continue.

The work group also discussed whether the expenses incurred via long term care centers should be factored into a single payer program. Rep. Ken Tschumper (DFL-31B) stated that long term care facilities are largely funded by Medicare, which, in effect, makes them government run. However, work group members stated that there might be a need to factor long term care centers into their legislation.

Work group members also discussed the use of deductibles and copays in a single payer program, which sparked some disagreement amongst work group members. Tschumper supported the use of copays to dissuade superfluous care, but Sen. John Marty (DFL-54) and Sen. Mary Olson (DFL-4) each felt that copays often result in low income families deciding against receiving preventative care because of cost.

Preventative care was another item of discussion. Dr. Hart stated that preventative care has a very complicated definition, which may not translate smoothly into statute, and it may take some finesse to ensure the translation does not leave out any necessary procedures or include any unnecessary steps. Work group members seemed to lean toward a more liberal definition of preventative care.

The work group closed by noting that it should hear from representatives from the counties, health care providers and health plans as the group continues to meet. Eileen Weber with the Minnesota Universal Care Coalition also stated that the group should try to receive testimony from an economist as the research process continues.

Mark Your Calendar

Legislative Commission on Health Care Access
WEDNESDAY, July 25, 2007
9:00 AM
Room: 15 State Capitol

Chairs: Rep. Thomas Huntley, Sen. Linda Berglin

Agenda:
ERISA overview

Presentations by legislators on current health care bills.

Pay for performance/financial incentive review

NCSL presentations on initiatives that achieve access to health care and cost containment in other states.

A more detailed agenda is at http://www.commissions.leg.state.mn.us/lchca/meetings.htm.

HCAC Working Group: Development of New Cost Containment Strategies
TUESDAY, July 24, 2007
1:00 PM
Room: 123 State Capitol

Chairs: Rep. Jim Abeler, Sen. Ann Lynch

Agenda:
1) Introduction of topic and working group members

2) Cost of Sexual Assault: Presentation by the Department of Health

3) 2004-2010 Heart Disease and Stroke Prevention Plan: Presentation by the Department of Health

HCAC Working Group: Cost Containment
TUESDAY, July 24, 2007
2:00 PM
Room: 200 State Office Building

Chairs: Rep. Erin Murphy, Sen. Tony Lourey

Agenda:
Introduction of working group members

Presentation on health care costs in Minnesota

Overview of the charge assigned to the working group

HCAC Working Group: Public Health
WEDNESDAY, July 25, 2007
3:00 PM
Room: TBA

Chairs: Rep. Steve Gottwalt, Sen. Patricia Torres Ray

Agenda:
Introductions

HCAC Working Group: Restructure the Health Care System Through the Identified Savings WEDNESDAY, July 25, 2007
3:00 PM
Room: 15 State Capitol

Chairs: Rep. Paul Thissen, Sen. Linda Berglin

Agenda:
MDH report on groups of uninsured not eligible for current programs - April Todd Malmlov, Asst Director of the MDH, Health Economics Program MDH information on anticipated savings due to administrative uniformity - Jim Golden, Director of Health Policy

DHS information on anticipated savings due to pay for performance - Vicki Kunerth, Director, DHS Performance Measurement and Quality Improvement. What other states have determined "affordability" to be Presentation on main financing mechanism for using Main's cost savings - Dr. Lynn Blewett, U of M Timeline for working group

Meeting Notice - Legislative Commission on Health Care Access

Wednesday, July 25, 2007
9:00am
Room 15, State Capitol

Co-Chairs: Rep. Thomas Huntley, Sen. Linda Berglin

Agenda

Morning:
ERISA Overview - Michael Scandrett.
Presentations by Legislators on current health care bills.
Pay for performance/financial incentive review: Brian Osberg, Department of Human Services; Jim Chase, Community Measurement Project; and a representative from the Q-Care Council, Minnesota Department of Health.

Afternoon:
NCSL presentations on initiatives that achieve access to health care and cost containment in other states.

Commission Aims for October Deadlines

The Legislative Commission on Health Care Access and its work groups have tentatively established two deadlines for when they must submit their findings to the State Legislature. The work groups must submit their findings to the Legislative Commission on Health Care Access by October 15th. The Commission is required to submit its final report to the legislature by Oct. 30th.

Health Care Access Commission Announces New Work Groups

The Legislative Commission on Health Care Access held its second hearing today, during which Commission co-chairs Sen. Linda Berglin (DFL-61) and Rep. Tom Huntley (DFL-7A) announced the formation and composition of seven work groups which will review various aspects of health care reform. The work group members and objectives are listed below.

The commission also noted in its handout that work group co-chairs may appoint additional members to serve on the panels if deemed necessary, and serving in the Minnesota Legislature is not a prerequisite. We would encourage anyone interested in meeting with or possibly joining one of the work groups below to contact us as soon as possible. Please note anyone interested in meeting with or joining a work group should keep in mind that such a commitment has the potential to be time consuming, but well worth the personal investment.

Cost Containment: Identifying Health Care Costs and Savings

Members
Sen. Tony Lourey (DFL-8) – co-chair
Rep. Erin Murphy (DFL-64A) co-chair
Sen. Kathy Sheran (DFL-23)
Rep. Jim Abeler (R-48B)
Rep. Tom Huntley (DFL-7A)
David Doth, REM Minnesota
Dr. George Schoephoerster, CentraCare Health Plaza

Scope:
· Incentive payments, regulatory changes and licensing changes that will result in better health.
· Correct flaws in the marketplace that lead to inefficient use of resources by creating a reimbursement system structure that is less expensive by rewarding quality rather than volume of procedures.
· Develop a medical home model
· Allow wider variety of providers (nurses or others) to operate in rural geographic areas and treat underserved populations.
· Improve management of chronic conditions.

Cost Containment: Restructure the Health Care System Through the Identified Savings

Members
Sen. Linda Berglin (DFL-61) – co-chair
Rep. Paul Thissen (DFL-63A) – co-chair
Sen. Julie Rosen (R-24)
Rep. Julie Bunn (DFL-56A)
Tara Erickson
Marnie Moore-Lindman, Larkin Hoffman Daly & Lindgren Ltd.
David Doth, REM Minnesota
Jonathan Watson
Donna Zimmerman, Health Partners
Don Jacobs, Hennepin Faculty Associates
Charlie Fazio, Medica

Scope:
· Translate all identified savings in the health care system into lower premiums and lower public program costs.
· Create a methodology for defining minimally medically necessary benefits and maximum benefits
· Define “affordable”
· Explore distinctions between the underinsured and uninsured populations and determine numbers in each group.

Development of New Cost Containment Strategies

Sen. Ann Lynch (DFL-30) – co-chair
Rep. Jim Abeler (R-48B) – co-chair
Sen. Michelle Fischbach (R-14)
Sen. Linda Higgins (DFL-58)
Rep. Sandy Peterson (DFL-45A)
Barbara Burandt, Minnesota HomeCare Association
Holly Rodin, SEIU
Dirk Pattengale
Carolyn Pare, Buyers Health Care Action Group

Scope
· Discuss new strategies to achieve cost containment within the health care system that would go beyond those in group ‘a’.’

Sen. Patricia Torres Ray (DFL-6_) – co-chair
Rep. Steve Gottwalt (R-15A) – co-chair
Sen. John Marty (DFL-54)
Sen. Kathy Sheran (DFL-23)
Rep. Mary Ellen Otremba (DFL-11B)
Bruce Cantor, Pediatric Obesity Work Group
Mark Manley, Blue Cross Blue Shield of Minnesota
Carolyn Suerth, Hudson Midwest Dairy Council
Ellie Ulrich Zuehlke, Allina
Pat Arndt, Planning, MN-DNR Division of Parks & Recreation
Cindy Hiltz – School Nurse, Anoka
Dr. Sarah Jane Schwarzenberg, Pediatric Weight Management Clinic
Maureen Cassidy, American Heart Association
Kevin Morris, Coca Cola

Scope
· Evaluate other states’ and organizations’ proposals to address childhood obesity
· Promote early detection and prevention of chronic conditions
· Assure access to, and improve the quality of health services, in the area of prevention.

Insurance Market Reform

Members
Sen. Mary Olson (DFL-4) – co-chair
Rep. Diane Loeffler (DFL-59A) – co-chair
Sen. Linda Scheid (DFL-46)
Sen. Dan Skogen (DFL-10)
Rep. Sondra Erickson (DFL-16A)

Scope
· Evaluate reforms that allow the insurance market to be more competitive
· Ensure that products offer real coverage and are obtained in a cost efficient manner
· Evaluate the issue of guarantee issue
· Address the inequality of employers as the basis of coverage
· Look at changes made to ERISA law since 1992
· Look at what we would need to change if we mandated coverage.

Health Care for Long-Term Care Workers

Members
Sen. Paul Koering (R-12), chair
Sen. Linda Berglin (DFL-61)
Rep. David Bly (R-25B)
Barbara Burandt, Minnesota HomeCare Association
Conie Menne, REM MN, Inc.
Kathy Fondness, SEIU
Sally Erickson, D.A.C., Inc.
Jane Peltier, Merrick, Inc.
Bruce Nelson, Association of Residential Resources in Minnesota
Lori Meyer, Minnesota Health and Housing Alliance

Scope
· Utilize medical assistance funds to provide health insurance to long term care workers

Single Payer Health Care

Members
Sen. Yvonne Prettner Solon (DFL-7) – co-chair
Rep. Ken Tschumper (DFL-31B) – co-chair
Sen. Sharon Erickson Ropes (DFL-31)
Sen. John Doll (DFL-40)
Sen. Mary Olson (DFL-4)
Rep. Tina Liebling (DFL-30A)
Eileen Weber, Minnesota Universal Health Care Coalition

Scope
· Create a methodology for defining minimally medically necessary benefits and maximum benefits
· Develop a plan of transition for current public and private programs
· Identify the cost to implement a single payer system
· explore financing opportunities

Meeting of Note

The Minnesota Department of Health's Interpreter Services Work Group met on July 11, 2007.

The Minnesota Department of Health
Orville L. Freeman Building
Room B-145
625 Robert Street North
St. Paul, MN 55155

RSVP to Julie Kamrath at: julie.kamrath@health.state.mn.us

A link to directions to the Freeman Building is found at: http://www.health.state.mn.us/about/freeman.html

The Health and Human Services Omnibus bill (Minnesota Law 2007, Chapter 147) requires the commissioner of health to convene a work group of interested parties to discuss the provision of interpreter services to patients in medical and dental care settings. The work group shall develop findings and recommendations on the following: (1) ensuring access to interpreter services (2) compliance with requirements of federal law and guidance (3) developing a quality assurance program to ensure the quality of health care interpreting services, including requirements for training and establishing a certification process and (4) identifying broad-based funding mechanisms for interpreter services. The work group shall report findings and recommendations to the commissioner of health and to the chairs of the health policy and finance committees in the house and senate by January 15, 2008.

This meeting is intended to serve as the organizing meeting for satisfying the requirements of the Interpreter Services Work Group. If you would like to participate in the Interpreter Services Work Group's activities, you are welcome at this first meeting.

In order to assist the health department in preparing for the meeting, please send an RSVP to julie.kamrath@health.state.mn.us. Your RSVP will assist in creating a sign-in sheet for the front desk. Please feel free to pass this e-mail to other interested parties.

Hearings of Note

The Government Relations team at Lockridge Grindal Nauen is monitoring the action at the Minnesota Legislature, including the following hearings. As always, we will report any pertinent information. For details about these hearings, or if we can be of further assistance to you, please contact us at 612-339-6900.

TUESDAY, June 26, 2007
1:00 PM
Joint Committee: Health and Human Services Policy Committee and Health, Housing, and Family Security
Room: 15 State Capitol
Chairs: Rep. Paul Thissen, Sen. John Marty
Agenda: Department of Health's handling of asbestos-related cancer deaths on the Iron Range

WEDNESDAY, July 11, 2007
9:00 AM
Joint Committee: Legislative Commission on Health Care Access
Room: 10 State Office Building
Chairs: Rep. Thomas Huntley, Sen. Linda Berglin
Agenda: Overview of reform efforts by other states
Panel discussion on universal coverage

Health Care Update

June 15, 2007

Commission on Health Care Access Plans to Meet Through Summer:

The Legislative Commission on Health Care Access, a bipartisan panel of House and Senate legislators interested in health policy, held its first hearing Wednesday where legislators listened to presentations given by My Health Direct, St. Mary’s/Duluth Clinic Health System, the Innovative Care Coalition and the Department of Health. The Commission also voiced its intent to meet regularly over the fall and winter.

In responding to a call by DFL leaders to craft a legislative blueprint for providing health coverage to all Minnesotans by 2011, Commission co-chairs Sen. Linda Berglin (DFL-61) and Rep. Tom Huntley (DFL-7A) agreed that such an undertaking will require many work hours in the coming months. One challenge the legislators acknowledged was maintaining the balance of satisfying this call while crafting a proposal that will gain the governor’s approval – a caveat indicative of some lessons learned during the 2007 legislative session.

Sen. Berglin also recommended forming a number of work groups consisting of legislators interested in health reform, and noted that being a member of the commission wasn’t a prerequisite for being involved. The work groups would focus on array of topics including cost containment, reviewing and possibly retooling the current health care financing mechanism, providing health insurance to employees at long term care facilities and a work group focusing on promoting healthier lifestyles among youth – in response to the current obesity epidemic among children.

Reps Huntley and Paul Thissen (DFL-63A) each expressed enthusiastic support for the formation of such work groups, but indicated that each work group should have a clear mission statement complete with tangible expectations and deadlines. The Commission will continue refining the look and missions of these groups over the next couple of weeks.

Tom Riley gave legislators an overview of the web based tool, My Health Direct, which allows providers to schedule routine, preventative and/or follow-up appointments on behalf of consumers. The service targets uninsured patients who have chosen to seek primary health care in an emergency room setting, and give those patients an alternative for seeking such services. In doing so, My Health Direct intends to help contain the cost of health care by ensuring these consumers can obtain primary care in a more cost effective manner.

Former Senator Dave Durenberger spoke about the Innovative Care Coalition, which is a group of health care providers from seven states that has submitted a proposal to participate in a Medicare demonstration project where all of these physician networks would be given access to electronic medical records and Medicare data in hopes of coordinating the care for patients. This enhanced communication would hopefully simplify the process of implementing a uniform payment while enhancing the quality of care delivered.

Linda Wick with St. Mary’s/Duluth Clinic Health System spoke about St. Mary’s Heart Failure Program, which is a program managed by nurse practitioners in collaboration with cardiologists. The program enables providers to closely monitor patients’ diets and behaviors via regular clinic visits and an in-home scale tele-monitoring program between those visits. Wick claimed this focus on continued preventative care has resulted in an 82 percent reduction in heart failure among its patients. However, because the current health reimbursement system is not designed to reward preventative care, according to Wick, the clinic is losing money by providing care via this effective and innovative method.

Julie Sonier with the Minnesota Department of Health gave a presentation to the commission, providing some details on the demographics of uninsured Minnesotans who have access to health coverage through their employers. According to Sonier, 66% of uninsured people who have access to health insurance via their employer cited cost of care as a reason for not having health insurance.

Senate Health, Housing and Family Security Committee Meets in Mankato:

The Senate Health, Housing and Family Security held its first of a series of field hearings this week where Committee members discussed access to health care services. In a packed room at Minnesota State University in Mankato, members of the local community took the time to share their concerns with respect to access to health care while giving a situation report on the current status of access.

Dr. Ann Vogle with Mankato’s Open Door Health Center urged the legislature to consider providing funds that would go toward establishing a regional partnership across southern Minnesota for treating low income families across the state. Vogle stated that there are multiple health care providers that focus on treating the low income community, and these groups could be more effective if such a regional network existed. Funding, however, remains a challenge.

The committee also heard reports of people on public assistance programs having significant trouble accessing dental care in Mankato. Sen. Paul Koering (R-12) informed testifiers that the access challenges were a result of dentists being unable to treat patients on public programs because of the programs’ low reimbursement rates. Committee chair Sen. John Marty (DFL-54) stated that the Committee would continue holding field hearings across the state.

Health Care Update
May 15, 2007

House and Senate Craft New Health Spending Bill:

In an effort to adjourn the 2007 legislative session on time, DFL lawmakers are preparing a second round of budget bills and are hoping to put them on Governor Tim Pawlenty’s desk by Wednesday night. This strategy will give legislators enough time to potentially craft a third round of spending bills should Pawlenty veto the second round of proposals.

In conjunction with this plan, House and Senate conferees to the Health and Human Services Omnibus spending bill formed a work group yesterday, and quickly assembled another health spending measure that may be more palatable to the governor. In doing so, the work group cut about $50 million from the original spending measure, reducing funding for a variety of programs and initiatives and cutting all funding for others. The new bill slashed funds allocated to the Governor’s mental health care initiative, the Governor’s Healthy Connections legislative proposal and a number of initiatives affecting child care programs and welfare reform initiatives.

Despite these reductions, Governor Pawlenty has been on record asking the legislature to cut closer to $100 to $200 million out of the health budget, and it is unclear whether the Governor and legislative leaders have agreed on a final target for the health bill. With that in mind, it is likely that the revised omnibus health bill will be vetoed as well.

Health Care Update
Week Ending May 11, 2007

Governor Pawlenty Vetoes Health and Human Services Budget:

Confirming months of speculation, Gov. Tim Pawlenty vetoed the Health and Human Services Omnibus spending bill (S.F. 2171) Tuesday, citing significant concern over the dramatic increases in Government spending programs. As reported in earlier updates, the Governor and Republican legislators have voiced emphatic opposition to rolling back cuts made to MinnesotaCare and proposed changes to the state’s allocation and eligibility standards for Welfare recipients.

Traditionally, vetoed bills are routed to a working group consisting of the bill’s conferees to draft an alternative legislative proposal. However, Governor Pawlenty met yesterday with House and Senate leaders to discuss compromises on all of the spending bills, and all parties plan to work through the weekend to reach an agreement. We will continue to monitor the status of these negotiations and provide regular updates.

During conference committee deliberations, the conferees removed a provision requiring health plans to cover the cost of a language interpreter in a medical setting in response to a veto threat. This action was taken in spite of a compromise that supporters of the bill made with health plan representatives that included a provision creating an Interpreter Services Work Group to develop findings and make recommendations regarding access to and quality of interpreter services as well as identifying broad based funding for interpreter services.

Supporters of the language interpreter bill are now working to move the measure as a standalone bill (S.F. 827 in the Senate and H.F. 1077 in the House), and are circulating the attached handout around the Capitol.

House and Senate Set to Debate Freedom to Breathe Conference Report:

By a vote of 43-21, the Senate approved the Freedom to Breathe Conference Report today, which reflected an agreement between the two bodies on a measure that bans smoking in all places in employment to include bars and restaurants.

The conference report is significantly stronger than the House’s original ban which included a multitude of anecdotal exemptions, but the effective date for the ban was moved to October 1, 2007. Some of the remaining groups, situations and locations exempted from the ban include tobacco shops, farm and construction equipment, scientific study participants, traditional Native American ceremonies, theatrical productions where smoking is part of the performance, family farms and a disabled veterans rest camp in Washington County.

The House is set to debate the Freedom to Breathe Act today. If approved, the conference report will go to the Governor, who has indicated that he will sign the bill into law.

Proposed Constitutional Amendment Granting Right to Affordable Health Care Moves Forward:

The House State and Local Government Committee and the House Finance Committee approved legislation today proposing a constitutional amendment that grants every Minnesotan the right to affordable health care. Introduced by Rep. Tom Huntley (DFL-7A), the bill specifically states “that every resident of Minnesota has the right to health care and that it is the responsibility of the governor and the legislature to implement all necessary legislation to ensure affordable health care.”

Supporters of the proposed constitutional amendment, which would appear on the 2008 ballots if passed, have stated that comprehensive reforms are necessary in the health care industry to help contain the rising cost of care. Rep. Huntley specifically noted that universal health care currently exists as any American can seek care if necessary in the Emergency Room. However, this methodology for delivering medical attention is significantly flawed because of the high cost of emergency room services and the fact that people often go to the emergency room with ailments that would have been significantly less damaging had they been diagnosed earlier through preventative care – a service uninsured families oftentimes forego.

In order to recoup expenses incurred for providing uncompensated care in the emergency room, hospitals oftentimes must raise the cost of other services provided to all patients. Those costs are ultimately transferred to insured consumers via increases in their premiums. Huntley stated that a constitutional amendment is necessary to give legislators and the governor the incentive to implement comprehensive reforms to help curve this trend.

Opponents of the constitutional amendment have voiced concern that such an amendment may lead to a government run single payer health care delivery system which has delivered adverse, and in some cases catastrophic effects in other countries. Led by former Speaker of the House Rep. Steve Sviggum (R-28B), opponents stressed that government run systems in other countries have resulted in citizens waiting months for operations and preventative treatment measures such as diagnostic imaging procedures.

General Update:

Historically the final weeks of the legislative session have seen extensive conference committee work and floor action as the legislature wraps up for the year. However, an eerie calmness was felt around the capitol this past week with most legislative work completed by late afternoon or early evening. By weeks end only the Tax and E-12 Conference Committees had significant work remaining on the table. Still the question begs, what concessions will need to be made to pass provisions vetoed by Governor Pawlenty so the legislature can complete their job?

Of the eight omnibus finance provisions passed by the legislature this year, Governor Pawlenty has returned five bills vetoed in their entirety. The bills include the Capital Investment, State Government, Jobs and Economic Development, Health and Human Services and Higher Education Omnibus Bills. The vetoes were drawn by controversial provisions ranging from domestic partner language to the dream act, raising concerns by the Governor that the bills contained impracticable finance and policy proposals. Although the vetoes were anticipated, it came as a surprise to many that the Governor chose to veto entire provisions versus opting for the line items of concern.

Legislative leadership had voiced their desire to rework several of the provisions in order to obtain the Governor’s signature. However, under state law if omnibus finance bills are not re-passed this year the state budget would revert to ninety percent of the previous biennium, avoiding a situation reminiscent of the 2005 state government shutdown. The distinction between the two is the simple fact that the legislature provided the Governor with legislation to consider, whereas in 2005 the legislature failed to pass any finance provisions to the Governor. Knowing that a shutdown has been averted may lead to an unintentional consequence as there is no incentive for one side to concede to the other.

Not all was lost this week to Governor Pawlenty’s veto pen as the entire Public Safety Omnibus Bill and the vast majority of provisions contained in the Environment and Natural Resources Omnibus Bill were signed into law. In a less noted move the Governor also signed a law repealing the ninety-four year prohibition on ticket scalping. Other noteworthy provisions signed into law include: mandatory nurse overtime regulation; internet bullying prohibition; required hearing aide insurance coverage; and, motor vehicle fuel dispensing requirements.

On Thursday the Senate heard debate on a tax provision providing for property tax relief through an increase in the tax rate for the wealthiest of Minnesotans. Following extensive heated conversation on tax policy, the bill passed on a party line vote. Even with the Governor vowing to veto the proposal, the House will undertake the debate on Friday. Both bodies will also hear debate Friday on the conference committee report on a smoke free Minnesota. Assuming the report is passed, a widespread statewide smoking ban will take effect in October.

Merely ten days remain of the 2007 legislative session with the Governor and legislature attempting to reach middle ground on vetoed omnibus finance provisions. The impending deadlines have left few observers optimistic that work will be completed and discussions of a special session continue to persist. At this point both sides have political ground to gain, but they also have ground to lose. If neither side is willing to take a loss, the days leading up to adjournment will likely to be highlighted by nothing more than a political tug-of-war, leaving a pile of work remaining on the table.

Health Care Update
Week Ending May 4, 2007

House and Senate Conferees Discuss Health and Human Services Budget:

Leadership in the House and Senate continue discussions on finalizing omnibus spending bills. Earlier this week a deadline of Thursday noon was set for the Health and Humans Services omnibus bill to be out of conference committee. Thursday noon passed and no deal had been reached on overall spending or policy items within the bill. The committee did spend time agreeing on language that was included in both bills as well as non-controversial language. However, most policy provisions have yet to be acted on, and probably will only be done after the agreement is made on all of the spending initiatives.

The Senate and House continue to make offers back and forth, yet it appears they are still apart on key issues. It is anticipated that they will have an agreement either late this evening or early tomorrow and then spend the rest of the weekend finalizing the legislation. The bill would likely be voted on by the full House and Senate early next week and sent to the Governor mid-week. It is anticipated that the Governor will veto this legislation. It is unclear how they will move forward once that occurs.

As soon as the bill is finalized we will put together a summary of the legislation and provide you an update.

Freedom to Breathe Act:

As reported last week, the House passed the Freedom to Breathe Act and the bill will now be discussed in conference committee. A hearing is scheduled for Monday morning. It is expected that there may be only two or three meetings of the conference committee before the final language is agreed to and then sent back to the House and Senate for a final vote. It is anticipated that the final version will provide a comprehensive restaurant and bar smoking ban with an effective date of either late fall or early spring of 2008.

Medical Marijuana:

Taking a break from conference committee deliberations on Tuesday, the Senate heard debate on another highly controversial issue, the legalization of marijuana for medicinal use. Since landmark legislation was passed in 1996 when Arizona and California became the first states to allow for medical use of marijuana, the debate has remained heated. The sticking point revolves around the Controlled Substances Act of 1970 which classifies marijuana as a schedule I drug, meaning it is not recognized for any medical use. Under the Act any doctor prescribing or distributing marijuana is in violation of federal law and while actions against health care professionals and patients has been limited, states implementing provisions have seen an increase in raids of the drug. Still pressure continues to increase as terminally ill patients and their care providers tout the therapeutic nature of the drug. While the bill passed on a narrow margin, the provision faces stern opposition from those who fear legalization opens the door for further abuse and raises enforcement concerns. A House hearing is scheduled for Friday meaning the bill could be passed by the body as early as next week. However, it is anticipated Governor Pawlenty would veto the provision.

General Update:

Conference committee deliberations continued this week as House and Senate members attempted to pound out their joint finance proposals. For a number of committees the work proved complex as members of the respective chambers stood firm on their individual language. One major obstacle continued to be the sole substance of House and Senate provisions. The Senate bills, which for the most part contained strictly finance proposals, were met by substantially larger House bills encompassing both policy and finance initiatives. Staggered policy deadlines occurring between the House and Senate caused the disparity. Historically policy deadlines have lined up allowing for policy provisions from one chamber to “match up” with policy provisions in the other. This year many House policy provisions lacked companion bills in the Senate as conference committees began work. While both sides spent time this week pointing fingers over the failure of policy provision progression, in the end many individual proposals that remain traveling separately in the Senate were included in the joint finance proposals as proposed by the House.

For weeks legislative leaders had downplayed the veto threats that have draped over the legislature since the beginning of session. However, following little discussion on Tuesday Governor Pawlenty made good on his promise returning the entire Capital Investment Bill, also known as the Bonding Bill, to the legislature without his signature. Encompassing several cash proposals and funding for freshman member projects, the bill was rejected as “too big.” A surprise too many, the veto served as a stern warning to the legislative leadership causing a slight change in tides.

On Thursday afternoon both the House and Senate rejected the Public Safety Omnibus Bill, returning the bill to conference committee in order to remove a contentious insurance provision that was flagged for veto. In a similar move, the State Government conference committee altered controversial language defining domestic partnerships. The adopted compromise language originated from a Republican and focused on defining a significant individual (partner, parent, or another live-in significant individual). Whether the revisions will provide enough compromise to pass the Governor’s pen remains to be seen. Still the move by leaders highlights the pending urgency to complete work with as few hurdles as possible.

Taking a break from conference committee deliberations on Tuesday, the Senate heard debate on another highly controversial issue, the legalization of marijuana for medicinal use. Since landmark legislation was passed in 1996 when Arizona and California became the first states to allow for the medical use of marijuana, the debate has remained heated. The sticking point revolves around the Controlled Substances Act of 1970 which classifies marijuana as a schedule I drug, meaning it is not recognized for any medical use. Under the Act any doctor prescribing or distributing marijuana is in violation of federal law and while actions against health care professionals and patients has been limited, states implementing provisions have seen an increase in raids of the drug. Still pressure continues to increase as terminally ill patients and their care providers tout the therapeutic nature of the drug. While the bill passed on a narrow margin, the provision faces stern opposition from those who fear legalization opens the door for further abuse and raises enforcement concerns. A House hearing is scheduled for Friday meaning the bill could be passed by the body as early as next week. However, it is anticipated Governor Pawlenty would veto the provision.

Ninety-four years after being outlawed by the legislature, ticket scalping may soon become legal in Minnesota. The provision is headed to the Governor’s desk after a vote by the House on Wednesday. Currently forty-one states allow for ticket scalping including Wisconsin, which places a monopoly on available tickets, at high costs, for events in Minnesota. Seen as virtually unenforceable and a waste of law enforcement resources, the proposal is likely to be signed.

Governor Pawlenty is also expected to sign the Agriculture and Veterans Affairs Omnibus Bill into law on Friday providing for several veterans service initiatives. The signature falls on the heels of a legislative resolution on Monday naming May, Military Family Appreciation Month. The Governor will also consider several additional items over the weekend as the legislature is expected to forward the following omnibus bills for signature: Public Safety; State Government Finance; Environment and Natural Resources; Jobs and Economic Development; and Transportation Policy. Next week the legislature will shift their focus to Taxes, Health and Human Services, Transportation, and Education – an aggressive agenda with only two weeks left.

Health Care Update

Week Ending April 27, 2007

House and Senate Conferees Discuss Health and Human Services Budget:

In an effort to accelerate the finalization of a number of omnibus spending bills, Senate Majority Leader Larry Pogemiller (DFL-59) called for conference committees to conclude their deliberations by early next week. As a result, conferees to the health omnibus spending bill spent the majority of the week reviewing the differences between their respective chambers’ bills, and discussions will continue through the weekend.

Both bills seek to expand access to health care by expanding eligibility for various public health programs, but there are a number of differences between which programs the chambers choose to fund. The Senate bill seeks to reinstate cuts made to MinnesotaCare in 2003 and 2005, and expands eligibility for the program. The House companion also rolls back some of these cuts, but its primary vehicle for expanding coverage is the Cover All Kids bill introduced by Health and Human Services Committee chair Rep. Paul Thissen (DFL-63A). At this point, the Senate version may prevail primarily because of the Cover all Kids proposal’s potential long term fiscal implications.

The House version includes a 3 percent cost of living adjustment (COLA) increase for long term care facilities and its Senate companion authorizes a 3.25 percent COLA boost along with a 3.12 percent increase plus a 0.13 percent increase for facilities that receive certain high quality ratings. Both versions authorize a rate rebasing process which will be phased in over the course of five years.

The House version also includes a provision requiring health plans to cover the services of a language interpreter and a provision that places caps on health insurance premiums from 2008 to 2013 at the Consumer Price Index (CPI) for urban consumers for the preceding calendar year plus two percent.

The Senate health omnibus bill places caps on health insurance premiums from 2008 to 2013 at the Consumer Price Index (CPI) for urban consumers for the preceding calendar year plus two percent. The legislation also allocates an additional one percentage point to aid providers in implementing an electronic medical record system. Both chambers have included comprehensive legislation requiring the state to develop uniform billing forms and coding requirements to aid in simplifying the administrative aspect of delivering health care in Minnesota – a proposal that has also gained the support of the Governor. There are a few subtle differences between the two initiatives, which will likely be ironed out in conference.

As discussions continue, the question most political observers are asking at this point is whether all of this work will be in vain. Governor Tim Pawlenty has vowed to veto the vast majority of spending bills unless they are significantly revised – an action some DFL lawmakers seem reluctant to take at this time.

House Passes Statewide Smoking Ban:

The Minnesota House of Representatives passed legislation Thursday that would institute a statewide smoking ban in places of employment to include bars and restaurants by a convincing vote of 85-45. House authors Reps Tom Huntley (DFL-7A) and Dan Severson (R-14A) successfully negotiated a multiple of amendments seeking to dilute the strength of the ban.

Opponents to the ban led by Rep. Tom Rukavina (DFL-5A) were successful, however, in successfully adding an amendment allowing bar and restaurant owners who get most of their revenue from liquor to install separate indoor smoking rooms, where there would be no service, if they received approval from local governments. Other amendments successfully attached to the bill exempted two specific private clubs from the ban and authorized the establishment of a smoking room to be used in case of emergency.

Although the House language diluted the strength of the ban in its version, the Senate measure passed last month authorizes a more comprehensive statewide smoking ban, which gives supporters of the ban a significant advantage during committee deliberations.

Senate Passes Moratorium on Development of Radiation Therapy Facilities:

The Senate passed legislation this week which authorizes a two year moratorium on the construction of any radiation facility located in 14 counties across the state. The legislation, which was amended on the Senate floor, would not apply to the relocation or reconstruction of any facility owned by a hospital if the relocation or reconstruction is within one mile of the existing facility.

Introduced by Sen. Linda Berglin (DFL-61), S.F. 475 has created a great deal of concern among providers across the state because of the potential for an expansion of the practice of larger health care providers using the legislative process to stifle competition. Its House companion, H.F. 501, is expected to be debated in the House in the coming weeks. We have posted the language to the bill below for reference.

S.F. No. 475, 2nd Engrossment - 85th Legislative Session (2007-2008) Posted on Apr 24, 2007

1.1A bill for an act

1.2relating to health; removing the expiration date for radiation therapy facility
1.3construction limitations and providing a two-year moratorium on construction in
1.4certain counties; amending Minnesota Statutes 2006, section 144.5509.
1.5BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA:

1.6 Section 1. Minnesota Statutes 2006, section 144.5509, is amended to read:
1.7144.5509 RADIATION THERAPY FACILITY CONSTRUCTION.
1.8 (a) A radiation therapy facility may be constructed only by an entity owned,
1.9operated, or controlled by a hospital licensed according to sections 144.50 to 144.56 either
1.10alone or in cooperation with another entity.
1.11 (b) This section expires August 1, 2013 Notwithstanding paragraph (a), there shall
1.12be a two-year moratorium on the construction of any radiation therapy facility located in
1.13the following counties: Hennepin, Ramsey, Dakota, Washington, Anoka, Carver, Scott,
1.14St. Louis, Sherburne, Benton, Stearns, Chisago, Isanti, and Wright. This paragraph does
1.15not apply to the relocation or reconstruction of an existing facility owned by a hospital if
1.16the relocation or reconstruction is within one mile of the existing facility. This paragraph
1.17expires August 1, 2009.

General Update:

Conference Committee deliberations commenced this week as members begun working out the differences between their respective omnibus bills in public hearings – a departure from previous practice. Historically the bulk of conference committee work has taken place behind closed doors as members settled the vast majority of differences prior to revealing their joint proposal. This session, leadership has requested a varied approach working through their respective proposals during public hearings. The underlying intent may very well be to speed the process along, however the Revisor’s Office is backed up completing work on bills still traveling through the bodies, delaying the documents necessary to proceed. In addition, the Senate passed a one time appropriations bill containing many of funding provisions contained within the House budget measures. Lining up the two has subsequently complicated matters as spending projections vary greatly between the bodies.

The House Tax Committee released its tax proposal on Monday after a week long delay to accommodate the passage of omnibus bills. Although considered on the conservative side of the Senate’s proposal, the bill immediately drew sharp criticism from Republicans claiming that the bill is nothing more than “tax and spend liberal politics.” The bill was placed on a fast track for passage clearing the Tax Committee and Ways and Means Committee by Wednesday. Although those opposed to the bill have refrained from lengthy debate in committee, the debate is expected to be extensive when the bill hits the floor on Friday.

Following heated debate on Wednesday, the Senate passed a provision allowing for the use of state funds for the expansion of embryonic stem cell research. Although the proposal has been considered by the Senate in recent years, the Republican controlled House has blocked embryonic research expansion from moving forward. In fact, in recent years the House passed several provisions solidifying state statute outlawing embryonic stem cell research all together. With both bodies now controlled by Democrats, the proposal has gained new momentum. Though Governor Pawlenty has been supportive of expanding stem cell research from adult cells, he has vowed to veto any provisions containing funding for the expansion of embryonic stem cell research. In the interim, pressure continues to mount as a majority of Minnesotans now seem to advocate for the expansion. A recent nationwide Gallup poll indicated that up to seventy percent of Americans support an expansion of embryonic stem cell research within the country. Facing political pressures from stakeholders on both sides of the issue, the debate is bound to remain heated as it spills on to the public stage.

Following nearly nine hours of debate on Thursday, the House passed the Freedom to Breathe Act. After several unsuccessful attempts to implement wide spread smoking restrictions in past years, the proposal gained new momentum this year with Governor Pawlenty backing the proposal. Although differences remain between the Senate and House versions, restrictive wide spread smoking ban legislation is anticipated to be signed into law this year. For advocates the success of the Freedom to Breathe Act has been a long time coming and a victory for the health of all Minnesotans.

Friday marked the deadline for conference committee budget targets. However, long House floor sessions have hindered committees from meeting. With adjournment just over three weeks away and budget targets likely delayed until early next week, a special session is increasingly likely unless democratic leaders work with Governor Pawlenty to iron out a compromise on a number of finance bills.

Health Care Update
Week Ending April 20, 2007

House Health and Human Services Budget to be Debated on Floor Today:
Closing a week that included many hours of floor deliberations, the Minnesota House passed its version of the Health and Human Services Finance Division’s omnibus bill by a vote of 86-45. The House and Senate will now appoint conferees led by Sen. Linda Berglin (DFL-61) and Rep. Tom Huntley (DFL-7A) to iron out the differences between the two measures.

The $10 billion health budget, which spends about $300 million more than the Governor’s proposal, includes a 3 percent cost of living adjustment (COLA) increase for long term care facilities along with a provision authorizing a rate rebasing process which will be phased in over the course of five years.

Legislators offered close to 60 amendments to the bill including one that would have made the authorization of the language interpreter bill contingent upon the approval of the Commissioner of Commerce. Like the vast majority of amendments offered Friday evening, this proposal failed. Another amendment unsuccessfully attempted to delete the establishment of a committee to study the a policy implemented by two major health plans requiring physicians to gain authorization from a third party prior to recommending a number of imaging procedures generated significant controversy among health care providers.

The vast majority of amendments attempted to increase funding for long term care facilities and certain aspects of the Governor’s Healthy Connections proposal, using TANF monies or the Health Care Access Fund as revenue sources. Not surprisingly, the argument over defining the appropriate usages of the Health Care Access Fund drew heated debate on more than one occasion. Additionally, legislators offered a wide array of amendments dealing with abortion.

The health omnibus bill repeals cuts made to MinnesotaCare in 2003 and 2005, and expands eligibility for the program. It also includes a number of comprehensive mental health reform initiatives; a provision requiring health plans to cover the services of a language interpreter, and a provision that places caps on health insurance premiums from 2008 to 2013 at the Consumer Price Index (CPI) for urban consumers for the preceding calendar year plus two percent.

Opponents of the health omnibus spending bill have voiced concern about the dramatic increase in government spending on health care programs and the long term fiscal implications that could result from the expansions in public programs. Supporters have argued that the increased funds will aid in containing the rising costs of health care in future years by decreasing the amount of uncompensated care that health care providers currently perform across the state.

The full text of the House bill can be viewed at:
http://www.revisor.leg.state.mn.us/bin/getbill.php?session=ls85&number=HF297&version=list

General Update:

Although legislators have four and a half weeks remaining to complete their work, the bustle around the Capitol this week was reminiscent of the typical final days of session. Stretching floor debates past midnight and well into the early morning hours, the House was able to move the majority of their omnibus bills by the end of the week. With Senate omnibus bills already completed both bodies are anxious to move forward to conference committee. Although both House and Senate leadership are quick to point out the legislative session is on a fast track, by completing omnibus bill passage nearly two weeks earlier than in recent session, the reality is that a tremendous amount of work remains.

On Monday, the Senate passed sixty-two General Orders bills through the Committee of the Whole. Once resolved into the Committee of the Whole the Senate membership acts as one large committee to recommend passage of legislation. Known as preliminary passage, bills recommended by the Committee of the Whole are debated, amended and passed primarily on voice vote. The bills then lie over for one day before final roll call passage is taken. In past years, the process had been reserved for limited legislative action; however this year the Senate implemented the process for nearly all General Orders bills. Criticism was raised by some Republicans who see this procedure as an attempt to avoid recorded roll call votes on tough issues. The process proved successful though as the Senate cleared nearly half their bills off General Orders this week. Those provisions included: predatory lending legislation; emergency contraception for rape victims; colorectal screening insurance coverage; and, child welfare provisions.

On Tuesday, the House debated the Omnibus Environment and Natural Resources bill, Omnibus Agriculture and Veterans Affairs bill and the Omnibus Public Safety bill. Heated conversation on aquaculture, water quality and energy resources extended the debate on the Environment and Natural Resources through the evening hours with passage occurring at 1:30 am on Wednesday morning. Although the House had suspended the Rules to meet past midnight, it came as a surprise to many when the body took up the Public Safety Omnibus bill around 2:00 am. Many observers felt the extensive debate earlier in the evening was an attempt to stall the process. However, by 5:30 am on Wednesday morning the agenda was completed and the votes were tallied: Omnibus Agriculture and Veterans Affairs 131-2; Omnibus Environment and Natural Resources 95-38; and, Omnibus Public Safety 96-34.

On Wednesday, evening the House debated the K-12 Education Omnibus bill. Proponents of the bill claimed the provisions will reduce the property tax burden Minnesotans have experienced in recent years caused by the lack of and shift of state funding. Increasing the per pupil formula, the proposal also focuses on educational goals and providing special education and diversity services. Opponents state however that throwing additional money at a broken system only makes matters worse. They are also quick to refute claims by the majority that such per pupil increases will actually translate into direct property tax relief. Still the bill gained bipartisan support and passed on a vote of 119-13.

After several long evenings, the House floor debate took a different course on Thursday evening as Republican Minority Leader Marty Seifert pulled amendments to the State Government Finance bill, the last of the evening. The bill, which contains provisions for state employee domestic partner benefits coverage, has already received criticism from Governor Tim Pawlenty who has vowed to veto. Drawing sharp criticism from opponents who cornered Democrats on their promise to avoid wedge issues this year, the membership chose to avoid another late night session to focus their energy on the Omnibus Health and Human Services bill heard on Friday. The move by minority members was well received and highly regarded as a political touchdown. In the end the controversial issues contained with the bill lead to seventeen democrats rejecting the bill with a final vote of 68-64. The body also passed the Omnibus Higher Education bill on a vote of 95-37 after lengthy debate on the Dream Act, a provision allowing children of illegal immigrants to pay in-state tuition at state colleges and universities. The first bill of the day, the Omnibus Jobs and Economic Development bill, passed on a vote of 92-39.

The Health and Human Services bill hit the floor on Friday with many anticipating debate to last well into Saturday. With over one hundred drafted amendments by Republicans alone, the debate is likely to be contentious as members consider the expansion of state assistance programs, family planning provisions and potential domestic partnership language.

The lengthy floor sessions dominated the week forcing the House Tax Committee to postpone the release of their Omnibus Tax bill. On Monday, April 23rd, democratic leadership along with members of the tax committee will release their tax proposal. Committee debate will likely begin by mid week with floor passage completed by next Friday.

Health Care Update
Week Ending April 14, 2007

House Health and Human Services Budget Moves Through Committees:

The House Health and Human Services Finance Division’s omnibus bill gained approval of the House Finance and Tax Committees, and will receive further review in the House Committee on Ways and Means today. Introduced by Representative Tom Huntley (DFL-7A), the omnibus health bill includes a 3 percent cost of living adjustment (COLA) increase for long term care facilities. Additionally, an amendment which authorizes a rate rebasing process which will be phased in over the course of five years was successfully added to the bill in the Finance Committee.

The health omnibus bill repeals cuts made to MinnesotaCare in 2003 and 2005, and expands eligibility for the program. The bill also authorizes a 3 percent COLA increase for long term care facilities along with a number of comprehensive mental health reform initiatives. The bill also includes a provision requiring health plans to cover the services of a language interpreter.

The full House is expected to vote on HF 297 this week. Opponents of the health omnibus spending bill have voiced concern about the dramatic increase in government spending on health care programs, while supporters have argued that the increased funds will aid in containing the rising costs of health care in future years by decreasing the amount of uncompensated care that health care providers currently perform across the state.

The full text of the House bill can be viewed at:
http://www.revisor.leg.state.mn.us/bin/getbill.php?session=ls85&number=HF297&version=list

Language Interpreter Bill:

The Senate Commerce and Consumer Protection and State and Local Government Committees approved legislation requiring health plans to cover the services of a language interpreter, sending the measure to the Senate Finance Committee for further consideration. During committee deliberations, the Department of Employee Relations released a fiscal note indicating that passage of SF 827, introduced by Senator Linda Higgins (DFL-58), would cost the state in excess of $3 million. However, further analysis indicated that the cost would be significantly less.

The language interpreter bill, which comes in response to health care providers across the state urging their lawmakers to require health plans to assist in covering the cost of a language interpreter, is currently included in the House’s omnibus health bill. The Senate omnibus health bill does not currently include this language in its omnibus health bill.

General Update:

After a much needed break the legislature returned to work this week facing policy deadlines in the Senate and the daunting task of developing omnibus bills in the House. With a significantly greater number of committees in the House, the challenge of forming omnibus bills incorporating provisions from all divisions has proved challenging. The Senate also voiced frustration over their policy provisions seeing as the House policy deadlines have already passed. Combining the two factors, conference committees will have their work cut out. Many of the Senate policy provisions under consideration have already been incorporated into House omnibus bills and finance provisions in the House do not exist in the Senate, and vice versa. With House omnibus bills scheduled to hit the floor next week and passage anticipated by the following week, conference committee work can finally begin as the bodies attempt to locate middle ground.

The following omnibus bills are currently in the process of traveling through the House:

*Awaiting action by the Ways and Means Committee:
HF 2227: Omnibus Agricultural and Veterans Affairs
HF 0006: Omnibus Early Childhood, Family, Adult, and Pre-kindergarten through Grade 12 Education

*Awaiting action by the Tax Committee:
SF 2171: Omnibus Health and Human Services
SF 2089: Omnibus Jobs and Economic Development

*Referred to the General Register:
SF 2096: Omnibus Environment and Natural Resources
HF 1225: Omnibus Real Property
HF 0829: Omnibus Public Safety and Corrections

*Conference committee appointed:
HF 0946: Omnibus Transportation
HF 0886: Omnibus Bonding

Marking another transition point in session, the House will unveil their Omnibus Tax Bill early next week. Expected to contain multiple tax increase provisions to offset additional spending spread through the respective omnibus bills, the bill is likely to draw immediate criticism from Republicans and the Governor. Although the bill is likely to pass, the Governor intends to veto such provisions, meaning the legislature could be back at square one by early May. With a deadline to adjourn on May 22, serious discussion of a special session may not be far off.

Health Care Update
Week Ending April 6, 2007

Senate Approves Health and Human Services Budget:

The State Legislature went into recess, giving Representatives, Senators and their families a chance to recharge their batteries for the remainder of the session. Prior to leaving, the Senate approved its Health and Human Services Budget, and the House Health and Human Services Finance Division sent its version of the measure to the House Finance Committee for additional consideration.

Both bills reinstate a number of cuts made to the state’s health insurance programs in 2003 and 2005 to reduce the number of uninsured Minnesotans, address challenges relating to mental health and chemical dependency issues, and authorize some of the governor’s pay for performance initiatives. Below, we have provided a brief summary of several legislative issues affecting health care providers and their status in the bill.

Language Interpreter Bill:

The House health bill includes a provision requiring health plans to cover the services of a language interpreter. The provision also requires all entities providing interpreter services to disclose their methods for ensuring competency upon request of any health plan company, provider or consumer. This language comes in response to health care providers across the state urging their lawmakers to require health plans to assist in covering the cost of a language interpreter. The Senate bill does not include this language in its omnibus health bill. However, the language interpreter bill (S.F. 827) will be heard by the Senate Commerce and Consumer Protection Committee.

Prior Authorization:

In recent months, a policy implemented by two major health plans requiring physicians to gain authorization from a third party prior to recommending a number of imaging procedures generated significant controversy among health care providers. Prompted by accusations that physicians were ordering superfluous scans with ulterior financial motives, the new policy has resulted in delayed care for patients in some instances, and has angered health care providers who have found such negative characterizations inaccurate and offensive.

In response to those concerns, Rep. Tom Huntley (DFL-7A) and Sen. Sandra Pappas (DFL-65) introduced legislation (S.F. 1752 and H.F. 2003) establishing a Diagnostic Imaging Services Advisory Committee to further investigate the aforementioned accusations. In the interim, the legislation imposes a moratorium on preauthorization programs. Legislation authorizing the advisory committee has made it into the House version of the health budget; however the language authorizing a moratorium on preauthorization programs was not included. The Senate bill does not include any comparable legislation.

Caps on Health Premiums:

The Senate health omnibus bill places caps on health insurance premiums from 2008 to 2013 at the Consumer Price Index (CPI) for urban consumers for the preceding calendar year plus 2 percent. The legislation also allocates an additional one percentage point to aid providers in implementing an electronic medical record system. An earlier version of the Senate DFL’s health reform proposal gave health plans the authority to reduce health care providers’ reimbursement rates to adhere to the premium caps; however, that language was not in the final version of the legislation. It should also be noted that Sen. Linda Berglin (DFL-61) is an ardent supporter of utilizing premium caps as a means for containing health care costs.

COLA Increases for Long Term Care Facilities:

The House bill includes a 3 percent Cost of Living Increase for long-term care facilities. The Senate authorizes a 3.25 percent Cost of Living Allowance increase to long term care facilities in Minnesota and a 3.12 percent increase plus a 0.13 percent increase for facilities that receive certain high quality ratings. The Senate also authorizes a rate rebasing process which will be phased in over the course of five years.

Administrative Simplification:

Both chambers have included comprehensive legislation requiring the state to develop uniform billing forms and coding requirements to aid in simplifying the administrative aspect of delivering health care in Minnesota – a proposal that has also gained the support of the Governor. The House and Senate have each crafted policies for carrying out this project, and the differences between the two initiatives will likely be ironed out in conference. The Senate health omnibus bill requires all health care providers and health plans that contract with the state to use and accept the uniform billing forms and coding requirements established by the Administrative Uniformity Committee by January 1, 2009.

Its House companion permits the commissioner of commerce to consult with representatives of the health care industry to establish a uniform claim form, billing and claim codes by 2012. The commissioner is then required to rules to establish uniform claim forms, uniform billing and uniform claim codes, beginning January 15, 2012, and has been given the authority to issue rules requiring payers and providers to use uniform claim forms, uniform billing and uniform claim codes.

NASPER:

The House and Senate have each included legislation authorizing the establishment of a system requiring dispensers of controlled substances to electronically report specified information to the Board of Pharmacy. The NASPER bill, which includes an amendment prohibiting the Minnesota Board of Medical Practice from using information collected in the registry to prosecute anyone who prescribes the medication, was crafted in conjunction with the National All Schedules Prescription Electronic Reporting Act (NASPER). This amendment came in response to concerns that health care providers would feel pressure to under-prescribe medications to patients to avoid arrest, however, legislators have heavily emphasized that the intent of the bill is to go after people who are abusing or selling prescription drugs.

Clarification on Workers Compensation Bill:

In the March 30 Health Update, we reported that H.F. 2248, Introduced by Rep. Mike Nelson (DFL-46A) in the House and Sen. Thomas Bakk (DFL-6) in the Senate, authorizes the reduction of reimbursement and fee schedules for workers compensation for all hospitals within the 11 county metro region, and seeks to require physicians to use the fee schedules utilized by the Centers for Medicare and Medicaid Services for workers compensation. As a point of clarification, we want to emphasize that the reductions would apply exclusively to hospitals within the 11 county metro region, if this bill were to become law.

With that in mind, there is ample potential for this proposal, if passed, to affect all health providers in the metro area, particularly those clinics that work with hospitals to provide care to patients receiving treatment in conjunction with their workers compensation benefits.

This bill did not receive a hearing in the House before the policy deadline, and Lockridge Grindal Nauen’s government relations team is currently working to express health care providers’ concerns to Sen. Jim Metzen (DFL-39), who chairs the Business, Industry and Jobs Committee.

"Portions of the information contained in this update was provided by the Minnesota House of Representatives and Senate websites, found at http://www.house.leg.state.mn.us/ http://www.senate.leg.state.mn.us/, for additional materials on the topics discussed above please consult these sources."

Senate approves Statewide Ban; House Deliberates

By a convincing 41 to 24 vote, the Minnesota Senate approved the Freedom to Breathe Act. The measure authorizes a ban on smoking in most indoor workplaces, including bars and restaurants. According to the bill's author, Sen. Kathy Sheran (DFL-23), the state has a responsibility to protect citizens' individual liberties and to protect people from others who would do them harm. During her remarks on the Senate floor, Sheran stated that the bill seeks to protect both patrons and employees from the negative consequences of secondhand tobacco smoke.

The House version of the Freedom to Breathe Act, HF 0305, introduced by Representative Tom Huntley (DFL-7A), is moving through committees on its way to the House floor.

By approving a comprehensive smoking ban free of exemptions for private clubs and bars, the Senate has given supporters of the ban a significant advantage in conference committee negotiations. The House bill faces several possible hurdles before a floor vote. Governor Tim Pawlenty has indicated that he will sign the Freedom to Breathe Act into law if passed.

Minnesota has long led the nation in smoking regulation, implementing the Minnesota Clean Indoor Air Act in 1975. The act restricted smoking in most public places and places of employment giving Minnesota the distinction of being the first state in the nation to take a stance against second hand smoke. Minnesota was also the first state to settle with the tobacco industry in 1998, claiming $6.1 billion to recoup state costs for the treatment of smoking related illness, smoking treatment and prevention services. Minnesota's dedication to protecting the health of its citizens from second hand smoke is apparent; nevertheless, stakeholders have yet to persuade the full legislature to implement a statewide ban.

Faced by mounting pressures to further protect the health of citizens, local governments began implementing restrictive smoking bans at the county and city level. However, the inconsistencies that exist among local ordinances and the lack of a statewide regulation resulted in unintended consequences, hurting several consumer industries across the state. In recent years, the debate has been focused on whether or not the state should be responsible for implementing a wide spread ban or if local governments and individual entities should be allowed to decide what suits them.

The Freedom to Breathe Act has attracted enthusiastic support of numerous public health and public safety organizations along with stakeholders in the health care industry, including health care providers, health plans and safe workplace advocates.

Proponents of a statewide proposal argue the health benefits of such a ban. They claim it would make great strides in containing the cost of health care by reducing the number of smoking related illnesses resulting from exposure to second hand smoke. Opponents, however, have been successful at stalling past legislative efforts sighting personal rights and potential small business harm - an argument that is quickly losing steam as other states with statewide smoking bans in bars and restraints have not seen significant economic decline.

According to a report released by the Minnesota Institute of Public Health, smoke-free ordinances in Minnesota have caused no apparent economic harm to local communities that have passed laws protecting restaurant and bar workers from secondhand smoke. The study analyzed economic data from seven communities with smoke-free ordinances, and from the state as a whole, and found that the number of hospitality establishments in communities increased following implementation of smoke-free ordinances, suggesting a robust economic environment. It also found that hospitality industry sales remained consistent with established trends from the previous decade.

These findings reflect the results of a survey conducted by Clearway Minnesota in January which found that 86 percent of Minnesotans said they would go out to bars and restaurants as much or more frequently following the implementation of a statewide smoke-free law.

If the Freedom to Breathe Act is signed into law, Minnesota would join a dozen other states with similar laws.

www.locklaw.com

Disclaimer

2007 LEGISLATIVE SESSION UPDATES

LGN Hosts Health Care Policy Luncheon

Health Care Update

September 18, 2007

Health Care Update August 20, 2007

Health Care Update

August 2, 2007

Mark Your Calendar

Meeting Notice - Legislative Commission on Health Care Access

Commission Aims for October Deadlines

Health Care Access Commission Announces New Work Groups

Meeting of Note

Hearings of Note

Health Care Update

June 15, 2007

Health Care Update May 15, 2007

Health Care Update Week Ending May 11, 2007

Health Care Update Week Ending May 4, 2007

Health Care Update

Week Ending April 27, 2007

Health Care Update Week Ending April 20, 2007

Health Care Update Week Ending April 14, 2007

Health Care Update Week Ending April 6, 2007

Senate approves Statewide Ban; House Deliberates

Health Care Update
August 20, 2007

Health Care Update
May 15, 2007

Health Care Update
Week Ending May 11, 2007

Health Care Update
Week Ending May 4, 2007

Health Care Update
Week Ending April 20, 2007

Health Care Update
Week Ending April 14, 2007

Health Care Update
Week Ending April 6, 2007