ROCHESTER — Last week, Mayo Clinic sent an email to members of Gov. Tim Walz’s office and DFL lawmakers stating the health system’s intent to cancel $4.4 billion in investments within Minnesota if two legislative proposals become law .
The two deal-breaker proposals outlined by Mayo Clinic are the Keeping Nurses at the Bedside Act and the Health Care Affordability Board.
Both proposals have passed the Minnesota House and Senate in those chambers’ respective health and human services omnibus bills. Now, a conference committee of 10 legislators, including Rochester Rep. Tina Liebling and Sen. Liz Boldon, will settle the differences between the two omnibus packages and send the combined legislation to Gov. Tim Walz before the Minnesota Legislature must adjourn on May 22.
The passage of these two pieces of legislation, according to a Wednesday, May 3, email sent by Mayo Clinic vice chair of external engagement Kate Johansen, would prompt the medical system to cancel an unspecified, multibillion-dollar investment in Minnesota.
“Because these bills continue to proceed without meaningful and necessary changes to avert their harms to Minnesotans, we cannot proceed with seeking approval to make this investment in Minnesota,” she wrote.
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What are the bills that Mayo Clinic does not want to be made law, and how would they impact Minnesota’s health systems, staff and patients?
Keeping Nurses at the Bedside Act
The Keeping Nurses at the Bedside Act , championed by the Minnesota Nurses Association, would require hospitals to form staffing committees that set the minimum staffing levels for those hospitals. At least half of the members of those committees would need to be nurses or other direct care workers.
On Monday, DFL Sen. Erin Murphy, chief Senate author of the KNABA, said the three most important provisions in the legislation are providing a strong voice for nurses in the staffing planning and implementation process, reporting data to the public, and outlining measures for conflict resolution and arbitration.
“Minnesotans enjoy a high quality of life,” she said. “We enjoy a high quality of life because Minnesotans have set for us high expectations, and we meet those high expectations as policymakers and as nurses by setting high standards and meeting those standards. That is what we’re doing with Keeping Nurses at the Bedside.”
Supporters of KNABA say that a nationwide nursing shortage has led to nurses having to care for a larger number of patients at a time, which contributes to burnout and on-the-job injury. Speaking alongside Murphy and MNA leaders during a news conference Monday, MNA nurse staffing specialist Carrie Mortrud said higher patient-to-nurse ratios lead to less time spent with patients.
“When nurses don’t have enough time to assess, talk with patients, do skin assessments, they miss those little things,” she said. “When nurses don’t have time to spend with patients, serious symptoms slip through the cracks, and they suffer and very bad things can happen very quickly.”
Mayo Clinic isn’t the only regional health system that opposes KNABA as it is currently written. I n a House health committee hearing on March 14, several Winona Health representatives testified against the proposal, including president Rachelle Schultz. Schultz cited Winona Health’s minus-3% operating margin in its 2022 fiscal year and the projected minus-6% margin for 2023 as evidence that the health system is struggling under rising labor and supply costs.
“If enacted, this bill will make our financial future even more grim,” she said in the hearing. “To comply with the proposed rigid staffing protocols, we would need additional help, and there are simply not enough nurses to hire. We’re still trying to replace travel staff with our own caregivers.”
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In Wednesday’s email, Johansen asked lawmakers to provide a path for exempting the health system from the proposal’s requirements. The email included a draft amendment for KNABA that would provide exemptions for hospitals on three different grounds.
“The bill must include a path to full exemption from the bill’s requirements for systems, including Mayo’s full system in Minnesota, that meet high standards as demonstrated by use of a software-based acuity tool incorporating nurse input, achievement of Magnet designation and/or critical access hospital designation,” Johansen wrote.
On Monday, DFL Rep. Sandra Feist, chief House author of KNABA, said this proposed amendment is “not an option.”
“Any compromise that we would enter into would have to achieve those goals, and they cannot include the language that Mayo Clinic has proposed that … would exempt every single hospital in Minnesota from our bill,” Feist said.
Health Care Affordability Board
The second legislative proposal involves the creation of the Health Care Affordability Board. As currently written in the Senate Health and Human Services omnibus bill , the board would be made up of 13 health care, health administration and health economics experts appointed by the governor and other top legislative leaders.
The board would be tasked with setting health care spending growth targets for the state, recommend policy and market reforms that would slow the rate of growth in health care costs and monitor those changes. The goal: curtail the rising costs associated with health care and “improve the quality and value of care for all Minnesotans.”
If health care entities exceed the spending growth target set by the board, the board can ask those entities to file and act on a performance improvement plan that reduces cost growth to a level below the target set by the board.
The proposal would also spur the creation of a Health Care Affordability Advisory Council that would provide technical recommendations to the board for health care spending and the Office of Patient Protection, which would “assist consumers with issues related to access and quality of health care.”
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As it currently stands, the House version of this proposal, known as the Health Care Affordability Commission, mostly matches the proposal outlined in the Senate version, though the guidelines differ for the size of the board and how its members are appointed.
In her email, Johansen advocated for the complete removal of the Health Care Affordability Board proposal.
“This bill is extremely problematic and poses a huge threat to the well-being of Minnesota’s health care system as drafted,” she wrote. “It must be removed from the HHS omnibus bill and consideration for Mayo to move forward with the previously stated investment.”
Nine other states have established new commissions or have beefed up existing agencies to regulate those states' health care spending growth. California is the newest member of this group ; the state allocated $30 million last year toward creating its Office of Health Care Affordability.
The Minnesota Senate's Health and Human Services omnibus bill currently allocates just over $3 million for the Health Care Affordability Board through 2025 and a one-time $232,000 appropriation to evaluate the impact of the KNABA. The House omnibus bill, however, allocates $23.11 million to KNABA .
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