House committee advances health finance bill aligning state rules with HR1 after heated debate

The Minnesota House Ways and Means Committee voted 15–13 on April 29 to advance House File 44 66, a health finance and policy package that its authors say is necessary to align state program rules with federal HR1 requirements. Representative Berman moved the bill and said he would vote to advance the measure even though he described the bill as incomplete and warned it will reduce coverage for some groups.

"I will be a yes because this bill must get better for me to vote for it," Representative Berman said, urging the committee to send the measure to conference so changes can be negotiated.

Why it matters: Committee debate centered on the bill’s alignment with HR1, which members said will narrow Medicaid eligibility and add work or look-back requirements that could reduce coverage for groups including some noncitizen victims of trafficking and asylum seekers. Members warned the change could increase uncompensated care at safety-net and rural hospitals and raise premium costs.

Key votes and actions: The committee approved the bill as amended and referred it to the General Register by roll call, 15 yeas to 13 nays. Earlier in the meeting the committee rejected a large, bipartisan A9 amendment (described as 141 pages of child-care licensing and child-protection provisions) and the A11 amendment—focused on an all-payer/payer-claims data proposal—was withdrawn after questioning.

Financial impact: Fiscal staff told members the bill produces a small general-fund savings in the first biennium (just over $2 million for FY2026–27) and a larger projected savings in the 2028–29 biennium (about $98 million), figures that proponents said reflect alignment with federal policy.

Data sharing and privacy debate: A11 would have added language authorizing expanded use of payer-claims data. Vice Chair Scott repeatedly pressed Department of Health staff on whether de-identified datasets could be re-identified and whether penalties or contractual enforcement would prevent misuse. A Health Department witness, who identified himself as Stephen, Director of the Health Economics Program, said the agency will use contractual data-use agreements, an advisory vetting process, limited data elements and in-state secure research environments to reduce re-identification risk.

"There is an enforcement authority tied to [the data-use agreements]," Stephen said, adding that the state will monitor use and require destruction of datasets after approved research projects conclude.

Opposition and concerns: Several members, including Representative Frazier and others, said they would not support the bill because it implements HR1 provisions they view as harmful to vulnerable residents and rural hospitals. Others said the state risks large federal funding losses if it does not conform and urged advancing the bill to preserve the state's position in conference.

What’s next: With the committee’s referral to the General Register, HF 44 66 moves toward floor consideration and a conference process where authors and negotiators will seek changes. Committee chairs said they expect further work in conference and additional negotiation with the Senate on the contested provisions.

Votes at a glance: House File 44 66 (as amended) — Committee referral to General Register; roll-call tally 15 yeas, 13 nays.