MINNEAPOLIS, March 28, 2008 - The MMA continues to push lawmakers to pass health care reform this session, despite concerns about the bill that passed the Senate Thursday by a vote of 41 to 22.

“The proposals before the Legislature are not perfect,” said MMA President James. J. Dehen, Jr., M.D., in a prepared statement that was given to lawmakers Friday.  “We may even disagree with some of the details.  But we have an opportunity to pass historic legislation in 2008.  Let’s not lose this momentum.”

The Senate bill contains many of the provisions that the MMA supports such as increased health coverage, more public health initiatives, and payment reforms that encourage medical homes and chronic care management. However, the bill still includes a problematic payment reform, known as Level 3.

The MMA has called for lawmakers not to pass Level 3, because it is a vaguely defined payment scheme similar to capitation that may have unintended consequences, such as greater provider consolidation.

“Though the Senate bill is better than it was, it is still problematic because it has the language about providers being accountable for the total cost of providing care,” said Dave Renner, the MMA’s director of state and federal legislation.

During Thursday’s debate, the bill’s chief author, Sen. Linda Berglin, DFL-Minneapolis, did make some concessions to critics.

She replaced a proposed health insurance exchange to administer tax free health plans to individuals with a system of private brokers, and she accepted a delayed timeline for implementing  Level 3.

Thursday’s debate also exposed divisions among DFL lawmakers. An amendment proposed by Sen. John Marty, DFL-Roseville that would have essentially gutted the bill of any significant payment reforms was narrowly defeated by 33 to 32 votes.

The MMA didn’t support Marty’s amendment, on the grounds that it went too far and removed positive payment reforms designed to encourage disease prevention and care coordination.

Renner said the next health reform battle will be Monday in the House Finance Committee. At that time, the committee will consider amendments to the bill supported by the MMA.

The MMA has been working with the Rep. Thomas Huntley, DFL-Duluth, to amend the House bill to alleviate providers’ concerns.

The MMA has suggested changing the Level 3 plan so physicians would no longer bid for the total cost of care or assume insurance risk. Instead, providers would put forward pricing packages for episodes of care related to chronic diseases, such as asthma, diabetes, depression, heart disease, and pulmonary disease.

The MMA proposal would also slow down the timeline for implementation of Level 3 payment reform. Finally, it would require the Health Care Transformation Commission, which would be created by the bill, to further define the plan for comprehensive payment reform before implementing it.

Right now, the bill gives the commission the authority to enact changes without further legislative review.