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.

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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.

Mayo Clinic’s March 2023 letter to the Minnesota Legislature in response to the Keeping Nurses at the Bedside Act:

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