Mayo Clinic threatens to kill billions in state investment, if two health care bills pass

May 5—ROCHESTER — Mayo Clinic is threatening to reconsider planned construction projects in Minnesota "four times the size of the investment in U.S. Bank Stadium," if the Legislature and Gov. Tim Walz enact two statewide health care bills.

The threat was contained in an email from Kate Johansen, Mayo Clinic's vice chair of external engagement, to Walz and state lawmakers on May 3. The email had the subject line, "Mayo HHS Omnibus Concerns."

Johansen wrote, "The two proposals discussed — the Keeping Nurses at the Bedside Act (KNABA) and the Health Care Affordability Board — remain serious problems that require immediate attention and action."

The email was made public in reporting today by the Minnesota Reformer

.

Mayo Clinic asked for its facilities to be exempted from the KNABA requirements and to remove the "extremely problematic" Health Care Affordability Board proposal from the state's Health and Human Services omnibus bill.

The KNABA bill would require hospitals to form staffing committees that set the minimum staffing levels for those hospitals. At least half of the committees' membership must be made up of nurses and other direct care workers.

The Health Care Affordability proposal would establish a board to tackle rising health care costs by setting health care spending growth targets and making recommendations for legislative and market reform.

Both bills have been approved by the House and Senate as part of their separate omnibus bills. A

bicameral conference committee

has been established to find common ground between the bills before they are sent to the governor for his signature.

"The only path to maintaining this investment in Minnesota is to address these two bills as Mayo has suggested," Johansen wrote, referencing "significant facilities and infrastructure investments."

Mayo Clinic is Minnesota's largest private employer, with more than 48,000 people on its payroll.

Dr. Amy Williams, Mayo Clinic's chair of Midwest Clinical Practice, issued a statement on behalf of the Clinic.

She wrote, "At the heart of this is legislation we believe will negatively impact access to care and our ability to transform health care to support our staff and meet the evolving needs of our patients. Like any responsible organization, we must evaluate the legislative and regulatory environment in the places we operate.

"Mayo has been working to address these concerns for months and is committed to transparently sharing the impacts of these policy decisions. We will continue working with leaders on a bill that is in the best interests of patients, the State and Mayo Clinic."

Mayo Clinic previously has voiced its concerns to legislators about the Keeping Nurses at the Bedside Act.

In a written statement submitted to the Minnesota Senate Health and Human Services Committee in March, Mayo Clinic representatives wrote that the institution "supports certain provisions of the bill" but has "significant concerns with others."

"A complex committee structure that sets staffing ratios is not well aligned to meet the needs of staff or patients," the March statement reads. "It is also duplicative of current paths for nurses to provide input on staffing. Most importantly, it fails to solve the real problem — to retain and support our nurses, we need more nurses, not more committees."

The Minnesota Nurses Association, which supports the Keeping Nurses at the Bedside Act, is pushing back against what it describes as Mayo Clinic's "blackmail tactics."

"This desperate move by executives at Mayo Clinic Health System makes clear exactly why this bill is needed at Mayo facilities, and at every hospital in the state. Mayo executives have repeatedly demonstrated a disregard for transparency with patients, prioritizing instead their own corporate profit motives," wrote Minnesota Nurses Association President Mary C. Turner.

"The Keeping Nurses at the Bedside Act is designed to retain nurses and improve staffing to protect and improve patient care. Every patient, at every hospital in the state, deserves to know they will receive safe and high-quality care when they walk through the door of a hospital."

Sen. Erin Murphy (DFL-St. Paul), a registered nurse who authored the nursing bill in the Senate, has said the exception Mayo Clinic is seeking is unacceptable. Asked about Mayo's tactics threatening to pull billions in investment, Murphy said, "I don't deal in ultimatums."

"As a policymaker, as a leader for Minnesota, and as a registered nurse, my job is to keep working toward a solution. And that's what I'm going to do," Murphy said.

Giving Mayo an exemption from the nursing bill would prompt other hospitals to wonder why Mayo was getting a "special deal," Murphy said. More importantly, she said, "it would say that some hospitals, but not all hospitals, will be held to an important standard of safe patient care."

Murphy said she has asked for a meeting with Mayo leadership. While she is author of the nursing bill in the Senate, she is not on the conference committee that is working out differences between the House and Senate versions. She said she and Rep. Sandra Feist (DFL-New Brighton), the author of the bill in the House, have made "countless compromises" to create legislation to strengthen the bill.

State Sen. Liz Boldon, (DFL-Rochester) a nurse whose district encompasses Mayo Clinic, called Mayo Clinic's "blindside ultimatum very disappointing." She said backroom threats like the one issued by Mayo are why "many Americans feel disempowered by politics and believe that it serves corporate interests over the will of the people."

Boldon added that throughout the session, legislators have been working to improve health outcomes by working with an array of stakeholders, including patients, healthcare workers and hospitals. Mayo Clinic has been part of those discussions to craft policy that "addresses the conditions and issues facing our health care workforce."

Mayo has had "ample opportunity to bring their concerns to the authors of the legislation," and "significant changes have been made to accommodate them," she said.

"Mayo is a key partner in delivering healthcare to Minnesota, which is why the state and taxpayers have provided hundreds of millions of dollars through Destination Medical Center and other investments to support Mayo," Boldon said. "However, we will not and cannot allow private entities to have veto power over legislation that will help protect the health and well-being of Minnesotans and their ability to access affordable care.

"I urge Mayo to continue to work in collaboration with policymakers and not against them in that goal," Boldon said.

Reporters Matthew Stolle and Dené K. Dryden contributed to this report.

Good evening,

We wanted to follow up on the urgent issues Mayo Clinic has raised regarding extremely concerning provisions in the HHS omnibus bill. The two proposals discussed—the Keeping Nurses at the Bedside Act (KNABA) and the Health Care Affordability Board—remain serious problems that require immediate attention and action.

As we have shared previously, Mayo has long been planning significant facilities and infrastructure investments in Minnesota. The investments would be entirely from Mayo's resources and represent four times the size of the investment in U.S. Bank Stadium. They would result in excellent jobs for Minnesotans and, as promised by our contracting partner, the most diverse workforce on the project in state history.

Our Board was set to move forward to consider this investment next week. Because these bills continue to proceed without meaningful and necessary changes to avert their harms to Minnesotans, we cannot proceed with seeking approval to make this investment in Minnesota. We will need to direct this enormous investment to other states.

The only path to maintaining this investment in Minnesota is to address these two bills as Mayo has suggested:

Health Care Affordability Board

Removal

This bill is extremely problematic and poses a huge threat to the well-being of Minnesota's health care system as drafted. It must be removed from the HHS omnibus bill and consideration for Mayo to move forward with the previously stated investment. As we conveyed to its authors, Chair Wiklund and Rep. Reyer, we remain committed to discussing alternative approaches to achieve related goals during the interim. The bill's language is available in the Senate HHS omnibus at page 543 and the House HHS omnibus at page 52.

KNABA

Significant amendment

To be clear, this bill proposes antiquated and harmful policies that will reduce access to care and hurt patients. We also understand the political sensitivities surrounding the bill. We have negotiated in good faith with Rep. Feist and MNA and put forward an amendment that provides alternative paths to ensure MNA's stated objectives of nurse input and patient safety. The amendment Mayo shared weeks ago is attached here again.

For Mayo to move forward with the investment above, the bill must include a path to full exemption from the bill's requirements for systems, including Mayo's full system in Minnesota, that meet high standards as demonstrated by use of a software-based acuity tool incorporating nurse input, achievement of Magnet designation and/or critical access hospital designation. Adoption of this amendment is necessary for Mayo to proceed with its investment. Given the dynamic nature of other parts of the bill, Mayo would need to review the bill's final language following incorporation of the amendment language, too, to ensure the full exemption remained intact.