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A
B
I
do
thank
you,
madam
chair.
I
would
like
to
recognize
matt
dineen
here
today.
Matt
is
a
member
of
the
elizabethtown
city
council,
but
come
november
he
will
be
the
new
state
senator
for
the
10th
district
in
hardin
and
southwest
jefferson
county.
B
A
B
E
A
Chairwoman
mosher,
I
am
here
in
the
room,
okay,
we
have
a
quorum
and
our
dually
established
to
do
business.
I
would
like
to
just
reiter
reiterate
our
welcome
to
the
future
senator
dineen.
Thank
you
very
much
for
being
here
and
congratulations.
You
you
have
a.
This
is
a
great
accomplishment
to
not
have
opposition.
So
congratulations!
A
Okay.
I
just
want
to
remind
all
members
to
silence
your
phones.
Everyone
knows
the
drill,
I
think,
and
the
members
who
are
on
campus
and
in
person
are
our
voting
members
today,
just
as
a
reminder,
so
we
will
go
ahead
and
get
started
with
house
bill.
227
welcome,
representative
hart-
and
I
don't
know
if
you
have
any
guests
but
introduce
yourself
and
please
proceed.
B
Representative
hart
78th
house
district
and
the
bill
I'm
about
to
present,
I
worked
on
with
representative
massey.
Unfortunately,
he
got
tied
up
in
louisville
so,
but
I
wanted
to
give
him
a
shout
out.
He
we
worked
on
this
together
and
you've
got
it
in
front
of
you.
It's
very,
very,
very
simple.
B
What
this
bill
does.
It
establishes
the
first
saturday
of
october
of
each
year
as
first
responder
doctor
nurse
and
health
care
professional
days
motion.
B
A
B
B
C
B
B
A
Oh
representative
bowling,
would
you
like
to
register
a
vote
for
house
bill
225.
D
I'd
like
to
register
yes,
ma'am
like
to
register
a
yes
vote
for
house
bill
227,
as
well
as
a
present
vote
for
committee.
A
G
We're
going
to
go
a
little
out
of
order,
we're
going
to
do
house
bill
to
525
first.
So
if
any
guests
coming
forward
for
525
want
to
make
their
way
to
the
table,.
G
A
Okay,
thank
you
very
much,
madam
chair
and
committee.
I
am
state
representative
kim
mosher,
representing
the
64th
district
and
I'm
very
happy
happy
to
be
joined
by
some
wonderful
community
health
workers
this
morning
and
experts
in
this
field,
and
that's
what
we're
going
to
talk
about
today.
This
is
house
bill
525,
and
I
just
want
to
talk
a
little
bit
about
just
briefly
about
what
community
health
workers
are.
A
A
A
There
are
many
reasons,
as
we
know
why
individuals
don't
access
the
care
that
they
have
available
to
them.
We
have
expanded
medicaid
to
almost
a
third
of
of
our
population.
Here
in
kentucky
we
have
1.6
million
enrollees
in
medicaid
and
we
have
not
moved
our
health
metrics.
We
still.
We
continue
to
have
high
rates
of
diabetes,
heart
disease,
smoking
a
lot
of
a
lot
of
issues
that
we
know
that
community
health
workers
can
really
help
educate.
A
Folks
about
so
you
know
we
we-
and
I
I
think
some
of
these
are
going
to
discuss
some
of
those
barriers,
but
you
know
lack
of
transportation,
oftentimes
fear
just
a
inadequate
health
literacy,
understanding
of
even
insurance
forms.
So
in
in
well,
I
talked
a
little
bit
about
our
medicaid
expansion,
so
I
really,
I
don't
feel
like.
A
I
need
to
go
into
that
any
further,
but
we
know
that
it's
time
because
of
this
medicaid
expansion
to
really
get
more
targeted
with
our
medicaid
dollars
and
work
on
programs
that
work,
we
have
had
pockets
of
community
health
workers
throughout
kentucky
for
probably
close
to
about
20
years.
I
think
through
the
kentucky
home
place
and
the
kentucky
home
place,
did
a
study
over
that
period
of
time
that
really
analyzed
the
usefulness
of
community
health
workers.
It
was
very
successful
and
showed
about
an
11.30
return
on
investment
for
every
dollar.
A
One
dollar
invested
in
medicaid
dollars.
So
it's
it's
really.
The
cost
benefit
analysis
has
shown
it
to
be
a
very
productive
use
of
our
taxpayer
dollars.
So
what
this
legislation
would
do
would
be
simply
to
expand
this
community
health
worker
program
throughout
the
state
making
a
making
it
a
medicaid
medicaid
eligible
reimbursable
service.
A
The
the
cabinet
wanted
some
flexibility
in
looking
at
the
funding,
because
oftentimes
there
are
federal
funds
that
come
in
that
dictate
how
the
how
the
funding
should
be
structured.
We
also
put
in
the
bill
that
we
would
like
the
we
are
directing
the
cabinet
to
look
at
things
like
a
state
plan,
amendment
waivers
looking
at
other
ways
to
fund
this
program
and
and
not
necessarily
have
it
be
strictly
medicaid.
A
So
that's
really
what
this
does.
It
also
addresses
the
health
care
worker
shortage.
We
all
know
that
we
have
a
real
problem
with
our
health
care
workers
in
kentucky,
and
this
will
in
this
legislation
we
are
partnering
with
kctcs
to
us
to
allow
and
grant
college
credit
for
certification
through
this
program.
So
that's
really
what
this
bill
does.
A
H
H
This
bill
house
bill
525,
creates
a
very,
very
important
pathway
to
expand
our
current
network
of
community
health
workers.
As
representative
mosher
said,
we've
had
community
health
workers
in
kentucky
for
decades,
but
there
has
not
been
a
sustainable
funding
source
for
community
health
workers,
and
this
bill
creates
a
pathway
to
have.
G
H
I
apologize
emily
beauregard,
I'm
the
director
of
kentucky
voices
for
help,
and
we
have
been
working
to
find
an
opportunity
to
reimburse
through
medicaid
for
community
health
workers
for
many
years
now,
since
it
became
an
opportunity
through
the
centers
for
medicaid
and
medicare
services,
and
so
having
this
bill.
Allowing
chws
to
bill
for
medicaid
services
and
to
provide
these
services
to
enrollees
is
a
real
game.
Changer
there
is
nothing
that
is
more
patient
centered
than
having
a
community
health
worker
as
part
of
your
care
team
and
there's
nothing.
H
I
can
say
about
chws
that
chws
can't
say
better
themselves.
So
I
have
with
me
today
many
chws
and
program
administrators
from
around
the
commonwealth,
who
are
here
to
tell
you
just
a
little
bit
about
the
work
that
they
do
every
day
in
their
communities,
the
impact
that
it
makes
and
I'll
invite
pam
to
start.
If
you'll
motion
on
the.
A
G
Did
you
get
that
motion
in
a
second
okay
represent
fleming?
Has
a
question.
F
Thank
you,
and
I
I
would
say
with
a
heartfelt
thank
you
for
everything
that
you
all
do
in
the
community
to
help
elevate
people
to
have
a
better
life,
not
only
for
themselves,
but
all
the
family.
I
I'll
go
on
the
on
the
limb
that
my
appreciation
and
thanks
for
is
felt
by
all
the
committee
members.
What
y'all
do
you're
very
in
the
thought
of
our
mind
to
make
sure
that
y'all
are
taken
care
of
not
only
from
a
pay
but
also
from
a
tool
to
provide
those
services.
F
So
I
just
want
to
say
thank
you
very
much
for
all.
You
do.
You've
got
a
good
good
champion
there
with
a
chairwoman
mosher
in
terms
of
pushing
this
thing
through
to
help
out.
I
do
have
one
question:
it's
a
little
bit
off,
but
it's
still
germaine.
F
We
recently
passed
out
of
the
house
and
it's
going
through
the
senate
house
bill
127
about
tim's
law
and,
as
you
all
might
know,
it's
a
court
order
process
are,
are
y'all
being
utilized
or
do
you
know
much
about
it
in
terms
of
providing
that
type
of
a
care
for
individuals
that
have
severe
mental
health
to
make
sure
they're
on
medication,
make
sure
there's
a
wrap
around
services?
All
that
can
y'all
comment
on
that.
F
I
Sure
I
think
I
can
speak
to
that
to
start,
but
I'm
sure
the
community
health
workers
themselves
probably
have
anecdotal
stories
that
they
can
tell
about
that
as
well.
I'm
pam
spradling,
I'm
the
director
of
strategic
planning
and
development
for
big
sandy
healthcare,
we're
a
federally
qualified
health
center
operating
in
five
counties
in
eastern
kentucky,
and
I
can
say
that,
yes,
we
work
with
we
work
with
patients,
primarily
with
chronic
conditions,
and
we
consider
mental
health
conditions
also
chronic
conditions
for
many
patients,
so
those
patients
with
severe
mental
health,
mental
illness
issues.
I
We
do
work
with
those
patients
and
we
provide
pretty
much
the
same
services
for
those
patients
that
we
would
someone
with
diabetes
or
asthma
or
chronic
heart
disease
or
whatever
conditions.
So
so.
Yes,
we
do
work
with
those
patients
and
we
just
as
we
would
work
on
not
only
clinical
issues,
but
also
helping
those
patients
to
reduce
barriers
that
they
might
have
in
accessing
health
care
and
and
and
as
emily
mentioned
and
and
representative
moser
also
mentioned.
I
I
They
they
can't
afford
their
medications,
and
some
of
the
mental
health
medications
that
are
that
are
prescribed
are
very
expensive,
so
helping
those
patients
access
that
medication,
helping
them
to
separate
out
their
medication
into
a
pill
box.
You
know
once
a
week
or
once
every
couple
of
weeks,
helping
them
grocery
shop,
have
access
to
healthy
foods,
helping
them
access
social
support
and
and
help
to
develop
their
health
literacy
level
a
little
bit
more.
I
All
these
are
issues
that,
while
we
may
not
think
of
them
necessarily
as
clinical
issues
community
health
workers,
they
they
can
expand.
I
always
call
community
health
workers,
the
cherry
on
top
of
the
clinical
services
that
we
provide
because
they're
just
that
extra
a
little
bit
extra
service
that
so
many
of
our
patients
need.
Sometimes
I
tease,
because
I
I'm
always
pulling
my
community
health
workers
into
my
own
health
care.
You
know,
can
you
call
about
my
medicines?
I
I'm
not
sure
when
I'm
supposed
to
pick
them
or
whatever-
and
you
know
they
help
me-
navigate
the
process
because
it
is
a
very
complicated
structure
of
healthcare
and
social
services
that
we
have
to
in
these
days,
and
so
community
health
workers
can
really
make
the
difference
in
helping
people
access,
services,
clinical
services
or
social
services
in
the
community.
So
yeah
did.
I
answer
your
question.
Yeah.
F
Yeah,
yes,
and
I
have
one
we'll
just
follow
up
real
quick
comment
and
I
hope
the
audience
and
those
of
the
committee
and
people
are
looking
at
ket.
This
is
the
this.
Is
the
the
grassroots
bare
knuckles
approach
to
helping
people
out,
and
I
can't
thank
you
all
enough
representative
willa
and
I
really
pushed
that
bill
pretty
hard,
because
I
see
the
value
and
we're
looking
at
1800,
more
people
that
could
be
serviced
under
the
under
the
tim's
law.
So
I
just
want
to
say
thank
you
very
much.
G
To
introduce
yourself,
yes,
my
name
is
celine
moutier
maria.
I
am
a
community
policy
strategist
at
the
louisville
urban
league,
and
I've
worked
as
a
community
health
worker
for
three
and
a
half
years
and
I'll
always
be
a
community
health
worker.
But
one
of
the
other
things
about
mental
health
is
that
oftentimes,
the
communities
that
we
serve
have
been
underserved
for
quite
a
while.
G
They
have
not
had
access
to
health
services
for
various
reasons,
and
so
sometimes
there
are
certain
stigmas
associated
with
certain
types
of
health
care
and
especially
mental
health
care
and
as
a
chw,
we're
able
to
connect
with
patients
on
a
different
level
and
really
be
able
to
normalize
getting
treatment
for
mental
health,
and
it
makes
them
more
open
to
exploring
those
issues
and
then
also
what
lessons
are
learned
in
that
mental
health
treatment.
We're
able
to
support
them
in
the
community
so
applying
a
lot
of
their
things
that
they
learn
in
their
treatment
plan.
G
D
Yes
explain
my
vote.
I
want
to
thank
chairman
moser
for
bringing
this
bill
today
and
I
certainly
want
to
thank
you
all
sitting
at
the
table
for
all
your
work.
D
Everything
you
do,
I'm
making
my
yes
vote
on
behalf
of
ashley
shumate
killian,
who
works
out
of
a
clinic
in
lexington,
does
great
work,
but
she
was
my
next-door
neighbor
growing
up.
Oh
that's
good!
I'm
proud
of
everything
you
do.
Ashley.
B
G
A
First
or
yes,
we
do
have
a
committee
sub
that
I
would
like
to
adopt.
G
A
Proceed
all
right.
Thank
you.
So
much,
let
me
move
my
microphone
a
little
closer,
so
this
is
a
very
short
but
a
very
substantive
bill.
I
am
kim
mosher
state
representative,
the
64th
district,
and
I
do
have
some
guests
with
me
today.
I
will
just
give
a
brief
overview
and
I'll
then
allow
them
to
introduce
themselves
and
expound
upon
this
this
legislation.
A
So
we
are
here
today
to
talk
about
house
bill
430
and
I
think,
as
a
committee,
we
deal
a
lot
with
medicaid
issues.
We
don't
necessarily
talk
about
medicare.
Very
often
it's
a
federal
insurance
policy
available
to
individuals
who
are
generally
65
and
over.
There
are
some
provisions
in
federal
statute
that
allow,
through
the
social
security
act,
individuals
with
end-stage
renal
disease
to
apply
for
and
have
this
have
medicare
as
their
health
insurance
policy.
A
So
just
as
a
general
kind
of
overview
of
what
medicare
is
the
medigap
policy
is
what
we're
talking
about
today,
and
that
is
a
supplemental
policy.
It's
something
that
individuals
can
purchase
in
addition
to
their
original
medicare
and
it
medicare
is
a
little
complicated.
A
But
if
you
wait
six
months,
you
sign
up
for
a
different
policy
and
you
decide
that
you
want
to
have
medigap
coverage
or
a
supplemental
policy,
and
incidentally,
there
are
59
different
policy
writers
for
a
supplemental
insurance
in
kentucky,
so
that
just
tells
you
how
many
varying
opinions
you
might
get
when
you
go
to
sign
up
for
this
policy,
but
anyway,
the
the
issue
at
hand
is
there
are
questions
around
pre-existing
conditions.
If
you
wait
longer
than
this
six
month
period,
it's
kind
of
an
arbitrary
length
of
time.
A
We
think
that
it's
it's
discriminatory
and
we
would
like
to
tighten
that
up
and
allow
folks
more
options.
Now
what
the
committee
sub
does
is.
We
have
had
many
meetings,
several
meetings
with
the
kentucky
association
of
health
plans
and
health
insurance
plans
folks
and
have
discussed
some
of
their
concerns,
and
one
was
around
open,
enrollment.
A
It's
problematic
to
be
able
to
sign
up
for
this
supplemental
policy
at
any
time
during
the
year-
and
I
understand
I
mean
we
don't
want
that
you-
we
wouldn't
want
folks
to
get
homeowners
insurance
when
their
house
is
on
fire
right.
We
don't
want
people
to
be
able
to
just
get
health
insurance
when
they
have
an
issue,
and
so
we
tightened
that
language
up
and
we're
using
what's
called
the
birthday
rule,
and
I
know
that
elizabeth
will
be
able
to
expound
upon
that
a
little
bit
or
maybe
eric
and
then
the
issue
of
premiums.
A
We
are
using,
what's
called
average
weighted
premiums
and
it's
a
formula
to
calculate
what
a
what
a
person's
premium
would
be
using
age,
not
necessarily
pre-existing
conditions,
so
it's
not
truly
medically
underwriting,
but
it's
giving
the
insurance
providers
some
ability
to
average
out
those
premiums
so
that
it's
it
truly
is
a
compromise.
A
J
J
J
What's
important
about
our
organization
is
our
mission
and
our
policy
are
patient-led
by
our
members
and
by
our
board
and
our
board
of
directors.
Every
single
member
of
our
board
is
an
end-stage
renal
disease.
Patient
I'm
testifying
today
in
support
of
house
bill
430,
which
would
provide
access
to
medicare
supplement
plans,
also
called
medigap
for
dialysis
patients
who
are
under
the
age
of
65..
J
The
bill
also
provides
key
consumer
protections
and
affordable
premiums.
Let
me
describe
to
you
the
universe
of
kidney
failure.
Patients
these
patients
comprise
an
extremely
vulnerable
population.
Nearly
half
of
them
are
also
on
medicaid
they're
called
dual
eligibles,
with
both
medicare
and
medicaid
coverage.
In
kentucky,
there
are
9047
dialysis
patients,
as
currently
reported
by
the
u.s
renal
data
system,
of
that
number
5245
of
them
are
under
the
age
of
65..
J
J
African
americans
are
three
and
a
half
more
times
likely
to
have
kidney
failure,
hispanics,
asians
and
native
americans
one
and
a
half
times
more
likely
so
fair
and
affordable
access
to
medigap
coverage
for
underage
dialysis.
Patients
is
critically
important,
and
I
want
to
talk
about
two
main
reasons
why
it's
critically
important.
J
J
There's
no
cap
on
this
and
the
ticker
starts
again
on
january
1
of
every
year.
So
these
out-of-pocket
expenses
for
dialysis
patients
can
be
up
to
twenty
thousand
dollars
a
year
that
they
are
responsible
for
paying
medigap
covers
these
out-of-pocket
expenses.
Eliminating
this
struggle,
do
I
pay
my
medical
bills.
I
need
my
medical
treatment
to
stay
alive.
Do
I
buy
food?
Do
I
pay
rent?
J
It's
not
hard
to
understand
that
people
will
spend
down
their
assets
to
qualify
for
medicaid
becoming
a
dual
eligible
for
both
medicare
and
medicaid.
The
state
pays
for
the
20
out
of
pocket.
The
second
reason
is
a
life
saving
reason.
While
some
patients
are
okay
on
dialysis,
the
optimal
therapy
remains
a
kidney
transplant.
J
So
this
is
the
list,
that's
maintained
by
the
health
and
human
services
by
the
federal
government,
but
there's
a
different
list.
It's
called
the
active
kidney
transplant.
Wait
list
you
get
on
that
list
at
your
transplant
center,
following
an
extensive,
obviously
medical
screening
to
make
sure
you're
healthy
enough
for
the
transplant.
The
organ
will
survive
and
also
with
financial
screening.
J
The
reason
for
that
is,
the
twenty
percent
out
of
pocket
needs
to
be
covered
so
that
these
patients
can
continue
to
receive
the
medical
care
that
they
need.
This
helps
the
kidney
to
have
the
optimal
survivability.
These
organs
are
very,
very
scarce.
I
learned
this
firsthand
when
I
worked
for
an
organ
procurement
organization.
J
J
I've
witnessed
this
first
hand
in
other
states
where
we
have
worked
on
medigap
coverage
in
rhode,
island,
for
example,
the
sponsor
of
the
bill.
That's
currently
working
its
way
through
the
rhode
island
general
assembly,
one
of
his
family
members
was
under
age.
65
on
dialysis,
had
purchased
a
medic
gap
plan.
Rhode
island
is
exactly
like
kentucky
nothing
in
place
for
under
age
65,
the
insurers
were
not
regulated,
she
was
dropped.
J
J
So
it's
clear
that
access
to
fair
and
affordable
plans
can
transform
the
lives
of
these
under
65
dialysis
patients,
but
what's
going
on
in
kentucky
right
now,
so
currently
some
plans
are
available
for
purchase,
but
because
the
commonwealth
doesn't
have
any
statutory
authority
in
place.
Insurers
have
broad
parameters
for
how
they
deal
with
the
under
65
market.
J
First
plans
are
all
medically
underwritten.
This
means
all
pre-existing.
Conditions
are
taken
into
account
when
an
under
age
65
individual
applies
for
coverage,
because
because
they're
not
regulated,
carriers
can
refuse
coverage,
they
can
cancel
coverage.
As
I
explain
what
happened
in
rhode,
island
and
charge
higher
premium
rates,
medicare.gov
has
a
supplemental
insurance
online
tool
so,
for
example,
monthly
premiums
for
plan
a
which
is
the
leanest
benefit
plan
for
under
age.
65
ranges
from
248
dollars
a
month
to
1
118
a
month.
J
J
J
J
J
J
G
G
K
I'm
eric
evans
associate
state
director
of
advocacy
outreach
for
aarp
kentucky.
I
would
like
to
thank
chairman
moser
for
bringing
this
bill
and,
before
you
all
and
also
representative
wilner,
for
working
with
us
on
this
bill.
This
is
one
thing
that
aerp
really
finds
an
important
issue.
Aarp
is
a
non-profit
nonpartisan
organization
with
membership
and
we're
nearly
38
million.
K
We
have
4
430
000
members,
just
in
kentucky
aarp
fights
for
issues
that
matter
most
to
our
folks.
That
means
family
health
care,
family,
caregiving,
independent
living
and
financial
security,
which
this
bill
covers.
Two
of
those
so
house
bill
430
will
require
medigap
plans
to
cover
people
with
pre-existing
conditions.
K
Aarp
has
been
made
aware
of
this
by
many
of
our
our
members
that
have
been
denied
coverage,
and
so
we,
along
with
chairman
moser,
saw
this
bill
as
a
great
way
to
fix
this
problem
under
current
federal
minimum
standards.
Consumers
who
purchase
medigap
only
get
one
opportunity,
as,
as
we
said,
to
enroll
when
they
first
enjoy
medicare
and
many
of
our
folks
have
a
tough
time.
You
know
figuring
that
out.
G
Do
we
have
a
second
on
the
with
the
sub
okay
represent
marzian
before
we
vote
we're
going
to
have
entertain
a
few
questions,
and
then
I
know
we
have
a
few
folks
that
want
to
speak
against
it.
So
we
want
to
give
everybody
adequate
time
represent
bright.
Did
you
have
a
question.
D
Yeah
I
I've
got
a
couple
just
cause.
You
know:
we've
not
dealt
with
medicare
before
and
so
I'm
kind
of
swimming
in
water.
That's
over
my
head
here,
but
so
I'm
very
sympathetic
towards
patients
with
end-stage
renal
disease.
My
dad
actually
gave
a
kidney
to
my
aunt
because
you
know
she
suffered
from
that.
D
D
Okay,
yeah.
D
All
right
in
section
two,
it
talks
about
the
weighted
average
for
premiums.
I
I
guess
it's
so
that
people
aren't
discriminated
on
based
on
their
age.
Do
we
have
these
policies
similar
to
this
in
place
for
other
insurance
plans.
A
That
would
be,
I
mean
those
are
private
insurers
who
set
the
terms
of
those
policies.
So
I
don't
know
that
we
have.
Are
you
asking
if
they're,
if
they
are
medically
underwritten.
A
L
B
Thank
you,
chair,
lady.
My
first
question
is:
is
there
a
health
mandate
on
this.
A
No,
we
don't
have
a
health
mandate
on
this,
yet
I
mean
we.
We
can
do
that
elizabeth.
I
don't
know
if
you
want
to
speak
to
what
that
looks
like
or
the
physical
impact
I
mean
this.
Is
these
we're
not
talking
about
any
state
dollars?
These
are
what
this
allows
is
individuals
to
continue
paying
their
own
premiums,
we're
just
making
sure
that
it's
not
exorbitant
and
out
of
reach
for
people
to
stay
on
their
own
medigap
policy
and
not
not
have
to
move
or
spend
down
all
of
their
assets
to
become
medicaid
eligible.
A
A
B
Okay,
my
last
question
you
know
being
in
business
for
50
years
as
the
end
of
being
the
pharmacist
working
for
other
people.
He
seemed
like
every
time
I
got
involved
with
the
federal
government
or
federal
program
that
I
was
in
violation
if
I
tried
to
override
it.
Does
this
violate
any
federal
laws.
A
No,
it
doesn't.
There
are
provisions
in
federal
law
that
allow
states
to
make
these
sorts
of
adjustments.
F
F
Type
of
supplement
insurance-
and
you
said
it's
0.9-
and
that
equates
to
I
think
you
mentioned
earlier-
maybe
not
in
this
setting,
but
two
dollars
an
increase
per
individual
roughly,
yes,
okay,
all
right!
I
just
want
to
try
to
get
some
try
to
get
some
clarification,
because
obviously
I
got
a
pretty
good
number
of
folks
over
65,
which
I
feel
like
I'm
getting
closer
and
closer
each
day.
F
So
I've
been
mindful
of
that.
So
I
just
want
to
make
sure
that
there's
really
no,
if
not
extremely
minimal,
increase
in
terms
of
these
supplemental
plans
and
so
forth,.
M
Thank
you,
madam
chair.
Thank
you
for
this
bill
and,
if
I
remember
correctly,
did
you
not
have
a
bill
a
few
weeks
ago
that
helped
or
had
a
charitable
organization
could
raise
money
to
help
pay
for
yes
and
would
that
apply
to
this.
A
Yes,
the
charities
would
be
able
to
pay
premiums
on
behalf
of
medicare
patients.
M
Thank
you
and
just
to
comment
out
in
my
other
life.
I
was
a
dialysis
nurse
as
well
as
a
transplant
coordinator
and
after
someone
went
through
the
whole
workup,
which
was
very
extensive
and
could
take
months,
if
not
longer
and
then
to
get
on
the
list
and
then
be
dropped
because
of
financial
concern.
Because
of
the
coverage.
And
you
know
they
not
only
need
it
for
the
surgery,
but
also
for
the
medications
which
can
probably
run
thousands
a
month
to
keep
their
kidney.
M
So
this
is
so
important
for
that
population
to
be
able
to
get
off.
Dialysis
have
a
life
that
maybe
they
can
get
back
to
work
and
have
a
better
quality
of
life.
And,
if
I
remember
correctly
from
my
years
in
transplant,
it
was
about
a
three
year
length
of
time
for
the
transplant
to
be
in
effect
and
working
to
recover.
A
So,
thank
you
yeah.
Thank
you
for
bringing
that
up.
I
wholeheartedly
agree
that
the
the
point
in
discussing
the
end
stage,
renal
patient,
is
to
allow
them
to
get
on
with
life
to
to
to
become
a
productive
working
member
of
society
and
contributing
to
their
families,
but
also
the
the
return
on
investment
is
probably
a
huge
win
for
the
insurers
as
well.
I
would
think
I
mean
dialysis
is
lifelong.
A
It's
expensive,
and
I
I
mean
you
know
I
think,
to
make
this
adjustment
in
premiums
and
make
it
manageable
for
patients
is,
is
a
win
for
everyone
representative.
G
E
Thank
you
very
much
just
brief
comment
good
deal,
and
thank
you
very
much.
I
I
I
do
have
a
quick
question.
I
you
know,
but
would
you
consider
the
the
single
issue
here
really
is
this
thing
has
been
allowed
to
operate
this
way
in
the
free
market
kind
of
dynamics
for
all
this
time,
and
there's
been
absolutely
no
regulation
in
this
particular
area?
Would
that
be
appropriate.
K
K
Conditions
and
to
charge
different
by
age
so.
E
E
This
is
this
is
the
good
of
our
citizens
and
sometimes
it's
necessary
to
step
over
into
health
care
and
make
sure
our
citizens,
especially
since
all
of
health
care,
is
highly
regulated
highly
all
the
way
down
to
what
are
reimbursed
allowables,
who
can
provide
which
hospital
which
pharmacy.
So
I
say,
good
for
you,
and
this
is
a
place
we
step
over
and
we
say
you
can't
take
advantage
of
our
people
anymore,
and
I
appreciate
your
courage-
and
I
think
this
is
the
right
thing
to
do,
and
thank
you
very
much.
G
G
N
N
Yesterday
afternoon
I
was
well
first
off.
Let
me
say
it's
not
a
pleasure
to
sit
next
to
the
chair
against
her
own
bill
and
that's,
but
we
had
met
with
her
before
and
and
brought
brought
her
up
to
speed
on
where
what
we
were
thinking
from
a
health
plan
perspective,
and
yesterday
we
provided
you
all
with
an
email
outlining
ahip's
concerns
with
the
bill,
and
they
they
generally
revolved
around
open
enrollment
period
and
the
guarantee
issue-ish
provisions.
N
The
healthy
the
unhealthy
folks
are
subsidizing
the
healthy
ones.
We're
also
concerned
that
the
it
doesn't
appear
that
the
enrollment
period
aligns
with
the
medicare
enrollment
period
and
the
folks
that
I
have
have
have
some
concerns
with
that
issue
and
I
think
the
premium
and
I'll
let
representative
moser
respond
to
this
one,
but
the
premium
discussion
about
two
dollars.
N
That
seems
to
only
apply
to
subsection
two,
the
the
non-age
eligible
folks
and
when
it
comes
to
the
the
enrollees
over
65,
that's
going
to
be
a
whole
different
number
and
I'll
be
curious
to
see
what
that
what
that
comes
out
to
be,
and
with
that.
O
Thank
you,
madam
chair
members
of
the
committee,
and
certainly
appreciate
chair
moser's
work,
dealing
with
people
that
who
are
on
dialysis,
have
renal
disease
and
certainly
representative
marzian.
We
did
meet
with
her
relative
to
house
bill
317
and
chairman
was
very,
very
generous
with
their
time
and
addressed
some
of
our
concerns.
O
The
the
concern
we
have
with
the
house
bill
430,
including
the
committee
sub,
is,
if
you
look
at
section
2
that
deals
with
the
non-age
eligible
persons.
This
is
the
individuals
who
are
eligible
because
they
have
renal
disease.
However,
if
you
look
at
sections
1,
3
and
4,
that
applies
to
the
entire
medicare
population,
everybody
over
the
age
of
65.,
and
if
you
look
at
section
one,
it
builds
in
the
guaranteed
issue.
O
Community
rating
provisions-
that's
in
essence,
say
that
when
you're
65,
if
you
delay
obtaining
a
med
sub
policy
because
you're
healthy
and
then
four
or
five
years
down
the
road,
you
develop
a
serious
health
condition.
You
can
come
in
at
that
point
and
obtain
a
med
sub
policy
and
there's
no
rating
based
on
your
age,
gender
or
health
status.
So
you
get
the
same
premium
as
that
healthy
65
year
old,
who
was
responsible,
who
signed
up
for
a
med
sub
policy
when
they
first
became
eligible
for
medicare.
O
The
irony
is
medicare
for
the
basic
benefits
discourages
exactly
what
I
said.
There
are
penalties
if
you
do
not
enroll
within
six
months
of
attending
the
age
of
65
and
that's
both
parts,
a
and
b
the
problem
with
subsection
one
is.
It
says
it
creates
this.
This
incentive
for
healthy
65
year
olds
to
delay
obtaining
a
med
sub
policy
until
they
develop
a
health
condition
and
there's
no
penalty
for
that
delay,
meaning
that
you're
penalizing
those
who
are
responsible.
Who
do
the
right
thing
obtain
the
med
sub
policy
when
they're
65.
O
the
risk
pools
by
all
59
insurers,
all
based
on
people
signing
up
for
med
sub
policies
at
age
65.
The
market
works
exceedingly
well.
It
works
because
you
have
healthy,
65
year
olds,
signing
up
for
the
med
step
policies
as
they
progress
and
maybe
have
that
severe
health
condition
they're
having
the
benefit
of
the
coverage,
because
they,
you
know,
have
paid
into
the
system
and
it
works
because
it's
everybody's
participating
their
incentives
to
participate.
So
you
have
healthy
and
then,
as
you
you
know,
go
on.
You
have
more
severe
health
conditions.
O
The
concern
we
have
with
subsection
one
as
well
as
three
and
four
is
that
you
have
a
med
sup
market
that
works
exceedingly
well
and
I
personally
participate.
I
can
from
firsthand
experience
tell
you
it
works
exceedingly
well,
it's
very
stable.
The
risk
pools
have
all
been
underwritten
based
on
the
laws
exist
today,
and
our
concern
is
that
we're
going
to
create
disruption
in
the
this
market,
you
can
ultimately
may
result
in
higher
premiums
for
medicare
eligible
seniors.
O
You
may
have
some
of
our
existing
plan
issuers
exit
the
market
because
they're
going
to
have
to
rewrite
the
risk
pools.
It's
just
going
to
be
very,
very
disruptive
and
working
with
chair
moser.
What
we're
trying
to
accomplish
is
if
we
could
have
a
very,
very
targeted
bill,
dealing
with
her
concern,
which
is
totally
legitimate
in
dealing
with
this
fairly
discreet
population,
the
the
non-age
eligible
individuals.
We
want
to
work
with
her
to
get
there,
but
our
concern
is:
if
you
look
at
one
three
and
four,
it
applies
to
the
entire
medicare
population.
O
Ma'am
chair
members
of
the
community.
Thank
you
for
allowing
me
to
testify.
A
Yes,
if,
if
I
could
just
respond-
and
thank
you
very
much
for
your
conversations
about
this,
I
do
understand
the
issue
a
whole
lot
better
since
I've,
since
I've
really
had
to
educate
myself
about
medicare.
A
There
are
a
lot
of
moving
parts
and-
and
I
have
told
you,
mr
brinkman,
that
I
am-
or
I
should
say,
secretary
bringman,
a
representative
that
I'm
willing
to
work
with
you
on
on
this
on
this
language.
So
thank
you
for
bringing
your
concerns
to
us
and-
and
I
am
willing
to
to
look
at
this-
you
know
I
I
still
maintain
that
there
are
protections
that
we
should.
We
should
put
in
place
for
individuals,
so
that's
kind
of
where
we
are.
G
Are
there
any
other
further
questions
representative
elliot.
D
D
N
O
We'd
have
to
circle
back
on
the
open
roaming
and
make
sure
that
it
lines
in
any
concerns
are
addressed.
You
know
I
wanted
to
speak.
You
know
primarily
about
how
I
think
this
could
be
very,
very
disruptive
to
the
market
because
of
the
guaranteed
issue
and
community
rating
features,
but
that's
so
certainly
we'll
circle
back
and
get
back
to
you
on
that.
That
point
and
and
chair
moser
is
right.
O
Medicare
is,
is
a
federal
program,
there's
no
state
dollars
involved,
but
the
med
sub
policies,
those
are
private
insurance
policies,
and
so
I
think
it
would
be
appropriate
to
have
a
financial
impact
statement
prepared
by
the
department
of
insurance,
because,
like
any
health
insurance
mandate,
where
they
do
the
analysis
and
say
if
this
becomes
law,
this
could
have
the
possibility
of
raising
premiums
by
you
know
a
range
between
x
and
y
dollars
per
month
per
member.
O
I
think
that
would
be
totally
appropriate,
because
this
is
private
insurance
and
I
think
it
would
be
appropriate
to
have
that
analysis
done
that
if
you
have
guarantee
in
essence,
guaranteed
issue
and
community
rating
for
all
the
entire
medicare
population
kentucky
what
impact
that
would
have
on
premiums
on
the
mid-sub
premiums
of
the
policies
issued
in
the
state.
E
E
We
hear
a
lot
about.
Well,
that's
going
to
cause
premiums
to
go
up
and
there's
some
good
things
here
and
I
agree
with
the
direction
everybody's
going
here.
I
think
you
need
to
work
together
and
figure
it
out,
but
but
it
concerns
me,
you
know
when
we
said,
for
instance,
how
many
people
you
said
that
it
would
include
all
the
rest
of
the
people
in
kentucky,
and
I
that
I
can
see
where
that
that
would
cause
some
eyebrows
to
go
up,
but
how
many
people
would
that
include.
E
O
Yet
two,
and
maybe
three
other
states
have
passed
similar
legislation
applying
to
the
entire
medicare
population.
Connecticut
new
york,
possibly
maine.
We're
trying
to
drill
down
part
of
our
problem
is,
is
that
we
really
don't
have
all
the
answers
and
you
raised
representative
a
very
legitimate
question,
which
is
why
I
think
it
would
make
sense
for
doi
to
do
the
financial
impact
analysis
to
to
no
and
again
we're
not
here.
O
E
And
I'll
just
follow
up
with
this,
then
that
I
don't
know
that
we
should
be
coming
out
and
sending
out
things
telling
everybody
the
premiums
are
going
up.
When
you
just
said
you
don't
know
new
york,
don't
know
other
people,
don't
know
you
don't
have
the
data.
I
do
agree,
you
should
do
the
health
mandate
and
let's
see
what
it
is,
but
you
know
it's
a
possibility,
I
suppose
and
a
possibility
a
along
the
way.
But
but
I
won't
keep
you
know,
we
won't
keep
going
down
this
road.
G
M
Martian,
thank
you,
madam
chair
good,
to
see
scott.
Can
you
tell
me
how
much
out
of
each
dollar
that
is
paid
in
insurance
is
paid
for
actual
services
and
how
much
has
gone
to
administration
and
ceos
and
how
profitable
the
health
insurance
industry
is?
I.
O
M
M
N
G
And
send
it
to
the
whole
committee,
if
you
don't
mind
absolutely,
I
just
have
one
question,
mr
brinkman.
If,
if
missouri
has
done
the
language
in
the
committee
sub
is
from
missouri
and
they've
done
it
since
2008
or
2009,
that
would
help
shed
light.
O
Again,
if,
if
section
2
section
2
is
based
on
missouri,
we
have
not
done
an
analysis
of
that
and
again
we
appreciate
the
concern
with
this
small
subset
of
the
medicare
population
and
certainly
appreciate
chair
moser's,
focus
and
compassion
for
this
group
of
individuals.
We
all
share
the
compassion.
The
problem
is
it:
this
committee
sub
is
not
limited
to
just
that
population.
If
you
look
at
non-age
eligible
persons,
they
are
within
the
scope
of
sub
sub
section
two
but
sections
one.
O
O
G
Okay
appreciate
the
fact
that
y'all
willing
to
work
together
and
see
no
further
questions.
Madam
secretary,
please
take
the
role.
B
D
My
vote
matt
explain
I'll
vote,
yes
to
get
it
out
of
committee,
but
this
has
got
a
long
way
to
go.
I
get
really
really
uneasy
when
we
start
talking
about
regulating
the
free
market,
especially
when
we're
talking
about
raising
insurance
rates
and
the
statement
is
you
know,
we
don't
know
how
much
this
will
impact
so
I'll
vote,
yes
to
continue
the
conversation,
but
I
do
look
forward
to
the
actuarial
analysis.
Thank
you.
B
F
I'm
going
to
join
representative
bray
and
bentley
on
voting.
I
but
I'll
observe
how
things
are
materialized
and
I
have
both
confidence
in
the
the
chairwoman.
As
the
secretary.
I
know
them
for
a
long
time.
They'll
come
up
with
a
solution,
so
I
look
forward
to
seeing
that,
but
I'll
vote
yes,
but
reserved
yes,.
M
E
Yes-
and
I
agree
with
mr
brinkman
about
that-
you-
you
do
understand
the
intent
of
the
law
and
we're
looking
forward
to
seeing
what
you
guys
come
up
with.
Thank
you.
L
Briefly
comment:
if
I
may
yes,
thank
you,
I'm
a
yes
and,
of
course,
we
I
understand
the
chairwoman's
intent
to
protect
the
small
subset,
who
are
the
underage
folks
who
qualify,
who
qualify
for
medicare
because
of
particular
health
conditions.
But
I
hope
we
don't
leave
out
the
people
who
are
65
and
older
who
have
been
excluded
because
of
pre-existing
conditions
and
because
of
missing
that
very
narrow
window.
So
I
vote
yes
and
I
look
forward
to
seeing
the
compromise.
Thank
you,
chairwoman,
moser.