After months of behind-the-scenes meetings and a series of revisions that stripped out all but two of the main tenets of the legislation, the Health Care Collaboration Act limped out of the Senate on Wednesday.

House Bill 926, which would relax restrictions on how the University of Mississippi Medical Center strikes partnerships and buys equipment, faced bipartisan scrutiny from the moment it debuted in a House subcommittee back in January. The bill ultimately passed 36 to 9, with six senators voting present.

Given the number of obstacles the bill faced on its road to the Senate floor, Sen. Josh Harkins, R-Flowood, pleaded with his colleagues to pass the legislation as he presented it, stressing that only his preferred version of the legislation had received the long-awaited blessing of both Mississippi Hospital Association and UMMC.

“The response I had from the hospital association was that they wanted a clean bill; they wanted no amendments,” Harkins said. “They’re comfortable with the legislation as it sits before you right now… They’re satisfied with the language as it is.”

Advocates had said the legislation would “loosen the handcuffs” on UMMC, which, as a state agency, goes through a more detailed procurement process than private hospitals. But opponents, many of whom were legislators from districts with strong private hospitals, worried that the original legislation would give UMMC a leg up over smaller hospitals with provisions that eradicated anti-trust regulations and let it fund projects with bonds.

Although the Mississippi Hospital Association, a powerful lobby in the state, initially refused to take a public position on the legislation, they met privately over several weeks with lawyers for UMMC to revise the legislation.

The amended bill that debuted last week in the Senate Public Health Committee represented a significant departure from the all-encompassing legislation originally presented. But it also bore a seal of approval from both UMMC and the Hospital Association.

Many senators still seemed wary about the bill. Sen. Derrick Simmons, D-Greenville, grilled Harkins on some of the original legislation’s most controversial provisions, getting verbal assurance that they were no longer in the legislation.

“Does this bill do away with the anti-trust (provisions)?” Simmons asked.

“Yes, that’s been removed,” Harkins said.

“What about the laws regarding state sales tax?” Simmons said.

“That’s been removed, too,” Harkins said.

“And bonds?”

“All the bond language has been removed.”

Despite Harkins’s plea to leave the legislation alone, both Sen. Hob Bryan, D-Amory, and Sen. John Polk, R-Hattiesburg, offered amendments on the floor that garnered bipartisan support but were ultimately unsuccessful.

Bryan’s amendment, which narrowly missed at a vote of 23 to 26 against, would have reinstated a provision in the original legislation that extended some of the authority granted to UMMC to smaller community hospitals. Bryan argued that the amendment was unlikely to face opposition from either UMMC, which had included the language in their original bill, or the Hospital Association, which represented these smaller hospitals.

But Harkins pushed back, along with Sen. Joey Fillingane, R-Sumrall, both driving home just how tenuous some felt the amended legislation was.

“In your negotiations with all the parties involved, is this a very delicate balance? Would it be your understanding, the way it is now, it can go on to the House but that even if we add innocuous or non-offensive language, it could… kill the bill?” Fillingane asked Harkins.

Polk’s amendment concerned Disproportionate Share Hospital payments, which Medicaid pays to hospitals to compensate for the amount they spend on charity care. As the state’s only teaching hospital, UMMC receives a greater share of these funds than private hospitals, at a rate of nearly two to one.

Polk, whose district includes the large Forrest General Hospital, argued that the bill should be amended so that UMMC’s higher share of the funds wouldn’t extend to the new partnerships.

“Let’s say Forrest General wants to do a collaborative agreement with a county hospital, and UMC comes in there. If UMC knows they’re going to be able to get a double payment for uncompensated care, it does not make a level playing field when you’re negotiating a collaboration with the local county hospitals,” Polk said.

The amended legislation now moves back to the House to approve the changes or go to a joint negotiating committee.

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Larrison Campbell is a Greenville native who reports on politics with an emphasis on public health. She received a bachelor’s from Wesleyan University and a master’s from Columbia University's Graduate School of Journalism.Larrison is a 2018 National Press Foundation fellow in public health, a 2019 Blue Cross Blue Shield Foundation of Massachusetts fellow in health care reporting and a 2019 Center for Health Journalism National Fellow.