One vote short: But for the absence of one DFLer, Gov. Mark Dayton’s MinnesotaCare buy-in program would have made the cut when a $600 million health care reinsurance bill cleared the Senate late Wednesday.
Reinsurance passed by a 37-29 vote Wednesday night after nearly three hours of debate. It now heads to a joint House-Senate conference committee to work out differences between the two companion bills.
The Senate bill differs modestly from the House version passed earlier in the week. It would have differed radically, however, had Sen. Ann Rest, DFL-New Hope, been present to cast her vote.
That’s because a MinnesotaCare buy-in amendment offered by Sen. Tony Lourey, DFL-Kerrick, succeeded in swinging over a GOP member, Sen. Scott Jensen, R-Chaska, a physician. Had Rest been present to vote with the Democrats, the amendment would have passed 34-33. Instead, it failed 33-33.
Rest was out of town attending a Great Lakes Commission conference in Washington, D.C. A Twitter post Wednesday by U.S. Sen. Al Franken, pictures Rest at the conference posing with the senator.
Both the bills create a state-funded insurance policy for health insurers. If passed, state money—and some federal block-grant money, should that come through—would be spent protecting insurers against runaway losses in the individually purchased health insurance market.
The Senate bill would begin helping an insurer when an individual’s medical costs reach $45,000; the House version kicks in at $50,000. Both max out at $250,000.
Within those ranges the state would pay a coinsurance rate of either 80 percent (the Senate bill) or 50 to 70 percent (the House version) of an individual’s medical costs.
The funding mechanisms also differ.
The House bill, authored by Rep. Greg Davids, R-Preston, would cost about $384 million over the next two years. The money comes from a variety of sources, including a one-time $80 million transfer from the Health Care Access Fund. Another $70 million per year over two years, derived from taxes on insurers, would come from the state’s general fund.
The Senate bill, authored by Sen. Gary Dahms, R-Redwood Falls, would transfer $360 million over two years from the Health Care Access Fund. Another $240 million in 2018 and 2019 would come out of the state’s budget reserves.
Both authors predicted that their bills would lead to lower premiums. Davids said during the March 13 House floor debate that his bill would reduce premiums by 17 to 18 percent. Dahms predicted 18 to 23 percent in premium reductions, but also acknowledged that rates could rise.
Much of the debate Wednesday focused on the MinnesotaCare buy-in plan, which the governor has dubbed a “public option.”
Lourey’s amendment altered Dayton’s concept by disqualifying the seven-county Twin Cities metropolitan area from the MinnesotaCare buy-in. Only residents of Greater Minnesota counties would have qualified to purchase a commercialized version of MinnesotaCare through the MNsure exchange.
That was a concession, he said, to Republicans worried about health care access in outstate counties with few or no insurance options on the individual market. It succeeded in drawing Jensen’s vote.
“This is one way we can make sure that every county has at least one option for every patient,” Jensen said, before pledging to support the amendment.
However, with Rest unavailable, the point was moot. The Lourey amendment was defeated and the full bill was approved.
Alyssa Siems Roberson, Senate DFL communications director, said DFLers could try to resurrect the public option during conference committee deliberations, not yet scheduled at the time of this writing. But it is unlikely, she said, that majority Republicans would accept it.
Prison health-cost spike: Lawmakers are nearing agreement on $9.2 million in emergency funding to make up for an unexpected spike in Corrections Department medical costs.
Senate File 809, authored by Sen. Warren Limmer, R-Maple Grove, was passed unanimously by the Senate Judiciary and Public Safety Finance and Policy Committee on March 10 and re-referred to Finance.
Its identical companion, House File 915, was authored by Rep. Tony Cornish, R-Vernon Center. It passed from House Ways and Means to the General Register on March 13 and awaits a floor vote.
Limmer told Judiciary committee members the 2017 medical budget shortfall resulted from a 33 percent spike in inmate health care costs since the state’s contract with managed care provider was signed in 2016.
Nan Larsen, the Corrections Department’s medical director, said that the increase results partly from a new Hepatitis C drug that cost $80,000 per treatment course when first introduced. That price since has fallen to $40,000 because of competition, she said.
But part of it, she suggested, is because prisoners tend to be sicker than the general populace. About 17 percent of prisoners have diabetes and between 10 and 12 percent have Hepatitis C. Both rates are far greater in the general population, she said.
“We have costs that you’re not going to see in the regular community,” Larsen told Ways and Means Committee members. “We have lots of high-risk behaviors.”
Another cost driver, Larsen said, is simple spite. Some inmates refuse to sign Medical Assistance applications that would cover half of prisoners’ inpatient hospital treatment claims with federal money. If they refuse to sign, she said, the state pays.
“Most often, they think that they are getting back at us by not signing their applications,” Larsen said. “So they’re kind of sticking it to us.”
The Senate Finance Committee has not yet scheduled its version for a hearing.
Strangulation bill: Past felony-level domestic assault convictions involving strangulation would have to be considered in family court custody hearings if legislators got their way.
Two identical bills, Senate File 1598 and House File 1654, have made headway in their respective chambers. The Senate bill, authored by Sen. Dan Hall, R-Burnsville, has moved farthest. It was passed by the Senate Judiciary and Public Safety Finance and Policy Committee on March 13 and was sent off to await a floor vote.
The House version by Rep. Marion O’Neill, R-Maple Lake, did not receive a vote when heard on March 9. However, it was laid over for possible inclusion in the House public safety omnibus bill.
The bills would add felony strangulation domestic-assault convictions to the list of crimes that judges must weigh when hearing child custody or visitation cases. Other such crimes include murder, kidnapping and felony stalking, among many others.
Melinda Hugdahl, a staff for Mid-Minnesota Legal Aid, testified at both hearings. She said that when the Legislature added a felony-level strangulation crime to statute in 2005, it neglected to add it to the list of crimes that judges must consider in custody cases.
Passing the bills would close an important gap, she said. Strangulation incidents are a significant factor in lethal domestic abuse cases, and convictions are a strong predictor of both future attacks and future homicides, Hugdahl said.
“These are incredibly dangerous cases and we think that the family courts should be looking at this,” she said.