What s in Store for the 2018 Legislative Session

Transcription

1 What s in Store for the 2018 Legislative Session Sponsored by: Eide Bailly LLP Speaker: Mary Krinkie Friday, Jan. 12, :30-3:20 p.m. Northland Ballroom

2 Mary Krinkie Mary Krinkie makes politics and the formation of public policy her vocation and her avocation. For more than a decade, she has been the vice president of government relations at the Minnesota Hospital Association, directing MHA s policy and advocacy efforts. Mary is the MHA staff person our government officials see at the capitol and the one who provides us with the most up-to-date information during the session and then helps us make sense of what happened after the session is over.

3 2018 Legislative Session Preview and MHA Priorities Mary Krinkie Vice President of Government Relations Minnesota Hospital Association Connecting Care & Communities Winter Trustee Conference, January 12, 2018 The Pace of Health Care Change Anthem buys HealthSun, a Florida network of primary care practices. UnitedHealth Group paid $4.9 billion for DaVita Medical Group. CVS Health made a $69 billion bid to buy Aetna. The data and analytics of a combined CVS\Aetna redefines the retail health care business. CVS has 9,700 locations. Could affect employee health benefits for a majority of U.S. corporations. Will Amazon potentially get into the pharmacy business? Cleveland Clinic CEO Toby Cosgrove said at a recent Medical Innovation Summit, "We are concerned about the major forces, Amazon... coming at us in purchasing. Cosgrove also said, "Without significant consolidation on the part of providers, it's going to put us at a disadvantage." Walgreens partnering with New York Presbyterian to offer in-store telemedicine. FDA approves Luxturna, a gene therapy drug treating an inherited form of blindness the first $1 million drug. A proposed merger between Providence St. Joseph Health System and Ascension Health would create the largest hospital system in the nation with 191 hospitals in 27 states. Without the individual mandate, will only those needing healthcare buy coverage? Will this bring premium increases and put the ACA in a partial death spiral, without an ACA repeal? 1

4 The Pace of Political Change In 2016, the Presidency and the U.S. Senate flip to Republican control. In 2016, Minnesota s State Senate flips to Republican control. Minnesota U.S. Senator Al Franken resigns. Lt. Governor Tina Smith appointed by Governor Dayton to the U.S. Senate. Who will serve as Lt. Governor? President of the MN Senate is Michelle Fischbach (R-Paynesville) One DFL State Senator and one Republican House member resign. Special elections set for February 12, MDH commissioner Ed Ehlinger resigns. DHS commissioner Emily Johnson Piper will miss the 2018 Session on maternity leave. MN will elect a new governor in Will 2018 be a wave election for the Democrats? Could the U.S. Senate, the U.S. Congress, and/or the Minnesota House of Representatives flip political party control to the Democrats? Federal Election Preview 2018 is a non-presidential election year. U.S. Senate has 51 Republicans, 47 Democrats and 2 Independents. In 2018, Republicans have to defend 8 seats. Democrats have to defend 23 seats, plus 2 Independents who caucus with the Democrats. Senator Amy Klobuchar is up for re-election. To date, three-term State Representative Jim Newberger (R-Becker) is the only announced Republican candidate. Newly appointed U.S. Senator Tina Smith will be up for re-election, running to complete the remaining two years of the Franken term. To date, State Senator Karin Housley (R-Stillwater) is the only announced Republican candidate. All 435 Congressional races are on the ballot. U.S. House has 241 Republicans and 194 Democrats. 24 seats needed to flip control. Minnesota likely to have several of the most competitive races in the country. Likely competitive races: First Congressional district (open seat) Second District Congressman Jason Lewis Third District Congressman Erik Paulsen Eighth District Congressman Rick Nolan 2

5 MN s 2018 Gubernatorial Race DFL Candidates: Chris Coleman, Mayor of St. Paul, Tina Liebling, Rochester, State Representative, 7 th term. Erin Murphy, St. Paul, State Representative, 6 th term. Rebecca Otto, State Auditor, former state representative. Paul Thissen, Minneapolis, State Representative, 8 th term, former Speaker of the House, candidate for Governor in Tim Walz, U.S. Congressman, CD1, 6 th term. Republican Candidates: Matt Dean, Dellwood, State Representative, 7 th term. Keith Downey, Edina, former Chair of the Republican Party and former state representative. Jeff Johnson, Plymouth, Hennepin County Commissioner, former state representative, Republican candidate for governor in David Osmek, Mound, State Senator, 2 nd term. The field may not be entirely set! Legislative Election Preview The Minnesota Senate will be at the mid-point of a 4 year term and will not be on the ballot until Republicans hold 34 seats compared to the DFL s 33 seats. Razor thin majority. State Senator Carla Nelson (R-Rochester) is running for Congress in the 1 st District. Could potentially leave vacant state senate seat in a competitive district. All 134 Minnesota House seats will be on the ballot. The Republicans hold 77 seats, compared to the DFLs 57 seats. If 11 seats flip to the DFL they would gain the majority. There will be an enormous demand for political contributions. Please give generously to the Minnesota Hospital PAC! 3

6 2017 Legislative Session Review Health & Human Services Issues ACA repeal & replace efforts create coverage and budget uncertainty Overview of health care policy in the 2017 Session: Relied on federal dollars. (Medicaid & BHP monies for the MinnesotaCare program.) Used the surplus in the HCAF (created in part because of BHP monies.) o For the biennium, an additional $ million will be spent from the HCAF for expenditures other than for the MinnesotaCare program. (Mostly for a $400 million reinsurance program and to defray costs in the Medical Assistance program.) Impact to MN IF Repeal of the ACA Simplistically, if the ACA had been repealed without a replacement, it would have impacted: About 300,000 low income Minnesotans whose health care coverage would have been at jeopardy; About 91,900 Minnesotans (or about 73% of people who bought individual market insurance through MNsure, 200% --400% of the FPG) would have potentially lost their federal premium tax credits; A potential loss to the state budget of about $2 billion a year in federal money supporting both Medical Assistance and MinnesotaCare. 4

7 State Budget Forecast The November forecast was released Dec. 5, Legislature will use the February 2018 state budget forecast to base financing decisions. The FY projected budget deficit is $188 million. Another $114 million for legislative funding is necessary. This increases the deficit to $302 million. The FY projected budget deficit is $586 million. Creates risk for provider payments & coverage in public health care programs. MMB characterization of this forecast: The outlook has weakened since the February forecast. 20 months until the end of biennium. No assumptions regarding the just passed federal tax bill were included. The projected shortfall is relatively small considering that state has a $46 billion two-year state budget and a healthy budget reserve of $1.6 billion. Health & Human Services Expenditures Changes from End-of-Session Estimates 5

8 Emergency Rooms Mental Health & Substance Abuse From 2010 to 2016 hospital claims data: Outpatient ER is up 15.5%. (Patient is cared for in the ER and NOT admitted.) Inpatient ER is down 4.8%. (Patient is cared for in the ER and admitted into the hospital.) Mental health and substance abuse outpatient ER visits --increased 68.5%. (Patient is cared for in the ER and NOT admitted.) Mental health and substance abuse inpatient ER visits --increased by 7%. (Patient is cared for in the ER and admitted into the hospital.) Substance abuse outpatient ER visits (this is a subset of the above data) increased 145.9%. (Patient is cared for in the ER and NOT admitted.) Substance abuse inpatient ER visits (this is a subset of the above mental health data) increased 35.5%. (Patient is cared for in the ER and admitted into the hospital.) MHA s 2018 advocacy agenda Encourage MHA members to participate in the state s Integrated Health Partnerships (IHP) program. Potential for 2019 DHS s PMAP procurement process to include proposals from a provider network rather than exclusively by Managed Care Organizations. Oppose provider payment cuts and eligibility/benefit restrictions as a response to a state budget shortfall. Support state funding for mental health initiatives, potential projects in the state s capital investment bonding bill. Support an opioid legislative package. Support workforce initiatives: Professional loan forgiveness, MERC, others (supplemental budget?) Work to build support for SF 2406/HF 2703, updating Minnesota s Health Records Act to align with the HIPPA standard. Strongly oppose the MNA s nurse staffing ratio bill. 6

9 On-going Mental Health Agenda Protect mental health benefit coverage in MA and MinnesotaCare. Invest in community-based services. Mental health needs can often be met in community settings, including via telemedicine. Community-based services, such as mobile crisis teams, can rapidly respond to individuals homes to resolve crisis situations and link people to needed services. Provide competency restoration in the community. Restoration services for people who have been found incompetent to stand trial don t have to take place in the same location as mental health treatment. Support transition programs to move people out of in-patient settings when they are ready for discharge. Grow our mental health workforce. Increase rates paid to mental health practitioners. Nine of 11 of Minnesota s geographic regions are designated a mental health professional shortage area. Streamline regulatory and approval processes to create additional intensive residential treatment facilities. The approval process to create intensive residential treatment facilities can take years even for health systems willing to fund these programs without state money Mental Health Priorities Partial Solutions: Streamline IRTS siting process Competency restoration funding Mental health structural/facility investments in a bonding bill Need to re-purpose the county share money for stays at Anoka (RTC) or the CBHHs that do not meet the hospital level of care criteria. Move from GF into mental health services. ($20 million a year) o 2017 Mental Health Innovation Grant program. $2.1 million for grants. 7

10 Bonding efforts (2018 or 2019) Personal commitment by Senator David Senjem (R-Rochester), Chair of the Capital Investment Committee. Working on two initiatives: Housing: Authorizes housing infrastructure bonds. Implemented by Housing Agency authority. Bonds to be used for permanent supportive housing for people with mental health needs. Up to $50 million in the original proposal. (Scalable) Regional Behavioral Health Crisis program facilities: Bond applicant to be the local mental health authority (Counties) Screen and assess patients at these locations. Up to $30 million in the original proposal. (Scalable) Substance Abuse MHA has produced two videos: CHI St. Gabriel s Health & Morrison County Drug Task Force work o Sanford Bemidji Medical Center s Neonatal Abstinence Syndrome (NAS) program o Opioid Legislative Agenda - Recently endorsed by MHA Board Support an Opioid Stewardship Program: o Willing to support various options; penny a pill, $5.00 a bottle, or $10.00 for larger supply require manufacturers to pay. Goal of generating about $20 million a year. Encourage (rather than mandating) participation in the state s voluntary prescription monitoring program. o State money to better align the Prescription Monitoring Program into EHRs. 8

11 MNA s nurse staffing ratio bill (not heard in 2017) SF 2382/HF 2650 includes several elements of bills previously introduced by MNA: Requires hospitals to provide direct-care registered nurse staffing at a ratio level based on the number of patients, specified for each hospital unit; Requires reporting of staffing levels for each shift on the MHA website and to the Commissioner of Health; Requires the staffing plan to have consent of union representatives; Requires new patient safety committees in hospitals; Gives direct care RNs the authority to close units and close the hospital to new admissions; and Prohibits hospitals from laying-off other positions to meet the RN staffing ratio. MHA continues to have strong opposition to this bill. Now the rest of the story 9

12 Public program coverage & the ACA Forecasts are based on current law. 200,000 low income (no minor children) adults (less than 138% of the FPG) are on Medical Assistance because of the ACA. MN gets about $1.6 billion a year for their coverage. (90% federal match) If ACA repealed, under current state law, those individuals would be eligible for MinnesotaCare. BHP revenues under current law: $877 million (FYs 2018 & 2019) BHP revenues under current law: $1,087 million (FYs 2020 & 2021) Health Care Financing Challenges The provider tax is still in place for 6 months of FY 2020, (current sunset of December 31, 2019). IF the federal BHP money goes away and depending on when that would happen, how long can the MinnesotaCare program stay operational? Something s Gotta Give BHP federal money stays in place Provider tax sunset goes away A new funding source is identified for a reinsurance program All of the above Or does Minnesota return to the days of 9+% uninsured? 10

13 Considerations Hospital margins are declining. Growing expenses, flat Medicare rates and reduced commercial payments. New MHA report: MN s median hospital operating margin went from 2.4% in 2015 to 1.7% in hospitals (39%) had negative operating margins. The ACA could still be repealed or scaled back in Coverage and budget implications for Minnesota. DFL wants Public Option MinnesotaCare and Republicans likely want to scrap/scale back MinnesotaCare. Legislature profile: Many new legislators Not an enormous amount of health care background Knowledge of MnCare program and its importance is missing What can Trustees do? The best lack all conviction, while the worst are full of passionate intensity. William Butler Yeats The Second Coming written in 1919 Develop more political friends in a purple world --who support health care coverage and health care providers. 11