Gov. Mark Dayton Thursday signed Senate File 1, a compromise health reform bill that will bring more than $325 million of relief to the estimated 125,000 Minnesotans who have borne the brunt of the ongoing insurance crisis.
The House overwhelmingly passed the bill Thursday afternoon by a 108-19 vote. Earlier in the day the Senate passed its bill by a comfortable 47-19 margin.
Dayton, who fainted during his Monday State of the State address and revealed Tuesday that he has prostate cancer, signed the bill privately on Thursday night, according to an administration spokesman.
“I do not agree with everything included in it,” Dayton said in a written statement. “I have said repeatedly that I think it is unnecessary and unwise to rush the ‘reforms’ added to this bill without proper public review or full consideration of their consequences.”
However, the governor said he appreciates that the joint House-Senate conference committee on Wednesday approved his version of a premium rebate, which will send 25 percent premium refunds directly to insurers through their invoices.
He also commended House leadership for championing a continuity of care addition aimed at allowing Minnesotans dealing with illness to keep their own doctors.
“The Legislature and I must now turn our attention to making good health care coverage available and affordable for all Minnesotans,” the governor said.
House debate Thursday afternoon was a near mirror image of earlier Senate discussions. Debate in the lower chamber opened with a motion by Rep. Jennifer Schultz, DFL-Duluth, to send back to conference committee provisions allowing for-profit insurers to do business in Minnesota.
Much of Thursday’s earlier Senate debate focused on the same issue. In that case, Sen. John Marty, DFL-Roseville, carried the motion to send the measure back to conference committee.
“Premiums would likely increase with for-profits because they are profit-seekers,” Schultz said in introducing her motion.
Harking back to the failed special session talks that dominated post-election political chatter at the Capitol, she accused Republicans of dragging their feet on insurance relief and putting Minnesotans lives and finances at risk.
She said there is no evidence that welcoming for-profit carriers into the state will stabilize the market, and could have the opposite effect.
“This is not making their lives better,” she said. “This is giving HMOs an opportunity to make profits.”
Rep. Erin Murphy, DFL-St. Paul, spoke in favor of sending the bill back to conference committee to strip out the for-profit provisions.
She said legislators were unprepared Thursday to vote on changing the state’s 40-year policy of allowing only non-profit insurers to do business in the state. No health plans or academic health experts testified in either the regular or conference committee to explain the changes to lawmakers, she said. “We really don’t really know what this means,” she said.
Dayton echoed that point in his written statement Thursday. “I ask the Legislature to seriously re-evaluate this provision when future health care legislation is considered,” the governor said.
Rep. Joe Hoppe, R-Chaska, the bill’s chief House author, acknowledged that the bill is not perfect. “We all would have liked to get it done during a special session and get premium relief out there, but we didn’t.”
Despite DFL House members’ efforts, the Schultz amendment failed in a 44-83 vote.
As debate on the main bill commenced, DFLers repeated a refrain heard often on Thursday, that Republicans had held premium relief “hostage” only to arrive at a compromise solution essentially identical to the one that Gov. Mark Dayton proposed last fall—albeit with several market reforms attached.
That was a bit much for Rep. Dan Fabian, R-Roseau. He denied that the governor’s plan was held back to secure market reforms. Instead, he suggested, it was the Dayton administration’s decision to pursue reforms under the federal Affordable Care Act that put the state in its current untenable position.
“Members, the people in my district are the ones who have been held hostage by the decisions that were made in the past,” he said.
Majority Leader Joyce Peppin, R-Rogers, agreed. She said it was the DFL that did the foot-dragging by denying a Republican request on the first day of session to put premium relief on an emergency fast track. That would have required a supermajority vote.
“You said no,” Peppin said. “So we have been trying very, very hard to do this.”
Eventually, the question was called and the vote taken. The bill won overwhelmingly.
Speaking shortly after the vote, Hoppe said DFLers’ fears may be ungrounded. It is unclear what effect the introduction of for-profit insurers will have on the state, he said, or even whether any will attempt to enter the Minnesota marketplace.
However, he said, offering them a chance to compete here provides a potential new option for consumers and could serve to expand care access and push down costs.
Earlier Senate action
During floor debate in the Senate Thursday, Sen. Melisa Franzen, DFL-Edina, the only Democrat to vote for the original Senate insurance relief bill and a member of the conference committee, opposed Marty’s motion to push the for-profit part of the bill back to committee.
By doing so, she essentially doomed the measure. The Senate went into session with one GOP member, Sen. Julie Rosen, R-Vernon Center, absent. That meant the chamber was split evenly on Thursday, 33-33. Without Franzen’s support and at least one GOP defector, the motion had no chance—a tie vote in the Senate is the same as a no vote.
Ultimately, Marty’s senate motion failed, 30-36.
When Senate debate turned to the full bill, for a brief period it was dominated by squabbling attorneys.
Sen. Scott Newman, R-Hutchinson, a former public defender and administrative law judge, took issue with a statement from Sen. Tony Lourey, DFL-Kerrick, criticizing part of the bill that allows contested case hearings to be brought to an administrative law judge if a hospital is excluded from a provider network in its area.
Newman said that, far from being cumbersome, the rules of evidence and discovery are much more relaxed and the process more efficient under an administrative law judge than in a full trial.
“An administrative law judge makes decisions quickly,” Newman said. “Most of the time people appear without an attorney and the administrative law judge is then required to at least give them some assistance.”
Another attorney, Sen. Bobby Joe Champion, DFL-Minneapolis, disagreed. He said that contested hearings require participants to understand the legal process and file necessary documentation.
He said that Newman is wrong to describe the process as “relaxed.” “It is not the People’s Court,” he said. “In fact, it is far from the People’s Court.”
The Senate debate went on for well over an hour. Just as happened in the House later in the day, Senators who supported the bill praised it as a hard-won compromise that brings much needed help to cash-strapped Minnesotans on the individual insurance market.
Those who opposed it decried it as sloppy legislation that threatens to shoe-horn dangerously untested reforms into the Minnesota marketplace, likely with unintended consequences.
Eventually a roll call was requested on the conference committee report. That passed by 46-20 vote in the Senate, which effectively meant the bill was approved. A technical final vote on the bill itself passed by a slightly wider margin, 47-19.
The bill’s primary Senate author, Deputy Majority Leader Michelle Benson, R-Ham Lake, wept briefly just before the final vote.
“We are listening,” she said, speaking to Minnesota citizens. “We are doing our very best to get you help today. This is the beginning of many discussions on health reform.”
The compromise bill eliminated several key Republican proposals, including income verification for anyone applying for premium relief and a provision that would have allowed insurers to omit more than 60 types of federally mandated coverage.
It retains Dayton’s preferred form of insurance relief, under which the state will pay down premiums on about 125,000 Minnesotans who make too much money to qualify for federal tax credits but not enough to cover exploding insurance premiums. Those refunds will be paid by the state directly to insurers through their invoicing system.
Democrats had to swallow a few bitter pills, as well, none so grimace-making as for-profit provision. Yet both sides were happy with some reforms, including the “continuity of care” component.
Among its numerous changes, the bill:
- Modifies stop-loss coverage to make it easier for more small businesses to offer affordable insurance to employees.
- Alerts the public to insurance premium changes faster by requiring earlier rate-change disclosures from insurers.
- Allows agricultural cooperatives to offer group health insurance to their members.
- Prohibits “surprise billing” to protect consumers from costs that were previously undisclosed.
All in all, Minnesota Management and Budget Commissioner Myron Frans said Wednesday, the compromise bill was probably the best one available. “It’s a good bill,” he said.
On a lighter note
Shortly after the Senate voted to approve the bill Thursday, Majority Leader Paul Gazleka, R-Nisswa, asked for special dispensation from Senate President Michelle Fischbach, R-Paynesville, to put the body temporarily in recess.
He said he wanted to offer a tribute to Gov. Dayton on his 70th birthday without breaking the Senate’s rigid rules of conduct.
Fischbach allowed it and Gazelka led the Senate in an impromptu rendition of “Happy Birthday,” after which the entire Senate stood in unison, giving the cancer-stricken governor a standing ovation to thunderous applause.