MAHU Legislative Update

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MAHU Legislative Update

• April 3, 2008

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Legislative ProfileState House of Representatives

• DFL 85
• R 48
• IR 1

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Legislative ProfileState Senate

• DFL 45
• R 22

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How a Bill Becomes Law

• Idea
• Legal Form
• Authors
• Introduction
• Committee
• Floor
• General Register
• Calendar for the Day
• Special Orders
• Conference
• Floor
• Governor

http//www.leg.state.mn.us/leg/howbill.asp
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How a Bill Becomes LawIdea

• Who can suggest an idea? Anyone individuals,
  consumer groups, professional associations,
  government agencies, legislators or the governor.
• HOWEVER, only Legislators can move the idea
  through the law making process.

http//www.leg.state.mn.us/leg/howbill.asp
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How a Bill Becomes LawLegal Form

• Office of Revisor of Statutes
• Puts idea for new law into proper legal form
• Assures text of bill conforms with both House and
  Senate rules

• Staff from Legislative Offices
• Assists the Office of Revisor of Statutes with
  this process.

http//www.leg.state.mn.us/leg/howbill.asp
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How a Bill Becomes LawAuthors

• Every Bill MUST have a legislator as its sponsor
• This legislator is the chief author, their name
  appears with the bills file number.
• The House allows 34 co-authors
• The Senate allows 4 co-authors

http//www.leg.state.mn.us/leg/howbill.asp
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How a Bill Becomes LawIntroduction

• The Chief authors in House and Senate introduce
  the bill to their legislative body.
• Identical bills introduced in the House and
  Senate are called companion bills.
• The bill introduction is called the first
  reading.
• The presiding officer of the House and Senate
  then refer the bill to committee.

http//www.leg.state.mn.us/leg/howbill.asp
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How a Bill Becomes LawCommittee

• The bill is discussed at one or more committees
• The committee assignment depends on the subject
  matter of the bill
• After discussion, the committee recommends action
  to the House or Senate
• The committee sends a committee action report to
  their respective legislative bodies

http//www.leg.state.mn.us/leg/howbill.asp
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How a Bill Becomes LawFloor

• House or Senate accepts committee report
• Bill has second reading
• Bill placed on the agenda of the House (General
  Register ) and the Senate (General Orders)

http//www.leg.state.mn.us/leg/howbill.asp
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How a Bill Becomes LawGeneral Register/General
Order

• House General Register
• Bill awaits action by the full body
• Senate General Order
• Members may debate the issue and offer amendments
  on the bill.
• They then vote to recommend various action
  (passage of the bill, progress, further committee
  action or no passage)
• Bill then placed on calendar

http//www.leg.state.mn.us/leg/howbill.asp
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How a Bill Becomes LawCalendar for the Day

• List of Bill designated for the entire House to
  vote on.
• Can amend bills
• After amendment, bill given third reading
• Fiscal calendar
• 68 Votes to pass House
• In the Senate, the calendar is bills approved by
  the "committee of the whole
• Bill gets third reading can no longer amend
  unless unanimous consent.
• 34 votes to pass Senate

http//www.leg.state.mn.us/leg/howbill.asp
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How a Bill Becomes LawSpecial Orders

• Towards the end of session only
• Bills may be designated from General Orders to
  Priority Consideration in their respective bodies
  
• Pursuant to the House Rules Committee
• Pursuant to the Majority Leader of Senate

http//www.leg.state.mn.us/leg/howbill.asp
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How a Bill Becomes LawConference Committee

• The conference committee meets to work out
  differences in the two bills and to reach a
  compromise.
• House
• Speaker appoints 4-5 representatives
• Senate
• The Subcommittee on Committees of the Committee
  on Rules and Administration selects the same
  number of senators

http//www.leg.state.mn.us/leg/howbill.asp
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How a Bill Becomes LawFloor

• Conference committee's compromise bill then goes
  back to the House and the Senate for vote
• If both bodies pass the bill in this form, it is
  sent to the governor for his or her approval or
  disapproval.
• If one body reject the compromised bill, it goes
  back to conference committee.

http//www.leg.state.mn.us/leg/howbill.asp
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How a Bill Becomes LawGovernor

• Options once the governor has the bill
• Sign it
• Veto
• Not sign becomes law
• Veto Override
• Two thirds vote in both House and Senate
• Line-Item Veto
• Pocket Veto

http//www.leg.state.mn.us/leg/howbill.asp
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Specific Issues of Concern

• Mandatory Statewide Health Insurance for School
  Districts
• HF 3112 Rep. Sertich (DFL-Chisholm) bill has
  passed all policy committees and is currently
  awaiting action in House Finance.
• SF 2747 Sen. Betzold (DFL-Fridley) bill has
  passed all policy committees and is currently
  awaiting action in Senate Finance.
• Ed MN is trying to resolve concerns raised by the
  Department of Commerce in hopes of passing a bill
  the Governor would sign into law.

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HEALTH CARE REFORM

• SF 3099 Sen. Berglin (DFL-Minneapolis)
• Co-authors Lourey (DFL-Kerrick), Lynch
  (DFL-Rochester), Rosen (R-Fairmount), Koering
  (R-Fort Ripley)
• Bill Status Bill has passed all Senate Policy
  and Finance Committees and adopted by the Full
  Senate on March 31, 2008 with a bipartisan vote
  of 39-23. The legislature is now awaiting action
  by the Minnesota House of Representatives. This
  bill number will become the number used for both
  bodies.

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SF 3099 Key Provisions

• Health Insurance Access Brokers replaced the
  Health Insurance Exchange
• Grants the Commissioner of Commerce the ability
  to register and assess a fee for those entities
  who document the following
• Licensed to sell health and life insurance in
  Minnesota
• Ability to provide a wide range of products from
  at least four health plan companies
• Agree to provide assistance to clients who may be
  eligible for state healthcare programs
• Ability to collect, hold and disperse funds on
  behalf of clients, employees or health plan
  companies
• Mandates Section 125 plans for all companies with
  more than 11 employees.

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• Health Improvement Fund (new revenue/hidden
  taxes)
• The goal of the fund is to reduce obesity,
  illegal drug use, tobacco use and alcohol misuse.
• Funding comes from an annual assessment
  established by the Commissioner of Health
  starting June 1, 2009. The Public Health
  Improvement Assessments will be made in the
  following manner
• For 2009, a 0.15 assessment of a hospitals net
  patient revenue and a 0.15 assessment of the
  total premium revenue of non-profit health plan
  companies.
• In 2010 and beyond, the annual assessment will be
  set at 40,000,000 and be divided between
  hospitals and health plans.

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• Health Savings Re-investment Assessment (new
  revenue/hidden taxes)
• Starting in 2008, The Commissioner of Health
  shall calculate the total annual projected
  healthcare spending for the State and establish a
  healthcare spending baseline. The Commissioner
  must also prepare a 10 year projection on annual
  growth in health care spending.
• Beginning in 2010, The Commissioner of Health
  must establish the total actual private and
  public healthcare expenditures for the previous
  year and determine the difference between the
  projected level of spending and the actual level
  of spending.
• If the actual level of spending is determined to
  be less than the projected level of spending, the
  Commissioner shall determine an aggregate
  Savings Re-investment amount not to exceed 33
  of the difference. The Commissioner is allowed
  to then assess this amount against health plan
  companies and third party administrators.
• These funds will be used to expand the level of
  coverage provided in Minnesotas public health
  plans.

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• BMI Monitoring of Children and Youth
• Payment Reform for hospitals/providers
• Automation and coordination of State Health Care
  programs
• Mandated electronic medical records
• Health Care Homes Complex and Chronic condition
  management plan aimed at helping manage
  healthcare costs from certain types of medical
  conditions.

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HEALTH CARE REFORM

• HF 3391 Rep. Huntley (DFL-Duluth)
• Co-authors Thissen (DFL-Minneapolis), Loeffler
  (DFL-Minneapolis), Bunn (DFL-Lake Elmo), Murphy,
  E. (DFL-St. Paul), Hosch (DFL-St. Joseph), Norton
  (DFL-Rochester), Fritz (DFL-Faribault), Ruud
  (DFL-Minnetonka)
• Bill Status Bill has passed all House Policy
  Committees, the House Finance Committee and
  awaits action (tentatively 4/2) in the House Ways
  and Means Committee. The bill was dramatically
  amended in the House Ways and Means Committee in
  response to concerns raised by the House
  Republican Caucus and Governor Pawlenty. The
  bill may be heard on the House floor as soon as
  4/3.

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HF 3391

• While the bill originally had these provisions
  it no longer includes provisions which MAHU has
  been working to defeat.
• Health Insurance Access Brokers or the Health
  Insurance Exchange
• Health Improvement Fund Assessments
• Health Savings Re-investment Assessments

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HF 3391 Key Provisions

• BMI Monitoring of Children and Youth
• Payment Reform for hospitals/providers
• Automation and coordination of State Health Care
  programs
• Mandated electronic medical records
• Health Care Homes Complex and Chronic condition
  management plan aimed at helping manage
  healthcare costs from certain types of medical
  conditions.
• Uses Healthcare Access Funds to expand public
  plan eligibility to 300 of Federal Poverty

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Where does MAHU stand on these bills and
provisions?
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What has MAHU been doing this session?

• Members have participated in numerous committees
  by either directly testifying or providing
  written comments.
• Members have met with key members of the
  legislature and the Pawlenty Administration to
  discuss legislative concerns.
• Operation Shouts
• Earned and Paid Media Campaign

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What have you been doing this session?
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What the Legislative Committee Considers when
Evaluating a bill
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Analysis Points

• How does it impact agents/brokers and others who
  work in our industry
• Short term concerns
• Long term concerns

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Short Term Concerns

• SF3099 HF3391 (Companion bills) ARE STILL OPEN
  TO CHANGE
• NOTHING IS SET IN STONE UNTIL THE COMPROMISE
  BILL IS VOTED ON AND PASSED IN BOTH THE HOUSE AND
  SENATE. IT IS STILL VERY MUCH A MOVING TARGET
  FOR US AS OF TODAY.

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Short Term Concerns (contd)

• Though the original Exchange language is no
  longer in either the House or Senate bills the
  new language for the Health Insurance Access
  Broker (HIAB) was amended in the Senate bill
  3099 this last week.

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Short Term Concerns (contd)

• CURRENT VERSIONS ARE TWO SEPARATE BILLS WITH THE
  SENATE VERSION BEING MUCH MORE ONEROUS FOR OUR
  INDUSTRY AND FOR MN TAXPAYERS.

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Short Term Concerns (contd)

• BOTH VERSIONS CONTINUE TO CREATE NEW
• LAWS TO COMPLY WITH WHICH CREATE NEW RESTRICTIONS
  AND COSTS NOT CURRENTLY IN EXISTENCE IN THE
  SYSTEM.
• EXTENSIVE ADDITIONAL COSTS FOR PRODUCTS AND
  SERVICES WHICH ARE ALREADY AVAILABLE THROUGH THE
  PRIVATE MARKET.

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Short Term Concerns (contd)

• CREATION OF NEW GOVERNMENT INVOLVEMENT AND
  BURACRACY THROUGH THE CREATION OF 10 OR MORE NEW
  COMMISSIONS OR COMMITTEES.
• AGENTS, INSURANCE CARRIERS AND INSUREDS ALIKE
  WILL BE REQUIRED TO ANSWER TO THESE COMMITTEES
  AND COMMISSIONS.

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Short Term Concerns (contd)

• What is the HIAB?
• Essentially it is the Exchange minus a couple of
  mandates, however, it leaves in place all the
  triggers to have the Exchange operational in the
  next legislative session.
• What the HIAB is initially intended to provide is
  insurance for individuals, the uninsured
  government sponsored healthcare plans such as
  MCHA MNCare.

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Short Term Concerns (contd)

• What does a HIAB require of an Agent?
• Brokers will be required to
• Provide web based communications available for
  clients to elect insurance options.
• Capacity to transact the establishment
  administration of Section 125 Plans.
• Has the capacity to provide the financial
  transactional ability to collect, hold disperse
  
• Brokers would be expected to be registered with
  the Department of Commerce and have their
  registered information available to the public
  via a Government run Web-based registry.

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Long Term Concerns

• THESE BILLS ARE THE OPENING OF THE FLOOD GATES.
  IT WILL BE MUCH EASIER FOR LEGISLATORS TO BUILD
  ONTO AND EXISTING LAW THAN IT IS FOR THEM TO GET
  A NEW ONE PASSED. INCREMENTAL MANAGEMENT

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Long Term Concerns

• Potential for the state to mandate that all
  remaining group plans operate through the HIAB,
  thus breaking up group insurance into individual
  policies increasing the agents workload and costs
  exponentially.

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Long Term Concerns

• Dept. of Commerce Registry Web-site becomes the
  access point to the HIAB for the purchase of
  health insurance in MN.
• Smelling the scent of fresh money, banks and
  other financial institutions, who have no concern
  for the insurance industry or the client, enter
  the scene. You can say Goodbye to 90 of all
  agencies in MN.

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Long Term Concerns

• INVITES OTHER INDUSTRIES, SUCH AS BANKING, TO
  ENTER INTO OUR INDUSTRY AND CLAIM CONTROL OF THE
  FINANCING ELEMENTS OF HEALTHCARE AND HEALTH
  INSURANCE THEREBY CREATING MORE COSTS FOR
  EVERYONE AND UNQUESTIONABLY ADDITIONAL REGULATORY

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Long Term Concerns

• NARROWS THE PLAYING FIELD FOR AGENTS/BROKERS WHO
  WILL BE ABLE TO OR ALLOWED TO PARTICPATE IN THIS
  NEW SCHEME. AS THIS FIELD IS NARROWED THE DOOR
  OPENS WIDER FOR GOVERNMENT TAKEOVER.
• SETS MN UP FOR THE ALL INDIVIDUAL HEALTHCARE
  COVERAGE SCENARIO WHICH IS, BY DESIGN, MEANT TO
  LEAD US TO A SOCIALIZED HEALTHCARE AND TOTAL
  GOVERNMENT CONTROL.

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Long Term Concerns

• INVITES OTHER INDUSTRIES, SUCH AS BANKING, TO
  ENTER INTO OUR INDUSTRY AND CLAIM CONTROL OF THE
  FINANCING ELEMENTS OF HEALTHCARE AND HEALTH
  INSURANCE THEREBY CREATING MORE COSTS FOR
  EVERYONE AND UNQUESTIONABLY ADDITIONAL REGULATORY

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What Do You Think?