May 31, 2019

What Got Done: A Summary of the 2019 Legislative Session

Following more than five months and one overtime special session, the 2019 Minnesota Legislature completed its work early Saturday, May 25.  After leaders reached a bipartisan agreement with Gov. Tim Walz, a Democrat, lawmakers in the divided Capitol — Democrats hold the House and Republicans hold the Senate — voted through thousands of pages of legislation following an all-night special session.

The reams include a $48.3 billion two-year budget, ranging from changes to tax policy to hiring more prison guards.

They also fell short on a number of priorities, especially those of progressives, leaving advocates frustrated and many Democratic lawmakers soberly noting that they’ll be back next year.

Here is what happened on a number of those health-related issues:

Opioid crisis: On the last day of the regular legislative session, lawmakers agreed to raise fees on drugmakers and invest the money into addiction treatment and prevention services. Walz signed the bill into law on Wednesday.

The state will now collect about $20 million per year from registration fees imposed on opioid manufacturers and distributors. Much of the proceeds will fund prevention strategies to reduce opioid deaths and overdoses. The other funds will reimburse Minnesota counties for child protection costs related to families harmed by the opioid epidemic.

Regulating middlemen of Big Pharma: The Legislature also passed a bill to regulate pharmacy benefit managers, which negotiate with drugmakers on behalf of insurance plans. They manage drug pricing and decide which medications are covered by insurance companies.

Under the new policy, which was signed into law by Walz, pharmacy benefit managers must be licensed, which gives the state authority to suspend, revoke or place a manager on probation. The managers must also disclose rebate and pricing information and notify health plans if an activity presents a conflict of interest.

Emergency insulin, precription drug plans: Heading into final talks, Democrats in the House and Republicans in the Senate appeared to be in agreement on two proposals: giving diabetics access to an emergency supply of insulin if they cannot afford it and requiring drugmakers to report price hikes and explain why they increased.

The proposals were included in both the House and Senate health and human services bills but did not make it into the final compromise.

The compromise health and human services bill did include a measure that would require pharmacies to provide emergency refills for patients who run out of their medicine, but the supply would not be free. It also would require health plans to report drug price trends each year, among other measures.

Health and human services

Child care assistance: Lawmakers moved to tighten oversight of child care assistance after the state Legislative Auditor reported it was difficult to gauge how much fraud was in the program.

The health and human services budget includes new rules to improve federal compliance and better ensure child care funds are spent properly. That includes tough rules for taking attendance and more money for fraud prevention. There are also new efforts to educate providers.

Welfare increase: Benefits in the Minnesota Family Investment Program are set to increase for the first time in 33 years. Under the budget deal, families on the state’s welfare-to-work program will see an increase of $100 a month in cash assistance.

The increase has been a perennial issue at the Capitol and had bipartisan support but failed to make it into past years’ budgets.

Reining in costs: Growth in the health and human services budget has been a key frustration for Republicans, and the next state budget creates a new task force to find ways to cut spending and waste. The panel will look for ways to stop fraud and abuse and save the state $100 million by 2023.

Protections for elderly: Lawmakers approved a package of elder care reforms that includes a framework to license assisted living facilities, making Minnesota the last state in the nation to do so. It also establishes consumer protection measures such as a bill of rights for seniors and the ability for residents to have a camera in their living space.

The far-reaching bill was spurred by reports of widespread abuse and neglect in state assisted living facilities and nursing homes. Walz signed it into law on Wednesday.

Health care

Provider tax: One of the top issues facing lawmakers was what to do with a 2% tax on health care providers that was scheduled to sunset at the end of the year. The tax raises about $700 million a year for the Health Care Access Fund that is used for programs to keep care affordable and accessible.

The budget deal keeps the tax but lowers the rate to 1.8%. There is no sunset provision, so the tax will not expire.

Tapping the access fund: In something of a twist, after sparring over the provider tax all session, the budget Republicans and Democrats agreed to relies on taking money out of the Health Care Access Fund. Over the next four years, $784 million will be moved out of the fund to pay for other priorities in the general fund.

No ‘OneCare’: One of Walz’s priorities this year was allowing residents to ‘buy in’ to MinnesotaCare, the public health insurance for the working poor. Walz said his OneCare proposal would help people who want to buy insurance on the individual marketplace MNsure but cannot afford the premiums.

Republicans balked at this plan, fearing the lower reimbursement rates government insurance pays could hurt rural hospitals. They also were skeptical the plan would be as affordable as Democrats promised.


Medical marijuana: Measures to expand the state’s medical marijuana program were included in the compromise health and human services bill. Pending the governor’s signature, Minnesota’s two medical cannabis manufacturers will be able to open twice as many dispensaries, write off their business expenses and buy hemp from local farmers.

A proposal that would have legalized the marijuana plant for medicinal use did not make it into the compromise bill.

Recreational marijuana: Proposals to legalize recreational marijuana or create a task force to study it did not make it through this year. The Republican Senate was the only chamber to hear a legalization bill, and a committee of lawmakers voted it down.

The Democratic House wanted to establish a state task force to study legalization, and members included the proposal in their public safety bill. It did not survive negotiations between the House and Senate.

Hot-button issues

Abortion: Senate Republicans included a ban on abortion after 20 weeks of pregnancy unless the mother is at risk of death or serious harm in their first health and human services budget plan. Supporters say the ban was intended to protect a fetus when it is able to feel pain.

Democrats opposed the change, saying it took away women’s reproductive rights and criminalized physicians who are trying to provide the best care for their patients. The proposal was not included in the final budget bill.

Paid family and medical leave: House Democrats pushed for a payroll tax to replace part of a worker’s income when they miss work because of illness or to care for a family member. The statewide paid family and medical leave program would have imposed a 0.6% tax on income, with employees and employers sharing the burden.

Democrats in the House included the measure in their initial jobs bill, but the Republican Senate opposed it, and it was dropped in final negotiations.