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From YouTube: 5/28/2021 - Assembly Committee on Ways and Means, Pt. 1
Description
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A
A
A
A
As
I
said
yesterday,
we'll
be
happy
to
give
you
a
a
heads
up,
but
with
that
today,
as
far
as
the
lay
of
the
land
goes,
the
first
bill
up
will
be
sb
380
and
then
the
second
bill
up
will
be
sb
420
420,
since
it
did
not
go
to
the
policy
committee
on
in
the
assembly,
we'll
be
giving
it
a
little
more
time
and
a
little
more
latitude
to
make
sure
that
everyone
has
their
voice
heard
on
the
record,
but
we're
going
to
keep
it
tight
and
we're
going
to
keep
it
to
the
two
minutes
for
everyone.
A
So
with
that,
I
just
wanted
to
make
that
that
perfectly
clear,
because
it's
a
big
piece,
it's
an
important
bill.
We
just
want
to
make
sure
that
it
has
the
time
that
it
deserves.
So
with
that,
I'm
going
to
go
ahead
and
open
up
the
hearing
on
sb
380,
the
chair
of
senate
health
and
human
resources
needs
to
get
to
finance.
So
we
need
to
get
her
in
and
out
of
there,
so
finance
can
get
all
the
things
that
they
need
done
too
so
good
morning.
Senator.
C
Madam
chair
for
the
opportunity
to
present
this
bill
and
for
the
discretion
to
go
first
today,
I
know
that
that
is
a
significant
gift
on
the
fourth
day
of
the
legislature,
the
fourth,
fourth
to
the
last
day
of
the
legislative
session,
my
name
is
julia
raddy,
and
I
am
here
today
to
present
present
sb
380..
C
Sb
380
continues
the
work
that
was
really
groundbreaking
work
that
was
done
in
the
2017
session
to
shine
a
bright
light
on
and
bring
more
transparency
to
how
we
come
to
the
cost
of
pharmaceutical
drugs.
You
will
probably
all
recall
that
in
that
session
we
started
by
focusing
on
one
of
the
drugs
that
many
people
depend
on.
That
was
in
the
news
quite
a
bit
at
that
time,
and
that
is
a
big
cost
driver
for
health
care
costs.
In
the
state
of
nevada-
and
that
was
that
would
be
diabetes.
Drugs
in
2019.
C
We
built
on
that
and
we
added
asthma
and
in
2021.
What
we
seek
to
do
is
to
modernize
the
program.
If
you
will
make
sure
that
staff
has
the
resources
that
they
need
to
both
collect
the
data
and
to
get
meaningful
information
from
the
data
and
to
expand
the
class
of
drugs
to
those
drugs
that
are
clearly
going
up
in
price
and.
C
C
That's
a
pretty
good
one:
okay,
yeah
plexiglas
all
right,
well
important
business
happening
today,
so
we're
just
going
to
keep
going
all
right
so
to
bring
it
home
this
bill.
Basically,
does
these
things?
It
removes
the
requirement
that
the
department
compile
a
list
of
essential
asthma
drugs.
So
we
think
that
we've
we've
gotten
where
we
need
to
go
on
all
asthma
and
we're
taking
asthma
off
the
table.
It
requires
the
department,
in
addition
to
the
list
of
essential
diabetes
drugs,
so
we're
keeping
diabetes
drugs.
C
That
program
is
still
important
to
us
to
compile
a
list
of
prescription
drugs
with
a
wholesale
acquisition
cost
exceeding
forty
dollars
for
a
course
of
therapy.
So
a
course
of
therapy
could
be
a
month
of
pills.
It
could
be
one
pill.
It
just
depends
on
what
the
defined
course
of
therapy
is
for
that
drug.
So
this
is
the
wholesale
cost
of
forty
dollars
and
have
undergone
an
a
price
increase
of
ten
percent
over
one
year
or
twenty
percent
over
two
years.
C
So
we're
narrowing
down
the
class
of
drugs
that
we
would
like
to
have
more
data
and
more
information
and
shine
a
brighter
light
on
from
a
transparency
standpoint
to
the
diabetes
diabetes,
drugs,
which
are
still
a
significant
cost
driver
for
the
state
as
well
as
now
any
drug
that
is
more
than
40
wholesale
acquisition
costs
for
a
course
of
therapy
and
not
or
and
has
a
10
increase
over
10
or
1
year
or
20
increase
over
two
years.
That's
the
most
significant
change
to
this
bill.
C
C
It
expands
the
information
that
a
manufacturer
is
required
to
report
that
that
is
in
sections,
11
and
12
of
the
bill.
It
expands
the
information
that
a
pharmacy
benefit
manager
is
required
to
report.
That's
in
section
13
of
the
bill
and
again
we're
talking
about
all
these
supply
chain
issues
right.
It's
not
just
the
manufacturer.
It's
the
wholesaler!
It's
the
pbm
and
it
requires
the
department
to
conduct
an
annual
public
hearing
based
on
the
report
findings.
So
we
want
to
make
sure
that
the
public
is
hearing
about
what
we
learn.
C
We
have
we've
done
some
updates
on
definitions
for
unit
and
manufacturer
just
to
make
sure
that
we're
getting
that
right
in
the
law,
and
then
it
maintains
existing
penalties
set
forth
in
nrs,
so
we've
been
collecting
penalties
for
those
who
do
not
comply,
and
we've
collected
some
of
those
penalties
and
knowing
that
we're
still
in
a
fiscally
tight
environment.
What
we
are
suggesting
from
a
fiscal
note
standpoint
is
that
we
use
the
penalties
that
have
been
collected
to
date
to
cover
the
costs
of
the
transparency
program
in
this
biennium.
C
If
we
there's
about
a
million
dollars
in
the
account
right
now,
the
cost
to
do
this
program
for
the
next
two
years
is
about
seven
hundred
and
seventy
thousand
dollars.
You
can
see
on
the
fiscal
note,
so
we
would
use
the
bulk
of
those
penalties
so
that
we
don't
have
to
touch
the
general
fund
in
this
cycle
and
there
would
be
some
remaining
penalties
left
over.
I
will
just
say
right
now:
we
do
not
know
if
that
is
sustainable
going
forward.
C
We
really
hope
that
people
will
comply
and
continue
to
do
their
reporting,
and
so
the
next
legislative,
the
next
governor
and
the
next
legislature
would
need
to
decide.
Is
this
something
that
we
now
want
to
put
in
the
base
budget
or
are
the
penalties,
an
ongoing
and
sustainable
form
of
funding
for
this
program?
But
as
of
this
biennium,
the
penalties
will
cover
the
cost.
So
with
that
and
knowing
that
time
is
always
of
the
essence
here
I
will
stop.
C
A
So
so
with
that
I
I
guess
some
of
my
questions
are,
and
I've
heard
some
conversations
around
this
bill
and
as
far
as
where
we're
going
so
I
I
believe
the
bill
was
amended
in
the
senate
to
to
address
some
of
these
things.
So
I
want
to
understand
the
40
course
of
therapy
a
little
bit
better.
I
believe.
C
I'd
be
happy
to
again
julia
ready
for
the
record,
as
the
bill
came
out
of
the
committee
and
and
hat
tipped
to
the
committee,
who
were
being
very
ambitious.
They
wanted
to
do
all
drugs
and
all
drugs
would
of
clearly
have
crushed
the
program.
We
couldn't
afford
the
number
of
staff
that
it
would
take
to
analyze
the
data
on
all
drugs,
and
that
would
have
been
quite
the
burden
for
the
industry
and
so
through
lots
of
conversations
in
this
we're
on
which
reprint,
oh
actually
we're
not
doing
so
bad.
C
On
this
one:
lots
of
conversations:
lots
of
stakeholder
conversations,
lots
of
conversations
with
the
industry
on
this
one,
multiple
iterations
of
it-
that
I
guess
we
just
moved
through
iterations
and
working
groups,
not
necessarily
in
amendments,
but
in
the
final
amendment
we
felt
like
the
best
focus
was
that
price
point?
Okay.
What
we
really
want
to
know
is
at
a
certain
level,
they're
too
too
cheap
for
it
to
matter
right.
So
forty
dollars
seemed
like
a
reasonable
price
point
and
then
that
the
price
is
going
up.
C
Ten
percent
in
one
year
or
twenty
percent
in
two
years
gives
us
that's
going
to
narrow
down
the
universe
of
drugs
that
we're
looking
at
and
hopefully
give
us
information
on
those
that
are
a
significant
cost
to
a
family
and
40.
Again,
that's
a
wholesale
number,
not
a
retail
number,
and
for
many
of
us
that
may
not
sound
like
a
lot
of
money,
but
for
many
of
our
seniors
on
fixed
income.
People
with
a
disability,
that's
a
significant
amount
of
money.
C
So
we
feel
like
it
was
a
good
starting
point
and
then
growth,
10
or
20
growth
in
prices,
plus
keeping
the
diabetes
program
intact
and
the
diabetes
program
stays
intact
completely
because
we've
got
two
years
of
good
data,
and
so
we're
not
tweaking
that
program
at
all,
because
we
want
to
keep
that
data
stream
for
a
while
to
make
sure
that
we've
got
those
good
apples
to
apples
comparisons
for
a
couple
of
years,
because
we
learn,
we
learn
things
from
that
as
well.
All.
A
Right
senator-
and
I
guess
my
next
question
is
going
to
be
in
the
unsolicited
fiscal
note.
You're,
basically
saying
that
the
dollars
that
they
have
now
can
cover
that.
My
question
is:
I've
watched
a
lot
of
bills
come
through
in
the
last
hundred
or
so
days,
and
there's
a
lot
of
responsibilities
being
given,
and
we
know
we
always
need
resources
to
get
those
things
done.
A
We
can
have
all
the
great
policy
in
the
world
and
we
can
fund
it,
but
there
are,
if
there
aren't
the
people
to
actually
get
it
done,
we're
not
going
to
get
the
data
that
we
need
next
time.
So,
within
the
unsolicited
fiscal
note,
are
there
positions
included
in
that
and
I'd
like
to
make
that
clear
that
what
those
positions
are,
because
I
think
it's
really
important
when
we
do
these
things
to
to
give
the
the
folks
the
resources
that
they
need
to
get
it
done.
So
are
those
positions
included.
C
Thank
you,
chair
carlton.
For
that
question.
It's
a
really
important
question:
julia
ready
for
the
record.
I
will
say
that
the
legislature
was
with
no
judgment
to
pass
decisions
but
very
enthusiastic
about
getting
this
program
done,
as
was
the
agency,
and
so
they
absorbed
some
workload
in
the
past
two
bienniums,
and
so
one
of
the
things
that
was
very
important
to
me
was
to
sit
down
with
staff.
C
So
this
bill
started
without
a
fiscal
note,
and
I
don't
think
it's
very
often
that
you'll
see
a
legislature
go
a
legislator,
go
back
to
the
agency
and
say
I
want
a
fiscal
note.
I
want
to
know
what
it's
going
to
take
to
do
this
because
collecting
the
data
is
helpful,
but
if
we
don't
have
the
people
to
analyze
and
process
the
data
and
get
to
insight,
then
it's
not
as
helpful
as
it
could
be.
A
A
D
Sure,
thank
you
so
beth
slamowitz
a
senior
policy
advisor
on
pharmacy
for
the
department
of
health
and
human
services
for
the
record,
so
the
two
positions
that
were
requested
within
the
unsolicited
fiscal
note.
There
is
a
advanced
pharmacist
position
as
well
as
a
management
analyst
position
right
now.
As
senator
ratty
pointed
out,
we
have
absorbed,
we
don't
have
any
designated
staff,
that's
doing
the
work
and
we
have
absorbed
the
work
and
relied
on
staff
within
other
programs,
as
well
as
contract
work,
to
help
with
the
collection
of
the
data.
D
The
advanced
pharmacist
position
really
would
give
us
the
expertise
and
the
knowledge
to
understand
the
complexities
of
the
supply
chain
to
be
able
to
comply,
the
lists
of
the
essential
drugs
and
analyze
the
drug
files,
and
also
to
give
some
oversight
to
the
program.
That
position
would
actually
supervise
the
management.
Analyst
position.
D
The
pharmacist
that
would
be
managing
the
program
would
also
be
responsible
for
the
analysis
of
the
information.
That's
provided
by
all
of
the
reporting
entities
and
then
be
able
to
develop
and
submit
the
annual
reports,
as
required
as
well
as
to
be
able
to
participate
in
the
public
hearings,
as
well
as
the
high
level
and
complex
discussions
that
take
place
with
not
only
stakeholders
but
as
well
as
legal
counsel.
That
occurs
with
some
of
the
reporting
entities
when
that's
necessary,
so
that
position
would
be
vital
to
the
sustainability
of
the
transparency
program.
D
Having
that
staffing
in
a
permanent
position
would
definitely
assist
in
moving
the
program
forward
to
be
able
to
inform
and
change
any
future
policy.
The
management
analyst
position
would
help
with
all
of
the
reporting
and
the
templates.
D
We
don't
have
any
administrative
assistance
or
anything
like
that
for
the
program
and
we
do
get
multiple
emails
phone
calls
and
all
kinds
of
communications
that
need
to
occur
on
both
a
daily
and
a
monthly
basis
and
just
to
kind
of
give
you
an
idea
of
the
amount
of
work
that
comes
in
for
this
last
reporting
period.
We're
getting
ready
to
put
out
the
2021
report.
D
On
june
1st,
there
were
over
1500
drugs
that
needed
to
be
analyzed
and
put
into
reports,
and
then
each
one
of
the
reporting
entities,
the
pbms,
the
manufacturers,
as
well
as
the
drug
reps,
all
had
to
submit
reports
on
those
drugs
and
then
each
one
of
those
had
to
be
analyzed.
There
were
various
communications
back
and
forth
and
then
of
course,
the
final
completion
and
submission
of
the
end
result
report.
D
So
it
is
quite
a
a
bit
of
work
to
manage
and
with
adding
additional
reporting
requirements,
as
well
as
additional
drugs
to
report
on
the
work
will
just
increase,
which
is
not
a
bad
thing,
because
it
will
give
us
more
data
to
inform
our
policy.
D
A
So
we're
contracting
to
see
how
things
happen
for
the
next
couple
of
years
for
those
positions
and
then
the
conference
then
we'll
see
where
the
program
is
in
two
years
from
now,
they'll
you'll
be
able
to
reevaluate
and
see
if
those
positions
might
be
needed
on
an
ongoing
basis.
Do
I
understand
that
correctly.
D
Correct
right
now,
the
penalty
funds
that
would
be
used
are
in
a
non-executive
budget
account
and
that
would
be
used
to
sustain
those
positions
for
the
next
biennium
and
then
hopefully,
we'd
be
able
to
actually
put
the
program
within
a
consistent
budget
going
forward.
So
they
would
be
permanent
position.
C
Madam
chair,
if
I
may,
I've
made
a
rookie
maneuver.
I
should
have
said
at
the
very
beginning
that
we're
working
off
of
the
proposed
amendment
3
408,
to
senate
bill
380
mockup,
which
is
an
exhibit
on
your
committee's
page,
and
everybody
should
have
access
to.
I
apologize
for
not
acknowledging
that
earlier
and
the
fees
are
in
section
18
of
the
bill:
julia
ready
for
the.
C
A
A
We
wouldn't
we
wouldn't
want
to
miss
one.
So
with
that.
This
is
the
hearing
for
sb380
and
thank
you
mishlamowitz
for
being
here
and
we'll
go
ahead
and
open
it
up.
So
with
that.
Is
there
anyone
here
in
the
room
in
support
of
sb
380.?
A
E
Game.
Thank
you,
madam
chair,
and
thank
you
senator
for
presentation
this
morning
just
curious.
You
know
I
was
on
the
health
and
welfare
trust
representing
management
at
metro,
and
we
had
a
you
know.
A
lot
of
things
with
with
health
care
and
prescription
drugs
were
always
an
issue
for
a
lot
of
our
members,
and
you
know
I
see
this
as
a
transparency
bill.
E
C
Thank
you,
julia
ready
for
the
record
through
you,
chair,
carlton,
to
you,
assemblyman
roberts,
it's
a
great
question
and
we
did
start
with
insurers
in
this
bill.
At
the
beginning
of
the
session,
I
was
doing
a
lot
of
work
on
two
bills.
C
This
bill
on
behalf
of
the
interim
committee
on
pharmaceutical
costs.
But
then
I
was
also
had
the
privilege
of
having
the
patient
protection.
Commission
bills
come
to
the
senate
side.
First
and
there's
the
all
payers
claims
database
and
when
we
were
looking
at
workload
and
where
were
we
going
to
get
the
best
transparency,
the
all
payers
claims
database
is
100
insurance
data
and
we
get
to
see
all
of
the
claims
and
so
we're
looking
at
okay.
C
Well,
how
much
do
you
really
ask
these
insurers
to
be
sending
us
information
and
how
many
different
places
and
how
many
different
forms
can
they
put
it
in,
and
so
I
really
felt
at
the
end
of
the
day
we
were
going
to
get
the
best
bang
for
our
buck
by
having
the
all-payers
claims
database
go
forward
where
we're
getting
every
claim
on
all
health
care,
including
pharmaceuticals,
and
then
this
bill
focusing
on
the
rest
of
the
supply
chain.
So
it
really
was
a
matter
of
in
conversations
with
stakeholders.
How
much
can
we
ask?
C
E
C
A
So
with
that,
other
members
questions
at
this
time
for
senator
ratty,
assemblywoman,
peters.
B
Thank
you,
madam
chair,
and,
and
I
have
kind
of
a
similar
question,
but
related
to
how
we're
gonna
bring
those
two
data
streams
together
and
the
capacity
for
that
right
are
these
two
offices,
working
to
like
tangentially
together,
can
yeah.
C
That's
thank
you
for
the
question.
Assemblywoman
again:
julia
raddy
for
the
record
one
of
the
things
so
we're
data
geeks.
So
one
of
the
things
that
I
am
most
excited
about
this
session
is
and
again
we
would
have
heard
about
this
more
in
the
budget
committees.
The
money
committees
is
that
the
department
of
health
and
human
services
is
creating
an
entire
data
team
and
they
are
moving
towards
a
much
more
coordinated
professional
approach
to
data
collection
and
data
usage,
and
so
these
tools
that
we're
giving
them
pharmaceutical
transparency
all
payers
claims
database.
C
Some
other
things
that
have
happened
during
the
session
are
going
to
give
them
a
wealth
of
data
that
now
will
be
in
a
department
that
is
completely
focused
on
analyzing
data.
So
I'm
more
confident
today
than
I
have
ever
been
that
we
are
going
to
get
good,
meaningful,
coordinated
data.
But
if
you
need
more
than
that,
I
would
ask
dr
slamowicz
to
speak
to
it.
A
G
So
you
said
that
sb,
40
and
and
sb
380
were
going
to
work
with
this
data
team.
Now.
Would
that
be
also
be
true
with
sb5
and
all
everything
else
that
we've
been
pat?
I
mean
lots
of
moving
parts
that
passed
out
of
this
committee
yesterday,
so
I
just
want
to
make
sure
that
everything's
going
in
the
right
direction.
C
D
So
beth
slamwoods
for
the
record
so
yeah,
definitely
not
my
wheelhouse
as
far
as
all
of
the
analytics
goes,
but
really
the
drive
is
to
tie
all
of
these
pieces
together
right
now,
at
least
with
the
drug
transparency
program.
D
The
only
utilization
really
that
we
have
to
kind
of
look
at
how
these
drugs
are
being
used
in
the
state
is
medicaid
utilization,
which,
although
it
is
you
know
about
a
third
of
the
state
in
terms
of
utilization,
it
still
doesn't
give
us
a
really
broad
picture
of
how
these
drugs
are
being
used
and
what
kind
of
utilization
we're
looking
at
as
far
as
trends.
So
having
access
to
the
claims
information
from
the
all
payers
claims
database.
D
Not
only
does
it
give
us
an
opportunity
to
look
at
additional
utilization,
but
it
also
gives
us
an
opportunity
to
kind
of
do
a
cross-check
that
what
the
pbms
are
reporting
is
making
is
actually
happening
so
that
what
we're
seeing
that
the
pbms
are
claiming
as
far
as
you
know,
cost
of
the
drug
as
far
as
rebates
being
received,
then
we
can
go
back
to
the
all
payers
claims
database
if
those
pbms
are
reporting
that
pharmacy
data
for
those
health
plans
that
we
have
a
cross
check
now
to
be
able
to
look
at
that
and
actually
verify
the
data.
D
D
A
Thank
you
very
much
so
with
that
not
seeing
any
other
questions
at
this
time.
Thank
you
very
much.
Senator
I
want
to
get
you
back
to
senate
finance
as
soon
as
we
can
so
with
that
I'll
go
ahead
and
open
it
up
for
support
opposition
in
neutral
to
complete
our
hearing
process
on
sb
380
those
here
in
the
room
in
support
of
sb
380.
Please
come
forward
seeing
no
one.
Anyone
on
zoom
seeing
no
one
broadcast
services.
Do
we
have
anyone
in
audio
in
support
of
sb
380?
A
H
A
H
I
I
don't
know,
madam
chair,
if
anyone
is
here
from
pebb
this
morning,
but
we
are
in
support
of
this
bill
as
written
we've
also
taken
a
look
at
the
amendment
and
pebb
is
still
very
much
in
there
in
section
two
of
amendment
I
believe
it's
four
to
six
but
globally
and
briefly,
we
are
very
much
in
support,
even
as
amended
of
this
bill.
Thank
you.
A
H
J
Tom
tom
mccoy
mccoy
on
behalf
of
the
thousands
of
patients
with
one
or
more
chronic
condition
diseases
in
nevada.
We
share
our
concerns
with
sb
380,
as
it
now
reads,
the
nevada,
chronic
care
collaborative
supports
transparency
for
prescription
drug
pricing,
but
for
patients
to
truly
benefit
from
transparency
policy.
Notwithstanding
sb40,
the
policy
needs
to
apply
to
all
players
in
the
supply
chain.
Spectrum
parties
that
impact
what
consumers
pay
when
checking
out
at
the
pharmacy
counter.
J
Excluding
insurers
as
sb
380
does
from
the
same
reporting
obligations
is
not
true
transparency
and
offers
only
half
the
pricing
picture.
Sp
380
does
not
address
the
most
important
factor
for
patients
with
chronic
illnesses.
Out
of
pocket
cost,
moreover,
fails
to
address
what
pharmacy
benefit.
Managers
and
health
plans
do
not
pass
on
rebates
and
discounts
that
they
receive
from
biopharmaceutical
companies.
J
J
H
K
Good
morning,
madam
chairman
members,
I'm
brett
michelin
with
the
association
for
accessible
medicines.
Aam
represents
the
generic
and
biosimilar
manufacturers,
and
I
have
really
three
main
points.
I'd
like
to
make.
First,
I
think
the
state
needs
to
consider
what
it
is
going
to
be
paying
for.
With
its
fine
and
penalty
monies,
the
state
will
be
aggregating
data
and
reporting
information
submitted
by
manufacturers
with
a
wholesale
acquisition
cost
of
40
that
increases
by
10.
K
This
is
not
going
to
capture
the
high
cost
drugs.
In
fact,
it
will
generally
only
capture
generic
drugs
which
have
saved
nevada,
2.4
billion
dollars
in
2019
alone,
for
example,
this
bill
will
capture
drugs
that
cost
a
dollar
33
that
increased
by
13
cents
for
a
drug
taken
once
a
day
for
a
drug
taken
three
times
a
day.
It
will
capture
drugs
that
cost
44
cents
and
increase
by
only
4
cents.
K
However,
we
need
to
consider
what
it
won't
capture
consider
humera
real
world
example:
it
increased,
but
in
price,
according
to
medicare
part
d
by
44
over
five
years.
It
won't
be
required
to
report
under
this
bill,
because
that
is
just
on
average
about
nine
percent.
Just
below
nine
percent,
another
real
world
example
brand
name
ultram
it
its
wholesale
acquisition
cost
is
roughly
three
hundred
dollars.
If
it
increases
by
thirty
dollars,
it
won't
have
to
be
reported.
However,
generic
ultram
costs
about
three
dollars.
If
it
increases
by
three
percent
or
three
cents,
it
will
be
reported.
K
K
When
you
have
multiple
manufacturers
making
the
exact
same
drug
regardless
of
what
the
whack
price
is
the
state
and
the
plans,
they
don't
even
negotiate
with
wholesale
manufacturers
for
for
the
wholesale
price,
that's
done
on
a
national
sales
price.
So
again,
the
whack
is
not
going
to
reflect
what
patients
pay.
K
Absolutely
I
have
just
one
more
quick
point.
Thank
you
appreciate
that
this
information
has
already
actually
been
captured
by
california.
They've
done
this
work
for
nevada
already
and
from
california.
We
know
that,
even
with
the
most
expensive
generic
drugs,
they
are
25
of
all
prescriptions.
There
are
only
eight
percent
of
the
spend
and
less
than
one
percent
of
the
premiums,
so
this
bill
is
not
going
to
capture
the
information
that
nevada
needs
to
consider
other
proposals
to
reduce
the
cost
of
medicine.
Thank
you.
A
H
B
Thank
you
moderator.
My
name
is
beshore
lisik
spelled
a
s
h,
e
r
l.
I
s
e
c
s
b.
380
is
a
byproduct
of
the
interim
committee
on
prescription
drugs,
but
we
are
disappointed
that
many
of
our
measures
did
not
get
vetted
by
the
2021
legislature
that
would
have
truly
assisted
all
nevadans
with
their
prescription.
Drug
costs
pharma
appreciates
the
opportunity
to
work
with
senator
ratty
on
sb
380
to
address
our
primary
concerns
with
measure.
Thank
you
and
happy
anniversary.
Dr
slamwood.
A
C
You
again,
I
appreciate
the
time
of
the
committee
on
this.
I
will
say
that
we
worked
with
lots
of
stakeholders.
We
accepted
lots
of
amendments.
I
think
you
see
that
reflected
that
there's
not
a
long
line
of
people
here
to
testify
in
opposition.
C
I
think
the
folks
we
disappointed
the
most
were
the
folks
who
represent
generics
and
we
think
there's
a
good
argument
for
keeping
generics
in
for
at
least
two
years,
and
then
that
can
be
revisited
and
again
we'll
get
the
utilization
data
from
the
all
payers
claims
database,
which
will
help
us,
hopefully
if
that
gets
across
the
finish
line,
which
will
help
us
as
well.
So
again,
thank
you
so
much.
I
appreciate
your
time
today.
A
Thank
you
very
much
senator
so
next
we
had
sb
420
in
the
queue
with
our
little
earthquake
earlier
it
set
off
the
sensors
in
all
of
the
elevators,
so
none
of
the
elevators
are
working,
so
the
majority
leader
is
making
her
way
from
the
first
floor
to
the
third
floor
through
the
stairwell
right
now.
So
everybody
have
just
a
few
moments
of
patience.
J
A
M
Forgot
good
morning,
chair
carlton
and
members
of
the
ways
and
means
committee
for
the
record,
my
name
is
nicole
canazzaro.
I
represent
senate
district
six,
which
is
located
in
the
northwest
portion
of
the
las
vegas
valley,
and
I'm
pleased
to
be
here
with
you
all
today
to
present
to
you
senate
bill
420..
M
I
do
have
joining
us
today,
chair
carlton,
two
co-presenters,
which
I
promise
will
be
very
short,
but
I
think
can
provide
some
context
on
this
bill.
If
you
will
allow,
I
do
have
shaniqua
hawkins
of
care
with
purpose
medical
center
in
las
vegas
and
wendell
potter
from
the
center
for
health
and
democracy
who
can
join
us
via
zoom.
I
believe
they
should
be
connected
this
morning
also
here
to
assist
with
technical
questions
as
we
walk
through
the
bill
and
are
able
to
answer
questions
for
the
committee.
M
According
to
the
kaiser
family
foundation,
the
cost
of
health
care
ranks
at
the
top
things
that
americans
worry
about,
and
it
affects
every
aspect
of
patient
experience
from
decisions
about
whether
to
even
seek
care
to
the
impact
of
medical
bills
after
receiving
care.
And
importantly,
it
affects
decisions
about
insurance
coverage.
M
It's
not
just
families
that
are
concerned
about
the
cost
of
care
in
research
that
was
released
recently.
The
kaiser
family
foundation
also
found
that
more
than
90
percent
of
business
leaders
surveyed
believe
that
there
is
a
greater
role
for
the
government
to
play
in
controlling
health
care
costs
and
providing
coverage
options,
including
potentially
public
options.
M
Now,
in
the
years
following
the
passage
of
the
affordable
care
act
in
2010
nevada,
also
expanded
medicaid
and
began
offering
private
health
insurance
on
the
silver
state
health
insurance
exchange,
the
provision
the
number
of
nevadans
without
health
insurance
did
decline.
However,
the
uninsured
rate
in
the
last
few
years
has
remained
stubbornly
consistent
and
among
the
highest
in
the
nation
at
approximately
11
percent.
M
In
fact,
there
are
nearly
350
000,
uninsured
nevadans
and
our
uninsured
rate,
despite
being
one
of
the
states
that
did
in
fact
expand.
Medicaid
coverage
is
still
seventh
highest
in
the
nation.
We
pay
some
of
the
highest
costs,
but
still
struggle
with
disappointing
health
outcomes.
What
senate
bill
420
hopes
to
address
with
respect
to
that
issue
is
to
expand,
affordable,
accessible
quality
health
insurance
options
for
all
nevadans.
M
Excuse
me
a
medicaid
buy-in
legislation
that
legislation
was
ultimately
vetoed
by
governor
sandoval,
and
there
was
some
additional
ongoing
conversations
about
how
to
address
health
care
costs
here
in
the
state.
At
the
end
of
last
session,
in
2019
we
passed
senate
concurrent
resolution
number
10,
which
provided
for
an
actuarial
analysis
in
the
interim,
and
that
data
has
led
us
to
this
point.
An
introduction
of
senate
bill
420..
M
This
bill
also,
I
believe,
comes
at
a
critical
time.
We
are
more
than
a
year
into
a
global
pandemic
that
has
resulted
in
job
loss
and
loss
of
health
insurance
and
people
are
struggling
to
ensure
they
will
have
access
to
health
care
if
they
get
sick.
Now
is
an
opportune
moment
to
take
advantage
of
the
state's
considerable
bargaining
power
to
make
health
care
more
affordable
and
more
accessible
by
enacting
this
particular
bill.
M
This
bill
improves
access
to
health
care
in
two
key
ways:
first,
by
requiring
the
establishment
of
a
public
health
insurance
option,
and
second
there
are
also
provisions
in
here
that
make
various
changes
to
medicaid
to
expand
access
to
care.
Those
are
two
separate
pieces
of
the
bill.
With
your
permission,
madam
chair,
I
would
like
to
turn
it
over
first
to
shaniqua
hawkins,
who
is
joining
us
via
zoom
and
then
wendell
potter.
L
Good
morning,
madam
chair
and
members
of
the
committee,
thank
you
for
the
opportunity
to
speak
today.
For
the
record,
my
name
is
shaniqua,
hawkins
spelled
s-h-e-n-a-k-w-a
last
name
h-a-w-k-I-n-s.
L
I
am
speaking
in
favor
of
sb
420
and
thank
you
majority
leader
canazarro,
for
allowing
me
this
opportunity
also
and
for
proposing
legislation
and
for
having
me
here
to
describe
why
it's
needed.
I
am
a
healthcare
provider
and
a
small
business
owner.
I
am
an
advanced
practice
registered
nurse
and
I
run
care
with
purpose
medical
center.
Here
in
north
las
vegas,
we
predominantly
serve
people
of
color
and
low-income
communities,
including
a
large
population
of
homeless
clients.
L
I
have
submitted
a
full
remark
for
the
record:
it's
in
written
form.
So
out
of
respect
for
our
time,
I
will
just
briefly
say
this:
I
personally
know
what
it's
like
to
lose
a
job
and
with
it
health
insurance.
I
lost
mine
at
the
start
of
the
pandemic.
L
When
the
clinic,
I
worked
for
shut
its
doors,
our
practice
now
that
we
do
see-
and
we
treat
many
people
in
this
very
same
situation-
I've
been
a
registered
nurse
for
over
20
years,
including
in
emergency
and
trauma
centers.
L
I
know
that
not
having
health
insurance
means
that
people
end
up
needing
expensive
emergency
care
because
of
conditions
that
have
been
treated
proactively.
You
know
if
it
had
been
treated,
excuse
me
proactively
and
if
they
would
have
been
able
to
afford
insurance
earlier,
we
could
have
prevented
some
of
these
issues.
The
nevada
public
option
helps
make
preventative
medicine
more
affordable
and
accessible
as
an
aprn.
The
move
toward
pay
parity
is
great.
There
is
much
inequality
in
our
existing
system.
L
That's
part
of
what
inspired
me
to
open
my
own
practice
and
serve
historically
underserved
communities
and
populations.
We
are
providing
the
same
level
of
care
with
preventative
medicine
and
management
of
chronic
diseases
such
as
hypertension,
diabetes
and
cholesterol.
Issues
that
are
especially
problematic
in
communities
of
color
pay
parity
would
help
me
keep
my
clinic
open
long
term,
and
I
appreciate
this
step
in
that
direction.
L
L
A
And
thank
you
very
much
and
we'll
make
sure
to
put
your
comments
in
the
support
section
of
the
hearing,
we're
still
kind
of
in
the
presentation
section
of
the
hearing
so
majority
leader.
Do
you
have
anyone
else
wishing
to
be
in
the
presentation
section
and
then
walk
through
the
bill.
E
Madam
chair
and
members
of
the
committee,
my
name
is
michael
potter.
At
w-e-n-d-e-l-l-o-t-t-e-r,
a
dozen
years
ago,
president
obama
told
the
joint
session
of
congress
that
a
public
option
was
necessary
to
keep
insurance
companies
honest
and
hold
them
more
accountable
without
the
competition
that
a
public
option
would
provide.
He
said
it's
easier
for
insurance
companies
to
cherry
pick,
the
healthiest
and
drop
the
sickest
to
overcharge
small
businesses
in
the
jack
up
rates.
E
He
went
on
to
say
that,
as
one
former
insurance
executive
testified
before
congress,
insurance
companies
are
not
only
encouraged
to
find
reasons
to
drop
the
seriously
ill,
they're
rewarded
for
it.
All
of
this
in
the
service
of
meeting
what
this
former
executive
called
wall
street's
relentless
profit
expectations
that
former
executive
was
me
not
long
before
that
speech,
I
had
left
my
career
as
head
of
communications
at
cigna.
E
After
a
crisis
of
conscience,
the
powerful
insurance
industry
was
able
to
strip
the
public
option
out
of
the
affordable
care
act
to
protect
profits
in
the
years
since
that
bill
was
enacted.
Insurance
companies
have
only
become
bigger
and
more
emboldened
in
their
efforts
to
keep
people
from
getting
the
care
that
they
need.
E
Insurers
have
also
become
some
of
the
america's
most
profitable
companies.
In
fact,
most
of
them
have
posted
record
profits
during
the
pandemic.
Those
record
profits
are
the
result
of
barriers
that
insurance
companies
have
erected
that
make
it
more
and
more
impossible
for
people
with
insurance
to
get
the
care
that
they
need.
E
Hundreds
of
thousands
of
your
constituents
still
cannot
afford
health
insurance
because
of
ever
increasing
premiums.
Many
others
who
do
have
insurance
cannot
even
pick
up
their
prescriptions,
because
insurance
companies
now
make
them
pay
in
many
cases,
thousands
of
dollars
of
their
own
pockets
before
their
coverage
kicks
in.
It
isn't
just
ordinary
folks
who
are
being
fleeced
by
insurance
company
so
are
employers,
most
of
whom
were
hard
hit
during
the
pandemic.
E
I
helped
carry
out
numerous
propaganda
campaigns
to
scare
people
about
health
care
reform
proposals
at
both
federal
and
state
levels.
One
of
the
ways
we
succeeded
was
going
into
states
and
recruiting
hospital
executives
and
provider
groups
serve
as
our
messengers.
It
was
dishonest
work
which
I
will
always
regret
if
I
hadn't
quit.
I
might
still
be
writing
as
leading
talking
points
for
the
industry's
front
groups
like
the
ones
they
call
nevada's
healthcare
future
assembly
members.
E
How
you
vote
on
this
bill
will
result
in
either
more
nevadans
being
able
to
get
the
care
that
could
save
their
lives
or
further
enriching
the
people
who
are
bankrolling
the
campaign
against
the
bill
before
you.
You
have
the
power
to
hold
insurance
insurance
companies
more
accountable
and
bring
down
the
cost
of
health
care
and
health
insurance.
E
A
Okay,
thank
you
very
much
so
with
that
majority
leader.
M
Yes,
thank
you,
madam
chair.
At
this
point,
I
would
like
to
walk
through
the
provisions
of
the
bill
and
we'll
begin
with
the
public
option.
Piece
of
the
bill.
As
I
mentioned,
there
are
two
sort
of
separate
pieces
of
this
particular
bill,
so
this
bill
specifically
requires
the
director
of
the
department
of
health
and
human
services
in
consultation
with
the
executive
director
of
the
silver
state
health
insurance
exchange
and
the
commissioner
of
insurance
in
the
department
of
business
and
industry
to
design
establish
and
operate
a
public
health
benefit
plan
called
the
public
option.
M
Pursuant
to
section
10
of
the
bill,
the
public
option
must
be
made
available
to
all
nevada
residents,
both
as
a
policy
of
individual
health
insurance
through
the
exchange
and
for
direct
purchase.
It
may
also
be
available
made
available
to
small
employers
or
their
employees.
I
would
I
apologize.
I
should
have
started
with
this.
Madam
chair,
I
did
note
that
we
do
have
an
ellis
and
I
hope
all
the
members
of
the
committee
have
access
to
proposed
amendment
number
3463
to
the
second
reprint
of
the
bill.
M
That
includes
some
cleanup
language,
after
consultation
with
the
state
health
exchange
and
and
the
director
to
make
sure
that
what
we're
doing
here
has
accurate
definitions
of
what
is
included
in
there
and
you'll,
see
some
changes
to
section
10,
to
clarify
that
we
are
talking
about
natural
persons
in
this
particular
bill.
Section
10
further
requires
a
public
option
to
meet
requirements
established
by
federal
and
state
law
for
individual
health,
insurance
or
health
insurance
for
small
employers
to
keep
costs
down.
M
Premiums
for
the
public
option
must
be
at
least
five
percent
lower
than
the
premium
of
the
second
lowest
cost
silver
plan
available.
On
the
exchange
in
the
relevant
zip
code,
and
they
must
not
increase
by
more
than
the
medicare
economic
index
in
a
given
year
under
the
under
the
provisions
of
this
bill,
these
requirements
may
be
revised
by
the
director
of
dhhs,
the
executive
director
of
the
exchange
and
the
commissioner
of
insurance.
M
If
the
public
option
is
on
track
to
reduce
its
premiums
relative
to
the
state's
benchmark
premiums
by
at
least
15
percent
in
its
first
four
years
of
operation,
section
11
of
the
bill
requires
the
director
executive
director
and
commissioner
to
apply
for
certain
waivers
to
obtain
federal
financial
support
for
the
public
option
and
authorizes
them
to
contract,
with
an
independent
actuary
to
assess
the
impact.
The
public
option
would
have
on
health
care
and
health
insurance
markets
in
the
state.
M
Section
12
requires
the
director
to
use
a
statewide
competitive
bidding
process
to
solicit
and
enter
into
contracts
with
health
carriers
and
others
to
administer
the
public
option
in
order
to
increase
competition,
health
carriers
that
provide
medicaid
managed
care
plans
in
nevada
must
participate
in
the
competitive
bidding
process.
The
bill
also
authorizes
the
director
of
dhhs
to
directly
administer
the
public
option
if
necessary.
M
This
also
requires
a
health
carrier
who
is
administering
the
public
option
to
provide
information
to
the
commissioner
of
insurance
and
to
obtain
certification
as
a
qualified
health
plan.
Sections
13,
21
and
29
of
the
bill
require
health
care
providers
and
facilities
that
participate
in
medicaid,
the
public
employees
benefits
program
or
the
state's
workers
compensation
program
to
enroll
as
per
participating
providers
in
at
least
one
public
option
plan
and
accept
new
patients
who
are
enrolled
in
the
public
option.
To
the
same
extent
they
would
accept
new
patients
not
enrolled
in
the
plan.
M
Section
14
requires
aggregate
reimbursement
rates
under
the
public
option
to
be
comparable
or
better
than
medicare
reimbursement
rates.
It
also
requires
the
director
of
dhhs
to
establish
healthcare
provider
networks
for
the
public
option
that
minimize
disruptions
in
care
for
those
who
do
lose
coverage
through
medicaid
or
the
children's
health
insurance
program
and
enroll
in
the
public
option.
The
director
must
also
encourage
the
use
of
value-based
payment
models,
reward
delivery
of
high-quality
services
and
lower
the
cost
of
care
throughout
the
state.
M
Section.
15
establishes
a
public
option,
trust
fund
to
hold
certain
funds
for
the
purpose
of
implementing
the
public
option.
This
bill
makes
various
additional
changes
to
ensure
the
public
option
is
treated
similarly
to
comparable
forms
of
public
health
insurance
beyond
the
public
option.
The
second
piece
of
this
bill
relates
to
several
pieces
of
medicaid
expansion
that
came
as
a
result
of
conversations
we
were
having
with
dhhs.
M
As
we
were
discussing
the
implementation
and
the
pieces
of
the
public
option,
they
had
a
series
of
of
medicaid
expansion
pieces
that
would
help
to
aid
with
additional
care
for
pregnant
and
nursing
moms
for
both
prenatal
and
postnatal
care,
and
we've
included
a
lot
of
these
in
this
bill
after
work.
After
following
those
conversations
so
senate
bill,
420
does
make
some
of
those
various
changes
to
medicaid
by
expanding
coverage
for
those
pregnant
women,
in
hope
of
improving
health
outcomes
and
reducing
health
disparities
by
expanding
access
to
critical
prenatal
and
postpartum
care
among
other
services.
M
M
This
is
not
something
that
I
want
to
take
any
credit
on
leading
the
way,
for
I
know
that
we
have
several
members
on
this
committee,
even
who
are
doing
remarkable
work
on
other
bills,
this
session
and
have
done
remarkable
work
in
other
sessions,
assemblywoman,
gorlow
and
assemblywoman,
of
course,
monroe
moreno,
who
have
been
leaders
in
this
aspect
of
making
sure
that
moms
can
get
additional
care.
M
So
section
24
of
this
bill
enhances
medicaid
services
for
pregnant
nevadans
to
ensure
that
more
expectant
parents
and
their
children
receive
quality,
prenatal
and
postpartum
care.
It
increases
the
income
gap.
Caps.
Excuse
me
on
medicaid
eligibility
for
pregnant
women.
From
the
current
limit
of
165
percent
of
the
federal
poverty
level
to
200
percent.
M
It
prohibits
dhhs
from
requiring
a
pregnant
woman
who
is
otherwise
eligible
for
medicaid
to
live
in
the
united
states
for
a
certain
period
of
time
before
enrolling
in
medicaid,
section
25
further
expands
access
to
care
for
all
nevadans
by
requiring
medicaid
to
cover
the
services
for
community
health
workers
who
provide
services
under
the
supervision
of
a
physician,
physician
assistant
or
advanced
practice
registered
nurse
section
26
requires
medicaid
to
cover
certain
costs
for
doula
services.
Section
27
requires
fee-for-service
medicaid
to
reimburse
aprns
to
the
same
extent
as
services
provided
by
a
physician
section.
M
28
requires
medicaid
to
cover
breastfeeding
supplies,
certain
prenatal
screenings
tests
and
lactation
consultation
and
support,
and,
finally,
in
an
effort
to
improve
access
to
care
for
nevada's
rural
residents.
Section
30
requires
dhhs
to
establish
a
medicaid,
managed
care
program
to
provide
health
care
services
to
medicaid
recipients
in
all
geographic
regions
of
the
state,
rather
than
just
in
urban
areas.
As
is
the
current
practice.
M
The
department
must
conduct
a
statewide
procurement
process
to
select
health
maintenance
organizations
to
provide
these
services,
and
we
want
to
ensure
as
well,
that
under
statewide
managed
care,
rural
providers
and
fqhcs
could
expect
to
receive
at
least
the
same
rates
as
they
are
today
under
fee
for
service.
Finally,
the
bill
directs
the
the
exchange
in
dhhs
to
seek
a
waiver
from
the
federal
government
to
allow
multi-employer
health
trusts
to
offer
their
plans
on
the
exchange.
Under
certain
circumstances.
M
We
have
a
lot
of
nevadans
who
are
covered
under
these
plans
and
they
often
work
in
industries
that
are
particularly
sensitive
to
challenging
economic
circumstances.
This
waiver
would
be
an
innovative
way
to
make
it
easier
for
those
plans
to
provide
continuity
of
coverage
to
their
members,
leading
to
more
consistent
care
and
better
health
outcomes.
Section
39
also
requires
the
performance
of
the
actuarial
study
and
requires
the
director
to
apply
for
the
waivers
indicated
to
support
the
public
option.
M
Chair
carlton.
We
have
heard
time
and
time
again
that
nevadans
need
more
affordable
health
insurance.
We
have
heard
from
small
business
owners,
their
employees,
the
uninsured,
the
underinsured
and
those
who
have
lost
their
jobs
and
their
insurance
as
a
result
of
the
pandemic
and,
frankly,
who
lose
their
jobs
from
other
economic
circumstances.
M
M
That
is
also
married
with
data
from
an
actuarial
study
and
allows
us
to
utilize
the
state's
purchasing
power
to
help
increase
those
affordable
options
for
nevadans.
Madam
chair,
the
final
thing
I
wanted
to
touch
well
sorry,
two
final
things
I
wanted
to
touch
on
in
the
bill
as
presented
to
this
committee.
There
are
appropriations
for
the
public
option
for
the
pieces
on
the
medicaid
portions
that
are
not
savings.
They
have
been
made
to
read
that
they
would
be
permitted,
as
funding
may
become
available.
M
So
you
will
see
that
reflected
in
the
bill
as
well,
but
for
the
finance
committee
purposes
there
is
an
appropriation
that
we
did
add
over
in
the
senate
for
the
implementation
and
beginning
of
the
public
option.
The
other
thing
I
wanted
to
note
is
that
the
public
option
pieces
would
allow
for
procurement
in
2025
with
the
first
plan
year
being
in
2026..
M
I
also
think
that
that
is
an
important
note,
because
it
does
provide
time
for
us
to
ensure
that
what
we
are
implementing
makes
sense.
And
finally,
madam
chair,
I
do
know
that
jim
pemrose
is
here
and
was
planning
to
address
the
committee
about
a
proposed
amendment
that
we
have
worked
on
with
the
majority
leader
that
we
are
that
is
friendly
and
we're
supportive
and
happy
to
have
in
420.
M
A
I
think
now
would
be
better.
I
think
it's
best
to
have
that
comprehensive
conversation
all
in
one
section
of
the
bill,
since
we
were
working
from
a
previous
another
proposed
amendment,
and
then
we
do
need
to
get
into
the
fiscal
component
of
it,
because
we
believe
there
was
a
an
extra
fiscal
note
attached
after
it
left
the
senate.
So
we
want
to
make
sure
that
we
get
that
addressed
good
morning.
N
N
That's
that's
involved
here.
The
cost
can
be.
I
would
assume
two
or
three
times
that
amount
for
a
middle
income
family.
That's,
obviously,
a
substantial
amount
of
money
back
in
1997
the
legislature
mandated
that
health
insurers
provide
coverage
for
enfield
formulas
that
are
prescribed
by
a
physician
and
used
for
the
treatment
of
these
these
metabolic
diseases.
N
So
we
have
mocked
up
an
amendment
which
is
on
nellis,
which
amends
the
relevant
provisions
of
nrs
to
provide
explicitly
that,
as
used
in
the
coverage
mandate,
provisions,
an
entire
formula
includes,
without
limitation,
a
formula
that
is
ingested
orally
to
make
sure
that
the
formula
that
pam
and
so
many
other
patients
take
continues
to
be
continues
to
be
covered.
Pebb,
I
may
say,
as
a
matter
of
practice,
even
though
it's
largely
a
self-insured
program
has
undertaken
in
its
various
plans
to
provide
coverage
for
rental
formulas
quote
as
mandated
by
law.
N
Nevertheless,
as
I
say,
they
take
the
position
that
we're
not
talking
about
formulas
that
are
administered
orally,
so
the
final
provision
of
the
amendment
adds
language
to
nrs
287.04335,
which
sets
forth
the
various
provisions
that
the
pep
board
is
required
to
comply
with,
to
make
reference
to
the
particular
provision
that
relates
to
group
health
insurance
and
to
health
maintenance
organizations,
and
all
those
changes
would
be
effective
under
the
terms
of
the
amendment
on
july,
1st
2021
to
ensure
that
buck
abides
by
these
provisions
during
its
upcoming
plan
year,
which
is
called
the
2022
plan
year.
N
N
N
It
may
be
that
pam
is
the
only
patient
among
the
75
000
or
so
that
that
pebb
ensures
who
is
affected
by
this
particular
problem
and
we're
talking
100
patients
out
of
out
of
a
population
of
roughly
3
million
people
in
nevada.
So
I
don't
anticipate
that
there
will
be,
from
pebb's
standpoint
a
significant
fiscal
impact.
N
I
should
also
add
that
local
governments
that
provide
a
health
plan
through
a
plan
of
self-insurance
to
their
employees
under
the
provisions
of
nrs
287.010
are
subject
to
the
group
health
insurance
coverage
mandates,
and
so
potentially
there
would
be
an
additional
fiscal
impact
incremental.
I
would
argue
to
them,
but
I
wanted
to
make
that
clear
for
the
record
other
than
that,
I'm
happy
to
answer
any
questions
you
may
have
and
pam
is
here
to
answer
any
questions
you
may
have
of
her.
Thank
you
and.
A
Thank
you
very
much,
mr
penrose.
You
haven't
lost
your
mock-up
abilities
at
all,
so
we
appreciate
that
makes
it
very
clear
what
we're
doing
and
since
the
sponsor
considers
it
a
friendly
amendment.
We
would
normally
have
folks
come
up
in
neutral
to
propose
an
amendment
or
even
in
opposition,
but
since
it
has
been
previously
discussed
and
everybody's
on
board,
why
we're
this
bill
is
having
a
very
unique
way
through
the
system,
so
we're
trying
to
make
adjustments
in
the
last
four
days
of
the
session
to
make
sure
everything
gets
addressed.
A
So
with
that
committee
majority
leader,
did
you
have
anyone
else
in
a
presentation
mode
right
now,
committee
members
questions
for
the
majority
leader
at
this
time,
mr
hafen.
A
Oh,
mr
hafen,
if
I
could
stop
you
for
just
a
moment,
so
the
game
plan
is
we
started
at
about
nine
we're
at
about
9
26
right
now,
we'll
go
into
questions,
and
hopefully
we
can
keep
that
to
about
10
to
12
minutes.
If
possible,
then
I'd
like
to
open
it
up
for
support
approximately
15
minutes,
opposition,
approximately
15
minutes
and
then
neutral
and
I'd
like
everyone
to
keep
it
to
two
minutes.
We
have
a
lot
of
letters
associated
with
this
also,
so
they
have
been
uploaded
in
ls.
They
are
available
for
the
public.
A
G
Thank
you,
madam
chair,
and
thank
you
majority
leader
for
bringing
this
forward,
and
we
had
a
bill
yesterday
about
the
prenatal
care
and
that
that's
a
huge
huge
thing
for
me.
G
So
I'm
very
appreciative
of
that
that
aspect
I
I
did
want
to
touch
a
base
on
on
this
on
how
this
is
going
to
interact
with
the
new
american
rescue
plan
of
the
effect
of
april
1..
It
increased
the
eligibility
from
400
to
600
percent
and
then
limited
the
amount
for
insurance
to
eight
and
a
half.
I
believe
it's
eight
and
a
half
percent
of
that
their
income,
so
with
with
that
increase
in
the
exchange
to
600
percent
of
the
poverty
level.
How?
G
How
is
this
bill
going
to
interact
with
with
those
changes.
M
M
So
that
is
actually
a
question
that
has
come
up
throughout
the
course
of
discussions
on
this
particular
bill
and
while
I
think
that
there
is
obviously
a
lot
of
good
pieces
with
respect
to
the
american
rescue
plan
dollars
and
how
it
is
helping
to
get
more
nevadans
covered
on
insurance,
which
I
think
speaks
to
exactly
the
problem
that
we
have
is
that
there
are
people
out
there
who
are
uninsured,
who
need
to
be
insured.
And
how
do
we
start
to
address
that?
That
is
a
temporary
and
expiration
in
the
future
situation.
M
So
this
is
not.
I
think
that
this
actually
is
sort
of
the
complement
to
that
right.
We
know
that
there
are
people
out
there
who
are
underinsured
or
uninsured,
who
need
access
to
health
care
who
are
willing
to
get
access
to
health
care
when
it's
something
that
they
can
afford
and
something
that
they
can
qualify
for
and
get
proper
coverage.
M
I
think
that
speaks
to
the
exact
issue
that
senate
bill
420
is
trying
to
address,
but
what
is
happening
with
the
american
rescue
plan
dollars
and
some
of
those
effects
are
temporary,
and
so
I
think
here
in
the
state,
we
need
to
think
of
something
that
is
more
long-term.
That
is
permanent
and
has
helped
is
going
to
help
to
reduce
those
costs
and
that's
what
senate
bill
420
does
so.
This
will
operate
obviously
a
little
bit
differently
than
than
what
we're
seeing
with
the
arp
funds.
This,
I
would
note
as
well.
M
G
I
know
we're
short
on
time,
so
you
mentioned
that
this
is
only
temporary,
but
it's
my
understanding
that
president
biden
is
asked
that
that
600
percent
be
made
permanent,
and
so
if
it
did
become
permanent
or
I
guess,
since
the
conversation
is
being
had,
should
we
be
spending
time
in
the
interim,
studying
this
and
then
bring
this
back
as
a
whole
picture
and
piece
now
that
we
know-
and
I
understand
the
arp
stuff
just
hit
april
1
with
this
aspect
at
least
and
then
bring
this
back
next
session,
so
we
have
time
to
fully
tweak
it
and
get
all
the
bugs
out
of
it
before
we
actually
implement
this.
M
Thank
you
for
the
question
assemblyman
nicole
canozzaro
senate
district
six.
I
think
the
short
answer
is
yes.
Until
there
is
something
that
says,
this
is
absolutely
permanent,
we're
betting
on
on
conversations
that
would
happen
at
the
federal
government
and
hoping
that
we're
going
to
solve
a
problem
with
that.
M
I
also
don't
think
that
that
solves
the
entirety
of
the
problem
and,
I
think,
complements
very
well
with
the
actuarial
study
that
would
be
conducted
in
accordance
with
the
waivers
that
are
sought
in
this
particular
piece
and
is
not
going
to
cover
all
the
nevadans
who,
I
think,
really
would
fall
under
the
provisions
of
senate
bill
420.
If
we
are
able
to
implement
it.
A
B
And
first
is
just
a
quick
question:
I
apologize
if
I
missed
it,
how
many,
how
many
nevadans
are.
P
M
Thank
you
for
the
question
assemblywoman
nicole
cannizzaro,
senate
district.
Six.
I
would
invite
I
know
we
do
have
miss
weeks
who
can
provide
some
technical
assistance
and
she
may
have
that
answer
more
readily
at
her
fingertips
than
I
do,
but.
Q
Yes,
thank
you.
This
is
stacey.
Sorry
commit
yeah.
Madam
chair
committee,
members,
the
of
the
350
000,
uninsured,
37
percent,
are
out
medicaid.
Q
Q
A
B
Q
No
sorry,
my
apologies,
there
are
350
000,
uninsured
nevadans,
roughly
of
that
350
000
uninsured.
A
P
We
didn't
really
go
through
each
of
the
fiscal
notes,
but
just
looking
at
the
fiscal
note
for
dhhs
we're
looking
at
roughly
75
million
over
the
biennium,
and
I'm
just
wondering
if
it.
C
M
Thank
you
for
the
for
the
question:
assemblywoman
nicole
candacero
senate
district
six,
so
I
think
two
things
one
with
respect
to
some
of
the
dhhs
provisions
that
you're
seeing
in
the
in
the
fiscal
notes.
Prior
those
were
a
lot
of
those
were
related
to,
and
I
know
I
see
ms
biermann
on
the
zoom,
so
she
can
correct
me
if
I
am
wrong.
We're
related
to
some
of
the
medicaid
pieces
for
for
pre
and
postnatal
care
from
for
pregnant
and
nursing
moms
for
this
particular
provision.
M
I
don't
think
that
say
that
so
first
I
would
note
the
public
option.
If
you
were
eligible
for
medicaid,
then
you
would
not
qualify
well,
you
could
buy
it
off
the
exchange
if
you
wanted
to
buy
the
public
option
off
exchange,
but
obviously,
if
you
were
eligible
for
medicaid,
we
would
seek
to
get
you
enrolled
in
medicaid,
similar
to
when
we've
seen
expansions
of
other
health
provisions.
E
E
Thank
you,
madam
chair,
and
thank
you
senator
for
being
here
this
morning,
good,
to
see
you
again
so
a
question
about
the
hospital
rates
and
under
the
public
option.
Currently
medicaid
and
medicare.
I
think
medicaid's
in
the
50
percentile
for
reimbursement
and
it's
almost
90
for
medicare
or
may
have
it
backwards.
E
But
but
this
bill
proposes
to
move
people
from
the
commercial
rate
onto
the
medicaid
or
medicare
rate,
and
so
it's
going
to
cut
a
lot
of
the
reimbursements
to
hospitals
and
we
saw
this
last
cycle
or
when
we
restored
some
of
the
cuts
for
pediatrics
right,
because
we
were
trying
to
solve
an
issue
at
sunrise
and
because
they
were
ultimately
going
to
cut
services.
If
we
didn't
do
that,
do
you
think
that
this
creates
that
scenario?
Could
hospitals
potentially
cut
services
because
their
their
their
reimbursement
rates
are
going
to
be
forced
to
be
lower.
M
Thank
you
for
the
question
assemblyman
nicole
cannazzaro
said
at
district
six,
so
first
I
want
to
clarify
a
couple
things
about
the
public
option.
This
does
not
require
for
everyone
who
is
on
commercial
health
insurance
to
take
a
medicaid
or
or
medicare
rate.
What
the
public
option
has
in.
It
is
as
a
floor
that
the
public
option
must
at
least
be
medicare
reimbursement
rates.
We
didn't
want
to
do
medicaid,
obviously,
because
of
some
of
the
issues
that
I
think
you
have
outlined,
and
so
we
went
with
medicare
as
a
floor.
M
This
is
not
a
ceiling.
This
is
not
a
mandatory.
This
is
what
you
would
get
in
terms
of
reimbursement.
Some
of
the
concerns
that
we
have
heard
is
that.
Well,
if
you
set
a
floor,
then
that's
all
there
is,
but
frankly,
I
think
that
that
that
ignores
the
very
essence
of
bidding
on
insurance
products,
even
in
the
exchange
right,
if
somebody
else
has
a
different,
is,
is
bidding
on
what
it
is
that
they
would
offer.
You
still
have
that
negotiating
power.
The
state
is
still
going
to
utilize
its
negotiating
power.
M
Yes,
we
are
trying
to
create
something
that
will
cost
from
a
premium
standpoint,
nevadans
less,
but
we're
utilizing
not
only
the
state's
own
procurement
authority,
but
also
the
public
option.
Health
trust
fund,
which
will
allow
for
us
to
draw
down
some
federal
dollars
to
help
buy
down
those
premiums
as
well.
M
And
then,
of
course,
you
know
the
premium
reduction
over
time.
But
I
think
that
that
is
one
of
the
misnomers.
When
you
see
the
medicare
rates
in
there
that
it
is
not
mandating
that
that's
what
the
rate
would
be.
That's
what
it
must
at
least
be
when
we're
talking
about
bidding
on
these
particular
plans.
M
There's
other
provisions
in
the
bill,
of
course,
that
these
must
be
silver
and
gold
plans
that
we
want
to
incentivize
value-based
systems
where
we
can
get
people
into
care
that
can
help
to
address
issues
before
they
become
acute
and
one
of
the
issues.
I
think
the
secondary
issue
that
you
raised,
which
is
when
we
are
talking
about
adding
individuals
onto
health
insurance.
M
What
does
that
do
with
respect
to
lowering
rates
for
providers?
Currently,
the
individuals
that
and
the
small
group
employers
that
we're
trying
to
get
here
either
one
are
offering
health
care
plans
that
aren't
providing
the
kind
of
health
care
that
is
necessary
for
the
individuals
covered
on
those
health
care
plans
or
they're,
uninsured
or
underinsured.
M
So
when
an
individual
who
is
uninsured,
goes
into
a
hospital
and
receives
care,
it
is
often
for
a
more
acute
injury
or
disease.
It
is
often
an
emergency
type
basis
and
it
is
uncompensated
for
with
respect
to
the
providers.
So
when
we
are
talking
about
what
impact
this
would
have,
we
are
not
talking
about
taking
people
from
their
employer
plans.
In
fact,
they
wouldn't
all
the
provisions
of
the
aca
still
apply
and
that's
reflected
in
the
in
the
language
of
the
of
the
bill.
M
A
B
You
so
much
madam
chair
and
my
question:
is
it's
piggybacking
off
of
the
question
from
assemblymember
tolls
and
if
I
did
my
math
correctly-
and
this
might
be
a
better
question
for
medicaid
georgia
leader,
because
they
said
that
there's
30
350
000
people,
uninsured
37
of
them,
are
eligible
for
medicaid
and
with
the
help
of
my
phone,
that's
roughly
about
130
000
people
who
are
eligible,
and
my
colleague
asked
the
question
about
what
you
know
redirecting
that
money
on
the
fiscal
note
to.
Maybe
these
people
outreach
these
people.
B
Q
Good
morning,
suzanne
biermann
the
administrator
of
division
of
health
care
financing
and
policy
for
the
record.
Thank
you
for
the
question.
I
don't
have
that
amount
today,
but
would
be
happy
to
go
back
and
see
if
we
can
put
together
an
estimate.
The
division
of
welfare
and
supportive
services
does
eligibility
and
enrollment,
so
we
could
work
with
them
and
see
if
we
could
put
together
a
cost
estimate
for
reaching
the
remaining
uninsured,
what
outreach
and
education
of
cost
and
would
be
happy
to
do
that.
Q
I
did
want
to
clarify
that
we
have
submitted
an
updated
fiscal
note.
As
the
senate
majority
leader
mentioned,
that
prior
number
was
based
on
an
earlier
version
of
the
bill
that
didn't
have
the
as
funding
allows
language.
So
our
new
fiscal
note
is
decreased
significantly,
so
I
did
want
to
clarify
that
for
the
record.
A
F
You,
madam
chair
and
I
know,
we've
been
mourned
to
keep
this
short,
but
I
do
have
several
questions.
I'm
going
to
start
off
with
a
question
regarding
access
to
care
and
appreciate
your
senator,
for
I
absolutely
believe
you
want
good
health
care
for
all
nevadans,
and
that
is
why
you're
bringing
this
bill
forward
yesterday,
becker's
health
released
a
statement
that
the
top
five
worst
places
to
practice
medicine
are
as
follows:
west
virginia
louisiana,
new
mexico,
nevada
nevada's
and
the
top
five
worst
places
to
practice
medicine.
Do
you
feel
in
this
bill?
M
Thank
you
for
the
question
assemblywoman
nicole
canozzaro,
senate
district
six.
I
think
the
answer
is
yes,
and
I
know
that
there
have
been.
There
has
been
a
lot
of
conversation
about
that
this
would
lead
to
decreased
provider
access.
M
Frankly,
I
think
I
struggle
I
struggle
with
that
concept,
because
what
we
are
trying
to
do
is
to
include
yet
another
piece
of
health
coverage
in
order
to
ensure
that
when
providers
are
seeing
patients
right,
they
are,
they
are
getting
paid
for
that.
I
think
that's
an
important
piece
of
this
and
that's
something
that
I
think
gets
overlooked.
Some
of
the
the
other.
M
I
guess
caveats
to
those
kinds
of
statements
are
well,
we
have
the
arp
stuff
or
we
should
just
put
more
people
onto
medicaid.
Yet
at
the
same
time,
we
often
have
the
arguments
that
you
know:
medicaid
rates
are
too
low
here
in
the
state.
So
why
would
providers
want
to
have
to
take
more
medicaid
patients,
because
then
they
start
to
lose
money?
M
I
think
it
is
inconsistent
to
say
that
we
should
just
be
putting
more
people
on
to
medicaid
or
that
somehow,
if
this,
if
an
arp
temporary
solution,
which
I
know
we
had,
that
conversation
is
helpful
in
getting
people
onto
coverage
and
that's
so
great
for
providers.
Why?
If
we
are
creating
another
option
for
people
to
have
health
coverage
so
that
they
are
in
fact,
also
getting
preventative
care,
regular
checkups
and
in
this
bill
we've
built
in
obviously
as
part
of
the
procurement
preferences
for
value-based
services.
M
So
people
can
get
that
kind
of
care
and
make
sure
that
what
we
have
here
are
plans
that
are
actually
going
to
provide
that
kind
of
thing
that
absolutely
that
should
be
an
incentive
for
providers,
because
they're
going
to
get
compensated
for
having
seen
people
and
they're
going
to
be
able
to
help
with
better
health
outcomes.
Overall.
A
Q
F
On
that
you
mentioned
reimbursement
and
so
just
to
be
clear.
The
reimbursement's
not
going
to
be
based
at
the
medicaid
reimbursement,
it's
going
to
be
at
the
medicare
reimbursement.
M
Nicole
cannizzaro
senate
district
six
assembly,
woman,
that's
correct.
That
is
what
they,
what
the
minimum
would
have
to
be
for
the
public
option
plan,
so
it
could
be
higher
than
that
and
obviously
we
want
to
encourage
negotiations
in
those
in
those
spaces.
So
we
didn't
put
a
ceiling
on
that,
but
it
is
medicare.
F
And
it's
not
cost
based.
However,
it
is
not
great
because
because
the
medicaid,
of
course
see-
and
I've
said
on
this
here-
many
many
times
for
the
many
sessions
I've
been
here-
that
just
to
be
clear,
medicaid
rates
are
horrible.
Medicare
rates
are
bad,
so
none
of
it's
good
and
we
lose
money,
no
matter
which
one
of
those
rates
we
negotiate.
So
thank
you
for
that
clarification
and
then,
finally,
is
there
anything
in
this
bill
with
them?
M
Thank
you
for
the
question
assemblywoman
nicole
cannizzaro,
senate
district
six.
I
I
fundamentally
believe
that
we
are
going
to
see
a
place
where
we
are
going
to
have
an
option
that
is
going
to
help
get
people
insured,
that's
affordable
for
them,
so
I
would
start
there.
Second,
we
obviously
have
built
in
after
concerns
that
we
heard
over
in
the
senate
the
requirement
for
the
actuarial
to
take
place,
which
we
have
to
do
in
order
also
for
some
of
the
waivers
that
we
are
contemplating
that
will
help
buy
down
the
cost
of
those
of
those
products.
M
M
A
R
You
so
much,
mr
levitt.
Thank
you
so
much,
madam
chairman,
and
more
than
a
question.
I
think
it's
just
something
that
I
want
to
make
sure
that
we
have
on
the
record
for
food
for
food
for
thought,
and
it's
to
the
reference
of
smart,
the
definition
of
small
employer
in
section
10.,
and
so
I
believe,
the
way
that
we're
referencing
with
the
u.s
code.
R
This
is
the
reference
to
saying
a
small
employer
is
someone
with
less
than
50
employees,
and
so
I
think
what
we
have
been
doing
in
other
other
programs
throughout
the
state
is
kind
of
proposing
that
we
talk
about
a
small
employer
by
their
their
revenues
and
an
account
for
very
healthy
and
for
profits
and
for-profits
that
are
very
doing
very
well
and
having
the
resources
to
supply
things
and
cover
cost
of
things
like
health
insurance
for
their
employees
versus
just
a
hard
fast
quantitative
number
that
that
at
all
doesn't
reflect
whether
or
not
a
company
is
highly
profitable
or
not
right.
R
For
example,
we
did
that
in
the
pets
program
at
the
beginning
of
the
year
to
say
that
if
you
want
to
be
eligible
for
the
this
kind
of
assistance,
then
you
you
can't
be
a
company.
That's
grossing
more
than
four
million
dollars
a
year
in
in
revenue,
and
so
we
knew
that
in
2018
the
tax
department.
Let
us
know
that
there
were
388
000,
small
businesses,
taxpayers
who
did
not
qualify
in
terms
of
meeting
the
four
million
dollars
in
gross
revenue
to
have
to
pay
the
commerce
tax.
R
The
actual
bill
that
we
passed
that
if
you
come
within,
I
think
it
was
500
000..
So
if
you're
close
you
got,
you
got
to
file
just
to
make
sure
you
can't
pay
it,
but
we
would
have
388
000
non-filers.
R
So
that
was
a
great
number,
because
that
kind
of
gave
us
a
reference
for
how
many
businesses
out
that
are
out
there
that
don't
gross
more
than
four
million
dollars
a
year.
I
have
been
one
to
say
that
if
you
are
grossing
more
than
four
million
dollars
a
year-
and
we
start
to
line
things
up
with
our
that
commerce
tax
reference,
then
we're
talking
about
profitable
companies
and
what
we
want
in
this
state
is
for
profitable
companies
to
insure
their
employees.
R
We
do
not
want
highly
profitable
companies
to
be
forcing
their
employees
onto
medicaid,
because
that's
the
welfare
conversation
or
the
the
the
walmart,
the
amazons,
the
tesla's
right.
That's
our
big
problem
when
you
have
very
highly
profitable
companies
who
won't
insure
and
who
build
their
business
models
with
part-time
employees
and
won't
insure
them,
and
it's
only
been
getting
worse.
So
as
much
as
we
can.
I
think
it'd
be
interesting
to
consider
that.
R
I
think
it
would
be
a
great
statement
about
making
sure
that
when
we
talk
about
small
businesses-
and
we
we
have
a
quantified
number-
we
would
want.
R
You
know
close
to
400
000
small
businesses,
who
don't
make
a
lot
of
money
to
have
an
option
for
their
employees
to
have
afford
to
have
health
care
in
this
way,
I
don't
think
what
we
would
want,
though,
is
you
know
a
little
bit
of
that
conversation
where
some
folks
are
worrying
about
siphoning
where
we
have
highly
profitable
companies
pushing
their
employees
to
a
system
like
this,
simply
because
they
want
to
drive
their
margins
up?
That's
that
that
we
have
to
fight.
Thank
you
for
your
consideration.
A
Okay,
when
we
make
it
a
question,
we
just
say
correct
at
the
end
and
then
the
sponsor
says
yes,
so
that
works
out
really
well.
So
with
that,
I
think
I
had
mr
levitt
next
and
then
I
don't
think,
there's
any
other
questions
so
then
we'll
go
ahead
and
move
into
the
other
portions
of
testimony.
G
Thank
you,
madam
chair.
I
don't
know
if
you're
going
to
be
able
to
say
correct
at
the
end
of
this
or
not,
but
we'll
give
it
a
try
so
doing
some
research,
so
washington
currently
has
a
public
option
right
and
their
their
rates
are
actually
fairly
high
compared
to
the
non-public
option.
I
think
it's
29
percent
is
what
we
saw
and
so
like
very
few
people
are,
are
taking
the
public
option,
1900
people
taking
the
public
option.
G
M
Sure,
nicole
canozzaro
senate
district
six,
so
I
will
say
I
think,
with
the
caveat
that
this
is
a
different.
This
is
different
than
what
is
what
exists
in
washington
and
I
know
miss
weeks
may
be
able
to
hopefully
have
some
good
technological
connections
and
be
able
to
provide
a
little
bit
more
context
to
that
answer.
Q
Madam
chair
committee,
member
stacy
weeks
from
aurera
health
group,
thank
you
for
the
question.
Washington
is
different.
I
would
start
with
this.
Bill
has
been
trying,
I
think,
to
address
many
of
the
issues
seen
in
washington
around
the
premier,
and
so
in.
The
bill
includes
a
premium
target
where
at
least
plans
have
to
come
in
at
least
five
percent
lower.
That
was
not
in
washington.
Q
Q
This
bill
includes
a
procurement
process
that
would
be
bid
simultaneously
with
the
medicaid
managed
care
plans
and
by
tying
those
two
together,
the
state
is
able
to
basically
leverage
its
purchasing
power,
which
you
don't
typically
see
with
the
other
public
options
that
are
currently
out
in
the
world
of
discussion,
and
with
that
you
know
it's
similar
to
a
large
employer
who
has
a
number
of
covered
lives
and
money
that
health
insurers
are
wanting
to
win
the
contract.
They
can
leverage
that.
The
other
thing
to
note
about
nevada
is
just
that.
Q
A
I
believe
we
might
have
lost
you
for
the
last
couple
of
sentences,
but
mr
levitt,
did
you
get
most
of
the
information
that
you
needed?
I
think
mr
lovett
has
the
answer
to
the
question
that
he
posed.
So
thank
thank
you
very
much.
We
understand
the
technology.
M
A
With
that
any
other
members
of
the
committee
with
the
question
at
this
time,
not
seeing
mr
lovett
okay
yeah,
I
did
say
you
could
have
one
make
it
short.
G
So
keeping
that
in
mind
to
where
you're
you're
you're
adjusting
the
rates
accordingly-
and
I
would
imagine
I'm
not
at
I'm
not-
I
didn't
work
on
the
washington
plan,
but
I
would
imagine
the
rates
were
set
that
way
in
order
to
not
lose
providers,
and
so
the
is
there
a
potential
that
we're
going
to
lose
prodigals
because
we're
not
adjusting
those
rates
and-
and
and
I
because
I
would
imagine
that
that
that's
why
they
did
it
was
because
they
didn't
want
to
lose
providers.
So
is
how
are
we?
G
How
are
we
balancing
that
out
to
not
lose
providers
by
by
by
by
managing
rates?
The
way
we
weights
laid
out.
M
Nicole
canozzaro
cena
district
six,
so
I
think
I
will.
I
will
note
a
couple
of
things
and
then
I
know
we've
been
having
some
technical
difficulties
and
I
apologize
madam
chair
with
miss
weeks.
M
First,
I
would
say
that
we
are
pairing
this
with
actuarial
data
that
will
also
look
into
the
premiums
and
and
to
look
at
what
we're
talking
about
in
terms
of
reducing
those
over
time
with
the
15
that
you
see
in
the
bill,
and
so
I
think
that
that's
a
notable
difference
and
again,
I
think,
because
these
plans
are
are
different
than
what
what
is
what
is
occurring
and
what
is
happening
in
washington,
we're
just
in
a
very
different
space,
and
I
don't
know
if
miss
weeks
had
anything
else
that
she
wanted
to
add.
A
A
Ms
kaufman,
would
you
address
the
fiscal
note
from
the
silver
state
health
insurance
exchange?
Please.
P
Thank
you,
madam
chair,
for
the
record.
Sarah
kaufman
legislative
council
bureau,
the
silver
state
health
insurance
exchange
testified
in
the
senate
that
there
would
be
a
600
000
cost
related
to
the
waiver
development
as
well.
Well
as
an
actuarial
actuarial
assessment,
and
during
that
that
testimony
it
was
unclear
whether
or
not
they
could
utilize
their
reserves.
In
order
to
pay
for
these
expenditures.
M
Thank
you,
madam
chair,
nicole,
canozzaro,
senate
district
six.
My
my
recollection
is,
I
think,
has
miscompensated
that
we
had
had
a
conversation
about
it
in
the
senate
that
there
was
an
indication
that
they
they
may
be
able
to
use
their
reserves.
That
question
had
not,
I
think,
been
100
decided,
but
when
we
left
the
senate
we
did
not
allocate
that
600
000.
For
that.
A
B
The
carrier
premium
fee
that
the
exchange
collects
is
our
only
source
of
revenue
and
the
carrier
premium
fee
is
governed
by
the
affordable
care
act,
specifically
section
title:
42
of
us
code,
section
18,
0,
3,
1,
paragraph
5,
a
and
b,
which
indicates
the
funding
limitations.
Paragraph
a
indicates
that
exchanges
are
to
be
self-sufficient
and
they
may
become
self-sufficient
to
not
use
federal
funds
by
the
imposition
of
the
fee
of
punctuation.
So
on
the
exchange
marketplace.
B
Paragraph
b
indicates
that,
among
other
things,
that
these
user
fees
cannot
be
used
to
for
the
state
or
for
state
legislative
or
regulatory
programs.
So
we
cannot
use
this
for
for
programs.
A
Okay,
thank
you
very
much,
so
that
would
mean
majority
leader
that
a
general
fund
appropriation
would
be
needed
in
order
to
be
able
to
do
that.
M
Thank
you
for
that.
Madam
chair,
nicole
cannizzaro
sent
it
district
six.
It
was
not
put
on
the
sheets
on
the
senate
side,
the
allocation
that
is
included
or
the
appropriation
rather
that
is
included
in
the
bill,
was
for
the
other
pieces
for
division
of
welfare
and
supportive
services
and
dhhs.
Okay.
A
We
just
want
to
make
sure
we
have
a
complete
record
as
we
move
forward,
as
we
have
to
be
able
to
figure
out
how
to
fund
everything.
So
with
that,
I
think
that
addresses
that
issue.
So
that's
something
we're
going
to
have
to
work
on
also
so
with
that,
I
believe
we're
good
there.
As
I
said,
we
were
going
to
open
it
up
for
support
opposition
and
neutral
I'd
like
to
keep
everyone
to
two
minutes.
A
So
with
that
I
will
go
to
support
in
the
room
and
in
order
to
try
to
be
fair
I'll,
do
a
couple
in
the
room
couple
on
zoom
couple
on
phone
and
go
around
that
way,
so
that
the
room
doesn't
take
up
the
whole
time.
It
would
not
be
fair
to
the
other
folks.
So
with
that
majority
leader.
Thank
you
very
much.
We
appreciate
it.
K
Madam
chair
chris
daley,
nevada,
state
education,
association
and
nsea
supports
sb
420,
creating
the
nevada
public
option
like
education,
nevada
ranks
near
the
bottom
in
states,
an
investment
in
health
care,
in
addition
to
under
investment,
health
disparities
continue
to
run
deep
with
low-income
communities
facing
fewer
options
and
higher
prices
and
significant
health
disparity
in
nevada's
communities
of
color
and
nevada's
rural
communities.
There
are
even
fewer
health
insurance
options,
but
typically
just
one
plan
on
the
exchange
or
none
at
all.
K
In
order
to
access
basic
healthcare
in
rural
areas,
many
nevadans
have
to
travel
hours
in
some
emergency
emergency
situations.
Air
transport
is
required
at
a
very
high
cost,
due
to
wep
gpo
many
retired
nevada
teachers
face
barriers
with
medicare
and
instead
rely
on
private
insurance
plans.
Some
of
these
carriers
have
been
known
to
push
older
nevadans
into
plans
with
high
deductibles
and
co-pays.
Public
option
created
by
sb420
will
ensure
that
nevadans
always
have
equal
access
to
affordable
quality
coverage.
We
hope
you
support
the
bill.
Thank
you.
S
Thank
you
chair
and
members
of
the
committee.
My
name
is
tess
opferman
speaking
on
behalf
of
seiu
local
1107
and
the
nevada
women's
lobby.
Seiu
local
1107
represents
hospital
workers
across
nevada,
including
more
than
9
000
nurses
and
ancillary
professionals
across
nevada
who
serve
on
the
front
lines.
Caring
for
the
uninsured.
Our
members
see
first
hand
that
the
vast
majority
of
these
patients
are
suffering
from
conditions
that
could
be
treated
earlier
if
they
had
access
to
quality
health
insurance
plan
and
preventative
care.
S
All
nevadans
deserve
the
opportunity
to
be
covered
by
quality,
affordable
health
care,
and
it
is
up
to
our
state
legislature
to
pass
policies
that
ensure
they
have
access.
Sb
420
is
an
important
measure
to
help
protect
nevadans
sei
seiu,
local
1107
and
the
nevada.
Women's
lobby
are
in
full
support
of
this
measure,
and
we
thank
you
for
your
time
this
morning.
S
Good
morning,
madam
chair
and
members
of
the
committee,
my
name
is
sarah
adler,
with
silver
state
government
relations
representing
the
nevada,
advanced
practice,
nurses
association,
so
napna
is
in
full
support
of
sb
420
in
two
pieces
to
the
public
option.
Piece
nevada
obviously
needs
affordable
health
care
and
aprns
or
nurse
practitioners
as
fully
licensed
accountable
and
qualified
primary
care
providers
will
be
a
great
provider
source
for
public
option
plans.
S
Aprns
are
often
receiving
horrible
reimbursement
rates
now,
and
they
would
be
glad
to
go
to
bad
reimbursement
rates
under
public
option
plans
and
then
the
second
piece
that
napna
supports
is
the
medicaid
enhancements.
Many
aprns
specialize
in
obstetric
and
pediatric
care
the
focus
of
the
medicaid
enhancements
in
420
as
well.
They
very
much
support
section
27,
which
will
provide
reimbursement,
parity
for
aprns.
Should
funds
be
available.
S
A
H
I
H
J
Good
morning,
chairwoman,
carlton
and
members
of
the
committee
for
the
record,
my
name
is
tom,
tom,
wellman
w-e-l-l-m-a-n
and
I'm
a
resident
of
assembly
senate
district
1..
I
have
successfully
retired
from
the
clark
county
school
district
and
am
currently
serving
as
president
of
the
nevada
state
education
association,
retired
program.
I'm
submitting
these
remarks
in
support
of
sb
420,
one
of
the
major
expenses
that
all
senior
citizens
and
our
members
face
in
retirement
is
the
continuing
and
escalating
cost
of
health
care
care.
J
Retirees
that
live
in
rural
nevada
also
face
the
additional
burden
of
accessibility
to
quality,
affordable
health
care.
That
does
not
require
them
to
drive
over
two
hours
or
more
to
see
a
doctor
or
go
to
a
hospital.
Any
measure
that
can
be
put
in
place
to
help
curb
this
runaway
train
is
greatly
appreciated.
J
However,
please
keep
in
mind
that
nevada
is
a
weapon
gpo
state
and
many
of
our
retired
members
may
not
qualify
for
access
to
either
social
security
or
medicare.
Please
consider
as
you
move
forward,
that
active
educators
will
also
need
to
have
access
to
quality,
affordable
health
care
when
they
retire
working
together.
We
can
help
help
to
solve
this
problem
for
the
employees
to
continue
to
handle
these
life-changing
assignments
on
a
daily
basis.
H
B
I
A
B
Please
proceed
good
morning,
chair
and
members
of
the
committee
for
the
record.
My
name
is
christine
saunders
and
I'm
the
policy
director
with
the
progressive
leadership
alliance
of
nevada
here
in
support
of
senate
bill
420..
This
morning
I
actually
want
to
share
a
very
brief
personal
story
with
you.
I
just
recently
celebrated
my
fifth
wedding
anniversary.
While
I
had
been
with
my
partner
for
many
years
prior
to
getting
married,
the
date
of
our
wedding
was
rushed.
B
B
A
G
Good
morning
and
thank
you,
chair
carlton
and
members
of
the
committee
for
the
record,
my
name
is
benjamin
chandler
and
I'm
the
policy
director
for
faith
in
action
nevada.
We
are
here
in
strong
support
for
senate
bill.
420.,
loving
your
neighbor
and
healing
the
sick
are
major
priorities
of
the
faith
communities
that
make
up
faith
in
action
nevada.
It
is
our
moral
obligation
to
be
able
to
provide
affordable
and
accessible
health
care
to
all
by
providing
a
public
option
that
is
that
all
nevadans
can
buy
into.
G
A
B
Good
afternoon,
chair
and
committee
members,
my
name
is
amy
ku,
the
deputy
political
doctor
with
one
api
in
nevada
nevada
is
home
to
over
300
000
asian
pacific,
islander
americans
comprising
about
10
of
the
total
population,
and
we
are
the
fastest
growing
community
here
in
the
state
we
have
written,
submitted
or
written
testimony,
and
we
also
have
community
members
who
will
be
submitting
op-eds
in
different
newspapers
throughout
the
week,
including
asian
journal
and
the
philippine
times.
We
urge
you
to
review
those
and
support
or
sb420.
M
You,
madam
chair,
for
the
record,
my
name
is
annette
magnus
and
I'm
the
executive
director
of
battleborn
progress.
We
thank
senate
majority
leader
canazarro
for
leadership
on
this
bill
and
we
support
sb
420.,
I'm
going
to
skip
to
the
part
where
it
matters.
I
want
to
add
that,
technically
we
are
a
small
business.
I
pay
a
hundred
percent
of
our
ten
employees,
health
insurance
and
their
children.
M
A
H
I
I
As
a
woman
with
factor
five
lightens
from
bophilia,
it
would
have
cost
me
over
ten
thousand
dollars
in
prescriptions
alone,
to
have
my
pregnancy
in
nevada.
In
the
interest
of
time,
I
won't
go
into
details,
but
I
did
some
written
testimony
that
I
hope
you
will
review.
I
am
in
strong
support
of
sb
420,
as
is
make
the
road
nevada,
and
I
hope
that
you
will
join
us
in
that
support.
Thank
you.
H
I
Thank
you
for
your
time
and
this
morning,
chair
and
committee
members
for
the
record.
My
name
is
reverend
michael
willoughby.
Today
I
am
speaking
in
my
personal
capacity.
That's
w-I-l-l-o-u-g-h-b-y
m-I-c-h-a-e-l,
I'm
here
today
to
speak
in
support
of
scp-420
and
while
I'd
normally
be
here
to
give
voice
to
your
conscience
today,
I'm
here
to
give
voice
to
my
best
friend,
ian
wilkinson,
I'm
speaking
on
his
behalf
today,
because
he
can't
be
here
after
28
years
of
love
and
friendship
after
he
beat
what
should
have
been
fatal
lymphoma.
I
I
lost
my
my
best
friend
last
december
ian
died
because
he
lost
his
employer-sponsored
health
insurance
and
couldn't
afford
to
get
basic
medical
treatment.
He
died
by
himself
on
the
floor
of
an
eagles
hall.
None
of
his
friends
had
a
chance
to
say
goodbye.
None
of
his
family
had
a
chance
to
say
goodbye
and
sadly,
ian's
story
isn't
unique
or
even
rare.
I
It
could
be
anyone
in
this
room,
please
let
something
good
come
out
of
the
death
of
my
best
friend
ian
wilkinson.
Please
support
sb420.
I
have
also
support
sent
in
this
testimony
for
review
as
well.
Thank
you,
chair.
H
H
I
Good
morning,
madam
good
morning,
madam
chair,
I
apologize
members
of
the
committee
priscilla
maloney
p-r-I-s-c-I-l-l-a
m-a-l-o-n-e-y,
representing
the
afscme
retiree
chapter
this
morning.
We
did
submit
written
remarks
on
may
4th
to
the
senate
committee
on
health
and
human
services,
but
just
to
reiterate,
sb
420
will
capture
a
portion
of
the
350
000,
uninsured
in
nevada
that
mr
daley
and
the
nsea
retirees
just
referenced.
These
are
folks
who
are
pre
by
virtue
of
their
age
and
non-medicare.
I
A
All
right
with
that,
do
we
have
anyone
else
in
support
on
the
phone
line.
H
B
Thank
you,
madam
chair.
My
name
is
katie
robbins
k-a-t-I-e
r-o-b-b-I-n-s,
and
I
am
here
on
behalf
of
planned
parenthood,
votes,
nevada,
I'll,
say
ditto
to
what
we
have
already
heard.
Increasing
access
to
health
care,
including
reproductive
health
care,
will
make
our
state
stronger
and
more
equitable.
Thank
you
for
your
time
and
we
urge
the
committee
support
of
sb
420.
Thank
you.
A
H
I
Oh
good
morning,
chair
and
committee,
thank
you
for
your
time.
For
the
record,
my
name
is
anwar
green.
That
is
a
w
ar
last
name
is
green,
like
the
color
g-r-e-e-n,
I'm
here
to
express
my
support
of
senate
bill
420,
as
I
believe,
a
public
option
benefits
all
of
us
as
someone
who,
just
recently
obtained
insurance
through
my
employer.
I
A
Thank
you
very
much
and
with
that,
if
there
is
anyone
else
on
the
phone
lines
and
support,
we
would
ask
you
to
submit
your
comments
in
writing.
Please
we're
going
to
go
ahead
and
open
it
up
for
opposition.
It
is
10
20.
we're
going
to
do
about
the
same
process
so
I'll
go
to
folks
here
in
the
room.
Please
keep
the
two
minutes
in
the
back
of
your
mind,
mr
wadhams.
O
Thank
you,
madam
chair
members
of
the
committee.
My
name
is
jim
wadhams
w-a-d-h-a-m-s
here
today,
representing
the
nevada
hospital
association.
Hospital
association,
of
course
supports
access
to
care.
In
fact,
hospital
facilities
with
emergency
rooms
are
open
to
all
all
comers
are,
irrespective
of
of
any
condition
of
insurance
or
otherwise.
O
So
access
to
care
is
important,
and
I
think,
having
listened
to
the
testimony
today,
and
I
complement
senator
canazzaro
and
her
advocacy,
I
think
it's
very
important
that
this
committee,
in
particular
that
is
charged
with
the
fiscal
impact,
analyze
the
contingencies
and
the
uncertainties
that
are
represented
by
this
bill
that
are
so
important
in
that
regard,
and
specifically,
I
want
to
draw
the
committee's
attention
to
the
purposes
of
the
bill,
as
stated
in
section
two:
it
is
designed
to
improve
access.
It
is
designed
to
reduce
disparities
in
access
and
designed
to
increase
competition.
O
O
So
this
is
an
industry
that
is
prepared
to
deal
with
people
who
come
and
who
have
needs.
The
concern,
of
course,
though,
becomes
the
cost
and
looking
at
page
25
of
the
scr-10
monette
study,
they
specifically
indicated
that
that
study
did
not
address
the
risk
modeling.
That
is
what
is
the
cost
of
this.
There
are
certain
contingencies
built
into
the
proposal,
including
applying
for
federal
waivers
federal
grants,
all
of
which,
as
this
committee
especially
knows,
uncertainty
raises
issues
of
cost.
O
O
I
think
it's
especially
noteworthy
that
the
drafters
of
the
bill
paid
particular
attention
to
this
issue
in
section
13,
subsection
2,
where
they
exempted
the
mandatory
participation
if
it
is
determined
to
diminish
the
access
of
for
medicaid
recipients
and
and
peb
beneficiaries.
Why
would
that
be
the
case?
If
you
lose
physicians,
you
will
decrease
access
and
as
hospitals,
we
can't
go
anywhere
we're
bricks
and
mortar.
O
We
strongly
suggest
that
the
committee
consider
taking
taking
the
first
step
on
this
on
this
laudatory
goal
of
universal
access,
but
do
it
in
the
incremental
steps
that
show
we
have
set
aside
the
money
to
accommodate
it,
and
we
have
assessed
the
measuring
tools
to
accumulate
the
data
to
address
it
with
that.
I
appreciate
the
committee's
time
this
morning.
Thank
you.
G
Thank
you,
madam
chair
and
members
of
the
committee
for
the
record,
trey
abney
here
today
on
america's
health
insurance
plans,
otherwise
known
as
ahip
here
to
testify
in
strong
opposition
to
sb420.
I
was
going
to
open
and
provide
context
and
talk
about
the
american
rescue
plan,
but
mr
hafen
and
mrs
toles
stole
my
thunder
on
that.
But
suffice
it
to
say.
The
american
rescue
plan
means
that
approximately
80
000,
uninsured
nevadans,
now
qualify
for
zero
cost
or
significantly
reduce
plans
through
nevada
health
link
and
an
additional
50
000
qualifying
for
reduced
price
plans.
G
Also,
41
000,
uninsured
nevadans
will
now
qualify
for
premium
tax
credits,
who
have
never
been
eligible
for
subsidies
before
and-
and
we've
already
mentioned,
the
37
percent
of
uninsured
nevadans
who
qualify
for
medicaid
now
but
are
not
on
it.
However,
sb
420
would
destabilize
the
nevada
health
healthcare
system
and
to
dr
titus's
point
by
requiring
providers
to
accept
reimbursements
at
lower
than
cost.
This
would
force
these
providers
in
a
state
already
experiencing
a
severe
provider
shortage
to
recoup
their
costs
by
demanding
higher
reimbursement
rates
from
all
group
plans,
including
small
business
plans.
G
Moreover,
this
bill
does
nothing
to
address
the
underlying
cost
drivers
that
are
driving
higher
premiums
other
than
setting
arbitrary
rates
for
providers
and
hospitals.
There
is
no
mechanism
included
in
the
proposal
to
actually
drive
down
the
health
care
cost
to
achieve
the
bill's
premium
reduction
goals.
In
particular,
we
should
discuss
the
ever
increasing
price
of
prescription
drugs.
Prescription
drugs
represent
the
largest
portion
of
health
care
spending,
making
up
more
than
21
cents
for
every
premium
dollar.
G
Sb
420
demands
that
the
public
option
premium
achieve
five
percent
reduction
in
premiums,
but
does
nothing
to
actually
address
the
portion
of
premium
that
keeps
increasing
the
high
price
of
drugs
and
and
madam
chair
and
closing,
we
urge
you
to
focus
on
getting
those
in
nevada
without
coverage
covered
without
driving
up
the
cost
of
coverage
for
everyone
else.
G
T
Good
morning,
madam
chair
and
members
of
the
committee,
my
name
is
jaren
hildebrand
and
I
am
the
executive
director
of
the
nevada
state
medical
association
and
on
behalf
of
the
american
medical
association
and
our
physicians
and
med
students,
as
well
as
the
nsmen,
are
over
2
000
members
statewide.
We
express
our
concerns
today
with
the
legislation
we
have
before
us.
Our
organization
shares
your
interest
in
improving
access
to
care,
the
affordable,
the
affordability
of
health
insurance
covering
uninsured
and
improving
health
health
come
out.
T
First,
under
the
sections
sections
with
the
legislation
of
the
physician
participation
of
medicaid
workers,
comp
pebs,
we
we
would
require
to
participate
in
networks
of
this
public
option
to
accept
new
new
public
option
patients
in
the
same
manner
as
they
would
in
except
any
new
patients
under
the
program
and
sma
supports
physicians
freedom
of
choice
when
it
comes
to
health,
health
plan
participation
and
therefore
we
oppose
this.
This
effort
participation
in
a
public
option
by
trying
to,
by
tying
it
to
participation
of
these
three
three
important
programs.
T
This
mandatory
participation
provision
overlooks
the
complexities
of
running
running
a
physician
practice,
the
balance
of
determining
the
capacity
of
the
ability
of
a
practice
to
serve
their
patient
mix.
There
are
many
reasons
as
to
why
practices
will
not
participate
with
plans,
including
low
reimbursement
levels,
burdensome
administrative
policies,
saturation
of
practice,
resources
and
physician
time.
The
engagement
in
alternative
payment
models,
pending
retirement
and
so
on.
It
is
critical
that
a
physician
should
be
able
to
weigh
in
in
their
on
their
contract
options
and
make
decisions
what's
best
for
their
patients
and
their
practices.
T
Secondly,
we
have
concerns
with
the
general
established
provider
payment
of
using
medicare
rates
as
the
floor.
While
we
appreciate
medicare
rates
meant
to
serve
as
a
starting
point,
the
targets
for
the
negotiation
between
a
provider
plans
and
many
physicians
rightfully
fear
that
these
rates
will
ultimately
become
the
de
facto
of
ceiling.
This
scenario
is
even
more
likely
in
returning
requirements
on
participation
remain
in
place
and
contract
negotiations
not
required.
T
Moreover,
as
a
plan,
we
worked
as
plans
work
to
meet
premium
saving
requirements
outlined
in
sb40.
It
is
highly
unlikely
that
they
will
offer
rates
above
the
statutory
minimum,
given
the
finest
financial
risks
of
setting
a
public
option.
Rated
medicare
baselines
for
physician
practices.
Nsma
urges
this
body
to
consider
the
impact
of
the
policy
of
the
long-term
sustainability
of
our
small
practices.
Ultimately,
access
to
care
in
nevada,
such
as
as
such
we
respectively
ask
this
legislator
from
refrain
from
using
medicare
rates
as
the
floor
for
physician
payments
under
this
issue.
T
We
do
feel
that
this
would
cause
access
to
care
issues
and
also
network
adequate
adequacy
issues,
especially
with
the
mandate
when
you
look
at
other
states
where
their
starting
reimbursement
rates
are
at
160
above
medicare,
without
physician
mandates,
one
this
bill
is
not
means
tested.
We
just
heard
on
the
record
that
some
folks
are
looking
forward
to
build
this
path,
so
they,
whoever
already
have
commercial
insurance,
would
hop
off
those
and
move
to
this.
T
This
public
option
should
be
for
those
folks
that
are
make
just
enough
above
medicare
and
medicaid
and
are
in
those
coverage
gaps
that
can't
afford
a
plan
on
the
exchange,
and
we
feel
without
that
means
test.
This
bill
will
likely
cost
cost
shifting
deductibles
and
increased
premiums
like
we
just
saw
in
washington,
who
already
had
to
amend
the
bill
after
five
months.
Thank
you.
A
H
J
Thank
you,
madam
chairman,
and
the
rest
of
the
committee.
I
really
appreciate
you're
taking
phone
calls
and
I'm
just
an
ordinary
citizen,
and
when
I
listen
to
this.
J
The
record
yes
ma'am
bill
last
name,
harrenberg
h-a-r-e-n-b-u-r-g
and
again,
I'm
just
an
ordinary
citizen.
Thank
you
for
all
representing
me.
I'm
really
impressed
by
all
the
knowledge
and
wisdom,
that's
in
the
room
there
and
all
the
research
that
you've
done.
My
immediate
reaction
is
that
this
bill
is
just
too
risky
for
nevada.
It's
just
too
it's
the
chances
of
us
overflowing
and
requiring
more
money.
J
Just
is
is
too
much.
If
you
look
at
the
federal
government
at
least
they
can
write
checks
and
and
print
money,
but
nevada
can't
do
that,
and
so
those
are
my
comments.
Thank
you
and
I
I
strongly
oppose
this
bill.
H
B
Good
morning,
chair,
carlton,
mary
beth,
seawalled
s-e-w-a-l-d,
I'm
president
and
ceo
of
the
biggest
chamber.
While
I
compliment
leader
canazarro
on
her
advocacy,
and
we
at
the
vegas
chamber
do
agree
that
everyone
should
be
able
to
access
health
care,
we
are
opposed
to
sb
420.
This
bill
would
not
reduce
health
care
costs;
rather,
it
would
shift
costs
on
to
other
nevadans,
also
mandating
a
state
insurance
plan
to
offer
a
rate.
Five
percent
lower
than
commercial
rates
is
another
cost
shift.
B
Evidence
from
other
states
that
have
implemented
similar
programs
confirms
that
insurance
costs
did
go
up,
which
is
also
very
concerning
to
us.
We
agree
that
a
thorough
actuarial
analysis
to
understand
the
full
financial
impact
that
sb
420
would
have
on
the
state
and
health
care
sector
would
be
very,
very
helpful.
There
are
also
concerns
about
requiring
health
care
providers
to
accept
government
set
reimbursement
rates
as
well,
and
the
impact
that
it
will
have
on
doctors
is
a
concern
to
us.
Thank
you
so
much
chair,
carlton
and
committee
members.
H
B
Thank
you.
Greetings
chair
members
of
the
committee
amber
stidham,
that's
s-t-I-d-h-a-m
for
the
henderson
chamber
of
commerce.
I'll
be
brief.
We
too
continue
to
be
extremely
concerned
about
the
impact
to
all
nevadans.
As
a
result
of
this
proposal,
we
believe
it's
an
unproven,
costly
government
program
will
shift
costs
on
to
nevadans,
with
private
and
employer,
provided
health
insurance,
making
health
care
more
expensive
and
having
the
potential
to
dissuade
doctors
from
accepting
new
patients
on
medicaid
and
medicare,
thereby
reducing
health
care
access
and
choice
to
all
nevadans.
B
T
Thank
you,
madam
chair
members
of
the
committee.
My
name
is
tom
clark,
I'm
here
on
behalf
of
the
nevada
association
of
health
plans.
I
come
before
you
in
opposition
to
the
public
option,
provisions
that
are
outlined
in
senate
bill
420.,
the
financial
burden
that
it's
going
to
place
on
nevadans
and
the
instability
in
the
healthcare
market
it
could
place
on
our
state.
You've
heard
references
to
the
monot
study.
To
be
clear,
there
was
a
report
that
was
put
forth.
An
initial
analysis
of
public
option
plans
that
report
states
clearly
nevada.
T
T
While
there
is
a
study
currently
referenced
in
the
bill
specific
to
the
waiver,
there's
nothing
that
requires
the
results
of
the
actuary
analysis
be
submitted
for
review
by
the
governor
or
by
the
legislature
before
moving
forward
with
this
public
option,
in
other
words,
that
the
bill
does
not
stop
enactment
of
a
public
option
pending
the
result
of
that
study.
Our
recommendation
is
that
the
legislative
action
should
not
be
taken
until
the
results
of
that
study
are
reviewed
and
put
forward,
and
also
before
considering
and
putting
anything
in
nrs.
T
We
strongly
suggest
the
state
perform
an
actuary
analysis
examining
the
impact
on
insurance
market
stability,
network
adequacy
of
health
care
providers
and
potential
cost
drivers
that
could
unintentionally
impact
consumers
throughout
our
state.
Private
insurance
managed
care
organizations
must
demonstrate
that
the
insurance
products
they
offer
are
actuarially
a
sound
shouldn't.
The
state
expect
the
same
from
a
public
option.
We
firmly
believe
so.
Thank
you,
madam
chair.
B
Thank
you,
chair
carlton
and
members
of
the
committee
lindsey
knox
with
mcdonald
carano,
representing
the
nevada,
self-insurers
association,
the
workers
com,
comp,
the
workers
compensation
community,
already
struggles
to
empanel
adequate
choices
of
qualified
physicians
in
all
areas
of
health
care.
Many
physicians
already
choose
not
to
accept
workers,
compensation
patients
because
of
the
regulatory
requirements
involved
and
the
burden
it
places
not
only
on
themselves,
but
also
on
their
administrative
staff.
There
are
many
injured
injuries
in
industrial
related
conditions
that
require
specialized
care
with
few
to
know
appropriate
physicians
available
to
treat
them.
B
While
nsia
fully
supports
the
desire
to
increase
access
to
health
care
for
nevadans,
we
believe
that
sb
420
will
create
additional
detriment
against
workers,
compensation
stakeholders,
including
injured
employees
and
our
state
and
communities
in
2019,
nsia
worked
with
the
nevada
justice
association
to
pass
sp
381
created
to
expand
each
injured
workers
access
to
quality
health
care.
We
believe
this
change
will
undermine
the
changes
made
under
sb
381
physicians,
who
do
not
have
the
staff
desire
or
resources
to
treat
both
workers
compensation
and
the
public
option.
Patients
will
simply.
B
Of
approved,
treating
physicians
and
chiropractors
for
working
workers
compensation,
this
will
cause
a
reduction
in
the
limited
numbers
of
physician
already
available
to
our
workers
compensation
community.
We
therefore
respectfully
request
that
you
remove
workers
compensation
physicians
from
the
public
option
requirements.
Thank
you.
Thank
you.
S
A
H
I
Good
morning,
madam
chair
members
of
the
committee,
my
name
is
jeanine
hanson
state
chairman
of
the
independent
american
party.
Sb
420
will
cost
taxpayers
those
with
private
insurance
and
those
who
pay
cash
for
their
care
because
they
don't
have
health
insurance
much
more
than
any
fiscal
notes
listed
on
the
bill.
Obamacare
caused
health
insurance
premiums
for
average
people
to
double
between
2013
and
17..
I
That
means
that,
essentially,
we
are
creating
a
hidden
tax,
that
of
financing
medicare
patients
and
patients
covered
under
the
public
option,
whose
health
care
will
now
be
subsidized
by
those
who
have
private
insurance,
causing
their
insurance
rates
to
go
up
or
those
who
don't
have
insurance,
causing
their
cash
cost
for
medical
care
to
go
up.
I
live
in
elko
county
already.
It
is
difficult
to
find
a
doctor
or
get
specialized
treatment
at
the
hospital.
I
Everyone,
I
know
in
elko
has
to
go
out
of
town
to
twin
falls:
idaho,
two
and
a
half
hours,
salt
lake,
three
and
a
half
hours
or
reno
four
and
a
half
hours
to
see
the
doctor
or
go
to
the
hospital
fb
452
will
make
access
to
health
care
in
rural
areas.
Worse,
medicaid
reimburses
at
only
52
percent
in
medicare
at
80
of
actual
costs.
This
makes
it
much
more
difficult
to
find
a
doctor
who
will
take
medicaid
or
medicare
patients
in
rural
counties
or
in
a
hospital
that
can't
afford
to
stay
open.
I
Who
can
continue
to
treat
patients
at
below
cost?
So
the
means
that
means
there
will
be
fewer
doctors
or
hospitals
and
especially
in
the
rural
counties.
As
ronald
reagan
said,
government
is
not
the
solution
to
our
problem.
Government
is
the
problem.
The
solution
is
simple:
freedom
is
the
solution:
freedom
from
government
regulations
and
laws
regarding
health
care,
freedom
for
insurance
companies
to
truly
compete,
freedom
of
choice.
A
H
J
J
Doctors
are
forced
to
treat
people
below
cost
and
medical
decisions
often
shift
from
the
patient
and
doctor
to
bureaucrats
who
run
the
programs
they
decide.
If
you
are
eligible
for
certain
tests
and
treatments.
No
thanks.
I
do
not
want
some
state
bureaucrat
deciding
my
medical
fate.
Secondly,
government-run
health
care
programs
are
money,
sinks
treatment.
Quality
is
poor,
while
costs
skyrocket.
J
What
percentage
of
our
state's
budget
will
be
gobbled
up
by
this
wasteful
program
in
2010
in
ontario,
canada
government-run
healthcare
took
up
46
percent
of
their
budget
by
2030.
That
number
is
projected
to
be
80
percent,
not
much
money
left
for
anything
else,
as
nevada
families
for
freedom
explained.
J
This
bill
will
ask
more
doctors
to
treat
people
below
cost
undermining
care
for
everyone
and
forcing
those
who
have
insurance
or
pay
out
of
pocket
to
subsidize
those
who
are
on
medicaid
or
receive
the
public
option
this
bill
is
passed,
will
fail
miserably
for
the
citizens
of
nevada.
So
let
us
save
ourselves
a
headache
and
high
cost
and
oppose
it
now.
Thank
you
very
much.
A
A
So
with
that
I'll
go
to
neutral
testimony
is
there
anyone
in
neutral
in
the
room
doesn't
seem
like
a
neutral
kind
of
bill.
So
with
that
there's
no
one
on
zoom,
I'm
going
to
go
to
neutral
on
the
phone
line.
Please.
H
J
Begin
chair,
this
is
jim
sullivan
from
the
culinary
union.
I
was
having
some
technical
technical
difficulties
earlier
and
I
wasn't
able
to
get
through
on
the
support
side.
Could
I
please
give
a
support
statement
here.
A
J
A
Thank
you,
please
submit
the
rest
of
your
comments
in
written
form
and
we'll
be
sure
to
include
them
in
the
support
section
of
the
bill.
We
understand
technical
difficulties
with
that.
Is
there
anyone
else
in
neutral
on
the
phone
line.
A
M
M
For
me,
so
much
of
what
is
is
voiced
as
opposition,
I
think,
is
addressed
in
a
couple
of
factions.
First
to
ignore
the
fact
that
we
are
going
to
do
an
actuarial
analysis
and
that
that
is
required
as
part
of
the
waivers
that
we
are
seeking
to
get.
I
think
ignores
that
that
is
going
to
provide
us
with
some
data
that,
if
we
needed
to
make
adjustments
such
that
this
was
not
going
to
get
at
those
individuals
that
we
are
attempting
to
get
at
and
those
small
groups,
then
we
can
make
those
adjustments.
M
I
think
this
body
is
plenty
smart
enough
to
be
able
to
do
that
with
two
intervening
legislative
sessions
and
with
being
able
to
take
a
look
at
it,
but
simply
saying
that
we
should
just
continue
to
keep
studying
this,
and
I
know
I'm
in
this
point
in
the
senate
as
well.
When
there
have
been
studies,
there
have
been
studies
prior
to
my
entering
this
building
in
2017.
M
There
were
bills
proposed
to
to
solve
those
solutions
or
seeming
to
solve
those
problems.
Those
bills
were
vetoed
and
we
were
asked
to
look
at
it
again.
That
happened
yet
again,
then,
last
session,
the
concept
was
brought
forward
and
they
said
well.
We
should
study
it
again.
So
we
have,
we
have
data,
we
have.
M
We
know
where
there
are
people
who
are
uninsured
and
frankly,
I
think
that
is
even
supported
by
the
fact
that
we
are
seeing
the
federal
government
come
in
and
give
some
money
in
order
for
people
to
be
able
to
afford
health
insurance.
The
idea
that
that
is,
okay
and
that
we
should
still
oppose
something
like
420,
which
is
seeking
to
to
utilize
federal
dollars.
To
do
the
same
thing.
To
get
people
insured
to
me
doesn't
make
any
sense.
M
The
idea
that
we
should
just
expand
medicaid
as
the
only
option
when
we
continually
hear
how
much
that
is,
a
burden
for
providers
for
hospitals
and
then
the
argument
that
accompanies
420
is
that
this
is
going
to
cost
the
state
a
significant
amount
of
money.
I
I
would
venture
to
guess
that
placing
people
on
medicaid
also
does
all
of
those
things.
M
Yet
that
seems
to
be
an
appropriate
solution
in
order
to
solve
this
problem,
rather
than
trying
to
find
affordable
health
insurance
for
individuals
who
simply
are
underinsured
cannot
get
insurance
fall
into
gaps
where
they
do
not
qualify
for
insurance
and
for
us
to
be
able
to
put
forward
something.
That
does
that.
I
don't
think
puts
the
state
at
risk
for
having
to
spend
millions
and
millions
of
dollars
over
time
such
that
we
are
in
a
fiscally
precarious
position.
M
A
Thank
you
very
much,
madam
majority
leader,
and
I
truly
hope
that
the
elevators
are
working.
Thank
you.
So,
with
that
committee
remembers
we're
going
to
close
the
hearing
on
sb
420,
we
have
some
budget
bills.
We
need
to
move
so
I'll.
Give
you
lay
of
the
land
we're
going
to
pull
up
a
couple
of
them
here.
I've
got
409
421,
422
and
426
we're
going
to
try
to
get
through
those.
If
we
can
and
I'm
sorry-
oh
I'm
sorry
446
446..
B
B
Once
to
give
you
a
brief
bit
of
background
and
I
will
keep
it
moving,
I
promise.
When
senate
bill
135
was
passed
by
the
80th
legislature.
It
contained
an
assessment
to
support
the
government,
employee
management
relations
board
known
to
everybody,
as
emrb.
B
Exclusive
representation
putting
together
the
bargaining
team,
scheduling
the
negotiation
sessions
and
otherwise
interfacing
with
the
union
personnel
in
implementing
the
collective
bargaining
agreements.
The
existing
personnel
assessment
was
expected
to
be
utilized
during
a
current
biennium
to
support
the
work
of
the
labor
relations
unit
and
indeed
it
has
been,
and
the
committee
might
remember
that
we
returned
to
the
interim
finance
committee
to
support
the
labor
relations
unit
position.
So
this
bill
takes
the.
A
So
with
that,
if
I
understand
this
correctly,
basically,
the
folks
that
are
into
collective
bargaining
unit
and
benefit
from
the
collective
bargaining
unit
will
be
paying
the
assessment
for
that
for
participation
in
that
it's
not
being
spread
across
all
employees,
it's
being
picked
up
by
those
folks.
I
just
want
to
make
sure
that's
clear,
because
there's
been
conversations
about
folks
paying
for
something
that
they're
not
getting
so
miss
reed.
B
Oh
yes,
madam
chair,
for
the
record,
laura
freed,
the
agency.
I.
B
On
to
the
employee,
that's
part
of
the
bill
and
that's
true
of
the
emrb
assessment
as
well.
But
yes,
you
are
correct.
The
agencies
will
that
have
those
employees
in
those
units
will
pay
it
and
then
they
will
get
a
they
will
substitute
for
what
they
used
to
pay
in
personnel
assessment
in
this
biennium.
A
All
right,
thank
you
so
with
that
we're
just
trying
to
I'm
not
going
to
say
true
up
again,
because
apparently
I
say
that
too
much
so
we're
just
trying
to
reconcile
how
this
is
being
handled.
Okay,
thank
you
very
much
so
with
that
committee
members.
Are
there
any
questions
on
sb
409,
not
seeing
any
dr
titus
a
question.
F
A
And-
and
this
is
a
budget
implementation
bill
and
basically
the
fee
that
they
would
have
been
paying
through
our
normal
rate
to
human
resources,
will
now
be
adjusted
to
go
in
in
basically
a
different
direction.
So
this
is
reconciling
how
those
rates
will
be
addressed
for
agencies
that
have
collective
bargaining
units
so
with
it
being
in
the
budget.
It's
it's
a
shift
that
way
it's
not
a
a
new
fee
which
would
be
a
two-thirds
notation,
great.
A
You're
welcome
so
with
that
committee
members,
any
other
questions
on
sb409
not
seeing
any.
This
is
the
hearing
for
sb409
I'm
going
to
go
ahead
and
open
it
up.
Is
there
anyone
in
the
room
in
support
of
sb409,
not
seeing
anyone
in
the
room?
Anyone
in
zoom
in
support
of
sb409
not
seeing
any
anyone
on
broadcast
services?
Do
we
have
anyone
on
the
phone
line
in
support
of
sb409.
A
A
A
E
Good
morning,
madam
chair
and
members
of
the
committee,
brian
mitchell,
for
the
record
and
I'll
be
very
brief.
When
osip
was
created,
all
employees
were
in
the
non-classified
service,
like
those
of
the
governor
and
the
decision
was
made
to
bring
agencies.
H
That
are
not
in
the
unclassified
classified
service
into
unclassified
classified
service,
and
the
executive
budget
recommends
the
conversion
of
the
non-classified
staff
positions
into
classified
and
unclassified
positions,
and
that
is
essentially
what
the
bill
does.
I'm
happy
to
answer
any
questions.
A
Thank
you
very
much.
I
believe
we
had
these
conversations
when
we
were
hearing
the
budget
also.
So
this
is
the
implementation
portion
of
that
discussion
point.
Are
there
any
questions
from
any
committee
members
at
this
time,
not
seeing
any
question
from
any
committee
members?
This
is
the
hearing
for
sb421,
so
I'll
go
ahead
and
open
it
up
or
is
there
anyone
in
support
in
the
room
for
sb
421,
not
seeing
anyone
come
forward?
Anyone
on
zoom
seeing
no
one
wishing
to
be
recognized
broadcast
services,
anyone
on
the
phone
line
in
support
of
sb
421.
A
A
A
Thank
you
very
much.
I
don't
believe
there's
any
closing
comments
that
need
to
be
made
we'll
go
ahead
and
close
the
hearing
on
sb
421
and
we
will
open
up
the
hearing
on
sb
4
22.,
miss
kaufman.
P
A
B
Thank
you
very
much
chair.
Yes,
this
is
a
budget
implementation
bill
that
would
create
a
new
division
of
mail
services
and
it
would
transfer
the
responsibilities
of
the
central
mail
room.
B
A
B
So
it
was
not
an
independent
division,
it
used
to
be
under
buildings
and
grounds,
and
it's
a
state
public
works
division
and
about
a
decade
it
was
moved
from
public
works
over
to
the
state,
librarian
archives,
and
so
it
it
has
never
been
a
standalone
division
and
the
unique
mission
of
the
roles
and
responsibilities
or
or
what
is
prompting
this
request.
A
Thank
you
very
much
for
clarifying
that.
I
I
appreciate
that.
I
do
remember
that
it
did
get
moved
okay,
so
with
that
committee,
not
seeing
any
questions
at
this
time,
we'll
go
ahead
and
open
it
up
for
hearing.
Do
we
have
anyone
in
the
room
in
support
of
sb422,
seeing
none
anyone
on
zoom
seeing
none
broadcast
services,
anyone
in
support
of
sb422.
A
A
Thank
you
very
much.
Anyone
in
neutral
in
the
room
seeing
none
anyone
in
neutral
on
zoom
no
broadcast
services.
Anyone
in
neutral.
A
P
Thank
you,
madam
chair
sena,
bill
446
removes
the
western
interstate
commission
on
higher
education
from
the
office
of
the
governor
senate.
Bill
446
further
specifies,
among
other
things,
that
the
three
nevada
state
commissioners
of
the
western
interstate
commission
on
high
higher
education
shall
appoint
a
director
which
serves
at
the
pleasure
of
the
commission.
P
A
A
I'm
happy
to
take
any
questions.
Thank
you
very
much,
mr
lutt.
So
with
that
committee
members,
are
there
any
questions
at
this
time?
Not
seeing
anyone
wishing
to
be
recognized,
we
can
go
ahead
and
open
up
the
hearing
for
senate
bill
446
anyone
in
the
room
in
support,
seeing
none
anyone
on
zoom,
I
don't
believe
so
broadcast
services.
Anyone
in
support
on
the
phone
line.
A
A
A
Thank
you
very
much
with
that.
I
believe
we
can
close
the
hearing
on
senate
bill
446
and
hold
on
for
just
a
moment.
A
P
A
Thank
you
very
much,
mr
reynolds,
nice
to
see
you
would
you
like
to
make
a
statement.
G
Yes,
thank
you,
chair
carlton,
terry
reynolds,
director
for
the
department
of
business
and
industry.
The
consumer
affairs
unit
has
been
in
the
department
of
business
industry
for
the
last
since
2011
actually
and
each
year
it's
had
a
sunset,
each
biennium.
Excuse
me:
it's
had
a
sunset
provision.
You
know
this
removes
that
sunset
provision.
It
also
changes
the
name
from
division
to
unit.
G
So
it
is
now
the
consumer
affairs
unit,
as
indicated
in
447,
just
wanted
to
thank
you
for
the
passage
of
the
the
budget
for
this,
and
we
think
this
is
a
a
good
step
forward
and
it
gives
the
staff
some
security
in
terms
of
knowing
that
they're
going
to
be
continuing
with
that
subject
to
appropriation.
Obviously,
but
we
have
6.6
staff
members.
G
We
are
very
small
but
mighty
unit
last
year
in
2020
they
recovered
hundred
and
thirty
thousand
dollars
in
restitution
and
products
for
the
general
public
and
have
done
extremely
well
with
about
a
ninety
two
to
ninety
three
percent
resolution
rate
for
their
cases
that
they
hold.
We
did
2500
cases
during
the
pandemic
time
and
we
average
about
2
000
cases
a
year.
So
we
really
appreciate
going
forward
with
this
bill.
Thank
you.
A
And
thank
you
very
much,
and
I
know
this
unit
as
we're
going
to
call.
It
now
has
had
a
lot
of
history
and
a
lot
of
moves,
but
they've
always
done
they've
always
stepped
up
and
done
a
very
good
job
for
the
citizens
of
the
state.
So
thank
thank
the
staff
for
me
that
they
were
able
to
help
the
citizens
that
needed
help.
So
we
appreciate
that
so
with
that
committee
members.
Are
there
any
questions
on
sb
447
of
mr
reynolds
not
seeing
any
we'll
go
ahead
and
open
it
up?
A
A
A
Thank
you
very
much.
Anyone
in
the
room
in
neutral,
seeing
none,
no
one
on
zoom
broadcast
services,
anyone
in
neutral
on
the
phone
line.
A
Thank
you
very
much
so
with
that
not
seeing
any
other
questions
or
comments,
we
can
close
the
hearing
on
sb447
and
with
that
committee
we're
going
to
go
into
a
work
session
and
the
bills.
You
just
heard
we're
going
to
send
to
the
floor
to
make
sure
that
our
most
important
responsibility
for
the
committee
other
than
the
big
budget
bills
is
to
make
sure
all
the
budget
implementation
bills
follow
right
along
behind
them.
So
the
first
bill
that
we
will
work
them
in
the
same
order
that
we
just
heard
them
so
miss
kaufman.
P
P
A
So
with
that
committee,
any
questions
or
comments,
hearing
none
this
would
be
a
do
pass
correct,
because
these
are
all
clean
straight:
oh,
no,
yeah
yeah!
These
are
all
clean
straight
to
us.
So
with
that
this
would
be
a
do.
Pass
I'll,
accept
a
motion
from
miss
monroe
moreno,
a
second
from
ms
beninis
thompson
questions,
comments,
hearing,
none
all
in
favor,
please
signify
by
saying
aye
any
in
opposition
hearing
no
opposition
passes
unanimously
of
the
members
present.
Moving
on
to
the
next
bill,
421.
P
Thank
you,
madam
chair
senate
bill
421
changes
the
employment
status
of
the
director
of
the
office
of
science,
innovation
and
technology
in
the
office
of
the
governor
from
non-classified
to
unclassified.
This
is
a
budget
implementation
bill
and
brian
mitchell
from
the
office
of
science.
Innovation
and
technology
presented
this
bill
and
there
are
no
amendments
recommended.
A
P
A
With
that
questions,
seeing
none
this
would
be
a
do.
Pass
accept
a
motion
from
ms
monroe
moreno.
Second,
from
ms
benitez
thompson
comments:
hearing
none
all
in
favor,
please
signify
by
saying
aye
any
in
opposition
hearing
no
opposition
passes
unanimously
of
the
members
present
moving
on
to
senate
bill
446.
Please.
P
The
senate
bill
446
further
specifies,
among
other
things,
that
the
three
nevada
state
commissioners
of
the
western
interstate
commission
on
higher
education
shall
appoint
a
director
which
serves
the
pleasure
of
the
commission,
jennifer
ollett
director
of
which
he
presented
this
bill.
This
is
a
budget
implementation
bill
and
there
are
no
recommended
amendments.
A
Thank
you
very
much
any
questions
from
committee
members
not
seeing
any.
I
would
accept
a
motion
to
do
pass.
Sb
446
from
miss
monroe,
moreno
second,
from
ms
benitez
thompson
comments.
Hearing,
none
all
those
in
favor,
please
signify
by
saying
aye
aye
any
in
opposition
hearing
no
opposition
passes
unanimously.
The
members
president
we'll
go
ahead
and
address
sb
447
next.
P
Thank
you,
madam
chair
senate
bill
eliminates
the
consumer
affairs
division
of
the
department
of
business
and
industry
and
makes
it
the
temporary
consumer
affairs
unit
in
the
department
permanent
terry
reynolds
from
the
department
of
business
and
industry
presented
this
bill.
This
is
a
budget
implementation
bill
and
there
are
no
recommended
amendments.
A
Thank
you
very
much.
Any
questions
from
committee
members
seeing
none
this
would
be
a
do
pass
I'll
expect
accept
a
motion
from
miss
monroe
moreno
second,
from
ms
benitez
thompson
comments.
Seeing
none
all
in
favor,
please
signify
by
saying
aye
any
in
opposition
hearing
no
opposition
passes
unanimously
of
the
members
present.
A
So
with
that
committee
members,
I
believe
our
responsibilities
for
this
morning
are
complete.
We
do
have
some
bills
left
on
our
agenda
to
address.
We
do
plan
on
coming
back
this
evening
depending
upon
the
policy
schedules
this
afternoon,
so
we
will
go
into
recess.
I
hope
that
we
can
be
back
in
the
room
at
approximately
6
p.m,
but
I
cannot
guarantee
that
we
do
need
the
policy
committees
have
been
very
nice
to.
Let
us
get
our
work
done
those
couple
of
days.