The bill includes several new ways for the state to raise money for health programs.
The Minnesota House passed a health and social programs budget late Monday with a small salary increase for nursing home and long-term care workers, but some lawmakers questioned whether they were enough for struggling homes in rural areas.
The Democratic-sponsored, $7 billion health and human services bill passed on a mostly party-line vote of 70-64. It includes a 3 percent pay hike for nursing home workers and 2 percent for long-term care workers. The bill's sponsors said it would also give about 600,000 additional Minnesotans access to some form of health insurance in the next two years, although some of those costs would be covered by federal and not state funds. The bill also steers new money to expanding access to mental health treatment for students.
The bill includes several new ways for the state to raise money for health programs. It would increase a state surcharge on hospital budgets from 1.56 percent to 2.63 percent, a move that's likely to be felt mostly at Mayo Clinic and suburban hospitals that serve fewer medical assistance patients. The measure also would collect about $50 million by making HMOs return excess operating reserves fed by government insurance programs.
Few bills at the Capitol are more complex than those that fund human services programs, forcing lawmakers to tackle questions of eligibility and juggle state and federal funding streams. As Monday's debate got rolling, House members spent more than three hours on a single amendment that made changes to the surcharge on hospitals.
The long debate also steered into abortion politics, when minority Republicans joined by a handful of Democrats attached a provision requiring clinics that perform more than 10 abortions a year to pay a $3,700 annual license fee and undergo inspections twice a year.
However, Gov. Mark Dayton vetoed identical legislation last year. The abortion provision also faces a tougher audience in the Senate, where there are fewer Democrats opposed to legal abortion.
Lawmakers also steered into unusual territory when a Republican member moved to require drug and alcohol screenings for state welfare recipients. A Democrat countered by proposing those drug tests be extended to Minnesota lawmakers in order that they be eligible for their pay and benefits. The ensuing debate led to a few comical moments.
"Bring on the cup," Rep. Duane Quam, R-Byron, said of potential urine testing. "I have nothing to fear."
House members voted to add the drug tests for welfare recipients and lawmakers to the larger bill, though some suggested such requirements would have a tough time surviving a court challenge.
In all, the House health budget spends about $170 million less on health programs than Dayton proposed. And while the bill has no direct cuts to safety net programs, it trims about $150 million from total spending that would be needed to fully keep up with inflationary growth in health costs. DFL legislative leaders have said it's a step toward controlling costs in one of state government's biggest spending areas.
"Although there are certain things we'd like to do better on, especially funding for nursing home workers, we are not cutting them in this bill. They are getting a raise," said Rep. Tina Liebling, DFL-Rochester. "We're very proud of that."
A group of rural Republicans focused their criticisms of the bill on funding for nursing homes. Of the $150 million spending slowdown, about $26 million comes out of nursing homes. Republicans said homes in many small, rural communities are in danger of closing and that Democrats should give 5 percent pay hikes to nursing home and long-term care workers.
"Every time we lose a facility out in greater Minnesota, it's just that much further for folks to drive to get the care they need," said Rep. Ron Kresha, R-Little Falls. "I think we really need to look at this, step back and make sure our values and priorities are where our budget is."
House Majority Leader Erin Murphy, DFL-St. Paul, said Republicans could have hiked care worker pay when they had legislative majorities in 2011-12. "They don't have a real plan and they don't have credibility on this issue," Murphy said. Republicans failed in a series of amendments to steer more of the bill's funds to nursing homes, with Democrats saying that would sacrifice other important spending priorities.
But some Democrats from rural areas also expressed a desire for more money for nursing homes. Rep. Jay McNamar, DFL-Elbow Lake, said six out of 10 nursing homes in his western Minnesota district are the largest employer in their respective communities.
The proposed pay increases are "not enough. We need help," McNamar said. He was successful in amending the bill to reduce a state surcharge on nursing home beds.
But an alternative Senate health spending bill actually increases the nursing home surcharge, and one on HMOs. The Senate bill excludes the hospital surcharge and the HMO reserve cap. The Senate bill awaits a floor vote.
Once both proposals have passed, lawmakers from both chambers will produce a final version in conference committee to be sent to Dayton for his signature.