2023-2024 Legislative Biennium
Coming off the heels of the 2022 election cycle, the Minnesota DFL Party won a “trifecta” going into the 2023-2024 legislative biennium, with the DFL holding the majority of seats in the House and Senate and DFL Governor Tim Walz winning re-election. Nurses were ready to build power with the newly elected pro-nurse majority to solve the crises of staffing, patient care, working conditions, recruitment, and retention that corporate healthcare executives created in Minnesota’s hospitals by putting profits before patients.
2023 LEGISLATIVE SESSION
Despite having a pro-labor majority at the Capitol, nurses discovered that the outsized power of corporate executives was alive and well in the halls of power. In the 2023 legislative session, nurses fought to pass the Keeping Nurses at the Bedside Act (KNABA), a bill that would have addressed the crisis of understaffing and retention in Minnesota hospitals. KNABA would have established nurse staffing committees to set staffing levels locally, helped eliminate patient boarding in Emergency Departments, required hospitals to post emergency room wait times, mandated more robust workplace violence prevention plans and training for all healthcare workers in hospitals, funded mental health grants for healthcare workers, and broadened RN student loan forgiveness.
Unfortunately, after months of moving through the legislative process, KNABA was ultimately killed in the final days of the 2023 legislative session due to anti-democratic tactics by anti-labor executives at Mayo Clinic who bullied legislators into a carve-out for Mayo Clinic, which would have made them the only hospital system in the state who would not have to comply with KNABA. The idea of exempting Mayo was unacceptable to too many legislators, leading to the bill no longer having the votes needed to pass. However, out of this bill came a new
bill—the Nurse and Patient Safety Act—which passed in the final hours of session.
The Nurse and Patient Safety Act (NAPSA) includes some of the nation’s strongest workplace violence protections for nurses, student loan forgiveness for nurses working in hospitals, childcare supports, and a workforce study on why nurses are leaving the bedside.
Parallel to the fight for safe staffing at the Capitol, nurses took on one of the biggest challenges to healthcare in Minnesota in 2023—the proposed merger of M Health Fairview and Sanford Health. Nurses’ voices in public meetings on the merger, at media events, and on social media created an incredibly powerful narrative about why the attorney general (AG), governor, and legislature needed to act in order to prevent the further consolidation of the Minnesota healthcare market and ensure that worker and patient needs were the center of this conversation. Nurses, in partnership with other healthcare workers, medical students, and farmers concerned about healthcare consolidation, provided the narrative that was needed in committee hearings and elsewhere at the Capitol to give Minnesota a chance of stopping the merger. As a result of this work, HF402 passed into law, creating new public interest requirements regulating healthcare mergers through enforcement by the attorney general. These new regulations ensure that a merger will not be allowed if it is detrimental to patients, workers, communities, and the state healthcare system. Worn down by constant pressure from nurses and the public, and facing increased scrutiny to prove the merits of their proposed merger under the newly passed regulations in HF402, the campaign to stop the merger culminated in late July 2023 when the CEOs of Sanford and Fairview announced they were calling off the merger after ongoing “opposition from certain stakeholders” – a huge win for Minnesota’s patients, communities, healthcare workers, and the healthcare delivery system.
While the 2023 legislative session ended without a staffing bill for nurses, the labor movement still achieved historic wins including Paid Family Medical Leave, Earned Sick and Safe Time for nearly all workers in Minnesota, new protections for public workers in the Union Freedoms bill, and more.
2024 LEGISLATIVE SESSION
The 2024 legislative session kicked off with leaders in both chambers indicating expectations should be measured considering the much smaller budget targets. With the DFL only having a one-seat majority to pass bills in the Senate, paired with last year’s unprecedented spending, legislative leaders made it clear to advocates early on that any legislative proposals this year that carry a price tag, particularly a large one, would be difficult or impossible to pass given their budgetary constraints. This included a particularly low budget target for all
health-related spending, meaning MNA would have to be thoughtful and strategic to advance any of our priority bills in 2024.
After the disappointments of the 2023 legislative session, nurses brought several bills forward as part of the Healing Greed Agenda during the 2024 session, aiming to put hospital executives in check to make our hospitals work for patient needs, not corporate greed. The plan included incentives and protections for nurses who stay at the bedside, efforts to shine a light on the lack of accountability in non-profit hospital financing, the creation of new transparency regulations if a health system plans to close a unit or reduce services in a community, requirements for tax-exempt hospitals to give back to the communities that exempt them from local taxes and provide them with millions in profits, and stopping the prioritization of pay raises for wealthy executives at the top.
In a year with many challenges from the get-go, nurses and healthcare workers did not achieve all we set out to, but we still had several significant legislative wins. This session we:
1. Secured $5 million in additional funding for RN Student Loan Forgiveness;
2. Created new Community Health Needs Assessment (CHNA) reporting requirements so that hospitals must prove that they are prioritizing community health in their budgeting and practices;
3. Ensured ongoing funding for the Adverse Health Events annual report;
4. Created a new law that will force hospitals to provide longer notice periods, and more detailed notice, before closing a unit or reducing/ relocating services;
5. Successfully advocated for an audit of hospital community benefit spending by the Office of the Legislative Auditor (OLA), which is currently underway. This audit will lead to a published report that will provide the public with more of a look at the reckless, profit-driven behaviors that
are damaging healthcare access, affordability, worker retention, and outcomes across the state;
6. Passed new regulations making it harder for a Health Maintenance Organization (HMO) to convert from a nonprofit to a for-profit entity and explicitly prohibits the state from contracting with for-profit HMOs to provide services to state employees or programs;
7. Worked in coalition with patient advocacy groups, labor unions, faithbased entities, and social justice organizations to pass into law new regulations protecting consumers from unfair medical debt collections practices.
We also successfully defeated, once again, the harmful Nurse Licensure Compact (NLC), despite hospital lobbyists continuing to aggressively push the compact as if it were a miracle solution to the broader list of healthcare workforce issues. MNA has long argued that the NLC is a false solution to the nursing workforce issues in our state, and would only weaken the nursing practice, create new patient risks, and serve as a union-busting tool for hospital executives.
Additionally, MNA worked in coalition in 2024 to fight off efforts by anti-labor corporate lobbyists who were advocating to water down the Paid Family and Medical Leave (PFML) law that was passed in 2023, and supported changes to the 2023 Earned Safe and Sick Time (ESST) law that will prohibit employers from forcing workers to draw down sick time from separate sick leave pots.
MINNESOTA’S HEALTHCARE LANDSCAPE
Over the biennium, it was clear that corporate healthcare executives continue to hold too much power over patients, nurses, and our political process. While we saw some steps forward in addressing the corporatization of healthcare crisis in Minnesota, we also continued to see the same hospital CEOs who refuse to solve the safe staffing crisis demonstrate their willingness to hold our elected official’s hostage to inaction.
Consistent, strategic action by nurses, patients, and healthcare advocates has led to wins in the fight against the corporatization of healthcare in Minnesota. Hospital executives will continue to donate to anti-nurse politicians, run ad campaigns against nurse priorities, and fund an outsized number of lobbyists to aggressively derail and kill labor and nursing priorities. Matching the power of corporate healthcare can be accomplished through true people power, with nurses and allies continuing to organize and stand up to corporate power at the bargaining table, at the Capitol, in our communities, and beyond. It’s time for hospital CEOs to be held accountable to patients, not profits.
MNA’s 2024 Legislative Allies
Throughout the 2024 Legislative Session, several legislators stood out as exemplary advocates for nurses’ legislative priorities. MNA’s Legislative Allies do not just “vote the right way” when a bill comes to the floor or committee that nurses and MNA care about — MNA’s strongest allies actively utilize their relationships and political capital to advance nurses’ priorities during the legislative session. To be designated as an MNA Legislative Ally a legislator must have gone above and beyond to fight for MNA’s legislation at the Capitol this year, including proactively engaging with colleagues or stakeholders to help pass our bills into law. MNA’s 2024 Legislative Allies are as follows:
Representative Emma Greenman (House District 63B, DFL – Minneapolis)
• Rep. Greenman was MNA’s biggest champion for an audit of certain hospital spending, a priority of MNA’s this session. This audit will be conducted by the Office of the Legislative Auditor (OLA), investigating what tax-exempt (“nonprofit”) hospitals are reporting as “community benefit” spending. Greenman’s support as a member of the Legislative Audit Commission was instrumental in including this in the five audit topics for the OLA to carry out.
• Rep. Greenman co-authored MNA’s Tax-Exempt Accountability Law proposal and has been a consistent supporter of MNA’s safe staffing efforts.
Representative Steve Elkins (House District 50B, DFL – Bloomington)
• As a member of the House Health Committee, Rep. Elkins was a co-author and fierce advocate for two of MNA’s priority legislative proposals in 2024: the Tax-Exempt Accountability Law (TEAL) and the hospital/unit closures notifications bill.
• Not only did Rep. Elkins engage fellow legislators to obtain support for our bills, but he was also a fierce supporter of MNA’s OLA proposal to audit “nonprofit” hospital community benefit spending, stepping up for nurses by engaging with and educating many of his colleagues to churn up support for the audit.
Representative Andy Smith
(House District 25B, DFL – Rochester)
• As the lead author in the House on MNA’s legislation to provide transparency and accountability around hospital or unit closures, as well as other service reductions or relocations, Rep. Smith was a fierce advocate for this legislation, fighting off attempts by hospital lobbyists to water it down and shield the big health systems from public accountability.
Representative Rick Hansen
(House District 53B, DFL – South St. Paul)
• Chair of the Legislative Audit Commission, Rep. Hansen led the commission tasked with garnering enough consensus from legislators from both the House and Senate (and equal members from both sides of the aisle) to agree on a list of topics for the Office of the Legislative Auditor (OLA) to conduct an audit on.
• Rep. Hansen’s leadership on the Legislative Audit Commission, his smart understanding of state programs and agencies, and his willingness to work with MNA helped lead MNA’s proposed audit topic
– an audit of community benefit spending at “nonprofit” hospitals – to be chosen as one of five topics selected out of nearly 100 proposed audits.
Senator Zaynab Mohamed
(Senate District 63, DFL – Minneapolis)
• Before the 2024 legislative session even started, Sen. Zaynab Mohamed was reaching out to MNA about how she could work with nurses to combat corporate power in healthcare. She became the lead author on MNA’s bill to expand student loan forgiveness for nurses, and worked closely with MNA and other labor unions as the lead author of legislation to make striking workers eligible for unemployment insurance (UI) benefits. While this legislation didn’t pass this biennium, Rep. Mohamed has committed to continue trying.
Senator Jim Abeler
(Senate District 35, GOP – Anoka)
• After MNA’s efforts to stop the closures at Unity/ Mercy and North Memorial failed to get the support needed from members of the House Health Committee to keep it alive, Sen. Abeler introduced an amendment on the Senate floor that would have required hospitals go through a public interest review, overseen by MDH, before they could close a unit, move beds, or reduce or relocate services. Although his amendment passed on the Senate floor in a bipartisan vote to be added into the Health omnibus bill, the two chairs of the Health Omnibus conference committee, Senator Melissa Wiklund and Representative Tina Liebling, did not include any version or portion of it it in their final omnibus bill.
Senator
Rob Kupec
(Senate District 4, DFL – Moorhead)
• Sen. Rob Kupec was the lead author in the Senate for MNA’s hospital closures, relocations, and service reductions bill that forces health systems to be more transparent about their plans to consolidate services. Not only did Sen. Kupec carry the bill for MNA, but he stood firm when hospital lobbyists and others came out in droves to kill or weaken the bill.
Senator Jen McEwen
(Senate District 8, DFL – Duluth)
• After a 2023 session where she fought until the last moment for MNA’s safe staffing legislation, Sen. McEwen picked up right where she left off by helping support many of MNA’s priority bills in 2024, including the Healthcare Employee Anti-retaliation and Labor Act (HEAL Act).
• Understanding the importance to nurses and other unions going into contract negotiations, McEwen worked hard with the lead author of the Unemployment Insurance for Striking Workers bill despite opposition from businesses, most Senate Republicans, and a few members of her own caucus who unfortunately bought into the misinformation and fearmongering of several employer groups.
