One of the major sticking points in the budget negotiations between DFLers in the governor's office and House and the GOPers in the Senate is the future of the "provider tax."
The provider tax has existed since 1992, created by the Legislature and then Gov. Arne Carlson to provide funding for MinnesotaCare, though it's now also used for other healthcare programs for low-income Minnesotans.
MinnesotaCare offers health coverage for those who either can't afford private insurance or don't get it from their employer, but earn too much to qualify for Medicaid or Medical Assistance.
The tax itself is a 2 percent levy on medical services provided by Minnesota's doctors, hospitals, opticians, psychologists, physical therapists, ambulance services and wholesale drug distributors, and more, with the taxes applied to the bills they charge patients for treatment/hospital stays etc.
MinnPost notes that 1.5 million Minnesotans benefit from the services the provider tax helps to pay for, and says that both Democrats and Republicans in the Legislature want to continue funding these programs.
They do however disagree over using the provider tax – which generates $600 million a year – to fund these programs, with state Republicans wanting to allow the tax to expire as scheduled at the end of 2019.
Democrats however want to renew it, with Gov. Tim Walz having pledged to sign its renewal if such a bill reaches his desk.
So what are the arguments?
Republicans, among them House Minority Leader, Rep. Kurt Daudt, dub the provider tax the "sick tax." They see renewing the planned sunset as a tax increase on Minnesotans who have private or employer-provided health insurance, who see the 2 percent tax tacked onto their medical bills.
They believe that with Minnesota continuing to produce budget surpluses, there is space within existing state coffers to cover the cost of the programs the provider tax pays for.
Republicans have suggested an alternative: taxing insurance claims paid by health plans and third-party administrators, so the tax would be levied on insurers rather than coming direct from Minnesotans' medical bills.
But if the tax does expire, there are no guarantees that the 2 percent tax reduction would be reflected in the prices charged by medical service providers.
Democrats, on the other hand, argue that renewing the tax isn't a tax increase given that it's been in place for 27 years, and that failing to renew it would leave a huge hole in Minnesota's finances in a few years' time.
"If this fund was to go away, we know that by the end of 2022 we would be in deficit," said Rep. Tina Liebling, the chair of the House health and human services finance committee, per MPR. "The problem there is that big expenses that are now being paid for would then have to be paid for by the general fund."
MPR also notes that Gov. Walz and Democrats see the loss of the provider tax as a potential blow for their hopes of offering a MinnesotaCare buy-in, which would see MinnesotaCare compete with other health insurers by offering a "public option" health plan.
Both the provider tax renewal and the proposed 20-cent gas tax hike are proving to be the major sticking points at least on the Republican side as both parties try to reach an accord before the end of the legislative session on Monday.
If no deal is reached by then, a special session would have to be called to figure out the next budget.