Budget that expands Minnesota health care, abortion access, heads to governor

Minnesota lawmakers passed an 844-page "billosaurus" Monday that leans on a $17.5 billion budget surplus to expand medical, dental and child care benefits and fund new shelter options to address homelessness.

The health and human services budget includes priorities for a legislature controlled for the first time in a decade by the DFL, including increasing reimbursement rates and removing barriers to abortion services. Plans to dramatically increase access to MinnesotaCare were delayed a year, but the legislation extends the publicly subsidized health benefits to as many as 40,000 undocumented children and adults.

Republicans gave the bill its Jurassic nickname because of its size, but its lead sponsor, Sen. Melissa Wiklund, DFL-Bloomington, said "it's also large in terms of the impact it's going to have on Minnesotans."

The senator highlighted a 3% and inflation-adjusted boost in payment rates by state programs to mental health providers, funding for a suicide hotline, and a recalculation of state subsidies that will allow families to afford 75% of their local child care providers.

"This will be a game-changer for families," she said.

Both the Senate and House passed the bill along party lines on the final day of the legislative session. The bill mostly spends $6.2 billion in state general fund dollars over the next two years, but also uses a tax on health care providers and premiums to support the MinnesotaCare expansion.

In an ode to pop culture, Sen. Jim Abeler, R-Anoka, mentioned man-eating dinosaurs, bank robberies by Jesse James and the "cone of silence" in the TV show "Get Smart" as he railed against the lack of public testimony on the final, compromise legislation. Wiklund and Rep. Tina Liebling, DFL-Rochester, led efforts to iron out differences between the original House and Senate versions of the budget — with the final version released late Sunday.

"Seems like it should be decided by more than two people in a room," Abeler said.

The bill repeals long-standing abortion restrictions, including an informed-consent rule, a 24-hour waiting period, and a requirement that an abortion after the first trimester be performed in a hospital setting. Some information, including women's reasons for abortions, will no longer be collected and reported annually.

A Ramsey County judge struck down many of the restrictions last summer, but Liebling said it was important to remove them from state law books because they "were put in there to chip away at abortion rights, to demonize doctors, to put an image in people's minds that was never the truth."

Republicans criticized the actions as an overreach in response to the Supreme Court's overturn of Roe v. Wade, especially after Democrats earlier in the session codified abortion rights into state law and provided protections for patients traveling to Minnesota.

"The Democrats have come back in this bill and changed all of our state laws and all of the protections that are in there," said Sen. Steve Drazkowski, R-Mazeppa.

The legislation was good for Mayo Clinic, which threatened to relocate a billion-dollar expansion over a proposal to create a health care affordability board that would set growth targets and penalize Minnesota hospitals that exceed them.

The board is being replaced by a center within the Minnesota Department of Health that will analyze escalating health care costs but won't fine or penalize high-cost providers.

Mayo also opposed separate legislation that sought to require hospitals to use committees of administrators, nurses and other providers to set nurse staffing levels. That requirement was removed Monday evening from the final bill, which instead concentrates on preventing violence against nurses and launches detailed studies of why nurses are burning out and leaving the bedside.

Legislation giving the attorney general more authority over health care transactions, such as the Fairview-Sanford merger, was pulled from the HHS bill and approved separately on Sunday.

No funding was authorized for a University of Minnesota buyback of its medical center — which was proposed in response to the merger to prevent out-of-state Sanford from controlling the state's primary teaching hospital. State leaders said a special session later this year might be needed as merger talks progress.

The HHS bill includes research into long COVID and support for people suffering from the post-pandemic condition. It also relieves Minnesotans from copays and cost-sharing for tobacco cessation and prophylactic HIV treatment, and reduces barriers to treatment of rare diseases. A requirement for insurers to cover infertility treatments if they cover childbirths did not make the cut.

A public option to make MinnesotaCare available beyond its low-income limits was delayed at least a year to first study its economic impact. A plan for the state to try to reduce drug costs by taking direct control of its pharmacy benefits was delayed as well.

Funding for hospitals and nursing homes has historically been a bipartisan issue, but it was primarily Republicans on Monday who lamented the bill's lack of "rebasing" to boost reimbursement rates for financially struggling hospitals.

"Our rural health care is precarious at best," said Rep. Debra Kiel, R-Crookston.

DFL lawmakers pointed to other provisions in the bill that support hospitals and also relieve the overcrowding of their inpatient units and emergency rooms.

State coverage of recuperative care services for homeless people should give hospitals more options for discharging patients, Wiklund said. The MinnesotaCare expansion also offers more upfront care to undocumented people, preventing them from needing costly and preventable ER visits.

"They don't wait until an emergency situation," she said, "where health care is more expensive."

Staff writer Briana Bierschbach contributed to this report.