►
Description
No description was provided for this meeting.
If this is YOUR meeting, an easy way to fix this is to add a description to your video, wherever mtngs.io found it (probably YouTube).
A
B
A
We
appreciate
everybody
coming
either
here
in
the
district.
This
is
excuse
me.
Can
you
hear
me
we
can
dennis?
This
is
senator
pardon
I'm
here
in
my
district
in
my
home
office.
Thank
you.
Thank
you
senator
barrett.
Well,
we
have
good
attendance
either
in
the
room
or
in
their
district.
A
So
we
appreciate
everybody's
attendance
and
we
have
a
pretty
pretty
good
agenda
today
that
shouldn't
take
forever,
but
it'd
be
informative
information,
but
we
need
to
first
of
all
approve
the
minutes
from
august
the
3rd
2021
to
have
have
a
motion,
although
a
second
all
those
in
favor
signify
by
saying
aye.
Any
opposed
amendments
are
approved
if
you're,
if
you're
in
your
home
office,
working
or
in
your
district,
you
may
want
to
mute
your
line,
so
we
don't
hear
a
lot
of
background
noise.
A
A
I
have
to
harass
my
friend
there.
If
I
don't,
he
thinks
I'm
mad
at
him.
Miss
clark,
I
believe,
you're
up
first
on
our
agenda
to
update
us
on
long-term
care
insurance
rates
and
their
increases
are
you?
Are
you
there
online.
H
I'm
doing
fine.
Thank
you,
mr
chairman,
members
of
the
committee,
and
yes,
the
subject
matter
today
is
the
long-term
care
insurance
and
I'd
like
to
give
you
a
little
background
and
then
some
of
the
challenges
we're
facing
and
then
ironed
issue
to
another
individual
with
the
department
who
can
get
into
the
more
technical
aspects.
Long-Term
care
insurance
has
been
a
product
on
the
marketplace
now
for
about
40
years,
and
it
has
proven
to
be
a
challenging
economic
and
actuarial
element.
H
H
Kentucky
joins
our
sister
states
and
seeking
solutions
to
bring
about
more
consistent
and
equitable
approaches
to
premium
rate
increase
request,
but
we
also
need
to
consider
policyholders
and
the
financial
choices
that
they
have
to
make
our
national
association.
The
naisc
has
also
submitted
proposals
to
congress
for
assistance
to
these
policyholders.
H
One
such
proposal,
which
is
allowing
for
plan
participants
to
purchase
long-term
care
with
their
401
k
funds
with
no
tax
penalties,
is
one
that
has
been
introduced
in
congress.
There's
several
challenges
facing
this
industry
pricing
is
a
major
factor.
It
involves
longer
life
spans,
increasing
care
costs,
the
underpriced
legacy
policies
and
the
actuarial
assumptions.
H
So
mr
dillon
dave
dillon,
who
is
with
contract
actuary
with
the
department
with
the
firm
lewis
and
ellis,
is
the
actuary
that
has
reviewed
the
rate
filings
that
have
been
submitted
for
a
transamerica
in
particular,
which
I'm
sure
you're
familiar
with.
H
D
Thank
you,
commissioner,
thanks
again
for
inviting
me
to
this
committee.
It's
not
always
the
most
fun
conversation,
but
I
appreciate
the
opportunity
again.
I
do
have
some
slides.
I
don't
know
if
I
need
to
share
my
screen
or
if
those
are
available,
I
can
go
ahead
and,
let's
see,
let
me
just
go
ahead
and
share
my
screen
all
right.
D
D
Okay,
you
guys
got
it.
You
see
that
all
right
so
thing
about
long-term
care
is
the
the
first
graph
is
the
very
simplistic
description
of
long-term
care
and
and
how
actuaries
price
it,
and,
and
in
the
very
top
graph
kind
of
that
that
flat
line
is
the
premium
right.
The
hope
was
to
have
a
flat
premium
and
but
the
claims
cost
increase
right.
So
when
someone
buys
a
policy
at
age,
60
they're
not
expecting
to
have
many
long-term
care
costs.
D
So
that's
why
that
the
claims
line,
the
kind
of
the
light
blue
line
is
underneath
the
premiums
and
it
increases
as
you
age.
Obviously
now
I
I
think
I
said
this
two
years
ago
and
I
got
funny,
looks
then
I'll
probably
get
some
funny
looks
now
that
graph
right
there.
I
had
three
semesters
in
college
on
that
graph.
That's
how
obviously
there's
a
lot
behind
those
those
rather
simplistic
looking
lines,
but
there's
a
lot
of
actuarial
math
behind
that
stuff
and
some
of
that
actuarial
math
is
kind
of
illustrated
in
the
graph
below.
D
So
we
just
talked
about
how
premiums
are
flat
and
insurance
carriers
collect
money
that
they're
not
going
to
spend
for
a
while?
Well,
they
obviously
can't
just
go
spend
that
money,
because
they
have
to
have
it
available
to
pay
for
claims
later
and
that's
what
in
this
bottom,
we
call
the
reserves
build
so
they're,
building
up
the
reserves,
they're
taking
that
excess
of
premium
over
claims
and
they're
holding
it
until
they
have
to
release
the
reserves
or
pay
for
claims,
20,
30,
40
years
down
the
line.
D
Now
the
deal
with
long-term
care
when
it
was
a
new
product,
as
commissioner
clark
mentioned
40
years
ago,
is
unfortunately
the
pricing
was
wrong.
We
missed
it.
We
missed
that
graph
and
we've
been
paying
for
those
sins
ever
since,
and
that's
kind
of
what's
gotten
us
to
to
this
conversation.
So
what
what
went
wrong?
Well,
there's
a
misestimation
on
how
much
income
that
insurers
would
get
from
investments
that
also
help
collect
money
to
pay
for
future
claims.
There
are
simplistically
points
two
and
three
here
simplistically.
There
are
more.
D
D
It
was
missed
at
the
beginning
and
we're
still
dealing
with
it
today
and
this
graph
kind
of
shows
the
importance
of
addressing
those
problems
as
quickly
as
possible.
So
what
this
is
showing.
So
you
know
if,
in
year
five-
let's
say
you
know,
some
things
are
missed.
Your
claims
are
higher
than
you
expected
the
lapse
rate,
which
you
know
how
many
people
are
still
there
was
off.
These
are
the
rate
increases
in
that
first
column.
You
know,
seven
eight,
ten
percent
is
what
you
would
need
to
correct
that
problem
after
year.
D
Five
well
part
of
the
problem
is
after
five
years.
I
showed
you
that
graph
earlier
there's
a
pretty
big
gap
and
we're
not
expecting
a
whole
lot
of
claims
in
year.
Five
right,
it's
still
say
someone
bought
it
at
age,
50.
Well,
now,
they're
55.
We
still
don't
expect
them
to
have
many
claims.
So
it's
kind
of
hard
to
know
if
you're
wrong,
and
so
while
year
five
would
be
great.
We
would
only
need
a
eight
to
ten
percent
increase.
D
It
is
really
hard
to
know
that
you're
off
in
year
five,
because
everyone
is
still
young
and
you
don't
know
how
many
people
are
going
to
be
there
25
years
from
now.
But
what
this
table
demonstrates
is,
if
you
do
wait,
if
you
don't
act
early,
those
rate
increases
can
can
be
very
high
and
if
all
of
these
three
very
simplistic
scenarios
happen,
you
know
it
could
be
90
increase
or
more
now.
So
what
is
long-term
care?
You
know
what's
naic
doing
about
long-term
care.
D
As
I
said,
you
know,
one
of
the
kind
of
issues
with
insurance
and
not
just
long-term
care
is
what
happens
when
an
insurer
is
wrong.
Who
who
kind
of
takes
the
hit?
Well,
there
are
different
classifications
of
insurance,
there's
what
we
call
non-tankable,
there's
guaranteed
renewable
there's,
optionally,
renewable
and
there's
kind
of
different
rules
depending
on
the
type
of
policy,
but
simplistically
the
insurance
company
does
not
take
the
false
hit.
They
just
don't
get.
They
don't
absorb.
D
All
of
those
losses
very
simplistically,
the
reason
why
is
if
they
absorb
all
of
those
losses
there
won't
be
an
insurance
company
to
be
around
to
pay
the
claims.
Okay,
their
long-term
care.
It
was
missed
so
much
that
there
were
some
severe
solvency
issues
and
there
were
a
lot
of
companies
that
went
out
of
business
because
of
that
miss
and
so
but
then
they
insured,
the
consumer
doesn't
take
the
full
hit
either
right.
You
know
the
insurer
needs
to
take
some
risk.
It's
not
a
risk-free
product.
D
Well,
so
the
nic
has
different
committees
to
help
with
this
process
of
figuring
out.
You
know
what
is
right,
what
to
do
at
the
state
level,
so
I'll
quickly
just
go
through
this,
but
the
nic
is
definitely,
you
know,
there's
a
lot
of
different
subgroups
and
things
that
work
with
long-term
care
and
the
rate
increases.
D
Now,
as
I
mentioned,
you
know,
this
is
a
relatively
new
product.
It's
only
30
40
years
old
and
there's
been
a
lot
of
variations
on
how
it
was
priced
and,
as
I
said,
kind
of
the
original
which
we
got
wrong
was
based
on
a
lifetime
loss
ratio
of
sixty
percent,
which
is
basically
for
a
hundred
dollars.
A
premium.
D
The
consumer
or
the
insurer
would
expect
to
pay
sixty
dollars
in
claims
and
then
the
other
stuff
is
for
comm.
You
know
administration
expenses
and
things
like
that.
Well,
as
I
said
they
got,
it
got
wrong,
and
so
then
the
next
step
was
what
we
call
rate
stabilization.
D
I
don't
need
to
go
through
the
details
here,
but
it's
basically
a
way
to
maybe
to
make
the
front
end
pricing
a
little
bit
more
conservative.
So
hopefully,
if
things
go
wrong,
it
doesn't
go
so
badly.
You
need
big
rate
increases
and
then
there's
other
variations.
There's
some
a
new
model,
that's
being
voted
on
now
in
a
lot
of
states
and
a
few
states
have
approved
it's
just
with
different
alternatives:
different
margins,
different
protections
for
consumers.
D
So
there's
a
lot
again.
So
really
what
it
comes
down
to
is
carriers
got
it
wrong,
and
now
the
state
insurance
departments
have
to
review
the
data,
assess
what
is
a
reasonable
and
appropriate
rate
increasing.
What's
the
balance,
and
unfortunately
there
there's
not
one
answer
that
everyone
has
right,
and
these
are
just
kind
of
a
list
of
different
approaches
that
we
use
to
help
assess
what
is
a
reasonable
rate
increase.
D
You
know
we
we
just
look
at
you
know
I
think,
to
see
here
the
prospective
present
values,
one
of
the
key
ones-
and
you
may
hear
me-
call
it
kind
of
the
texas
approach
later
texas
and
minnesota
have
kind
of
devised
a
couple
approaches
that
are,
I
wouldn't
necessarily
call
them
standards
yet,
but
everyone
kind
of
always
looks
at
them
and
the
texas
is
prospected.
So
it's
like
okay,
let's
kind
of
forget
what
happened
in
the
past.
D
We
know
it's
gone,
let's
just
make
sure
it's
right
looking
forward
and
that's
a
big
one
and
then
we
look
at
you
know
we
can
tap
the
increases.
You
know
blend
the
increases,
there's
all
sorts
of
ways
we
could
try
to
mitigate
the
increases,
but
but
also
again
focusing
on
that
solvency
is
a
big
consumer
protection.
You
know
the
insurance
department
is
charged
with.
So
that's
always
in
the
back
of
our
mind
too,
when
we
look
at
these
rate
increases.
D
So
here's
some
other
things.
You
know
the
landing
spots
is.
It
is
really
an
important
one
now
and
we'll
talk
about
this
a
little
bit
more
when
we
get
into
the
transamerica
filing
specifically,
but
basically,
a
lot
of
the
old
policies
were
really
rich
in
benefits.
D
You
know,
if
you
want
to
simplistically
call
them,
they
were
cadillac
plans.
When,
probably
you
know
just
a
regular
old
chevy
would
work
well.
What
these
landing
spots
are
is:
okay,
let's
reduce
the
rate
increase,
but
we're
also
going
to
take
away
your
cadillac
and
we'll
give
you
a
chevy.
It
should
be
great.
It's
going
to
cover
a
lot
of
what
you
really
need.
It's
not
over
insuring
you
you're
not
paying
for
what
you
may
not
need.
D
Now,
I'm
going
to
transition
to
just
some
quick
metrics
on
the
kentucky
department
of
insurance
and
and
long-term
care
rate
increases.
Lewis
and
ellis
has
worked
with
the
department
for
about
10
years.
11
years
on
these,
and
and
this
data
not
only
shows
kind
of
the
kentucky
information,
but
it
is
based
on
nationwide
it
compares
kentucky
versus
nationwide
and
basically
the
thing
to
focus
on
here
is
in
the
top
row.
D
D
So,
for
example,
if
I
look
at
like
a
20
to
40
percent
rate
increase,
you
know
they
we're
we're
approving
versus
requested,
so
we're
cutting
it
about
23
for
a
40
to
60
percent.
We're
cutting
it
in
half
and
80
to
100
above
80
is
about
a
third
again
30
to
40,
so
significant
reductions
over
the
last
10
11
years
on
the
submitted
rate
increases
now
specifically
on
the
transamerica.
D
The
transamerica
filing
is
very
similar
to
what
we
see
in
other
in
other
filings.
You
know
some
pretty
good
increases
and,
as
I
alluded
to
earlier,
transamerica
specifically
the
kentucky
retirement
teachers
group
did
have
very
rich
benefits.
Okay
and
and
what
does
that
mean?
Well,
you
get
paid
for
a
long
benefit
period
time,
a
lot
of
cost
of
living
adjustment.
So
if
you
bought
a
hundred
dollar
per
day
policy
that
will
increase
so
it
may
be
200
300
a
day.
D
You
know
20
30
years
from
now
now,
when
these
rates
were
submitted
by
transamerica,
they
asked
for
a
flat
61,
and
that
basically
means
every
policy
that
was
covered
in
these
four
in
four
blocks
of
business.
Was
they
asked
for
a
61?
D
Well,
there's
a
lot
going
on
underneath,
and
so
we
we've
started
by
asking
okay,
let's
break
that
down
by
the
four
specific
blocks
in
the
rate
increase.
If
you
look
at
this
table,
the
krta
is
the
kentucky
teachers
association,
and
you
can
see
that
it
is
the
largest
of
of
the
blocks
here
and
but
we
want.
You
definitely
want
to
break
it
down
by
the
block
and
by
the
benefit
period
which
I'll
I'll
show
next.
D
So
this
breaks
down-
and
this
is
very
important
to
the
level
of
the
rate
increases.
If
you
look
at
the
krta
column,
you
can
see
that
63
or
two
thirds
of
the
block
again
this
goes
to
that
richness
of
the
benefit.
63
of
the
block
has
inflation
protection,
so
the
daily
benefit
increases
and
it's
a
lifetime
benefit.
D
You
know,
so
you
can
see
that
some
of
the
other
box
and
some
of
the
other
teachers
you
know
they
may
have
a
limited
benefit,
and
this
is
very
important
because
of
the
exposure
to
the
company
and
because
of
the
benefits
that
are
being
paid,
and
it
goes
to
the
flat
61
percent.
Is
that
appropriate
for
all
of
those
sub-pieces?
D
So
what
we
look
at
here
is
kind
of
the
losses
on
these
blocks
so
and
loss
ratio.
I
mentioned
earlier
in
the
conversation
that
60
loss
ratio
is
what
most
companies
expected,
and
it's
really
turning
that
to
about
a
hundred
percent
loss
ratio,
so
they
get
they
charge
a
hundred
dollars
a
premium.
They
have
to
pay
a
hundred
dollars
in
claims
and
then
that
doesn't
even
account
for
their
admin.
Expenses
and-
and
things
like
that,
so
with
the
relatively
flat
there's
a
few
variations
here
by
block,
but
for
this
total
transamerica.
D
This
is
pretty
detailed
graph,
but
it
and
you
don't
need
to
worry
about
some
of
the
numbers
in
here,
but
it
just
shows
that
there's
a
lot
of
different
approaches
that
we
use
actually
speaking
to
it,
set
the
block
and
this
kind
of
shows
some
of
the
the
ranges
of
things
and
different
approaches.
We
looked
at.
I
mentioned
that
texas
method
earlier,
which
is
kind
of
a
forward-looking
thing,
but
I
also
talked
about
there's
rate
increased
mitigation
offers.
You
know
how
you
know,
reducing
the
benefit
you
know
cutting
back.
D
D
That
kind
of
thing
you
know
we
mentioned
rate
guarantees
is
a
very
common
approach
to
rate
increase
mitigation
and
then
there's
a
buyout
option
on
this,
which
is
a
kind
of
a
new
thing,
is
basically
you
get
75
of
the
estimated
value
of
your
policy,
which
is
an
actually
calculated
number
and
you
could
walk
away
from
this,
never
get
future
increases
and
you
get
75
of
the
estimated
value.
D
D
So
a
very
significant
cut
there
and
the
the
very
important
things
to
point
out
is
there's
also
a
10-year
rate
guarantee
on
this.
So
after
implementation
of
this
40
in
this
15,
consumers
will
not
get
another
increase
for
10
years,
which
is
significant,
because
this
is
a
senior
population
and
10
years
is
a
very
significant
period
of
time
for
them.
So
that
is
it.
That
is
the
end
of
my
prepared
remarks
and
I
will
stop
the
share
any
questions.
C
Thank
you,
mr
chairman,
and
thank
you
for
your
presentation.
Obviously
this
is
an
area
of
interest
to
me.
I
do
a
lot
of
care
in
long-term
in
long-term
care
industry
and
I've
received
some
emails
from
constituents
who
were
concerned
about
their
rates
almost
quadrupling
in
the
last
little
bit
I
mean
they
had,
I
think,
a
premium
about
800
a
month
and
it
went
to
1600
under
3200,
saying
it's
unaffordable,
I've
paid
in
for
this
many
years.
C
I
can't
afford
it
going
forward.
We
had
doi,
take
a
look
at
it
and
had
some
responses
to
it.
So
I'm
looking
forward
to
the
other
presentation.
That's
coming,
I
guess
some
of
the
things
that
I
think
we
need
to
probably
be
educated
on.
Is
you
know
we're
saying?
Okay,
what
we're
offering
for
premiums
isn't
isn't
enough.
You
have
to
increase
those.
Obviously
I
think
that's
related
to
cost.
C
D
Yeah,
so
that's
that's
a
great
question
and
I'm
going
to
try
to
answer
that
kind
of
breakdown.
The
word
cost
a
couple
different
ways,
so
I
from
a
let's
say,
going
into
a
retirement
facility
or
a
nursing,
home
or
whatever
and
in
terms
of
the
increase
it
costs
there.
Yes,
there
are
some
increase
in
costs
there,
and
that
could
be
just
regular
inflationary
issues,
but
I
will
say
from
a
long-term
care
cost
aspect:
it's
really
not
necessarily
the
daily
benefit
that
is
given
that's
causing
the
premium
increase.
D
It
really
is
they're
just
way
more
people,
it's
really
the
lapse
in
mortality,
so
it
is
that
has
been
the
most
significant
and
and
I've
seen
these
numbers
in
the
past,
and
I
I
don't
remember
the
exact
number,
but
if
you
don't
that,
don't
hold
me
to
it
numbers
probably
80
of
the
increases
are
due
to
lapses
and
improving
mortality
and
things
like
that,
where
the
pure
just
like
cost
of
the
service
is,
you
know,
20
or
much
smaller
piece,
and
so
it
is
hard
to
make
that
up
on
old
policies
and
that's
what's
happening
here
is
we're
trying
to
find.
D
You
know
there's
no
good
solution,
we're
trying
to
find
a
passable
solution
now
newer
policies,
as
commissioner
clark
mentioned,
there
aren't
a
whole
lot
of
newer
policies
out
there,
but
now
that
we've
had
this
experience
of
40
years,
we
can
at
least
understand
the
lapses
now
way
better
than
we
did
before
and
mortality
and
so
most
of
the
new
policies
out.
There
have
corrected
for
this
issue,
because
now
we
have
data,
but
it
it
is
hard
to.
You
know
correct:
for
those
past
cents.
C
If
I
may,
mr
chairman,
so
I
know
your
perspective
probably
comes
from
a
national
one,
I
would
imagine
specific
to
kentucky,
because
I
think
our
reputation
for
longevity
isn't
exactly
very
good.
We're
trying
to
improve
that
our
mortality
rates
are
higher.
Life
expectancy
is
a
bit
lower
than
the
national
average
so
specific
to
kentucky.
C
I
know
I
talk
to
a
lot
of
the
folks
that
are
in
the
long
term
care
space,
and
their
comments
are
typically
that
you
know
when
they
look
at
costs,
particularly
things
like
liability
costs,
43
of
their
costs
for
20
different
states.
43
of
those
costs
occur
right
here
in
kentucky,
and
so
I
guess
that's.
My
question
is
you're.
Looking
at
it
from
a,
I
think,
a
bit
of
a
more
international
we're
more
focused
on
our
state.
C
D
Yeah,
so
the
kentucky
specifics
up,
so
we
do
review
long-term
care
increases
in
other
states,
and
I
would
say
some
of
those
states
are
similar.
You
know
other
southeastern
southern
states
and
some
are
not-
and
I
would
say,
generally
speaking,
the
rate
increases
for
kentucky
are
fairly
comparable
to
other
states.
It's
not
worse,
it's
not
significantly
worse.
There
may
be
some
policies
and
some
insurers,
where
the
kentucky
specific
experience
is
worse,
but
I
think
that,
generally
speaking,
some
of
those
differences
you
mentioned
were
accounted
for
in
the
initial
premiums.
D
You
know
so
so,
maybe
at
the
very
beginning,
minnesota
was
100
and
kentucky
was
120
because
of
the
issues
that
you
mentioned,
but
they've
both
increased
at
the
same
level.
So
it's
not
necessarily
so.
The
rate
increases
are
approximately
the
same
across
the
country
because
some
of
those
variations
were
accounted
for
initially.
C
So
to
that
end-
and
I
came
to
chairman-
I
appreciate
the
your
your
latitude
on
this
and
again
to
you.
That's
I'd
like
to
see
that
data.
I
know
you're
speaking
in
generalities,
but
I'd
like
to
be
able
to
see
if
you're
saying
hey,
our
costs
are
20
higher
from
the
baseline
compared
to
other
states.
That's
important
for
us
as
kentuckians
to
know
is
so
hey.
The
rate
of
increase
is
the
same
because
I
think
it's
being
spread
out
nationwide,
but
just
like
healthcare
policies.
C
You
know,
if
someone
here
in
kentucky,
if
you
have
a
higher
rate
of
heart
disease
and
diabetes,
and
that
sort
of
stuff
health
costs
are
higher
from
their
baseline
compared
to
neighboring
states.
I'd
like
to
see
that
those
numbers,
if
you
can
somebody
could
break
that
down
for
us
to
say
here's
what
kentucky's
baseline
rates
are
compared
to
minnesota
compared
to
utah
compared
to
neighbors
and
the
other
question
I've
got
also
if
this
is
a
state,
I
don't
know
how
we
compare
in
terms
of
dementia
rates.
C
I
mean
obviously
there's
certain
diagnoses
that
are
more
likely
to
wind
you
up
in
a
long-term
care.
Setting.
Does
that
affect
the
rates
that
are
based
here
in
kentucky
as
well?
I
mean,
if
there's
somebody,
let's
say
in
your
family:
if
I've
got
my
grandparents
and
my
parents
have
all
had
dementia
and
the
odds
are
I'm
going
to
have
it
too
genetically
and
I
say
hey,
I
want
a
long-term
care
insurance
plan
because
I
probably
will
wind
up
in
a
long-term
care
institution
for
my
disease
state.
C
Does
that
naturally
give
me
a
higher
rate
compared
to
other
people
who
might
be
buying
one
just
just
in
case
they
have
a
problem
going
forward.
So
there's
two
questions
there.
I
guess
is
what
you
know:
how
does
our
state
compare
to
other
states
in
terms
of
their
baseline
costs
and
then,
if
you
have
a
diagnosis
that
would
lend
you
to
be
more
likely
to
be
admitted
to
a
place?
Does
that
reflect
a
higher
cost
for
them
as
well.
D
Yeah,
so
I
I
went
through
some
of
those
tables
pretty
quickly
in
my
presentation
and
I
kind
of
glossed
over
it,
so
I
could
get
to
all
of
them,
but
some
of
those
tables
did
cut
kind
of
show.
I
only
picked
some
kind
of
the
averages
across
all
the
filings,
but
it
does
show
that
kentucky
is
kind
of
in
that
normal
range
and
we
can.
We
can
provide
and
break
down
that
information
further.
I
I
have
those
kind
of
those
metrics
by
state,
so
you
can.
D
You
can
see
that
and
to
your
second
point
in
terms
of
dementia,
I
do
not
know.
I
do
not
have
that
information,
let's
say
separated
between
dimension
non
dementia
claims.
However,
I
will
say
you
know
some
of
the
earlier
policies.
D
You
know
you
could
underwrite
right,
so
you
could
kind
of
medically
underwrite
and
at
the
beginning,
yes,
you
probably
would
if,
if
there
was
any
signs
of
that,
then
the
premiums
may
be
higher
on
the
on
the
onset
now
moving
forward.
You
cannot
like
post
claim
underwrite.
You
cannot
adjust
claims
differently
after
the
policy
is
issued,
so
there
there
should
be
no
differences
after
that.
E
Thank
you,
mr
dylan,
for
this
timely
presentation.
I
want
to
thank
the
chairman
for
putting
on
the
agenda,
there's
probably
no
bigger
questions
from
more
frequent
questions
from
my
constituents
about
insurance
and
their
problems
with
long-term
care
facility
insurance.
I
know
from
personal
experience
when
you
buy
one
of
these
policies.
E
I
don't
know
you,
don't
read
the
fine
print
and
they
lead
you
to
believe
that
the
premiums
will
not
go
up
after
you
initially
purchase
it.
I'm
curious
because
I
know
the
two
I'm
familiar
with
is
a
five
year
and
a
three
year
and
I'm
curious
if
what
the
the
insurance
industry
or
what
you
recommend
as
far
as
a
length
of
time,
three
five,
maybe
there's
a
time
longer
than
that
I've
never
heard
of
it
that
does
better
or
it
seems
to
be
working
out
better
for
customers
and
companies.
D
Yeah,
no,
no,
and,
as
I
kind
of
alluded
throughout
the
presentation,
is
we're
finding
that
the
lifetime
benefit
is
probably
needed
and
it's
probably
too
expensive,
and
so
that's
why
the
reductions
on
newer
products
have
come
down.
The
benefit
periods
have
come
down.
I
I
think
right
now,
most
sales
are
in
that
five-year
benefit
period.
I
think
you
know
there's
with
long-term
care.
D
I
I
think
there
there
is,
I,
I
guess
I'm
kind
of
hesitant
to
say
this,
but
that's
kind
of
becoming
the
sweet
spot
where
most
people
are
purchasing
and
that's
where
most
of
the
benefit
periods
are
now
and-
and
I
will
also
I'm
going
to
react
to
you.
Your
first
comment
that
you
know
the
policy
farms
and
the
contract
language,
and
you
know
the
rate
increase
and
how
often
that
is
also
that
is
very
tricky
in
terms
of
consumers.
D
Thinking
that
you
know
they're
going
to
stay
and
that
so
that
you
know,
there's
not
going
to
be
increases
or
you
know
I've
got
an
increase,
aren't
going
to
be
any
more.
So
that
is
something
industry-wide.
That
is
definitely
a
focus
now
as
well
in
terms
of
trying
to
modify
the
language
moving
forward.
So
it
is
clear
what
is
allowed
and
what's
not
allowed.
E
Yes,
thank
you,
mr.
E
J
E
D
J
J
E
D
That's
a
great
point,
and-
and
that
was
something
that
I
I
almost
said
and
didn't
say
in
an
answer
to
the
previous
question-
that
is
something
that's
being
considered
yet
right,
but
more
of
the
kind
of
the
family
care
earlier.
You
know
in
that
transition
stage.
There
is
no
question
that
is
going
on
now
and
I'll
speak
for
myself,
my
mother's
80.
She
just
moved
into
a
facility
about
you
know
a
year
year
and
a
half
ago,
and
we
did
have
that
transition
period
where
we
had
other.
D
F
Thank
you,
mr
chairman,
is,
is
this
open
for
questions
for
the
commissioner
also.
F
Okay,
commissioner
clark,
this
is
for
you,
if
you
could
answer
it
for
me.
The
experience
that
I've
had
with
long-term
care
in
my
area
has
been
the
concern
with
a
lot
of
them
losing
their
homes
losing
their
assets
because
they
were
attached
and
they
didn't
realize
a
lot
of
families
didn't
realize
at
the
time
that
that
first
is
what
goes
before
medicaid
kicks
in
and
if
I'm
wrong
on
any
of
this,
you
you
can
straighten
me
up
because
I'm
used
to
that
part
of
it.
F
But
that's
the
biggest
concern
that
I
have
in
my
area
is
the
awareness
that
these
long-term
care
facilities
can
attach
their
assets,
cause
them
to
lose
their
homes,
cause
them
to
sell
it,
and,
if
that's
correct,
could
you
address
that?
Is
that
a
is
that
a
standard
procedure
in
long-term
care
that
their
first
move
on
somebody
that's
in
the
facility
is
to
attach
their
assets.
H
Well,
sir,
it
you
know
that
that's
really
kind
of
a
tax
question,
and
that
certainly
is
not
my
area
of
expertise,
but
it
is
my.
You
know,
understanding
that
those
assets
that
are
available
are
taken
advantage
of-
and
you
know
like
long-term
care-
is
like
any
type
of
insurance.
It's
you
know,
people
are
buying
it
to
try
to
protect
themselves,
but
with
the
cost
of
average
cost.
H
I
think
is
well
over
a
hundred
thousand
dollars
a
year
for
a
nursing
home
or
a
long-term
care
facility,
and
that
is
certainly
a
financial
strain
for
anyone.
F
Quick
follow-up,
mr
chairman,
it
was
my
understanding
when
we
passed
the
budget
last
time
that
there
was
an
additional
revenue
for
long-term
cares
per
day.
Is
that
right.
H
F
Okay,
then
I
apologize-
I
I
I
don't
very
often
have
the
opportunity
to
talk
to
commissioners
or
secretaries,
so
I
was
just
trying
to
be
able
to
put
together
if
there
was
an
increase
in
daily
costs
for
long-term
care.
If
that
affected
the
insurance
rate
to
hopefully
reduce
it.
If
there's
some
other
means
of
revenue
coming
in
that's
what
I
was
trying
to
put
together
in
my
mind
so
again,
who
would
you
recommend
that
I
discuss
the
part
about
being
able
to
attach
assets
for
long-term
care?
E
Yes,
sir,
thank
you,
mr
chairman.
This
this
question
is
actually
for
both
of
you
and
just
just
to
kind
of
give
a
picture
of
what
you
see
as
the
future
of
long-term
care
insurance.
I
think
we've
seen
it
over
the
last
several
years.
This
is
a
recurring
issue
to
where
companies
come
to
doi,
they
ask
for
double-digit
increases
in
premiums,
they
come
back
and
they
say
well,
if
you
don't
take
the
double-digit
increase,
then
you
can
have
this
option
of.
E
Say:
reduced
benefits
of
of
some
type.
My
fear
is
that,
over
long
term
that
the
majority
of
these
companies
are
going
to
price
themselves
completely
out
of
the
market
in
terms
of
just
your
average
kentuckian
will
not
be
able
to
afford
long-term
care
insurance.
So
could
could
you
both
kind
of
speak
to
what
you
see
ongoing
corrections
that
can
be
made
and
and
what
you
see
as
the
future
of
long-term
care
insurance
is.
H
Dave
I'll
take
the
first
step
and
then
I'll,
let
you
follow
the
specifics
representative
lockett.
I
think
from
your
time
over
the
department
of
insurance,
you,
you
know,
you
know
this
is
a
regular
occasion
and
it's
not
just
kentucky
it's
all
over
the
country,
these
policies-
these
are
what
we
call
legacy
policies.
H
These
are
the
type
of
long-term
care
policies
that
we're
dealing
with
now,
they're
the
ones
that
are
in
trouble.
As
I
mentioned
earlier,
there
used
to
be
a
hundred
insurance
companies,
and
so
these
it's
now
less
than
20.
these
are
going
to
dissipate.
They
will
fade
away.
What
is
being
so
now
is
a
new
type
of
hybrid
problem
product.
A
lot
of
those
are
tied
in
with
annuities
or
in
with
others,
some
type
of
financial
planning.
H
So
you
know
the
long-term
care
the
legacy,
the
really
rich
rich
benefits
that
we
see
they're
not
even
being
offered,
and
they
will
not.
So
what
I
as
commissioner
in
kentucky
and
what
all
of
my
colleagues
and
peers
across
the
country
we
are
just
trying
to
reach
the
most
fair
and
equitable
conclusion
that
we
can,
when
we're
addressing
these
rate
increases.
H
The
other
situation
is
if
the
companies
become
financially
insolvent,
they're,
not
able
to
pay
claims
and
then
that
triggers
a
whole
different
perspective
here,
where
there's
rehabilitation,
there's
liquidation,
but
most
of
those
are
going
to
end
up
in
what
we
call
the
life
and
health
guarantee
association
to
pay
any
benefits.
So
you
know
I'm
walking
that
fine
line-
and
I
hear
it
I
have
my
mother-in-law-
has
one
of
these
policies
and
probably
every
other
time.
I
talk
to
her.
H
They
scrub
them
with
a
wire
brush
and
they
get
down
into
those
particulars
and
in
his
presentation
earlier,
you
can
see
that
we
have
held
everyone's
feet
to
the
fire,
as
close
as
we
can
to
walk
that.
You
know
straight
lines
so
dave
if
you
want
to
add.
D
Yeah
I'll
just
kind
of
agree
with
you,
I
think
I
I
think
two
things
one
is
the
the
policies
like
we're
talking
about
today
are
gone.
We've
talked
about
the
three
and
five-year
benefit
period.
I
think
that
using
my
bad
analogy
before,
I
think
that
you
know
it.
There's
gonna
be
chevy's
in
the
market.
Now
there
aren't
gonna,
be
you
know
the
really
big
cars
with
all
the
bells
and
whistles.
But
I
I
think
what
commissioner
clark
mentioned
is
is
really
where
it's
gonna
go.
D
I
think
kind
of
the
three
to
five
year
might
be
like
the
railroads
right
it
used
to
be
the
big
thing
now
we're
down
to
kind
of
a
small,
steady
three
to
five
year,
but
I
really
see
these
hybrid
products
are
really
where
the
long
term
care
market
is
going
to
go
and
that's
really
piggy
backing
off
of
life,
insurance
and
annuity
policies,
and
things
like
that.
So
utilizing
the
funds
in
those
new
pilot,
you
know
in
an
annuity
or
life
insurance
to
pay
for
anything
like
long-term
care.
D
A
Well,
we
appreciate
you
all
answering
the
questions
and
your
testimony
today.
Is
there
any
other
questions
or
comments?
I
know
this
is
a
big
issue
and,
like
senator
schickel
said
it
affects
lots
of
folks
and
they
get
used
to
a
policy
that
they
have
had
and
they
start
asking
questions
about
going
into
the
future.
So
we
appreciate
your
all's
testimony
on
that
and
I'm
sure
there'll
be
some
members
that
may
reach
out
to
you
for
further
questions.
So
thank
both
of
you
all.
D
A
I
think
our
next
person
to
present
is
the
kentucky
association
of
health
plans,
tom
stevens,
with
his
executive
director
tom,
are
you
on
there?
Oh
you're,
actually,
an
audience
good
live
and
in
person
we
we're
not
used
to
that.
A
G
Better,
my
name
is
tom
stevens,
I'm
the
executive
director
of
the
kentucky
association
of
health
plans.
I
started
in
that
role
in
january
and
in
a
prior
life
I
had
the
opportunity
to
come
and
present
here
on
a
regular
basis
about
the
kentucky
employees
health
plan,
which
is
part
of
my
my
old
job
duties.
G
So
I
appreciate
the
opportunity
to
be
here
on
behalf
of
my
clients
today,
so
the
kentucky
association
of
health
plans
get
started
here,
we're
going
to
give
you
a
little
bit
of
an
industry
update
and
then
talk
about
some
things
that
we're
up
to
as
an
association.
G
So
we
are
the
trade
association
that
represents
kentucky's
health
insurance
industry,
we're
comprised
of
seven
major
carriers
offering
health
plans
in
kentucky
we're
working
together
to
provide
effective
solutions
for
consumers,
employees
and
public
purchasers.
G
G
G
Of
course,
looking
at
the
total
covered
employees
by
insurance,
and
then
you
can
see
some
breakdowns
by
other
factors,
two
that
stuck
out
stuck
out
to
me
when
I
was
reviewing
the
data
is
one
the
average
employer
contribution
for
single
coverage.
It's
that
forty
nine
hundred
dollar
number,
and
also
that
percentage
of
single
coverage
premiums
paid
by
employers
and
thinking
about
that
and
where
we
find
ourselves
just
the
the
tremendous
cost
of
insurance
is
a
benefit.
G
So
a
lot
of
things
going
on
here.
The
importance
of
kentucky
employer
provided
health
coverage.
You
can
see
here
where
employer
sponsored
health
coverage
harnesses
the
collective
market
power
of
plan
members
to
achieve
cost
savings.
You
see
at
the
top
particular
areas
of
emphasis,
so
prescription
drugs,
emergency
care
and
preventive
care,
especially
as
a
growth
area
and
as
all
you
know,
I'm
sure
in
conversations
with
your
members
and
what
we
see
the
employee
health
insurance
is
just
a
huge,
hugely
important
benefit.
G
G
So
while
we
know
that
these
are
well
intended,
mandates
typically
result
in
higher
premiums
and
can
reduce
access
to
care.
So
one
of
the
things
that,
since
taking
on
this
role,
I
went
back
and
did
a
little
study
of
my
own.
So
we
look
back
over
the
last
four
regular
sessions
and
we
looked
at
the
cost
or
potential
cost
of
mandates
to
the
state.
In
particular,
since
2018
we
were
able
to
find
that
there
were
253
health
mandates
that
were
introduced
to
the
general
assembly.
G
So
in
two
two
of
the
pillars
that
I've
gotten
to
work
with
since
I've
gotten,
the
association
have
probably
been
more
fun
than
the
advocacy
pillar.
One
is
education,
and
so
one
of
the
novel
ideas
that
we've
come
up
with
in
association
is
doing
a
better
job,
leveraging
our
ability
to
work
together
so
you're
all
familiar
with
the
house
bill
8.
This
was
the
ambulance
provider,
enhanced
medicaid
payment
program.
G
So
the
challenge
of
a
program
like
that,
where
you
have
multiple
providers
in
this
case
with
the
ambulance
program,
I
think
they're
a
hundred
and
they're
over
170
different
ground
ambulance
providers
in
the
commonwealth,
one
into
the
state
to
the
other.
It
was
an
opportunity
for
us
to
work
together
as
an
industry
to
come
up
with
some
common
practices
and
also
to
go
out
to
those
members
directly
on
our
own
engage
them
in
a
way
that
we've
never
done
as
an
association
and
just
try
to
improve.
G
I
don't
want
to
say
gridlock,
but
let's
say
streamline,
eliminate
red
tape,
something
where
we
definitely,
I
think,
have
an
opportunity
to
do
more.
So
on
our
own
we
went
out
in
may.
We
worked
with
the
ambulance
association,
we
developed
a
webinar,
we
developed
a
website,
we
put
it
on
the
website.
We
uploaded
all
the
materials
and
so
about.
G
125
of
the
different
ambulance
providers
participated
with
us
in
that
provider
forum,
one
of
the
most
interesting
things
we
did
there
too,
is
we
were
able
to
work
amongst
the
carriers
and
consolidate
the
forms,
so
it
didn't
work
for
every
carrier,
but
four
of
our
carriers
were
able
to
work
together,
consolidate
down
to
a
single
form
and
process.
That's
a
huge
benefit
when
you're
looking
at
so
many
different,
distinct
providers.
G
Another
area
that
not
as
much
fun
to
talk
about,
but
something
that
we
take
very
seriously,
is
prior
authorization.
It's
an
important
thing.
We
have
to
talk
about
it
in
our
industry
because
it
really
is
a
key
element
of
the
health
insurance
process,
so
prior
authorization
ensures
that
providers
are
here
to
nationally
recognize
care
criteria,
particularly
sensitive.
That
in
kentucky
is
what
the
opioid
crisis
you
see,
that
encouraging
the
use
of
generic
drugs,
preventing
drug
interactions,
providing
checks
on
costs
and
overuse
of
imaging
and
curbing
waste
fraud
and
to
bruce
abuse,
rather
so
additional
information.
G
G
G
That's
an
opportunity
for
us
to
work,
collaboratively
and
innovate
is
in
social
determinants
of
health
conditions
and
the
places
where
people
live,
learn,
work
and
play
that
affect
a
wide
range
of
their
health
risks
in
a
state
is
geographically
diverse
in
kentucky
with
the
different
health
challenges
that
we
have
that's
an
area
of
great
opportunity
for
us,
so
some
examples
there
would
include
dealing
with
food
insecurity,
loneliness
and,
in
particular,
really
in
kentucky.
This
is
a
very
sensitive
one
during
covet,
but
access
to
transportation.
G
One
of
the
additional
things
that's
been
a
a
real
opportunity
for
the
association
is
to
develop
opportunities
for
collaboration
amongst
our
membership.
Not
only
does
this
just
sort
of
an
element
of
fellowship
to
it,
but
really
the
opportunity
to
share
knowledge.
G
A
particular
example
of
this
is
in
the
work
of
our
chief
medical
officers,
so
giving
them
the
opportunity
to
get
together
on
a
regular
basis
and
share
what
they're,
seeing
across
their
different
plans,
has
had
tremendous
value.
So
that's
that's
an
example.
We
really
also
see
this
with
our
behavioral
health
teams
and
the
opportunity
to
get
them
together
and
talk
about
different
things
that
they've
seen.
G
We
also,
of
course,
work
with
all
manner
of
different
government
agencies.
Commissioner
clark,
who
is
just
on
we
have
standing
meetings
with
the
department
of
insurance
cabinet
for
health
and
family
services,
department
of
medicaid
services,
we're
on
the
house
joint
resolution,
57
task
force,
which
is
the
bread
insurance
bridge
insurance
program
and
we've
recently
joined
the
chamber
of
commerce,
so
that
we
can
work
with
their
health
policy
group.
G
G
The
members
without
exception
believe
in
data-driven
approaches
and
they
have
information
that
shows
that
the
shop
works.
So
we've
done
all
number
of
things.
We
started
with
a
traditional
marketing
campaign
that
was
orchestrated
through
radio
that
evolved
into
social
media,
youtube
videos
things
along
those
lines.
G
The
next
iteration
of
that
became
a
across
the
state
tour
with
kentucky
sports
radio-
probably
not
a
group
that
I
necessarily
had
that
much
in
common
with
when
I
first
went
out
on
the
road
with
with
matt
jones
and
his
crew,
but
it
was
great
to
see
the
response
from
people
across
the
commonwealth
and
encourage
folks
to
go
out
in
a
non-clinical
setting
and
get
the
shot
or
get
information
about
getting
the
shot.
G
So
you
can
see
some
of
the
places
we
went
beyond
that.
We've
done
a
vaccine
for
visas
program
that
was
focused
in
eastern
kentucky
with
different
health
departments.
It's
fascinating
to
go
in
there,
because
when
that
program
was
going
on,
we've
seen
a
really
considerable
drop
in
covid
and
at
the
time
what
we
were
hearing
from
the
directors
of
those
health
departments
is,
we
were
really
they
hadn't
seen
people
coming
out
to
get
vaccinated.
At
that
point,
the
stream
had
dried
up,
so
we
were
able
to
to
encourage
that
and
move
forward.
G
G
Let's
see
and
probably
most
exciting.
Now,
we've
entered
into
some
really
interesting
regional
and
local
projects.
Most
recently,
it
was
announced
a
few
weeks
ago
by
president's
divers
and
then
subsequently
there
have
been
some
press
announcements
and
other
media
coverage,
but
we're
doing
a
partnership
with
volunteers
of
america
and
really
what
we're
trying
to
do
are
find
novel
ways
to
encourage
vaccination.
Outreach
clay
county
makes
for
a
very
interesting
case
study.
The
county
is
about
24
000
people,
and
it
has
a
very
high
percentage
of
individuals
that
are
on
medicaid.
G
It's
a
very
red
county
and
it's
vaccine
hesitant
so
being
able
to
go
in
there
and
use
really
novel
approaches
such
as
ohio
valley,
wrestling
partnerships
with
local
officials
and
really
making
it
intimate,
has
moved
the
needle
and
it's
continuing
to
move
the
needle.
So
we're
excited
about
that,
and
we
would
love
to
hear
from
other
groups
that
are
interested
in
trying
similar
approaches.
G
Besides,
just
the
obviously
the
efforts
of
the
association,
there
are
numerous
outreach
programs
being
run
by
all
of
the
different
members
of
the
association.
This
is
a
list
that
I
threw
together
just
sort
of
spitballing.
G
G
I
G
E
G
G
That
we
also
depending
on
the
membership,
we
also
have
medicare
advantage.
Tricare,
I
mean
there's
all
different
numbers
of
things
that
they're
involved
with
in
different
capacities.
E
G
That's
a
great
question,
mr
chairman:
I
haven't
seen
that
of
late.
I
know
that
by
adding
the
additional
two
that
definitely
helps,
and
I
I'm
thinking
back
much
further
back
in
time
I
mean
we
were
in
a
real
crisis
mode
as
far
as
areas
of
availability
in
the
commonwealth,
but
I
can
get
you
that
number
yeah.
E
No
problem,
then,
and
then
finally,
with
your
slide
on
innovation,
just
made
me
think
that
kentucky
has
the
first
in
the
country
insurance
regulatory
sandbox.
So
if
any
of
your
companies
see
an
opportunity
there
to
do
something
new
and
creative
that
might
expand
access
to
the
citizens.
Well,
certainly,
keep
that
in
mind
and
thank
you
for
being
here.
C
I
know
I
know
it.
I
know
it
I'd
like
to
go
back
to
the
page
on
prior
authorization,
because
I'm
looking
up
your
references
here
into
your
your
claims
on
these
numbers,
which
I
know
sound,
very
dramatic
but
20
of
diagnostic
imaging
is
inappropriate
and
I
went
ahead
as
I'm
sitting
with
my
computer.
Looked
up
your
references
on
that.
I
think
you
referenced
the
bottom
there,
an
article
called
magnitude
and
financial
implications
of
inappropriate
diagnostic
imaging
for
three
common
clinical
conditions.
C
So
I
think
it's
important
for
us
to
know
that
when
statements
are
made
in
the
reference
that
those
are
made,
that
article
is
from
2019
looking
at
the
state
of
massachusetts
from
2010
to
2013.,
so
that
20
of
diagnostic
imaging
is
inappropriate.
It's
a
nice
statement,
but
it's
inaccurate
in
this
presentation
because
we're
going
to
use
that
as
a
reference.
C
It
should
say
that
20
of
that
is
inappropriate
with
regards
to
mris
in
the
state
of
massachusetts
for
20,
2010
and
2013.,
don't
know
how
that
applies
to
kentucky
or
even
the
rest
of
the
country
for
that
matter.
But
that's
what
that
that
reference
is
made
to
the
second
one
there
are
15
to
30
of
all
ordered
medical
care
is
unnecessary
or
unsafe.
C
It
was
that
was
from
the
journal
of
the
american
medical
association
and
asked
a
bunch
of
doctors
if
some
of
these
tests
were
being
done
and
what
what
what
the
reasons
for
those
were,
the
reasons
that
doctors
had
here
the
most
comments
and
I'm
quoting
from
the
findings
in
this
article.
The
most
common
cited
reasons
for
overtreatment
were
fear
of
malpractice.
84.7
percent
of
doctors
ordered
tests
necessarily
for
fear
of
medical
malpractice.
C
Patient
pressure
requests,
59
difficulty
accessing
medical
records,
38.2
percent.
None
of
these
recommendations.
Recommendations
were
to
help
fix
those
problems,
not
to
issue
more
insurance
oversight
of
prior
authorizations
and
the
other
one.
Before
I
had
a
chance,
I
was
reviewing
here
from
the
800
billion
dollars
is
spent
each
year.
Unnecessary
services
from
national
library
of
medicine
is
the
institute
of
of
medicine.
That
has
a
reference
there
as
well.
It's
rather
rather
long
articles,
I'm
trying
to
go
through
it
right
now,
but
I'll
probably
have
some
some
comments
to
be
made
on
that.
C
I
just
think
that
it's
important
when
you
put
that
in
a
slide
presentation
to
make
it
sound
like
it's
a
global
thing.
The
references
you
offer
are
just
for
very
small
pockets
of
very
small
states
and
individuals
there
and
it's
not
necessarily
a
global
thing,
that's
across
the
the
board,
so
I
wanted
to
make
sure
that
was
clear.
Mr
chairman,
I
appreciate
it.
Thank
you.
E
Thank
you,
mr
chairman,
thank
you
all
for
being
here
today
and
I
appreciate
your
efforts
in
clay
county.
Of
course,
you
know
we
do
have
a
surge
going
on
across
the
commonwealth
right
now,
especially
in
clay
county.
Boa
has
been
a
great
partner
and
community
pillar
down
there,
but
I
appreciate
that
I
also
want
to
jump
back
to
pre
prior
authorizations.
You
know
in
pharmacy,
which
I'm
involved
with
that
has
been
such
a
great
help
for
patients
during
copied.
E
You
know
flexibility,
you
highlighted
transportation
being
an
issue,
and
it
is.
It
is
absolutely
in
rural
kentucky
going
forward
whether
we're
talking
about
prior
authorizations
or
whether
we're
talking
step
therapy.
Is
this
something
that
you
are
looking
at
continuing
as
we
go
through
this
crisis.
G
Yeah-
and
I
think
maybe
this
does
come
back
to
what
senator
alvarado
said
too-
I
mean
a
challenge
with
respect
to
prior
authorization.
It's
not
to
say
I
mean
most
procedures
and
I
believe
I'm
correct
in
saying
this.
I
know
I'll
be
corrected
if
I'm
not
don't
are
not
subject
to
prior
authorization.
It's
a
certain
list
of
things
that
are,
and
I
think
that
it's
an
obligation
of
our
industry
to
proactively
look
at
that
and
when
it's
clear
that
something
isn't
being
it
doesn't
require
prior
authorization.
It's
up
to
the
industry.
G
They
need
to
proactively
eliminate
that
requirement.
So
I
did
I
just
wanted
to
make
that
comment
on
the
record
as
well,
but
yeah,
it's
a
it's
a
challenging
area.
Right
now
we
have
various
things
that
we've
been
asked
to
also
by
the
state
to
waive
prior
authorization
and
and
the
members
I
believe,
have
under
most
circumstances.
G
J
Because
he's
been
a
king
through
all
the
covid
and
all
the
things
that's
been
going
on
and
we've
had
it
in
caucus
a
couple
times.
J
J
I
that's
what
I'm
hearing
it
from
and-
and
I
know
that
me
and
him
is
on
that
same
page
of
that-
and
I
think
we
have
to
visit
that
you
know
the
same
thing
with
long-term
care,
an
example
I
told
john
about-
and
this
is
where
we're
running
into
it.
It's
long-term
care
just
like
we're
having
trouble
with
our
retirement
either
you
got
defined,
benefit
or
defined
contribution.
J
J
If
you
have
a
limit
for
a
surgeon
that
says
five
million
dollars
is
the
limit
and
and
then
you
would
cut
health
costs,
health
care
costs
by
a
good
percentage
of
the
money,
and
we
can't
afford
to.
I
don't
know
what
the
average
pregnant,
but
we,
as
consumers,
can't
afford
to
keep
this
up
with
long-term
care
with
health
care
and
the
whole
bid.
J
But
any
rate
that
is
one
of
the
problems
is
that
we
have
to
have
tort
limit
now,
getting
that
through
the
state
of
kentucky
with
as
many
attorneys
as
we
have
and
by
the
way
we
as
senators
are
catching
up
with.
We've
got
three
or
four
new
attorneys
in
our
group,
so
we
need
to
learn
to
protect
our
consumers
instead
of
our
occupation
or
instead
of
our
association.
J
J
J
Those
limits
of
liability
goes
to
take
care
of
those
people
for
the
rest
of
their
life.
If
it's
proven
they're
liable,
not
some
outside
group
that
gets
30
or
50
million
dollars
and
they
get
on
tv
and
advertise
we've
got
the
biggest
settlement
ever
so
we're
paying
for
that.
We,
as
consumers,
are
paying
dearly
for
that,
and
that's
where
I
feel
that
the
health
care
we
can
no
longer
pay
for
perfect
care
anymore.
J
So
and
I
apologize
for
dr
alvaro
for
using
him
for
the
253
bills,
but
I
did
see
I
looked
it's
just
2018..
If
we
go
back
to
2014
when
he
came,
I
had
probably
the
more
now
or
15
or
so
thank.
A
A
Senator
schickel
did
you
have
a
question
or
comment?
Thank
you,
sir.
Do
we
have
any
others?
Well
you
mentioned
something
we're
talking
about
covet.
Is
such
a
big
piece
of
I'm
sorry
I'll.
Let
you
go
next.
Representative
stevenson,
I'm
sorry!
I
apologize.
B
Quite
all
right,
hey
thanks
for
being
here
today.
I
kind
of
have
a
two-part
question
so
we're
starting
to
see
some
stuff
in
the
news
about
some
insurances
that
are
going
to
stop
waiving
cost
sharing
for
those
in
the
hospital
with
covid,
since
vaccines
are
so
readily
available,
and
then
also
I've
seen
a
little
bit
too
about
some
insurers
are
going
to
start
actually
charging
a
higher
premium
for
those
who
have
chosen
to
be
unvaccinated.
I
think
I
think
it
was
in
the
news
about
maybe
delta
airlines
was
going
to
choose
that.
B
Do
you
foresee
that
ever
being
an
industry
standard
or
if
you
think
that's
going
to
remain
on
an
employer
by
employer
basis.
G
Great
questions
with
respect
to
the
cost
sharing
I
specifically
have
asked
within
my
membership.
If
that's
something
that's
out
there
and
that's
not
something
that
we've
seen,
it
could
be
something
at
a
higher
or
national
level,
but
at
least
not
at
this
point
in
kentucky.
So
it's
certainly
something
that
we
would
follow
closer
with
respect
to
the
premium
changes,
I
mean
it's
an
interesting
idea
of
a
mechanism
to
nudge
people
to
make
certain
health
decisions.
G
You
know,
as
I
recall
kentucky,
I
believe,
is
a
state
that
still
has
certain
restrictions
on
asking
employment
questions
related
to
tobacco
usage,
which
is
an
interesting
thing.
That's
still
out
there,
although
you
can
charge
a
higher
rate
on
for
premiums
that
involve
tobacco,
or
perhaps
we
term
it
differently.
We
give
you
a
discount
if
you're,
a
non-smoker,
perhaps
is
the
way
that
we
actually
term
it.
G
I
think
I
think
it
is
a
possibility,
and
I
do
think
that
the
idea,
one
of
the
things
that's
interesting
in
kentucky,
of
course,
there's
always
their
number
of
insurance.
We
haven't
really
talked
about
managed
care
here.
We
get
to
come
back
in
a
few
weeks
and
talk
about
managed
care
in
a
very
substantive
way,
so
I
won't
go
there,
but
the
idea
of
competition
having
competition-
and
I
see
this
in
my
members-
they
are
hyper
competitive
when
one
of
them
comes
up
with
an
idea.
For
example,
on
covet
outreach,
it's
immediately
mimicked.
G
I
Thank
you,
mr
chairman,
welcome
tom.
First
of
all,
the
the
info
on
the
legislative
mandates,
raising
health
care
costs
made
me
as
happy
as
I've
been
in
a
banking
and
insurance
committee
enter
a
meeting.
I
I
agree
with
you
wholeheartedly
and,
and
I've
only
voted
for
one
of
those
in
15
years
and
trust
me.
We
get
plenty
of
opportunities
to
do
so
and
that
one
had
no
cost
to
it,
because
everybody
was
already
covering
it.
I
So
you
know
we
talk
a
lot
about
the
costs
on
one
end
and
then
we
raise
the
cost
on
the
other.
So
I
appreciate
you
saying
that
and
representative
stevenson
actually-
and
I
were
on
the
same
page
with
the
with
the
delta
and
and
what
they're
doing,
and
I
wanted
to
to
ask
generally
what
you
all
have
learned
in
the
last
18
months
and
more
specifically,
you
know
the
list
of
of
items
on
on
your
last
slide
about
outreach
is
nice.
I
But
you
know,
I've
said
on
twitter
plenty
of
times
incentives
work
and
I
I
think
what
delta
doing
is
doing
is
is
fascinating
and
certainly
for
those
that
don't
think
that
businesses
should
be
mandating
this.
This
is
a,
I
think,
a
better
alternative
and
you
know
is,
is
you
know
I
think
incentives
are
where
you
go.
So
is
anybody
doing
that
and
what
have
you
all
learned
in
general
in
the
last
18
months.
G
One
of
the
most
interesting
things
about
covet,
if
you
looking
at
the
media
coverage
right
now
in
the
state,
obviously
we're
in
the
midst
of
this
incredible
spike-
that's
taking
place.
But
if
you
look
at
coveted
numbers
of
la-
and
I
hadn't
seen
this
written
anywhere,
but
we
were
looking
at
a
map,
one
of
the
maps
of
kentucky
and
the
contiguous
states.
G
So
five
of
the
seven
states
kentucky
is
leading
in
coveted
vaccination
rates
and
you
wouldn't
think
that-
or
at
least
I
wouldn't
think
that
in
the
coverage
that
I
look
at,
and
so
we
took
that
broader
and
we
looked
at
southeastern
united
states.
So
you
look
at
the
old
south
right,
where
we
kind
of
tend
to
block
place
ourselves
for
different
statistical
things
and
regionally.
G
I
think
I
mean
really
where
we
find
ourselves
today,
especially
when
you
compare
it
to
other
comorbidities
and
other
ways
that
we
define
health
in
the
state,
so
cancer,
cardiovascular
disease,
diabetes,
tobacco
usage,
opioid
addiction,
those
things
that
we
see
so
that's
fascinating.
So
in
some
ways
I
mean
that
maybe
maybe
one
of
the
big
takeaways
is.
We
have
learned
something
from
this
and
really
the
number
of
people
that
are
truly
vaccine,
hesitant
is
considerably
smaller.
G
It's
just
taken
certain
things
that
have
motivated
us
in
certain
outcomes
the
opportunity
to
have
our
kids
back
in
school.
Maybe
some
double
speak
at
time
and
different
things.
We've
seen
nationally
have
have
hurt
the
effort,
so
I
think
kentucky
has
come
an
extraordinarily
long
way
from
where
we
started
this.
G
We
have
natural
tendencies
that
are
vaccine
hesitancy,
but
I
and
honestly
in
many
respects,
I
think
that
we're
we're
beginning
to
come
out
of
this
and
see
a
lot
of
positivity,
I'm
very
reluctant
to
say
that,
though,
in
light
of
the
public
health
crisis,
that's
that's
ongoing.
Right
now
I
mean
communities
like
clay
county
and
the
conversations
we
have
there,
but
I
think
maybe
some
things
we
just
had
to
learn
for
ourselves.
A
Thank
you
so,
just
following
up
with
that,
you
know
like
what
you're
doing
in
clay
county
the
partnerships,
what
are
some
other
communities
doing
or
are
there
other
partnerships
that
you
guys
have
got
engaged
in
that
you
saw
a
success
or
you're
having
it
right
now,.
G
So
we
tried
different
things
that
were
more
statewide,
so
even
the
state
fair
is
an
example
of
that.
We've
tried
things
where
we
worked
with
different
health
departments
to
encourage
that
part
of
what
we
have
needed,
though
I
mean
you're
you're.
The
entire
compliment
of
the
kentucky
employee
kentucky
association
of
health
plans
is
in
the
room.
Stephanie
is
our
lobbyist,
her
assistant
ethan,
and
then
we
have
an
individual
that
helps
us
with
communication,
so
we're
not
well
suited
to
go
and
do
outreach
on
the
ground.
We
need
that
partnership.
G
We
need
that
non-profit
that
501c3
that
church
group,
so
one
of
the
projects
that
we're
working
on
right
now
is
trying
to
turn
this
on
its
head
and
create
some
sort
of
a
grant
opportunity
to
go
out.
Find
organizations
like
volunteers
of
america
that
have
boots
on
the
ground
and
sort
of
that
project
is
as
much
individually
trying
to
tailor
something
to
clay
county,
as
it
is
trying
to
find
a
model
that
we
can
replicate
other
places.
G
So
small
community
24
000
people
slightly
geographically
isolated.
So
what
sorts
of
things
can
we
do?
Well,
I
mean
the
relationship
to
the
local
school
board
is
unique.
The
relationship
to
even
you
know,
athletes.
There
is
unique
sort
of
significant
figures
in
the
community
business
leaders
in
the
community.
That
has
an
impact,
that's
different
from
say.
A
Well,
good:
well,
it's
kind
of
weird
that
that
I
think
the
conversation
after
us
being
up
here
last
week
is
the
political
statements
by
people
that
just
are
ranting
and
trying
to
tell
people
that
they
need
to
get
it.
Hadn't
always
worked.
So
I
think
it
comes
better
from
other
folks
in
their
communities
that
say:
hey,
they're
you're,
not
putting
pressure
on
me
because
there's
still
people
out
there
that
think
that
there's
something
to
this,
that
we
don't
need
to
be
doing
it
or
there's,
there's
some
alternative
motive.
A
I
know
I
I
know
people
at
the
hospital
that
they
said
they
have
comments
that
people
are
saying.
Well,
you
just
want
me
to
get
the
vaccine,
because
the
hospital
makes
a
lot
of
money
from
from
from
covet.
You
know
so
there's
so
much
misinformation
out
there
and
I'm
a
guy
who,
before
I
come
up
here,
most
mornings
or
any
day,
I'm
not
here.
I'm
I've
got
work,
clothes
on
and
dirt
all
over
me
and
I'm
on
a
construction
site
or
on
the
farm
working,
and
so
I
I
didn't
take
the
the
vaccine.
A
I
tell
this
because
for
a
little
story
is
I
didn't
take
the
vaccine,
because
I
I
just
I
never
took
a
flu
shot,
I'm
not
that
type
of
person
I'm
like.
I
don't
think
I
think
I'll
be
okay,
and
so
I
you
know
we
could
have
taken
it
up
here
when
it
first
came
out.
I
didn't.
I
took
my
first
vaccine
about
a
month
and
a
half
ago
and
after
so
many
people
in
my
community,
and
I
saw
friends
and
people
around
me
getting
sick
and
I'm
44.
A
I
saw
a
lot
of
32
35
year
old
people.
It
wasn't
80
year
old
people
at
that
time
it
was
people
that
were
younger
that
were
pretty
healthy,
that
just
started
getting
symptoms
and
it
was
really
affecting
them,
and
I
was
like
I
don't
you
know.
I
think
now
is
the
time
my
mom
and
dad
are
pretty
young,
for
you
know
for
their
age
for
their
for
to
be
my
parents.
A
I
guess
you
know
they're
my
dad's
60
68,
my
mom's
65,
and
so
they
had
neither
one
taking
it,
and
so,
when
I
took
it
I
said
hey.
I
went
over
here
to
walgreens
and
walked
in
the
door
and
got
my
vaccine.
I
think
it's
time
for
you
all
to
get
it
and
they
went
the
next
day
and
got
it
my
dad's
really
really
stubborn
worse
than
I
am,
I
think,
and
so
he
was
anti-vaccine.
A
My
plumber
has
cove
it
now
and
so
he's
like
you
know,
I
should
have
gotten
it,
but
I
I
just
I
was
scared
and
so
there's
so
many
people
in
these
groups
that
that
that
are
realizing
that
it's
important
it's
an
important
thing
to
get
my
uncle
got.
It
come
over
and
called
me
and
said
he
he
got
covet,
but
he
had
no
symptoms.
Didn't
have
any
issues
at
all,
and
so
then
the
next
person
gets
it
and
you
know
they're
in
a
hospital
on
a
vent.
A
You
know
it's
just
it's
just
really
hard
to
predict
and
make
people
really
understand
the
severity
of
it.
But
I
think
dr
alvarado
has
talked
to
us
enough
up
here.
We
realized
that
this
thing
with
hospitals,
when
you
can't
find
a
room
when
you
realize,
if
you
have
a
car
wreck
or
my
son,
is
playing
football
game
on
friday
night
and
has
an
injury
that's
severe
and
we
need
to
go
to
hospital.
A
He
could
not
find
a
bed
and
that's
what
makes
it
a
reality
that
this
thing
is
real,
that
we
need
to
make
sure
that
we're
taking
care
of
it
and
I've
got
a
lot
of
people
in
my
area.
There
are
anti-vaccines,
they
don't
want
it,
they
don't
want
you
to
even
talk
to
them
about
it,
but
I
just
tell
people
they
can
make
their
own
decisions
and
I
think
that's
the
way
it
needs
to
be.
But
we
just
need
to
encourage
them
to
make
the
best
decisions
they
think
is
right
for
them
and
their
family.
A
C
Oh,
thank
you,
mr
chairman.
I'll
tell
you
all
of
us
knew
representative
bam.
Kearney
bam
had
a
catastrophic
abdominal
event
that
put
him
into
a
tailspin
and
eventually
cost
him
his
life.
What
he
required
that
evening,
which
is
on
december,
the
23rd,
was
critical
care
in
an
icu
and
he
spent
probably
a
year
of
his
life,
at
least
in
an
icu
setting.
If
any
of
us
here
we've
all
known,
we
all
knew
bam.
C
If
any
of
us
here
had
an
event
like
that
today,
you
would
struggle
to
find
an
icu
bed
to
provide
you,
your
care.
I
think
we
have
about
140.
There's
about
almost
70
percent
of
our
hospitals
are
at
critical
level,
which
means
that
nurses
are
being
stretched.
Then
they're
assigning
more
patients
to
those
nurses.
We
have
less
beds
available,
it
really
we're
in
a
crisis
situation.
I
don't
think
people
don't
realize
they
haven't
gone
to
an
icu
and
er.
C
Recently,
you
don't
see
it,
but
it's
critical,
and
so
I
just
pray
that
none
of
us
have
that
kind
of
an
event
in
the
next
couple
of
weeks
that
none
of
your
children
have
car
wrecks
and
require
icu
care,
because
if
they
did,
they
would
struggle,
and
I
would
just
remind
folks
out
there
I
I've
you
know
I've
been
commenting
about
this
since
april,
since
these
vaccines
were
available,
I
got
it
as
soon
as
I
could
get
them
into
my
system.
C
C
I
don't
want
to
see
bad
things
happen
to
people
that
I
know,
and
I
would
just
urge
you
to
take
that
type
of
a
tone
not
to
not
to
label
anybody
anything
not
to
call
them
names
not
to
you
know
what
no,
no
none
of
that
it
shouldn't
be.
Any
of
that
it
should
be
conversations.
What
are
you
fearful
of
I'm
interested
in
your
well-being?
C
I
don't
want
you
to
get
hurt,
and
so,
if
you
have
that
opportunity
for
discussions
to
have
those,
we
really
need
to
rely
on
our
medical
community
to
provide
that
conversation,
because
I
think
unfortunately,
politicians
on
all
sides
have
poisoned
that.
Well
and
it's
made
it
more
difficult
and
people
aren't
willing
to
listen
just
because
you
have
an
r
a
d
behind
your
name.
C
So
I
would
urge
anybody
if
people
are
watching
this
listening
to
this,
if
you're
able
to
have
that
conversation
to
let
people
know
the
people
in
the
medical
community,
you
know
there's
there's
no
nefarious
purpose
behind
the
scenes
for
doctors
and
nurses,
they're
stressed
they're
overworked
everybody's
pressed
to
the
limit
right
now.
C
It's
tough
and
it
wears
on
our
minds
too,
every
death
that
we
witness
everything
that
we
see
is
haunting
for
a
medical
provider,
the
more
of
those
that
we
see
the
tougher
it
gets
to
go
to
work
the
next
day,
and
I
think
that's
why
everybody's
struggling
so
we're
just
urging
people
just
to
understand.
C
Please
don't
get
your
information
from
facebook
go
to
your
medical
provider,
your
doctor,
your
nurse
talk
to
them
about
this
issue,
that's
where
the
conversation
needs
to
have
and
they're
going
to
be
looking
out
for
your
best
interests
and
I'll
leave
it
at
that.
Thank
you,
mr
chairman.
Thank.
A
You
I
appreciate
that
representative
lockett.
E
Yes,
thank
you,
mr
chairman.
I
just
had
a
quick
question.
You
mentioned
that
kentucky
in
the
south
was
that
was
ranked
the
third
right
in
terms
of
our
vaccination
rate.
E
E
E
Well,
my
only
thought
was
that
if,
if
there's
a
correlation
between
the
vaccination
rate
and
positivity
rate
in
cinder
alvarado,
you
may
know
this
that
that
would
be
obviously
a
huge
selling
point,
and
I
was
just
just
curious.
If
there
is
that
correlation.
G
C
This
is
becoming
like
a
health
and
welfare
committee.
Mr
chairman,
I
feel
right
at
home
yeah,
I
think
we're
over
14
right
now
in
positivity
rate,
which
is
the
highest
we've
been
at,
I
don't
know
where
we
rank
nationally.
I
know
I
think
we're
one
of
the.
I
think
we're
third
right
now
on
surge,
the
numbers
are
beginning
to
kind
of
flatten
a
little
bit
and
we
hope
it
does.
I
think
the
projections
are
showing
that
by
the
end
of
the
month,
it
should
be
on
the
decline
and
coming
out
of
it.
C
That
again,
it's
just
always
a
lot
of
uncertainties
and
there's
a
reminder.
Everybody.
This
is
the
delta
variant
that
we're
seeing
right
now
there
are
two
other
variants
that
are
out
there:
there's
a
lambda
and
a
mu.
These
are
all
greek
letters
as
they
come
down
the
line.
We
don't
know
what
those
are
going
to
do.
We
don't
know
if
the
current
antibodies
we
have
naturally
or
from
the
vaccines
are
going
to
cover
those,
so
the
fear
becomes.
We
see
it
drop
off
and
three
four
six
months
from
now
another
surge.
C
A
Yeah,
I
think
a
lot
of
that
has
my
kids
started
back
to
school.
You
know
I've
got
a
sophomore
and
a
a
sixth
grader,
and
so
you
know
they're.
You
know
they're
in
classroom
with
masks
on,
but
you
know
it's
you
talking
about.
Tough
is
trying
to
keep
a
mask
on
a
kid
walking
down
the
hallway,
and
so
you
know
one
of
my
friends
said
that
they
showed
up
with
a
mask
on
and
their
kids
showed
up
that
afternoon
and
they
said
well,
did
you
have
another
mask
in
your
locker
room
locker?
A
I
have
not
seen
that
mask.
They
said
no
man,
john
traded
mass
in
the
middle
of
class.
Today,
so
I
mean
you
know,
there's
some
things:
you're
not
you're,
not
going
to
be
able
to
stop
or
predict,
and
so
you
know
we're
going
to.
I
think
that's
really
what
positioned
me
to
get
it
to
decide
to
get
the
vaccination,
because
I
don't
think
it's
not
a
matter
of
if
or
if
you're
or
if
you're
gonna
get
it's
just
a
matter
of
when
you're
gonna
get
it
honestly
and
how
bad
it's
gonna
affect
you.
A
And
so
you
know,
I
know
plenty
of
people
who
have
been
vaccinated
that
still
get
it,
but
their
symptoms
are,
you
know
they
don't
feel
good
for
a
day
or
so
and
they're
they're
back
at
it.
So
that's
the
kind
of
thing
that
motivates
us
and
that's
the
information
that
we
need
to
spread
out
to
folks,
and
so
I
appreciate
everybody's
testimony
day
their
time.
I
think
this
is
an
important
issue,
especially
after
we
were
here
just
last
week.
A
You
know
spending
three
three
or
four
days
of
our
life,
and
I
know
lots
of
people
spent
lots
more
time
than
that
than
we
were
just
up
here
in
session.
So
if
there's
no
other
questions
or
comments,
our
next
meeting
is
october,
the
5th
at
11
a.m,
and
we
appreciate
everybody's
testimony
and
all
your
work,
and
I
th
with
that.
I
do
have
a
motion
for
adjournment.