MMA News
Legislative Update
Several health care policy bills on the MMA’s watch list were still viable in mid-March.
Dental Exam Mandate
A House committee voted in March to amend a bill so that it encourages rather than mandates dental exams for children on public health insurance programs.
Before being amended, the bill, S.F. 633, would have required primary care physicians to provide the following as part of a general well-child or teen checkup for enrollees in Medical Assistance and MinnesotaCare:
- An oral examination,
- A risk assessment for dental caries,
- A fluoride application for 1-year-olds at high risk for caries, and
- Educational materials about caries prevention and dental providers in the community.
The bill was introduced because of the shortage of dentists who treat children enrolled in public programs.
The MMA Board of Trustees voted in March to oppose the bill because it mandated that physicians provide the services.
The MMA supports improving dental health but opposes the mandate on the grounds that physicians may not be adequately trained to do the exams and that dentists are the most appropriate providers of oral health care.
“We have no problem if physicians are comfortable providing this care. What we objected to was the mandate that you have to do this. If people aren’t comfortable doing this, they shouldn’t be forced to do it,” says Michael Ainslie, M.D., MMA board chair and a pediatrician.
As of mid-March, the Senate version of the bill still included the mandate.
Medicare Balance Billing
H.F. 1027 would allow physicians in Minnesota who don’t accept Medicare assignment to balance bill Medicare patients up to the current 15 percent federal limit for services. The MMA supports the legislation, and Benjamin Whitten, M.D., testified in favor of it before the Health Care and Human Services Policy and Oversight Committee in March.
In most states, physicians have the option of billing patients up to 15 percent more than the amount Medicare will reimburse for services in exchange for taking a 5 percent reduction in Medicare reimbursement. Minnesota law currently prohibits physicians from balance billing Medicare patients.
Cutting Red Tape
The MMA has been supporting two bills designed to simplify health insurance and formulary requirements.
S.F. 1099, seeks to reduce the burden on physician practices associated with filing formulary exception requests. Initiated by SMDC Health System, the bill would require the development of a uniform, electronic formulary exception form that could be used by both providers and payers.
H.F. 384, calls for the state to form a commission that would study and make recommendations about simplifying health care administrative transactions through the use of swipe-card and other technologies. It was initiated by the Minnesota Medical Group Management Association.
Shared Decision-Making
The MMA raised concerns in March about a bill that would require patients to engage in a shared decision-making process before undergoing certain surgeries and treatments.
The bill, S.F. 696, would require patients to participate in a patient-centered decision-making process before providers would be reimbursed for surgeries for abnormal uterine bleeding, benign prostate enlargement, chronic back pain, early stage breast and prostate cancers, gastroesophageal reflux disease, hemorrhoids, spinal stenosis, temporomandibular joint dysfunction, ulcerative colitis, urinary incontinence, uterine fibroids, or varicose veins.
Sara Noznesky, the MMA’s manager of legislative affairs, told the Senate Housing and Family Security Committee in March that the MMA is very supportive of patient-centered decision-making but questions the value of mandating it.
“We agree that shared decision-making is a valuable tool that benefits patients,” she says. “But we have serious questions about whether a government mandate is the way to go.”
Budget Battle Lines Are Drawn
In March, budget battle lines formed as the state’s final economic forecast was released and DFL lawmakers in the House and Senate announced their budget targets.
The March economic forecast predicted the state would face a $4.57 billion deficit for the 2010-11 biennium. That number would have been much higher—$6.4 billion—had the state not been eligible for a large infusion of federal stimulus dollars.
The MMA's Budget Stance
In January, the MMA asked members how they would fix the state’s budget shortfall and found they support a combination of spending cuts and revenue increases.
The survey of 376 MMA members showed support for cutting benefits in safety-net programs rather than reducing the number of people enrolled in those programs.
Based on that finding, MMA leaders are calling for lawmakers to resolve the budget deficit in a way that would balance spending cuts and revenue
increases.
The MMA supports increasing the state’s tobacco and alcohol taxes and might support an increase in the income tax, if it meant elimination of the provider tax. Also, the association may support a tax on all services including legal services as a matter of fairness, if lawmakers insist on keeping the provider tax. MMA leaders say they will oppose any effort to raise the provider tax.
In terms of health care cuts, MMA leaders say lawmakers should make keeping patients enrolled in state health insurance programs their first priority, followed by maintaining payment rates and preserving benefits. “Eligibility is the important thing,” says MMA President Noel Peterson, M.D., “because people won’t stop getting sick. The best way to manage their illnesses is for them to have insurance coverage, so they can receive treatment at the appropriate time.”
|
Given that forecast, Senate Democrats called for a $2 billion tax increase and an across-the-board 7 percent spending cut that would save $2.4 billion.
The DFL budget would cut $719 million from health and human services programs, a smaller reduction than proposed by Gov. Tim Pawlenty.
“There are a lot of things we like in the sense that they protect the Health Care Access Fund and don’t focus the cuts on health care, but there are so few details it’s hard to know what might be in it that we wouldn’t like,” says Dave Renner, MMA director of state and federal legislation.
The Senate Democrats indicated they would raise revenues in part by taxing Minnesota’s wealthiest residents but did not provide details.
Democrats in the House put forward their proposal days after the Senate plan was outlined. The House plan would balance the budget for the two-year budget cycle with $843 million in spending cuts, a $1.8 billion payment delay to school districts into the following biennium, and $1.5 billion in increased revenues. The DFL House budget targets included a 5 percent or $400 million cut in health and human services spending for 2010-11.
Funding for public schools, early childhood education programs, and colleges and universities would stay flat under the House DFL plan. Health and welfare programs and local governments would lose the most.
House Speaker Margaret Anderson Kelliher, DFL-Minneapolis, said in March that it was the role of the legislative health care committees to outline the specific cuts needed to reach the budget targets.
Governor Delays Cuts
As Democrats in the House and Senate were outlining their budget proposals, the governor revised his plan in light of the revised forecast and the passage of the federal economic stimulus bill.
Pawlenty’s new budget uses $2.6 billion in federal stimulus funds to increase K-12 spending, restore higher education cuts, roll back cuts to the courts, and temporarily preserve eligibility levels for Medical Assistance, MinnesotaCare, and General Assistance Medical Care (GAMC).
However, the governor’s revised budget proposal eliminates paying for hospital care for GAMC enrollees, which would result in a $210 million savings. It also includes his previous proposals to eliminate the Health Care Access Fund and roll provider tax revenues into the general fund, cut physician payments by 3 percent, and eliminate coverage of services such as physical therapy and dental care in public programs.
He also indicated that he will carry through with his plan to drop about 110,000 Minnesotans from state health insurance programs after the federal stimulus funds run out in 2011.
The constitutional deadline for the Legislature to adjourn is May 18.