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Insulin makers should fund program

As someone with close relatives and friends who are insulin-dependent diabetics, the most disappointing outcome of this year’s legislative session was the failure of Alec Smith Emergency Insulin Act to be enacted into law.

Even more disappointing was the fact that our state senator Dr. Scott Jensen – who was a co-author on the bill – ended up voting against it when it mattered most.

Alec’s bill – named after a 26-year old restaurant manager who died in 2017 after rationing his insulin because he couldn’t afford the high cost – is a common-sense solution to this problem that has been vetted through months of consultation with legislators, health and pharmacy industry experts, and the diabetes community.  It relies on existing technology infrastructure and has a simple enrollment process. Under the terms of the bill, low- and middle-income Minnesotans with incomes too high to qualify for public assistance can get a 90-day emergency supply of insulin at reduced cost.

The program would not be funded by taxpayer dollars. Instead, the program would be funded by a fee on insulin manufacturers. This is an important component of the program, and let me explain why.

Insulin manufacturers are a major cause of this problem. Even though insulin has been commercially manufactured for the treatment of diabetes since 1923, the three companies that control the patents have exploited loopholes in the law to prevent an inexpensive generic version of insulin from being available to patients.

And those companies have fully exercised that leverage – the price of insulin has more than tripled in the last decade. Over this time, the three insulin manufacturers have all recorded record revenue and profits.

But because of these skyrocketing prices, about 25% of patients have been forced to ration their insulin to make their supply last longer– a practice that can lead to complications such as kidney failure, blindness, or in some cases (like Alec Smith) death.

American diabetics also pay far higher prices for their insulin than most other countries in the world. A box of insulin pens that costs $700 here costs $73 in Germany, $65 in Canada, $61 in Italy, $57 in Israel, and $40 in Taiwan.

Since the legislative session ended, Sen. Jensen and some of his Republican colleagues have come forward with a new plan. While this plan shares many of the same elements of Alec’s bill, it has one key difference.

The new GOP plan would principally rely on donations to supply the emergency insulin to patients, with taxpayers making up any shortages. It should be unacceptable to leave taxpayers on the hook for a crisis that is largely created and sustained by the practices of insulin manufacturers and the pharmaceutical industry.

Jensen and the rest of the Legislature need to make insulin manufacturers accountable for their out-of-control profiteering. The Alec Smith Emergency Insulin Act is one necessary step to make that happen, and I urge Jensen to support it.

This piece appeared in the June 13, 2019 edition of the Chaska Herald.

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Greg Boe: stripping away the moderate mask

A couple of weeks before the 2018 election, I made this remark about GOP House District 47B candidate (and eventual election winner) Greg Boe, who won his Republican primary and based his general election pitch on being a “moderate” choice:

Greg has always seemed like a pretty moderate guy — some may not know that he caucused with Democrats back in the late-2000s/early-2010s. So it’s fair to say that seeing Greg line up behind Donald Trump — a guy who is the antithesis of Greg’s “Reasonable. Thoughtful. Respectful” slogan — has been a bit of a shock.

Brick City Blog, Donzel Leggett for State House 47B

Boe ended up winning the election — by a slender 117 votes, or about one-half of one percent.

Well, we’re now one legislative session in the books. How did Rep. Boe do in his first few months around the State Capitol?

Sadly, I have to report that the results aren’t good.

Let’s start off by looking at some basic productivity metrics. Boe only chief-authored four bills during the session (and two of those were different versions of the same bill). Only one rank-and-file legislator (Rep. Nolan West) — excluding districts where a vacancy occurred mid-session — authored fewer bills. None of those four bills were passed into law or rolled into a larger omnibus bill.

But the most surprising — and disappointing — part of Boe’s performance this session was his hard right turn into extremism and bigotry on certain issues and incoherence and dishonesty on others.

Let’s start with abortion. Boe started off the session grandstanding with his fellow House and Senate Republicans in a photo-op designed to protest proposed laws in New York and Virginia. Unfortunately, Boe chose to lie about the content of those bills, claiming that they permitted infanticide. (They do not.)

Boe followed that up with legislative action, becoming a co-author on a version of the so-called “heartbeat bill”, which would ban all abortions after a fetal heartbeat can be detected (usually in the six- to eight-week range), with the only exception being to prevent the death of the mother or where there was “serious risk of substantial and irreversible impairment of a major bodily function” — a more restrictive definition of the health exception than exists in current state law.

The impact of this is remarkable — Boe is in favor of prohibiting abortions in all but the most threatening circumstances at a point in the pregnancy where some women may not even yet know they are pregnant. And if you’re a victim of rape or incest, Greg Boe would tell you to go pound sand.

Not only would you have to deal with the physical consequences of your attack, but you would be required to carry the baby to term — and under the policies Greg Boe advocates for, you wouldn’t have a right to health care, a right to take time off of work to handle your prenatal appointments, and no guarantee that you could keep your job or have paid leave after you gave birth to a child conceived because of a criminal act.

Reasonable, thoughtful, and respectful is not how I would describe that set of policies. But there’s more.

In March, Boe stepped into a pile of trouble when he tried to explain his vote against the Equal Rights Amendment. The focus of his explanation was around the point that using the word “gender” instead of “sex” would open up a world of complications citing his own personal internet search where he claims to have found 63 different gender definitions. But, in reality, “gender” is used 91 times in 68 separate state statutes without things turning into a free-for-all. When challenged by his constituents on that matter, he began illegally blocking them — by the dozens — from his Facebook page, eventually relenting after several hours and without an apology.

Boe has doubled down on that logic subsequently, using the scare tactic about transgender participation in athletics as a cloak for his vote. Note the snarky language and use of quotes around the bill’s name.

Greg Boe posting about the “so-called ‘Minnesota ERA'”
on a local conservative Facebook group

It should be pointed out — for the record — that the Minnesota State High School League has an established policy on transgender athletes that prevents the sort of fever dream that Boe and other conservatives seem to fear.

These sorts of positions are indistinguishable from the sort of nonsense that legislative radicals like Glenn Gruenhagen or Steve Drazkowski push (Gruenhagen, in fact, was Boe’s second-most common co-author on legislation this session, sharing authorship on over 20 bills.).

Despite representing a 50-50 district, Boe hasn’t even shown the courage to buck his own party from time to time the way that his Senate counterpart Scott Jensen has. The results our district has received from Greg Boe would be no different than if one programmed a robot to vote the default Republican position.

Boe has engaged in the usual sorts of political shenanigans, too, which I guess should be expected. Like many Republicans, he obfuscates on transportation funding, pretends to support increased education funding, and demagogues on taxes.

Beyond his performance at the Legislature, though, Boe missed some opportunities to provide leadership within the community. The Eastern Carver County School District has been rocked this year by a series of racial incidents. In April, the district held a community forum on equity in the district at a school literally kitty-corner from his house. While over 150 community members were inside the school working through tough problems, Boe and his wife were spotted walking on the sidewalk outside not knowing or not caring about what was happening on the inside.

Boe is already starting to try and build the coffers for his re-election campaign. It may be even harder this time around, though, because the mask has been stripped away. “Moderate” Greg Boe is no more.

Ortman back from War College: firing wildly and with shiny tap-dance shoes

As we mentioned earlier in the week, State Senator (and possible U.S. Senate candidate) Julianne Ortman spent the week at the Army War College’s National Security Seminar.   Part of a new Army recruit’s basic training regimen includes learning how to shine shoes.  Well, it seems Ortman may have taken a lesson or two while there because she came back ready to attack and with shined-up and ready-to-go tap dancing shoes.

Earlier today, Ortman fired off several rounds of criticism at U.S. Senator Al Franken on Twitter, which was countered by myself and a few others — not to defend Franken (because he and the rest of Congress have a lot to answer for), but rather to ask Ortman what she would have done instead.  After all, it’s easy to criticize, but harder to advocate alternatives.   We saw this in effect during this legislative session’s budget battle, where Republicans never articulated an alternative budget.

Did Franken “hide” his knowledge of the NSA program?

Ortman’s initial attack against Franken called out the Senator for “hiding” the NSA program.  As a member of the Judiciary Committee, Franken had been briefed on the program to some level of detail.  Well, it is certainly true that Franken did not comment publicly on this topic until yesterday.  Why is that?  Because it was illegal for Franken to discuss it publicly. 

Section 215 of the PATRIOT Act modifies Section 501 (d) of the Foreign Intelligence Surveillance Act as to say:

“No person shall disclose to any other person (other than those persons necessary to produce the tangible things under this section) that the Federal Bureau of Investigation has sought or obtained tangible things under this section.”

Even worse, the briefings that lawmakers received on such programs were subject to unusually stringent security.  Lawmakers were not allowed to take notes, staffers were not allowed to attend, and per the provisions of the law stated above, the lawmakers were prohibited from talking about the programs.

So did Franken “hide” his knowledge of the programs?  No.  Did he do enough to push back?  The record on that is unclear.  Two Democratic Senators, Ron Wyden of Oregon and Mark Udall of Colorado, have been pushing the limits on these programs, obliquely hinting that there was something afoot.

Ortman seems to be suggesting that Franken should have done more.  Perhaps that’s true.  But one can only imagine if Franken had violated the law and revealed details of a classified national security program.  I sincerely doubt that Ortman would be saluting his whistleblowing — rather, she’d be crying about Franken putting our national security at risk.

Ortman goes on to make an additional charge:  namely, that the PATRIOT Act didn’t authorize such programs.  Unfortunately, Ortman provides no basis to back up her claims that have any merit.  And, sadly, she tap-dances around any of the direct questions asked of her — would she have voted for the PATRIOT Act and FISA modifications?  What is her argument for why these programs were prohibited?  Where was her outrage when these programs were authorized under a Republican administration? Does she think Franken should have broken the law and spread details of these programs?

While I haven’t attended the National Security Seminar, I can only imagine such brazenly partisan behavior probably isn’t considered in our nation’s best interest.  Let’s hope that if Ortman does run against Franken that she finds some lines of attack that aren’t based in distortions and falsehoods.

Here’s the entire exchange, so you can judge for yourself:

Get to the appoint: Chaska Ward 1 looking for a new councilor and other news

Chaska City Councilor Scott Millard resigned his seat effective at the end of the May 20 City Council meeting, and the Council has chosen to appoint a replacement to hold the seat through the end of Millard’s term.  The seat will be up for election in 2014.  Ward 1 residents who are interested in the position are welcomed to pick up an application package at City Hall (inexplicably, there’s no information on this process on the city website’s homepage).  Applications are due back by June 12, and applicants will interview with the Council on June 17.  The appointment will be made at the July 1 City Council meeting.  Don’t know if you live in Ward 1 (the southwest ward)?  Check out this map to see where to fall among the city’s four wards.  Per the Chaska Herald, former Ward 1 Councilor Gino Businaro has indicated he intends to apply.

In other news:

  • State Senator Julianne Ortman (R-Chanhassen) is attending the 2013 National Security Seminar at the U.S. Army War College this week.  Certainly such news can (and will) be viewed within the prism of other rumors.
  • Last week was a crazy week for politics in the Sixth Congressional District (which covers Carver and central and western Carver County) as both U.S. Rep. Michele Bachmann and DFL challenger Jim Graves pulled out of the 2014 race.  Former State Representative, current talk show host, and 2010 governor’s race loser Tom Emmer seems poised to jump in the race, making him the leading contender for the GOP nomination.  Meanwhile, no names have emerged on the DFL side thus far.  The Sixth is the strongest Republican district in the state, so there’s a thin bench of state legislators to pick from.  St. Cloud’s Tarryl Clark, who lost to Bachmann in 2010 before failing to secure the DFL nomination in the Eighth Congressional District in 2012, is sure to come up as a possibility.  State Auditor Rebecca Otto also lives in the Sixth, but is considered unlikely to run.  Graves would have likely stood a stronger chance to win the seat given the fundraising he’s already accumulated, which makes his decision curious.  Politicians who fear defeat are unlikely to make a difference in the long run, so perhaps Graves’s decision is less of a loss to Democratic hopes than thought.

It’s not news when the train doesn’t wreck

With the central element of the Affordable Care Act (ACA) — the health care exchanges — slated to go online in October, there’s been a lot of concern about how these exchanges will be implemented.  17 states (including Minnesota) have elected to build their own exchanges, 27 states are defaulting to the federal exchange, and seven states are doing a hybrid model based on the federal exchange.

Opponents of the law, naturally are going all gloom-and-doom on the implications (even going so far as to take a quote by Democratic Senator Max Baucus where he worried about a “train wreck” out of context to further their cause).

But what if it doesn’t turn out to be a train wreck after all?  There have been some interesting developments in recent weeks that lead one to believe that strong, proactive management of exchanges by states can lead to positive results.

In Maryland, the largest insurer in that state (Care First) proposed a shocking 25% increase in premiums for 2014, which was widely cited as a troubling statistic for the ACA.  But nearly every other insurer in the state has proposed premium increases below 10%.  Care First either stands to lose a significant amount of market share, or they’re going to have to lower their rates.

In California, meanwhile, proposed premiums on their health care exchange have come in significantly lower than predicted.  2009 Congressional Budget Office projections anticipated that a “silver” plan (one that covers 70% of expected health care costs) would have a yearly premium of $5,200, while an actuarial firm projected an annual premium of $5,400.  When the actual prices were released yesterday, the actual average yearly premium for a “silver” plan is going to be about $3,300, or 35% lower than the CBO projection.

Oregon’s health care exchange is seeing similar patterns to Maryland.  After releasing the costs for all of the plans that will be on its exchange earlier this month, two large insurers have asked to come back and lower their prices after discovering that some competitors were pricing the same coverage for less than half the cost.

Meanwhile, we’ve seen evidence that health care inflation has been slowing substantially.  Provisions of the ACA have contributed to this trend and further policies, such as increased use of competitive bidding for Medicare-paid medical equipment slated to roll out between now and 2016, should only continue it.

These sorts of things should provide us here in Minnesota with hope that our health exchange — named MNSure — will be able to deliver coverage to citizens at a reasonable cost.  Minnesota has always worked hard to give our citizens access to health care and that should only get better under the ACA.

From a political perspective, we too should also remember that what voters tend to value about these sorts of programs is the real-world impacts on their lives.  Opponents of Medicare thought that implementation problems (that did happen) would end up undermining the program and resulting in its repeal.  Opponents of Medicare Part D thought the same thing.  In both cases, what opponents of those programs discovered is that voters ultimately liked the fact that they were guaranteed health care as a senior citizen and that they liked programs that helped them pay less for their prescriptions.  Outright repeal of these programs today is essentially unthinkable.

Ultimately, I think we’ll find the fact that the ACA ensures that you’re always going to have access to our health care system in a reasonably affordable way is going to outweigh any implementation problems at the beginning of the program. In fact, if states that are actively managing their exchanges end up producing better results, it may become a political liability for states that have chosen to actively fight implementation of the law.  After all, if dysfunctional California can build a working exchange with lower-than-expected health insurance premiums, why can’t Texas?

[Image courtesy of the Alexandria Echo Press, is of a 1904 train wreck in Osakis.]

Ortman faces uphill climb in potential race against Franken

Public Policy Polling released the first detailed polling on the 2014 U.S. Senate race today.  It shows that U.S. Senator Al Franken is — as of today, anyway — in pretty good shape 17 months out from the election.

Franken currently holds a +9 in his job approval ratings (51% approve vs. 42% disapprove) which is a solid rating for an incumbent heading into a re-election campaign.  Franken also currently holds at least a 15-point lead against any of the possible challengers polled.  Businessman Mike McFadden (the only potential candidate who has publicly expressed interest in the race) and Hennepin County Sheriff Rich Stanek trail Franken by 15 points, while State Senator Julie Rosen trails by 16 and U.S. Representative Michele Bachmann, radio talk show host Jason Lewis, and Chanhassen’s own State Senator Julianne Ortman trail Franken by 17.

There’s not a lot of good news in the polling data for Ortman.  Ortman’s name recognition is low (80% didn’t know who she was), but among those who did know her, almost four times as many had an unfavorable opinion as had a favorable opinion.  Those numbers gave her the lowest favorability numbers among the potential candidates in the poll.  Worse, she had an unfavorable opinion among Republicans and self-identified conservatives who knew who she was.  Franken leads Ortman by 29 points among women and by four points among men (even though Franken polls -8 in job approval among men).  However, her low name recognition does give her the opportunity to introduce herself on her own terms to voters.

Numbers like these help explain why Ortman may have felt the need to take time from the end-of-session rush last week to try and blast Franken over the IRS investigations of Tea Party groups.  If she intends to run, she needs to drive name recognition and establish herself as a credible contender because based on the polling numbers and Franken’s formidable fundraising — it’s going to be an uphill battle.

Carver County House Vote Tracker – 2013

With the 2013 Legislative Session in the books, here’s a look back at how Carver County’s House delegation, Rep. Ernie Leidiger (District 47A – central and western Carver County), Rep. Joe Hoppe (District 47B – eastern Carver County), and Rep. Cindy Pugh (District 33B – northeast Chanhassen) voted on the key bills that the chamber took action on this year:

votetracker13

[CORRECTION, 5/21: Pugh voted “Yes” on the SF 541 Sunday sales amendment, not “No”.]

Data sourced from the House archive of roll-call votes.

It’s totally not about that

State Senator Julianne Ortman held a press conference today to try and finger U.S. Senator Al Franken for playing a role in the current controversy over the Internal Revenue Service (IRS) giving unwarranted scrutiny to certain conservative 501(c)(4) groups.

In 2012, Franken and a group of other Democratic Senators sent two letters to the IRS, requesting that they give added scrutiny to 501(c)(4) groups.  Both progressive and conservative organizations had been setting such groups up because they are tax-exempt and not subject to campaign finance disclosures.

You can see the letters at the links below:

February 2012 letter

March 2012 letter

In each, the Senators in question ask the IRS to scrutinize all 501(c)(4)s.  Ideology doesn’t come up in either letter.

So, let’s sum up the argument here.  Ortman is asking us to believe that the letters from 2012 which called for additional scrutiny to be applied to all 501(c)(4)s are significantly responsible for IRS misbehavior that began in 2010 and was actually uncovered and stopped after the letter was sent.  Not even the reliable conservatives at Powerline are buying that one.

Why, then, would Ortman go to the trouble of calling a press conference to highlight this non-news with no real relation to her role as a State Senator?  Oh, yeah:

When asked about such a thing, Ortman played the “who me?” card.

Uh-huh.  It’s totally not about that.

And let’s not forget that Ortman has never exactly been shy about sending letters of her own demanding action by other parts of government.  Earlier this session, she asked Attorney General Lori Swanson to break from usual practice and preemptively give a ruling on whether legislation was constitutional or not.  Last session, Ortman demanded that the Chief Justice of the Minnesota Supreme Court investigate the handling of family cases in the First District.

So it seems that Ortman’s outrage over legislative letter-writing is rather subjective.  Just remember, though, about those 2014 rumors:  it’s totally not about that.

Senate passes care workers unionization bill; House vote expected Saturday

The Minnesota State Senate voted 35-32 today to pass S.F. 778, which would enable independent day care operators and personal care attendants who serve customers that receive state subsidies to organize unions.  All Republicans in the chamber, including Sen. Julianne Ortman of Chanhassen, voted against the bill as did four DFL Senators (Terri Bonoff of Minnetonka, Melisa Franzen of Edina,  Greg Clausen of Apple Valley, and Bev Scalze of Little Canada).  The bill now moves to the House; which is expected to take up the bill on Saturday.  It appears that there are sufficient votes in the House to pass the bill, which Governor Mark Dayton has indicted he would sign.

Republicans in the Senate subjected the bill to 17 hours of debate, reflecting the highly controversial nature of the bill.  Unionization of such persons would be a different model than the traditional form of labor union, where employees organize and collectively bargain with their employers.  If the union were to be approved in this case, independent day care operators and personal care attendants — who generally function as small businesses of their own or independent contractors — would have a union to work on their behalf in St. Paul, bargaining with state agencies on work rules and regulations and lobbying legislators on reimbursement rates.  Care workers who provide services to clients that receive state subsidies but who vote against the union would be subject to “fair share” dues to cover a portion of the costs of the union’s representation as they would benefit from whatever changes the union negotiates.

Republicans have objected to the redefinition of the traditional union relationship introduced by this bill.  Additionally, they point out that in some cases AFSCME Council 5 — which is seeking to represent the day care workers — would end up negotiating with other AFSCME employees over work rules.

These are indeed valid concerns — and that’s coming from someone who generally finds themselves in labor’s camp on these sorts of issues.  The much-derided federal Employee Free Choice Act had a number of good reforms in it, for instance — such as equalizing the standards for certifying and decertifying unions and improving enforcement of certification elections.

But S.F. 778 feels like a step too far.

That’s not to say, though, that independent day care operators and personal care attendants don’t have valid concerns.  Day care subsidies were cut by 2% in the last budget cycle, passing increased bills to strapped working class families and forcing hard decisions on providers of day care services.  Personal care attendants, meanwhile, are besieged by low pay, long hours, and physically demanding work.  They deserve better from state government than what they have received in recent years.

DFL majorities in the Legislature should focus on passing those reforms into law this session as opposed to passing a bill that looks like political payback.  There’s no reason that we can’t increase reimbursement rates and address a number of the work rule issues that would be of great benefit to these vital workers.  And if Republicans come back in the future and want to undo those changes, it shouldn’t be politically difficult to hammer them for it.

[Picture is S.F. 778 author Sandy Pappas.]

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