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Aiming for reform

Published (4/8/2011)
By Hank Long
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Rep. Jim Abeler presents the omnibus health and human services finance bill on the House floor April 6. (Photo by Andrew VonBank)House Republicans fit the final piece of legislation into their omnibus budget puzzle early Thursday. But DFL members didn’t like the picture that was coming into view.

After seven hours of discussion on the omnibus health and human services finance bill, the House approved HF927/ SF760* 70-62. Sponsored by Rep. Jim Abeler (R-Anoka) and Sen. David Hann (R-Eden Prairie), the bill now returns to the Senate. A conference committee is expected to be called to work out the differences.

The $10.65 billion budget for health and human services represents the second largest area of state spending, trailing only K-12 education.

The bill would cut $1.7 billion in projected General Fund health and human services spending over the next two fiscal years. Republicans pointed out that the bill would still spend $500 million more on health and human services than the current biennium, but DFL members called the methods outlined in the bill used to make the cuts nothing more than shifts, tricks and gimmicks.

As the bill received its third reading shortly after 1:30 a.m., Rep. Tina Liebling (DFL-Rochester) said much is still unknown about the bill’s impact on spending and services for the most vulnerable Minnesotans, an approach to budgeting she called “dishonest.”

Abeler said the bill enacts real reforms and “makes a great effort to focus on our priorities, live within our means, have a sustainable program that will survive for the next decade or longer as we care about the needs of the most vulnerable, seniors in nursing homes and people disabled keeping that safety net intact.”

The cost savings are expected to come from nursing home care reforms for the elderly and disabled and lower payments to HMOs that serve poor and disabled residents. Two major pieces include a federal global Medicaid waiver request that proponents believe will save $300 million, and a repeal of early Medicaid enrollment for adults without children whose income is less than 75 percent of the federal poverty guidelines. The majority of the $200 million in cost savings generated from that repeal would be used to reduce cuts made to elderly and disabled waivered service.

Contention over savings

DFL members pointed out a letter Department of Human Resources Commissioner Lucinda Jesson wrote to the House this week that said $750 million of the bill’s projected cuts, including the estimated savings on the global waiver and repeal of early MA enrollment, were unsubstantiated. The letter also states that the initiatives would result in Minnesota losing out on $1.3 billion in federal dollars over the next three years.

Rep. Thomas Huntley (DFL-Duluth) said the global waiver request is savings “that is never going to be there because some people in this room don’t have the guts to actually say what a cut is.”

Huntley pointed to Gov. Mark Dayton’s proposed health and human services budget that would cut $800 million in spending. He used a borrowed term from the governor to call the House Republican plan “Fantasy Island.”

Lobbyists and visitors in the hearing room gallery view amendments to the omnibus health and human services finance bill during a packed meeting of the House Ways and Means Committee April 5. (Photo by Andrew VonBank)Who makes the cuts?

Abeler said he believes the federal government will grant Minnesota the waiver, although a provision in the bill says that if the

$300 million in savings is not realized, the health commissioner would be instructed to outline the cuts.

DFL members rejected the notion and said that it irresponsibly delegates authority away from the Legislature.

“Members, I want to know how many of you wanted to come down to St. Paul so a commissioner can make decisions for you?” said Rep. Larry Hosch (DFL-St. Joseph).

Rep. Nora Slawik (DFL-Maplewood) unsuccessfully offered an amendment that would have the governor consider calling a special session so the Legislature could address any budget gaps should the Medicaid waiver request be rejected or its savings come under projections. Republicans called the amendment useless.

“We do both agree that the governor can call us back to special session under whatever language passes under this bill, whatever the outcomes of waiver request are. … Your amendment can’t compel him to do it,” said Rep. Torrey Westrom (R-Elbow Lake).

Abeler said he believes his plan will work one way or another to reduce spending without cutting rates.

“I am suggesting to this body and this state that we can find a better way to avoid these kind of rate cuts that are going to hamper the services we so want to provide,” Abeler said.

Building a bill on the House floor

Twenty amendments were offered to the bill — 11 came from Republicans, which prompted House Minority Leader Paul Thissen (DFL-Mpls) to accuse the majority of constructing a bill on the floor with amendments that were never heard in committee.

“I just don’t get the urgency of having to do this right now, and kind of building a bill as we go on the fly doesn’t seem to be the best process,” Thissen said.

Rep. Steve Gottwalt (R-St. Cloud) pointed out that it is not unprecedented to bring policy amendments to omnibus finance bills on the House floor.

Of the nine DFL amendments put forth, one unsuccessfully offered by Rep. Patti Fritz (DFL-Faribault) would have stricken language that would repeal nursing home equalization rates, a subject of contention when it was introduced in the House Health and Human Services Finance and Reform committees earlier in session.

Some of the amendments approved on the House floor include:

• “Freedom of Choice in Health Care Act,” sponsored by Rep. Glenn Gruenhagen (R-Glencoe), to declare Minnesota’s constitutional sovereignty from the federal government as it relates to the Patient Protection and Affordable Care Act;

• an exemption for nursing homes from taxes on vacant beds in nursing home facilities, offered by Westrom;

• a banning of synthetic marijuana, offered by Rep. John Kriesel (R-Cottage Grove); and

• making it illegal to use EBT cards to purchase cigarettes or alcohol. The amendment, offered by Rep. Kurt Daudt (R-Crown), is a scaled-back version of a bill he proposed earlier in the session that was heard in the House Health and Human Services Finance and Reform committees.

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