How Minnesota Repealed Its Provider Tax

Patricia Lindholm, MD,
2010-2011 MMA President

An unexpected but satisfying item was tucked in the final Health and Human Services Budget Bill passed by the Legislature and signed by Gov. Mark Dayton this week.

Lawmakers have agreed to phase out the 2 percent provider tax and repeal it altogether in 2019.

I am relieved by this unexpectedly positive development not because it is a pocketbook issue – though it should help reduce health care costs – but because lawmakers are redressing a breach of trust with Minnesota’s medical community that has soured the relationship between physicians and state government, since this law was passed in 1992.

To doctors, it has always felt particularly unfair that the state decided to make those who must seek medical services – which is already a hardship – also pay a selective tax. Then when lawmakers rolled out the tax, they weren’t transparent about it. They explicitly prevented providers from telling patients about the tax by itemizing it on bills.

The courts ultimately overturned this provision, but the feeling of distrust toward lawmakers remained. Finally, after saying the funds would only go to MinnesotaCare, lawmakers broke that promise time and time again by using hundreds of millions of these dollars to balance the general budget. Once again doctors were left feeling distrust and disillusionment.

So I want to thank lawmakers for taking this step to repeal this law and repair the relationship. I must admit that after many years of the MMA working to repeal this regressive, selective tax, this victory seemed to come out of nowhere.

The person who deserves the most credit for this is probably House Majority Leader Matt Dean (R-Dellwood).  Rep. Dean saw early on that as the Affordable Care Act is fully implemented, there will no longer be a need for MinnesotaCare and the provider tax. The MMA worked with Rep. Dean early in the 2011 Session to help him draft a bill that would reduce the size of the provider tax as the need for it went down.  This bill passed a few House committees but did not move in the Senate. Then during the final budget negotiations Rep. Dean, with the support of Senate leadership and Gov. Dayton saw an opportunity to replace the provider tax with the new federal subsidies that will come online in 2014 for Minnesotans earning up to 400 percent of the federal poverty level.

I am convinced that the MMA helped lay the ground work for this breakthrough by working hard since the tax was adopted’s adoption to remind law makers that it is regressive, hits sick people harder than healthy, and adds to the overall cost of health care. Many legislators over the years, both Republicans and Democrats, agreed with us that this was a bad tax, yet there was never enough support to find the $450-$500 million it raises each year to replace it.
 
Now, our challenge over the next eight years will be to continuously remind legislators of their commitment to repeal the “sick tax” and ensure that this unfair tax eventually goes away.

A Generous Listener is a Healer

Patricia Lindholm, MD,
2010-2011 MMA President

Recently I had the opportunity to attend a seminar by Rachel Naomi Remen, M.D., in California.  It was called “The Healing Power of Story:  Toward a Closer Human Connection.”  Many of us are familiar with Dr. Remen through her books Kitchen Table Wisdom and Blessings From My Grandfather.  In her books she tells stories that indeed are healing to the teller and to the reader/listener. 

In attendance were physicians from various specialties, chaplains, social workers, nurses, psychologists and others in the healing professions.  There were people from the US, Canada, Australia, Britain and Germany.  There was no formal syllabus for this course. 

Each day of the three day course was divided into two parts.  Most of the time we were doing guided small group activities with groups of 2 to 7 people.  Each half-day session had a theme and we had the opportunity to delve within ourselves and tell our stories to each other.  We were taught the technique of “generous listening.”  We were to listen completely and mindfully to each person without interjecting any comments or questions.  I found myself having to consciously restrain my impulse to ask follow-up questions which I so often use in my practice.  Likewise as a story-teller I felt completely supported and heard by my story-listeners.  The results of generous listening were profound.

I was privileged to be a listener to a story by a physician who had been carrying a load of pain and shame since her residency days.  She had not felt safe in telling her story before.  She clearly was relieved to tell her story to a generous listener and felt healed by the experience.  I also felt healed by sharing a story with her about a loss in my life. 

It occurred to me that patients come to us so that they can tell their stories and be heard.  They are looking for the healing that we can provide simply by being generous listeners and confidants.  This is true of procedural as well as cognitive specialists.  Sometimes a patient has a distressing and perplexing story to tell and we squirm because we do not have “answers.”  What Rachel Remen taught us was that we are “enough.”  We do not need special knowledge or wisdom to be healers.  A story listener is a healer.  That is enough.  We are enough.