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From YouTube: 5/4/2021 - Senate Committee on Health and Human Services
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A
Good
afternoon
I'm
going
to
go
ahead
and
call
to
order.
The
senate
committee
on
health
and
human
services
for
tuesday
may
4th
at
3
35
pm
with
a
roll
call.
D
A
All
right
welcome
everybody
to
senate
hhs.
We
have,
I
think,
almost
a
full
capacity
here
in
the
hearing
room,
and
I
know
some
folks
who
are
interested
in
on
zoom
for
those
of
you
who
are
working
to
participate
with
the
senate
health
and
human
services
committee
today.
I
think
we're
hopefully
getting
to
the
place
where
we're
figuring
out
how
this
all
works.
But
if
you're
having
any
technical
difficulties
on
the
nevada
legislature
website,
you
can
go
to
the
help
tab.
A
A
The
bill
order
will
be
senate
bill
420,
then
assembly,
bill,
205
assembly,
bill,
96
and
then
assembly
bill
217,
so
that
you're
able
to
plan
your
afternoon
for
senate
bill
420.
We
are
anticipating
a
significant
amount
of
interest,
and
so
as
of
right
now,
the
plan
is
to
hear
the
bill
have
testimony
in
support
for
30
minutes
and
testimony
and
opposition
for
30
minutes.
I'll
just
remind
everybody
that
our
goal
is
to
build
a
good
record
of
the
information
for
the
bill,
and
so
not
everyone
may
make
it
through
on
the
phone
lines.
A
If
that
is
the
case,
I
would
just
like
to
say
if
you
have
written
testimony,
make
sure
that
you
are
submitting
it
to
the
email
address.
That's
on
the
agenda
and
any
testimony
that
is
submitted
today
for
any
of
the
bills
that
we're
hearing
by
midnight
tonight
we
will
make
sure
it
gets
included
in
the
record.
So
that's
how
we're
going
to
manage
the
hearing
for
today
with
that
I'm
going
to
go
ahead
and
open
up
the
hearing
on
senate
bill
420
and
invite
majority
leader
canazarro
to
present
the
bill.
F
And
thank
you
so
much
to
ratty
for
having
me
here
today
with
the
senate
health
and
human
services
committee.
It's
my
pleasure
to
be
here
for
my
first
time
this
legislative
session
and
thank
you
to
the
committee
members
for
being
here
to
let
me
present
to
you
senate
bill
420
for
your
consideration
for
the
record.
My
name
is
nicole
canazzaro
and
I
currently
serve
as
the
senator
from
senate
district
six,
which
is
located
in
the
northwest
portion
of
my
hometown
in
the
las
vegas
valley.
F
Today,
madam
chair,
with
your
permission,
I
do
have
joining
us
virtually
a
few
folks
who
will
help
aid
in
the
presentation
we
have
katie
keith,
who
is
an
associate
research
professor
and
adjunct
professor
of
law
at
georgetown
university,
shaniqua,
hawkins
of
care
with
purpose
medical
center
in
las
vegas
and
dr
randy
lampert,
also
in
las
vegas.
Who
will
provide
a
bit
more
perspective
on
this
issue?
F
I
will
be
asking
each
of
them
to
provide
testimony
in
just
a
few
moments,
also
here
to
assist
with
technical
questions
as
we
walk
through
the
bill
itself
is
stacy
weeks
of
aurera
health.
So
I
want
to
first
talk
to
the
committee
a
little
bit
about
the
problem
which
brings
senate
bill
420
to
before
you
all
today.
One
of
the
most
common
concerns
that
I
hear
walking
and
talking
to
nevadans,
whether
it's
in
my
district
here
in
carson
city
or
anywhere
in
between,
relates
to
the
cost
of
health
care,
and
I
can't
overstate
that
enough.
F
Polling
and
studies
also
reflect
and
provide
data
to
support
that
reality.
According
to
the
kaiser
family
foundation,
the
cost
of
health
care
ranks
at
the
top
of
things.
Americans
worry
about.
It
affects
every
aspect
of
patient
experience
and
it
it
touches
everything
from
decisions
about
whether
to
seek
care
to
the
impact
of
medical
bills
after
receiving
care.
And
importantly,
it
affects
decisions
about
insurance
coverage
and
it's
not
just
families
who
are
concerned
about
the
cost
of
care
in
research
released
just
last
week.
F
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
in
the
years.
Following
the
passage
of
the
affordable
care
act
in
2010
nevada,
expanded
medicaid
and
began
offering
private
health
insurance
on
the
silver
state
health
insurance
exchange,
the
portion
of
nevadans
without
health
insurance
did
decrease
significantly.
F
In
fact,
with
nearly
350
000,
uninsured
nevadans,
our
uninsured
rate
is
the
seventh
highest
in
the
nation.
Nevadans
pay
some
of
the
highest
costs,
but
we
still
struggle
with
disappointing
health
outcomes
and
for
anyone
who
has
ever
had
to
seek
any
sort
of
health
related
services.
You
probably
have
your
own
personal
story
about
at
that
same
similar
situation,
senate
bill
420
seeks
to
help
address
this
problem
by
expanding,
affordable
quality
health
insurance
options
for
all
nevadans
senate
bill.
F
420
will
provide
these
options
to
individuals
shopping
in
our
state's
individual
market
and
also
may
provide
a
new,
more
affordable
opportunity
to
small
businesses,
who
have
often
struggled
to
find
affordable
health
plans
to
cover
their
employees.
As
members
of
this
committee
may
remember,
in
2017
the
legislature
passed
a
medicaid
bi
medicaid
buying
legislation.
The
legislation
was
vetoed
in
part
because
governor
sandoval
felt
it
moved
too
quickly
and
merited
further
study
before
implementation.
F
This
bill
comes
at
an
even
more
critical
time.
We
are
more
than
a
year
into
a
global
pandemic
that
has
resulted
in
job
loss
and,
consequently,
the
loss
of
health
insurance
people
are
struggling
to
ensure
they
will
have
access
to
health
care
if
they
get
sick,
and
that
is
the
plain
and
simple
place
that
we
are
in
reality.
F
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
senate
bill.
420..
This
bill
will
improve
access
to
health
care
for
nevadans
in
two
key
ways.
First,
by
requiring
the
establishment
of
a
public
health
insurance
plan
and,
second
by
making
various
changes
to
medicaid
to
expand
access
to
care
before
we
walk
through
the
provisions
of
the
bill.
G
Thank
you
so
much.
Thank
you
to
senator
canizaro
good
afternoon,
chairman
ratty,
and
vice
chair
spearman,
it's
an
honor
to
be
with
you.
My
name
is
katie
keith,
I'm
an
associate
research,
professor
at
georgetown
university,
where
I
study
access
to
health
insurance
coverage.
I
also
write
a
blog
series
for
the
journal
health
affairs,
where
I
focus
entirely
on
implementation
of
the
affordable
care
act
and
any
new
federal
and
state
health
care
policies.
G
A
G
Okay,
thank
you
and-
and
hopefully
that's
a
little
bit
better.
That
is.
Thank
you.
Okay.
Terrific
thanks.
I
wanted
to
say
I'm
especially
honored
to
join
you
all
today,
because
I
think
of
nevada
as
my
home,
so
I'm
speaking
to
you
from
washington
dc,
but
I
lived
in
las
vegas
before
I
moved
to
dc.
My
family
has
been
there
for
15
years,
and
it
truly
is
where
I
think
of
his
home.
My
father
was
in
the
retired
military.
He
worked
at
the
nevada
test
site.
G
My
mother
was
a
nurse
at
a
long-term
care
facility.
I
worked
at
united
way
of
southern
nevada
and
at
a
resort
on
the
strip
where
I
was
a
proud
member
of
the
culinary
workers
union.
So
it
is
just
an
extra
delight
to
be
here
with
you.
All.
I've
also
had
the
unfortunate
experience
of
navigating
healthcare
in
nevada.
After
my
father
was
diagnosed
with
and
ultimately
passed
away
from
leukemia
in
2012.,
he
was
treated
at
many
many
hospitals
throughout
the
valley.
I
think
he
was
hospitalized
22
times
during
his
course
of
treatment.
G
So,
while
I'm
here
testifying
as
an
expert
today,
just
please
know
the
issues
that
we're
discussing
are
very
personal
to
me
and
and
do
make
an
important
difference
to
families
like
mine.
So
turning
then
to
today's
topic.
I
really
would
like
to
share
four
key
data
points
with
you
to
help
inform
your
consideration
of
sb420
these
and
additional
data,
and
probably
more
data
than
you'd
ever
want,
are
also
included
in
my
written
testimony
for
your
review.
G
First
is
the
high
uninsured
rate
in
nevada,
senator
cannizzaro.
I
think
touched
on
these
points
already,
but
even
after
embracing
the
affordable
care
act,
nevada
continues
to
have
stubbornly
high
uninsured
rates,
including
some
of
the
highest
in
the
country.
Before
the
pandemic,
14
of
nevadans
about
350
000
people
did
not
have
health
insurance
and
we
think
that
number
has
gone
up
simply
because
of
the
pandemic
and
different
coverage
losses.
G
Even
with
the
very
important
federal
changes
made
under
the
american
rescue
plan,
these
individuals
will
continue
to
be
locked
out
of
affordable
coverage
options
unless
federal
and
state
policy
makers
take
action
and
sb
420
would
begin
to
address
some
of
these
gaps.
My
second
data
point
is
on
the
high
healthcare
prices
in
nevada
per
person.
Healthcare
spending
in
nevada
has
grown
by
35
from
2013
to
2018
alone.
G
It's
lower
that
truly
is
lower
than
in
some
states.
Unfortunately,
but
nevadans
across
the
board
report.
A
lot
of
difficulty
in
affording
care,
as
senator
canozzara
mentioned
in
2017
48
of
all
nevadan
adults,
reported
that
they
could
not
afford
the
health
care
that
they
needed,
that
put
nevada
in
the
bottom
third
of
states
in
terms
of
health
care,
affordability
and
a
separate
report
ranked
nevada
39th
out
of
43
states
in
2020
for
affordability.
G
G
The
third
data
point
I'd
like
to
hit
on
is
nevada's
healthcare
system
itself,
which
is
largely
dominated
by
for-profit
insurance
companies
and
hospitals.
The
state's
largest
private
health
insurers
are
among
the
nation's
most
profitable
companies
on
the
fortune
500
and
have
you
know,
seen
double-digit
increases
in
profits
from
2019
to
2020
at
least
nevada's.
Also,
the
first
in
the
nation
for
for-profit
hospitals,
meaning
nevada,
has
the
highest
percentage.
G
It
goes
without
saying
that
the
pandemic
has
certainly
had
a
an
effect,
an
impact
on
hospital
finances,
and
certainly
some
health
care
providers
are
struggling.
But
this
cannot
be
said
for
many
of
the
major
hospital
systems
given
rebounded
utilization
of
health
care
services,
billions
of
dollars
in
aid
from
the
federal
government
and
continued
profitability
that
we've
heard
on
our
recent
earnings
calls.
G
G
As
of
now,
there
are
twice
as
many
uninsured
people
as
there
are
in
nevada's
individual
health
insurance
market,
showing
we
could
make
much
more
progress
in
ensuring
more
people
having
more
people
insured
and
in
high
quality
plans
would
help
everyone.
It
would
limit
medical
debt
and
uncompensated
care
for
health
care
providers
and
consumers
alike,
and
it
would
help
nevada
policymakers,
like
this
committee,
turn
to
even
more
pressing
issues
such
as
you
know.
G
A
F
A
Vegas
it
does
not
look
like
you
are.
It
looks
like
you
are
still
on
mute,
ms
hawkins.
So
let's
see
if
we
can
solve
for
that,
okay.
E
Hello
there
good
afternoon,
madam
chair
and
members
of
the
committee,
thank
you
for
the
opportunity
to
have
me
today
for
the
record.
My
name
is
shaniqua
hawkins
s-h-e-n-a-k-w-a,
last
name
h-a-w-k-I-n-s,
and
I
am
speaking
for
favor
of
sb
420.
E
Thank
you,
majority
leader
carazano,
for
proposing
this
legislation
for
having
me
here
today
and
to
help
describe
why
it's
needed.
I
am
a
health
care
provider
and
a
small
business
owner,
I'm
an
advanced
practice
registered
nurse
and
I
do
run
care
with
purpose
medical
center.
Here
in
north
las
vegas,
we
predominantly
serve
communities
of
color
in
low-income
communities,
including
a
large
large
homeless
population.
E
I
am
in
support
of
this
legislation
for
a
number
of
reasons.
Firstly,
I
personally
know
what
it's
like
to
lose
a
job
with
your
health
insurance.
I
lost
mine
at
the
start
of
this
pandemic.
When
the
clinic
I
worked
for
shut
its
doors.
Our
practice
here
at
care
with
purpose
medical
center
sees
and
treats
many
people
that
are
in
the
same
situation
that
I
was
in.
E
I
have
been
a
registered
nurse
and
a
nurse
actually
for
over
20
years,
including
in
emergency
and
trauma
centers,
and
I
know
that
not
having
health
insurance
means
that
people
end
up
needing
expensive
emergency
care
because
of
conditions
that
we
could
have.
You
know
treated
proactively
if
they
had
been
able
to
afford
health
insurance.
E
I
see
this
far
too
much.
It
is
heartbreaking
and
you
know
a
bit
frustrating
anything.
We
can
do
to
make
this
health
insurance
more
accessible
and
affordable.
This
will
help
and
I
believe
that
this
bill
will
do
just
that.
Secondly,
as
an
aprn,
the
pay
parity
provision
of
the
bill
will
allow
me
to
keep
my
clinic
doors
open.
E
There
is
so
much
health
care
and
equality
in
our
existing
system.
That's
part
of
what
inspired
me
to
open
the
practice
and
serve
historically
underserved
populations.
We
are
providing
the
same
level
of
care
with
preventive
medicine
and
management
of
chronic
diseases.
Diseases
excuse
me
such
as
hypertension
and
diabetes
and
high
cholesterol,
especially
these
problematic.
You
know
medical
conditions
in
the
communities
of
color
pay
parity
will
allow
me
to
keep
my
doors
open
here
at
care
with
purpose
medical
center.
E
E
D
Hello,
thank
you
for
having
me
my
name
for
the
record.
Is
dr
randy
lampert
randy
r-a-n-d-I
lanford
l-a-n-p-e-r-t.
D
D
She
just
needed
to
buy
time
until
the
next
paycheck,
but
her
child's
asthma
went
away
and
they
ended
up
in
the
emergency
room,
while
the
child
did
well
with
appropriate
treatment
in
the
er,
she
suffered
unnecessary
invasive
treatments
and
missed
several
days
of
school.
In
order
to
recover
worse,
their
emergency
care
ended
up
costing
thousands
of
dollars
that
family
was
devastated
emotionally
and
financially,
and
the
child
suffered
physical
and
developmental
setbacks.
D
D
D
Nearly
every
parent,
I
I
know,
would
choose
their
child's
well-being,
but
too
many
of
them
do
so
at
the
cost
of
the
week's
express
resource
gas
for
the
car
and
no
nevadan
should
have
to
make
this
choice.
Getting
basic
health
care
and
seeing
the
doctor
when
the
need
arises,
are
simply
becoming
too
expensive.
For
too
many
people
in
nevada,
a
nevada
public
option
can
give
people
the
choice
they
want
and
deserve
an
affordable,
comprehensive
coverage
that
provides
health,
security
and
peace
of
mind
for
their
families.
D
The
nevada
public
option
expands
the
menu
for
families,
so
it's
not
just
a
choice
between
groceries
and
health
care.
There
can
be
both
low-income
families,
families
of
color
families
who
lose
a
job
and
their
health
insurance.
All
families
will
have
another
choice:
a
better
choice.
The
status
quo
isn't
working
for
the
families
I
see
every
day.
The
nevada
public
option
will
ensure
that
every
parent
can
bring
their
child
to
a
doctor
when
they
need
to,
and
never
have
to
pause
for,
even
a
second
to
do
the
math
about
whether
they
can
afford
to.
D
F
And
madam
chair,
with
your
permission,
I
would
like
to
take
this
opportunity
to
walk
briefly
through
the
bill.
I
will
note
that
we
did
provide
a
conceptual
amendment
that
provides
a
few
of
the
items
that
we
needed
to
clarify
in
the
bill
that
we've
worked
with
some
stakeholders
on.
I
will
advise
the
committee
that
there
were
a
few
other
amendments
that
had
been
proposed
to
us
that
we
are
still
currently
reviewing.
F
So
specifically
the
public
option.
The
nevada
public
option
requires
the
director
of
the
department
of
health
and
human
services
in
consultation
with
the
executive
director
of
the
silver
state
health
exchange
center
of
insurance
in
the
department
of
business
and
industry
to
design
establish
and
operate
a
public
health
benefit
plan
called
the
public
option.
F
F
Section
10
further
requires
the
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.
Premiums
for
the
public
option
must
be
at
least
five
percent
lower
than
the
premium
of
the
second
lowest
cost
silver
level
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.
F
F
Section
10
requires
the
director
of
dhhs
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
also
authorizes
the
director
of
dhhs
to
directly
administer
the
public
option
if
necessary.
F
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
participating
providers
in
the
public
option,
and
to
accept
new
patients
who
are
enrolled
in
the
public
option
to
the
same
extent
as
they
accept
new
patients
not
enrolled
in
this
plan.
Our
amendment
will
clarify
that
a
provider
must
only
contract
with
one
public
option
plan
and
not
every
plan
offered
section.
F
14
requires
aggregate
reimbursement
rates
under
the
public
option
to
be
comparable
to
or
better
than
medicare
reimbursement
rates.
It
also
requires
a
director
of
dhhs
to
establish
healthcare
provider
networks
for
the
public
option
that
minimize
disruptions
in
care
for
those
who
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.
F
F
With
respect
to
the
bill
and
beyond
the
public
option.
The
second
part
of
senate
bill
420
makes
various
changes
to
medicaid.
Importantly,
it
expands
medicaid
coverage
for
pregnant
women,
with
the
hope
of
improving
health
outcomes
and
reducing
health
disparities
by
expanding
access
to
critical
prenatal
and
postpartum
care
among
other
services,
currently
in
nevada,
non-hispanic,
black
american,
indian
alaska,
native
and
asian
pacific
islander
populations
have
the
highest
rates
of
severe
maternal
morbidity,
which
includes,
potentially
life-threatening
conditions
and
maternal
complications.
F
F
In
nevada,
section
24
of
the
bill
enhances
medicaid
services
for
pregnant
nevadans
to
ensure
that
more
expectant
parents
and
their
children
receive
quality,
prenatal
and
postpartum
care.
It
requires
the
director
of
dhhs
to
expand
coverage
for
pregnant
women
under
the
state
plan
for
medicaid
in
three
ways.
First,
it
increases
the
income
cap
on
medicaid
eligibility
for
pregnant
women
from
the
current
limit
of
165
percent
of
the
federal
poverty
level
to
200
percent,
which
is
25
760
dollars
for
an
individual
or
53
000
for
a
family
of
four.
F
Third,
it
prohibits
dhhs
from
requiring
a
pregnant
woman
who
is
otherwise
eligible
for
medicaid
to
live
in
the
united
states
for
a
certain
amount
of
time
before
enrolling
in
medicaid,
currently
lawfully
residing
pregnant,
women
must
have
lived
in
the
united
states
for
five
years
before
they
are
eligible
for
nevada.
Medicaid
nevada
is
not
alone
in
considering
or
implementing
these
policies.
F
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,
the
department
must
conduct
a
statewide
procurement
process
to
select
health
maintenance
organizations
to
provide
these
services.
F
Finally,
this
conceptual
amendment
creates
a
new
section,
directing
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,
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.
F
This
waiver
could
be
an
innovative
way
to
make
it
easier
for
these
plans
to
continue
to
provide
continuity
of
coverage
to
their
members,
leading
to
more
consistent
care
and,
overall,
better
health
outcomes
gerardi.
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
insurance.
As
a
result
of
the
pandemic,
they
need
health
care
and
frankly,
they
need
affordable
insurance
options.
F
F
Overall,
we
should
be
talking
about
how
to
provide
affordable
health
care
coverage.
I
am
a
consumer
of
quite
a
few
medical
services
in
preparation
for
a
little
one,
but
those
services.
I
am
also
lucky
enough
to
have
insurance
coverage
for
and
they're
still
expensive
for
families
who
don't
have
that.
F
I
can't
imagine
what
it
must
be
like
to
wonder
if
your
baby
is
okay
or
to
wonder
if
the
person
carrying
your
child
is
going
to
be
okay,
and
I
believe
that
doing
nothing
is
not
a
solution,
and
so
this
is
the
proposal
that
I
think
helps
get
us
there.
It
is
both
personal
to
me
and
it
is
something
that,
over
the
course
of
the
last
few
years,
I
cannot
reiterate
enough.
I
have
heard
at
the
doors
of
so
many
of
my
constituents
that
affordable
health
care
is
something
that
we
have
got
to
tackle.
F
So
with
that,
madam
chair,
I
would
remain
open
to
any
questions
that
the
committee
may
have
as
well.
I
would
note
that
we
do
still
have,
I
believe,
our
presenters
if
there
were
questions
for
them-
and
I
also
have
stacy
weeks
from
herrera
health
to
help
answer
some
technical
questions
if
they
do
come
up
as
well.
H
I
H
So
can
I
start
with
the
eligibility
for
people
for
the
public
option
you
envision
it
being
open
to
any
human
living
in
nevada
right,
and
so
I
I
guess
that
questions
sort
of
the
rules
of
the
exchange
as
they
currently
exist,
and
what
specifically
you're
going
to
ask
for
as
waivers
to
those
rules
as
a
part
of
the
innovation
waiver.
In
section
11.
F
Madam
chair
threw
you
to
senator
kikev
nicole
cannazzaro
senate
district
six,
so
I
I
do
want
to
actually
make
this
note,
because
I
think
it
is
an
important
one
for
individuals
who
are
currently
covered
under
their
employer
health
plans
and
especially
for
large
employers
for
multi-employer
health
plans.
This
does
not.
F
This
would
not
be
something
that
would
be
available
to
those
individuals
right,
we're
talking
about
the
individual
and
small
group
market
and
that's
what
this
product
would
be
designed
to
capture
and
with
respect
to
who
who
we're
talking
about
with
the
public
option,
because
I
think
that
there
has
been
some
conversation
about
whether
this
would
pull
what
is
the
vast
majority
in
nevada.
Something,
like
I
think,
55
of
our
of
our
insured
is
through
their
employer
that
this
would
not
under
current
law
and
under
the
aca.
F
I
believe-
and
I
can
let
miss
weeks-
provide
any
additional
data
on
that.
But
this
would
they
would
not
be
eligible
for
this
because
they
fall
under
those
categories.
So
we're
talking
about
the
individual
and
small
group
market
and
then
with
respect
to
the.
I
think
the
second
part
of
your
question
was
the
waivers
that
we
would
be
applying,
for.
We
would
be
working
with
dhhs
in
order
to
figure
out
what
exactly
those
waivers
are.
F
We
definitely
have
looked
at
the
1332
for
some
of
those
funds
and
want
to
make
sure
that
there's
enough
flexibility
built
in
there
that
if
there
are
other
things
that
we
can
be
applying
for
as
a
state
that
we're
using
that
in
an
innovative
capacity
in
order
to
get
those
funds
to
help
buy
down
the
cost
of
the
premiums.
H
Okay,
so
thank
you
for
that
mentor.
So
if
the
is
so
for
eligibility
purposes,
it's
individual
small
group
exclusive,
and
so
I'm
trying
to
figure
out
who
we're
targeting
right,
because
if
we've
got
whatever,
I
think
the
number
you
used
was
65
of
the
state's
population.
That's
either
already
eligible
for
medicaid,
which
is
it
doesn't
get
cheaper
than
free,
right
or
subsidy
eligible
under
the
aca.
Now.
H
If
the
and
right
in
my
understanding
that
a
lot
of
a
substantial
portion
of
the
rest
of
that
population
is
undocumented,
which
and
they're
not
eligible
for
subsidy
under
the
exchange,
who
are
we
capturing
into
who
are
we
bringing
into
this
market?
Are
we
going
to
disrupt
the
small
group
market
to
the
ex,
so
so
massively
that
it
brings
people
in
or
I'm
trying
to
figure
out,
understand
who's
going
to
sign
up.
F
Direct
thank
you,
chair,
nicole
canozzaro
senate
district
six,
there's
also
a
chunk
of
individuals
who
are
uninsured,
who
don't
qualify
for
subsidies
and
where
that
affordability
is
a
barrier
with
respect
to
the
exchange,
and
then
I
don't
know
if
miss
week's
is
available
and
would
like
to
provide
any
additional.
I
think
data
points
on
on
those.
B
Hi
madam
chair
committee,
members
I
can
provide
my
name
is
stacy
weeks
for
the
record.
I
can
provide
some
information
about
the
uninsured
market
if
it's
helpful
for
the
group
and
it's
based
on
data
from
the
quinn
study,
which
is
a
couple
years
ago,
and
so
I
just
want
to
note
that
some
of
the
medicaid
numbers,
I
think,
are
a
little
different.
B
I
can
mention
more
about
that,
and
also,
I
think
the
department
of
health
and
human
services
has
also
used
this
data
and
prepared
a
variety
of
materials
for
you
on
it,
so
you
might
have
seen
it
before
so
out
of
the
350
000
people
again,
senator
canozzaro
said
that
there
are
350
000,
individual
small
group.
37
are
eligible
for
medicaid,
but
have
not
yet
enrolled.
So
that's
a
part
of
the
population.
B
17
experience,
affordability
challenges
today
in
the
exchange
this
bill,
this
option
would
be
available
to
them
and
if
they're
eligible
for
the
exchange
they
an
individual
could
purchase
the
product.
27
percent
is
it's:
an
immigration
status
is
the
barrier
and
it's
not
always
it's
not
always
undocumented.
B
It
could
be
an
individual
who's
eligible
for
medicaid
and
they're
barred
by
the
five-year
residency
rule.
So
if
you
have
not
lived
in
the
united
states
for
five
years,
you
cannot
purchase
medicaid
and
a
lot
of
immigrants
struggle
with
that
barrier
because
they
are
often
low
income
when
they
first
move
to
the
united
states.
B
So
27
is
you
know
who,
on
the
outside
markets
this
product
will
be
offered
outside
and
on
the
exchange
and
to
your
question
senator
so
this
this
product
will
be
available
to
that
27
percent
and
on
the
outside
outside
the
exchange.
19
would
be
eligible.
We
know
are
eligible
for
nevada
health
link
but
are
not
enrolled.
There
are
a
variety
of
reasons
for
that,
and
this
product
would
be
eligible.
It
would
be
available
to
them
as
well.
H
Thank
you.
It
does.
I
appreciate
that
for
the
17
percent,
who
you
indicated,
have
affordability
challenges.
I
know
there
was
a
significant
expansion
of
of
tax
credit
subsidy
and
support
through
the
american
recovery
plan,
including
increases
beyond
400
of
federal
poverty
level.
Does
that
address
some
of
that
17
percent.
B
Madam
chair
committee,
members,
I
think
that
question
was
for
me.
I
apologize
that
that
subsidy
amount
is
temporary,
so
I
don't
think
it
would
be
a
long
term
addressing
the
issue.
H
Okay,
I
appreciate
that,
should
you
want
me
to
keep
going
or
you
want
me
to
stop.
A
K
J
A
So
what
what
I
would
say
is
we'll
go
ahead
and
have
some
general
conversation
about
the
cost
of
it
and
then,
of
course,
we'll
have
a
deep
dive
on
costs
when
it
gets
to
the
finance
committee.
So
I'm
willing
to
open
some
conversations
on
finance
for
at
the
general
level.
I
believe
that
we
do
have
a
fiscal
note
posted
just
also
for
the
committee's
benefit
go
ahead.
F
Thank
you
chair
and
that's
an
and
that's
an
excellent
question:
senator
hardy
and
nicole
candizaro
senate
district
six,
so
there's
sort
of
two
different
pieces:
the
public
option
piece
when
we're
talking
about
establishing
that
is
separate
from
the
medicaid
eligibility
pieces.
F
Obviously
I
think
the
overall
goal
of
senate
bill
420
is
to
help
increase
access
to
affordable
care,
and
one
of
the
ways
that
that
we've
been
talking
with
dhhs
in
the
exchange
was
with
respect
to
some
of
these
pregnant
women
in
those
populations
and
some
of
the
surrounding
prenatal
and
postpartum
care
pieces,
and
so
in
senate
bill
420.
You
see
reflected
in
there
the
inclusion
of
eligibility
for
some
of
these
services.
F
F
So
the
waivers
and
the
and
the
public
trust
fund
that
we've
talked
about
with
respect
to
the
public
option
is
talking
about
the
health
insurance
as
a
whole,
but
some
of
the
medicaid
pieces
would
cost
the
state
money
which
again
we'll
have
those
conversations,
and
I'm
sure
the
finance
committee
at
some
point,
but
would
I
think
overall
bring
in
some
federal
dollars
probably
help
with
savings
in
terms
of
more
acute
care
for
those
patients,
but
two
kind
of
two
separate
things.
If
that
answers
your
question.
A
L
J
At
the
five
percent
becoming
15,
not
in
five
years
but
in
four
years,
so
how?
How
does
the
insurance
company
or
the
hospital
or
anyone
figure
out
how
to
the
way
I
see
it?
They
they
are
required
to
come
up
with
a
process
to
and
I'll
call
it
bid
against
themselves
trying
to
bid
down
in
order
to
be
able
to
still
cover
lives.
F
For
the
question
senator
nicole
canozzaro
senate
district
six-
so
I
think
one
of
the
key
pieces
of
this
is
for
individuals
who
would
currently
be
folks
who
are
looking
at
the
public
option
right,
they're,
uninsured,
so
they're
uncompensated
care
at
this
point.
F
E
A
A
A
F
Thank
you
chair
for
the
question,
nicole
cannizzaro,
senate
district
six,
and
I
think
that's
a
really
important
piece
and
one
of
the
I
think,
one
of
the
key
aspects
of
this
bill
or
why
it
is
that
we
should
be
looking
at
more
affordable
options
and
why
we
should
be
motivated
to
look
to
reduce
costs.
Overall
right
is
the
same,
is
the
same
sort
of
thing
if
someone
is
eligible
for
insurance
and
they
can't
afford
it
that
is
akin
to
being
ineligible
for
insurance.
F
F
420
has
a
couple
of
things
in
it
that
I
think
address
that
very
that
very
notion,
some
of
which
are
that
we
are
requiring
for
individuals
for
for
groups
that
are
bidding
on
those
mco
contracts
to
also
bid
on
the
public
option,
to
make
a
good
faith
bid
for
that
for
that
product.
That,
if
you
take
medicaid
patients,
that
you
are
also
accepting
the
public
option
similar
for
workers,
comp
and
peb,
so
that
we
are
creating
a
network
of
providers
statewide.
F
That
will
see
these
patients
and
that
will
accept
that
insurance
to
hopefully
address
that
adequacy
of
care
issue.
Because
I
do
think
that
that
is
an
important
one.
And
I
think,
because
also
we're
talking
about
this
being
a
statewide
product
that
you're
also
seeing
continuity
of
care.
Even
if
somebody
were
to
let's
say,
move
or
if
they
were
an
individual
and
simply
weren't
qualifying
or
didn't,
have
employer-based
healthcare
that
they
could
also
have
that
flexibility
to
stay
with
their
providers
and
and
make
sure
that
they
can
continue
having
that
access
with
this
particular
product.
F
A
Okay,
nothing
dad,
okay,
thank
you
kind
of
along
the
same
line.
So
not
only
are,
if
I
understand
the
bill
correctly,
not
only
are
the
insurance
companies
required
to
bid
if
they
want
to
bid
on
medicaid,
but
is
it
also
the
case
that
if
providers
accept
medicare
or
medicaid,
then
they
also
have
to
accept
the
public
option?
Is
that
the
way
it's
set
up.
F
Thank
you,
madam
chair,
nicole,
cannizzaro,
senate
district
six.
That
is
correct.
It
also
includes
workers
compensation
if
they
take
the
the
workers
comp,
the
state
workers,
compensation
or
pen,
okay,
they
would
accept
the
public
option
as
well.
A
So
we've
had
some
challenges
with
providers
choosing
to
opt
out
of
our
medicaid
and
medicare
systems
because
of
the
rates,
and
so
I
guess
my
question
is:
do
we
have
any
experience
with
a
similar
model
in
other
states?
Are
we
concerned
about
that
potentially
unintended
consequence
of
losing
providers
who
just
choose
to
get
out
of
the
whole
public
space.
F
So
that
is,
that
is
an
excellent
point.
I
think
I
would
venture
to
guess.
You
may
hear
some
of
those
points
as
the
as
the
bill.
Testimony
goes
on,
so
a
couple
of
things
that
I
that
I
would
note
about
that.
First
of
all,
what
we're
trying
to
do
with
this
bill
right
is
to
ensure
that
there
are
providers
who
are
going
to
accept
the
public
option,
so
people
can
actually
get
access
to
services
again.
F
I
would
note
that
the
populations
that
are
sought
to
be
served
with
this
are
individuals
who
currently
either
are
not
insured
because
they
don't
qualify
or
not
insured
because
they're
having
affordability
issues
either
through
their
small
group,
employers
who
are
not
providing
them
insurance
or
through
or
because
they
simply
can't
afford
what
is
currently
being
offered.
And
so
when
we
talk
about
individuals
who
might
say
look,
medicaid
rates
are
really
hard.
These
are.
F
These
are
not
medicaid
rates
that
are
being
provided
here
right,
we're
not
increasing
eligibility
for
medicaid
and
saying
okay
now
cover
them
at
your
medicaid
rates,
we're
saying
people
are
going
to
get
on
an
insurance
product
and
pay
premiums.
For
that
and
the
goal
is
that
there
would
be
some
negotiated
prices
there.
That
would
incentivize
providers
to
want
to
take
these
individuals,
especially
when
the
opposite
side
of
that
coin
is
they
are
uninsured
and
we
are
providing
and
paying
for
throughout
the
system,
uncompensated
care
and,
frankly,
more
acute
care.
F
As
far
as
other
states
go.
We
have
not
seen
other
states
who
have
implemented
this
type
of
model,
but
I
think
one
of
the
important
key
aspects
about
this
particular
bill
is
that
there
is
built-in
time
to
allow
for
dhhs
to
help
implement
the
public
option,
in
consultation
with
the
exchange
and
the
insurance
commissioner,
to
make
sure
that
we're
getting
those
price
points
right
that
we're
making
the
right
decisions
and
how
this
would
how
this
would
be
implemented.
F
And,
additionally,
you
know
that
we're
going
to
take
the
time
to
actually
look
at
the
data
and
make
sure
that
that
what
we're
doing
doesn't
inadvertently
price
out
other
wouldn't
necessarily
result
in
a
loss
of
providers
and
things
like
that.
But
the
goal
was
to
ensure
that
there
was
individuals
who
would
be
accepting
the
public
option
to
create
that
network
of
providers.
And
then
I
don't
know
again.
I
don't
know
if
miss
weeks
had
anything
else
to
add
to
those.
B
Thank
you
senator
madam
chair
committee,
members.
The
only
thing
I
might
add
is
that
you
know
there
is.
There
is
a
state
that
minnesota
actually
has
a
similar
provision
and
for
medicaid
for
its
medicaid
program
and
its
public
employee
program
and
workers
com.
They
call
it
real
101
in
minnesota
and
and
it
works
really
well
there
providers.
You
know
we
have
very,
very
robust
networks
in
minnesota
because
of
I
think
in
part,
because
of
that
rule.
B
One
other
thing
to
note
about
this
is
because
you're
tying
it
to
medicaid
in
many
ways
and
doing
the
procurements
together
you're
going
to
be
incentivizing
plans
because
they're
going
to
need
if
they
want
to
be
able
to
offer
the
product
and
obtain
the
money
that
medicaid
can
bring
as
well
as
this
market.
To
you
know,
we
know
the
contracts
and
managed
care
close
to
2
billion
if
they
want
that.
B
Hopefully
this
would
incentivize
them
to
do
they're
going
to
have
to
do
better
by
providers
to
make
sure
they're
in
their
networks
to
be
able
to
offer
a
bid.
So
hopefully,
incentivizes
plans
to
come
forward
and
work
with
providers
in
a
way
that
maybe
they
aren't
today.
That
would
be
the
hope.
A
Great,
thank
you
and
then
I
just
asked
one
more
question.
Then
I'll
turn
it
back
to
senator
kiko
for
a
few
more.
Can
you
just
walk
me
through
the
time
line
of
it,
because
this
is
just
want
to
make
sure
that
it's
clear
on
the
public
record.
This
doesn't.
This
is
an
effective
july.
One
turned
on
and
folks
have
access
to
insurance
in
in
the
next
year.
So
would
you
just
walk
us
through
that.
F
Yes,
thank
you,
madam
chair
nicole,
cannizzaro,
senate
district,
six
and
that's
correct,
and
you
can
see
in
the
in
the
proposed
conceptual
amendment.
On
page
two
on
item
number
nine.
We
did
revise
this
so
that
it
would
be
available
for
the
coverage
year,
beginning
january
1st,
of
2026
to
allow
for
alignment
of
procurement.
So
this
is
not
something
that
would
be
implemented
july,
1st
of
2021.
F
Our
goal
here
is
to
build
in
that
lead
time,
so
that
there's
enough
space
for
dhhs
in
consultation
to
to
provide
for
that
procurement
and
then
also
for
us
to
get
the
data
in
the
interim
through
any
uses
of
actuarials.
F
That
may
be
necessary
in
order
to
make
sure
that
we're
putting
it
in
a
good
spot,
and
I
think
that
by
building
in
that
time
and
allowing
for
this
to
become
a
plan
year,
that's
effective
on
2020
in
2026
that
that
really
is
allowing
the
flexibility,
that's
needed
and
also
the
encouraging.
Hopefully,
some
creativity
on
our
part
as
a
state
to
come
up
with
the
way
in
which
to
implement
this.
That
actually
does
result
in
in
in
savings
to
nevadans.
H
H
So
we're
saying
in
section
5
subsection
2
that,
if
we're
going
to
disrupt
access
for
our
people,
the
people
we
care
of
the
people
that
we're
directly
responsible
for
through
medicaid
and
and
state
public
employees
that,
if
they're
going
to
have
insufficient
or
difficult
access
to
covered
services
that
we're
going
to
allow
them
to
waive
this
requirement
for
commensurate
access.
So
I
think
the
bill
recognizes
that
this
is
likely
to
be
a
problem.
H
The
so,
but
as
to
a
question
back
in
section
10,
we
talk
about
the
public
option,
but
am
I
reading
it
right
that
there
need
to
be
at
least
two
plans
at
least
one
silver,
and
at
least
one
gold
plan
offered.
F
Thank
you
for
the
question.
Senator
nicole
cannizzaro
sent
a
district
to
yes,
there
would
be
a
gold
and
a
silver
plan.
H
Okay
and
then
when
it
comes
to
the
to
the
cost
right,
and
so
when
you
get
into
subsection
five
of
section
10
and
as
it's
amended
in
your
conceptual
amendment,.
H
How
should
I
interpret
section
subsection
5?
Is
it
that,
over
four
years
the
costs
of
these
plans
will
be
15
less
or
should
I
read
it
as
I
originally
interpreted
it,
which
is
that
the
average
cost
of
all
health
insurance
plans
in
the
state
will
be
15
percent
less
because
that's
how
I
think
it
reads.
F
H
Okay,
so
the
the
the
targeted
price
reduction
of
health
insurance
is
not
it's.
It's
not
a
downward
pressure
on
all
plans
across
the
state
to
try
to
reduce
premiums.
It
is
specific
to
solely
these
two
public
options.
H
The
in
the
amendment
that
you
offered
on
bullet
point
six
as
it
related
to.
I
think
it
specifically
relates
to
the
culinary
health
plan.
I
don't
know
how
many
other
plans
in
the
state
might
currently
fit
into.
This
definition
is
the
idea
that
they
would
be
a
subsidy
eligible
if
they're
offered
on
the
exchange
and
b
would
they
be
able
to
enroll
people
who
are
not
currently
members
of
their
group?
F
Thank
you
for
the
question
senator
nicole
canizaro
senate
district
six.
So
this,
I
would
say,
is
not
it's
not
specific
to
any
particular
group.
F
H
F
I
believe
that
our
intention
is
to
make
sure
that
it
is
like
folks
who
would
still
be
qualified
under
that
qualified
group.
But
again,
I
think
if
there
was
some
indication
that
it
would
be
feasible
to
include
some
individuals
like
family
members
that
potentially
would
have
fallen
off
or
or
wouldn't
be
covered,
that
they
could
potentially
be
covered.
But
it's
not
as
prescriptive
as
that
in
the
in
the
language
and
how
we're
envisioning
it.
A
I'm
just
going
to
interrupt
you
for
a
second,
so
we
have
the
intent
of
the
bill
on
the
record,
but
I
would
like
to
kick
it
over
to
eric
roberts
to
just
talk
about
the
15
percent,
because
I
think
senator
kika
for
how
you
read
the
bill,
maybe
how
it's
reading
so
just
one.
Let's
get
that
on
the
record
so
that
if
there's
the
need
for
amendments
in
the
future,
we've
got
it
documented.
J
J
In
the
conceptual
amendment
in
which
the
public
option
is
in
operation,
and
so
the
the
text
of
the
bill,
as
I
read
it
now
would
go
along
with
senator
key
kepper's
initial
impression,
and
it
would
be
that
it
would
have
to
lower
the
it
would
have
to
create
down
ordered
pressure
on
all
of
the
health
insurance
in
the
state
and
lower
the
average
premiums
of
all
health
insurance
by
at
least
15.
H
Thank
you.
I
appreciate
that,
madam
chair
and
council,
so
just
because
we
say
that
a
health
insurance
plan
needs
to
have
premiums
that
are
15
percent,
less,
that
doesn't
reduce
costs
by
15
right.
It
may
may
actually
increase
costs
and
increase
utilization,
and
there
are
a
lot
of
different
factors
that
could
happen
downstream
who's
going
to
pick
up
that
cost.
F
F
We're
not
talking
about
instances
where,
if
you
like,
I
do
have
health
insurance
and
that's
what
you're
utilizing
we're
talking
about
individuals
who
otherwise
have
a
much
higher
cost
getting
them
insured.
So
they
have
access
to
regular
health
care
which
overall
will
reduce,
I
think,
their
utilization
of
those
emergency
acute
services
and
also
is
compensation
where
there
was
none,
and
so
yes,
there
are
costs
associated
with
that
and,
yes,
we
are
trying
to
make
it
more
affordable,
but
the
other
alternative.
Is
these
individuals
go
without
health
insurance.
H
I
think
I
appreciate
the
the
response
and
I
think
that
sort
of
philosophically
yeah-
I
just
I
just
don't
know
if
that's
where
we're
going
to
be
getting
people
from
if
we're
opening
it
up
to
the
small
group
market,
that
I
worry
that
it's
going
to
poach
more
people
out
of
that
than
some
of
the
categories
that
we're
talking
about.
Like
I
mean
if
I
forgot
jotted
down
the
numbers,
37
are
currently
medicaid
eligible
right.
H
If
they
go
into
a
hospital
with
a
significantly
with
a
significant
problem,
those
hospitals
do
everything
they
can
to
make
sure
that
they're
eligible
or
enrolled
right,
and
this
you
know
the
same
thing
for
if,
if
five
percent
greater,
if
if
we
make
a
plan,
five
percent
more
affordable
than
the
second
lowest
silver
plan,
but
people
have
made
the
choice
not
to
enroll,
even
though
they're
eligible
on
the
exchange.
Now
I
I
guess,
I'm
just
not
convinced
that
that's
going
to
trigger
them
to
suddenly
run
and
sign
up.
H
So
I
wonder
I
I
I
worry
about
where
the
cost
shifts
are
going
to
happen
to
make
up
for
some
of
this
sort
of
artificial
pressure,
and
I
think
it's
into
large
group
insurance
and
employer-based
insurance
and
downward
pressure
on
providers.
H
A
Senator
hardy
and
then
after
a
couple,
questions
from
senator
hardy,
I
think
what
I'd
like
to
do
is
take
us
to
the
testimony.
We
can
still
have
some
more
questions
after
the
testimony,
but
I
suspect
the
testimony
may
raise
some
other
issues
for
the
committee,
so
go.
J
We
would
see
patients
who
had
saved
up
all
of
their
illnesses
literally,
and
so
instead
of
one
problem
or
two
problems,
you
were
dealing
with
you're
dealing
with
five
different
diseases
all
at
once.
So
this
kind
of
thing
I
looked
for
that
same
kind
of
thing
to
happen,
so
there
would
be
an
initial,
quite
an
expensive
problem
that
you
would
be
facing,
but
at
the
same
time
that's
the
individual
practitioner
as
opposed
to
the
hospital
as
it
were,
and
in
talking
with
hospitals
for
years
and
years
and
years
they
don't
make
money
on
medicaid.
J
They
don't
make
money
many
times
on
medicare,
and
so
they
make
up
the
difference
on
private
insurance
and,
as
I,
as
I
see
this,
going
in
the
downward
push
to
be
able
to
afford
everybody,
I'm
just
trying
to
see
how
that
would
balance
out.
Because
the
more
you
see
it's
the
old
watermelon
truck.
If
you
it
costs
75
cents
to
make
to
sell
a
watermelon,
you
can
sell
it
for
50
cents.
J
You
just
need
a
bigger
truck
kind
of
philosophy,
so
so
I
have
that
problem
with
you
know:
what
is
it
going
to
amount
for
the
the
practitioners
in
hospitals
or
the
hospitals
themselves
or
the
insurance
companies
that
have
done
many
things
in
a
investment
in
the
community,
and
I
think
that's
one
of
the
challenges
that
we're
going
to
see
is
the
investment
in
the
community,
while
they're
trying
to
push
down
to
that
five
percent
and
eventually
15
more
statement
than
a
question
thanks.
Madam
chair.
A
No,
we
don't
need
to
if
I
just
want
to
make
sure
if
there
was
a
question,
we
know
what
it
was
all
right,
we'll
move
on
to
public
testimony,
so
we're
going
to
go
ahead
and
open
up
public
testimony
for
sb420.
A
Again,
we
are
going
to
start
with
the
folks
in
the
room,
the
entire
time
for
the
public.
Testimony
and
support
will
be
30
minutes
the
entire
time
for
the
public.
Testimony
in
opposition
will
be
30
minutes
and
we
are
going
to
limit
public
testimony
to
two
minutes.
So
I
do
ask
folks
to
be
concise
and
to
the
point.
If
they're,
if
it
turns
out,
we
have
some
extra
time,
we
can
go
back
to
questions
and
answers,
so
we'll
go
ahead
and
start
with
support
and
miss
compliancy
is
going
to
help
me
with
the
timer.
M
Good
afternoon,
madam
chair
and
members
of
the
committee
for
the
record,
my
name
is
annette
magnus
and
I'm
the
executive
director
of
battleborn
progress.
We
are
here
today
in
strong
support
of
sb
420
and
we
thank
the
senate
majority
leader
canezaro
for
her
leadership
in
bringing
real
solutions
to
our
state's
healthcare
crisis.
M
Health
disparities
continue
to
run
deep
in
our
health
care
system.
Right
now,
low
income,
communities,
communities
of
color
or
rural
communities
face
fewer
options
and
higher
prices.
These
health
disparities
significantly
affect
women
in
nevada.
In
our
state,
one
out
of
every
seven
women
of
childbearing
age
is
uninsured.
M
You
will
hear
that
there
are
little
to
no
support
for
a
public
option
in
nevada.
That's
a
flat
out
lie
accompanied
by
inaccurate
polling
by
the
opponents,
as
usual
as
scare
tactics
that
we
have
seen
time
and
time
again
in
reality,
nevadans
are
desperate
for
accessible
and
affordable
health
care
coverage.
How
do
we
know
this?
M
Because
for
years,
our
organizations,
along
with
our
partner
organizations
supporting
this
bill,
have
been
present
in
our
communities
and
we
have
been
we
have
always
heard
over
and
over
that
health
care
and
insurance
coverage
is
something
that
people
desperately
are
begging
for
and
they
need
help
from
our
elected
officials
too.
Plus
we
have
seen
these
exact
same
tactics
used
in
other
states
when
bills,
just
like
this
were
presented.
M
M
I
want
to
add
that,
technically
I
am
a
small
business
owner.
We
pay
100
of
our
10
employees,
health
insurance
and
their
children's.
We
pay
over
five
thousand
dollars
a
month
in
insurance.
That
does
not
always
cover
everything
we
need
with
the
best
plan
available
by
sierra
health
and
life.
I
cannot
wait
for
this
plan
to
be
available
to
us,
so
we
can
have
better
and
more
affordable
options
for
coverage.
M
This
plan
is
another
piece
of
the
puzzle
in
solving
the
insurance
and
healthcare
crisis
that
battleborn
progress
has
been
working
on
for
years.
We
thank
the
senate
majority
leader
for
her
work.
This
bad
this
bill
is
a
matter
of
life
and
death
for
so
many
in
nevadans,
and
we
are
counting
on
you
today.
Thank
you
and
we
urge
your
support.
Thank
you.
N
Thank
you,
madam
chair.
My
name
is
david
goldwater,
I'm
a
lobbyist
in
this
building,
and
I'm
representing
myself
today
and
the
small
business
I
work
for.
I've
worked
around
health
policy
for
since
the
time
I
entered
politics
last
year
or
almost
30
years
ago
now,
and
I
have
a
disclaimer
for
you,
and
that
is,
I
believe,
strongly-
that
access
to
affordable
health
care
is
a
right
of
all
nevada's
lucky
today
to
be
here
as
a
business
owner,
I'm
a
partner
in
a
small
retail
business
that
employs
about
35
people.
N
N
I
feel
like
if
the
building
were
open,
the
line
for
small
business
owners
would
be
out
the
door
in
support
of
this
bill,
because
health
care
insurance
costs
are
such
a
big
part
of
our
budget,
probably
10
to
15
percent
of
our
costs,
and
it
represents
between
20
and
30
percent
of
total
compensation
to
to
our
employees.
N
We
have
an
employer-based
insurance
program
and
I
guess
that's
great:
that's
how
we
deliver
health
insurance
is
through
our
employer.
Wasn't
my
choice
or
anybody
else's
choice,
but
that's
the
one.
We
have
that's
fine,
another
disclaimer.
I
believe
providers
should
be
paid
if
providers
should
be
paid
and
paid
for
their
services
and
those
costs
should
be
fair
and
not
shifted
between
the
insured
and
uninsured
and
the
incentives
for
care
should
be
aligned.
N
N
N
Yes,
I'll
wrap
it
on
up
and
we
have
a
very
close
relationship
with
our
employees.
I
believe
that
this
bill
fills
the
gap
for
small
businesses
in
an
employer-based
system,
and
I
I
encourage
your
support.
M
M
We
urge
your
support
for
sb
420
for
multiple
reasons,
a
lot
of
which
you've
already
heard.
We
thank
the
sponsors
and
co-sponsors
of
this
bill
for
bringing
it
forward
this
session.
We
believe
that
a
public
option
in
nevada
will
serve
a
critical
function
in
our
state,
especially
now
as
our
health
care
and
health
insurance
system
has
been
stress,
tested
by
the
enormity
of
the
global
pandemic
this
last
year,
and
which
has
also
revealed
critical
vulnerabilities.
M
Approximately
over
350
000
nevadans
are
currently
uninsured,
while
the
retirees
I
represent
have
access
to
health
care
insurance
through
the
public
employees
benefit
programs.
There
are
times,
depending
on
one's
life
situation,
where
the
gap
between
what
is
available
from
programs
like
the
silver
state,
aca
exchange
and
income-based
programs
such
as
medicaid,
is
too
large
for
some
to
navigate
successfully
financially.
M
In
particular,
this
gap
affects
the
pre-medicare
age
population,
that
population
when
suffering,
job
losses
later
in
their
careers
and
the
subsequent
loss
of
their
employer-provided
health
insurance
are
left
only
with
cobra
as
a
temporary
option.
Cobra
does
not
offer
affordable
short
or
long-term
solutions
for
those
individuals,
as
they
age
into
medicare.
M
Medicaid
has
its
own
limitations
and
restrictions.
Introducing
a
competitive
array
of
options
in
the
insurance
market
could
be
an
invaluable
tool
in
bringing
nevada
to
a
place
where
most,
if
not
all,
nevadans,
are
insured
and
have
access
to
affordable
health
care,
no
matter
what
their
life
situation
may
be.
We
strongly
urge
your
support
for
sb420
and,
if
I
could
just
real
briefly
address
the
issue
of
cost
shifting
the
kaiser
foundation
has
multiple
and
I
would
certainly
supply
the
committee,
if
requested
absolutely
the
research
on
this.
M
They
have
multiple
figures
and
data
they've
collected
over
the
years
of
the
cost
of
uninsured.
That
cost
is
on
it
of
uninsured
folks.
Accessing
care
in
emergency
situations
usually
is
already
a
cough
shifting.
It's
happening
right
now.
The
the
public
employee
benefits
program
has
an
excess
reserve
to
somewhere
between
20
and
and
30
million
dollars.
M
We
believe
right
now
because
of
a
situation
where
we
had
claim
suppression
this
last
year,
at
least
in
part,
so
there
is
cost
shifting
already
going
on
in
this
landscape,
and
we
again
just
urge
your
support
for
this
very
great
bill
and
we
so
much
thank
senator
canozzaro
for
bringing
it
forward.
Thank
you.
Thank.
A
A
Good
afternoon
senator
randy's,
senator
randy
and
members
of
the
senate
health
and
human
services
committee,
my
name
is
sarah
adler,
with
silver
state
government
relations.
Today,
representing
the
nevada,
advanced
practice,
nurses,
association
or
napna
napan
is
the
largest
association
of
aprns
in
nevada,
who
are
often
referred
to
as
nurse
practitioners.
A
As
you
are
aware,
aprns
are
critically
important
primary
care
and
specialty
care
providers.
They
have
full
practice
authority
and
are
fully
accountable
for
the
decisions
and
the
delivery
of
care
that
they
provide.
You'll
find
more
about
nafna,
and
our
support
for
sb
420
posted
to
the
exhibits.
Napna
supports
a
public
option.
They
are
all
about
healthcare
access,
aprns
daily
are
interacting
with
nevadans,
whom
they
wish
had
received
access
to
care
sooner
in
their
lives
or
in
the
experience
of
the
illness
or
disease
that
the
aprns
encountered.
A
A
The
nevadans
who
need
care,
perhaps
the
most
aprns,
are
difference
makers,
as
we
saw
from
the
dynamic
young
woman
advanced
practice
nurse
at
the
beginning
of
the
bill
presentation
just
a
moment
to
you,
the
policy
committee,
the
good
news
on
the
fiscal
note,
the
fiscal
note
provided
by
dhcfp
or
whatever
that
acronym
is
indicates
that
the
general
fund
impact
of
pay
parity
would
be
just
7.8
million
this
biennium
and
given
the
good
news
from
the
economic
forum
today,
that's
just
1.6
of
the
above
december
number
that
was
received
from
the
economic
forum
today,
so
this
parody
is
highly
affordable.
A
Amendment
to
section
30.
section
30
is
about
the
statewide
mco.
We
would
propose
that
pay
parity
follow
the
movement
to
a
statewide
mco.
Thank
you
very
much
and
appreciate
your
support
of
420..
Thank
you
still
in
testimony
on
support.
J
Thank
you,
madam
chair
and
members
of
the
committee.
My
name
is
eric.
Jang
e-r-I-c-j-e-n-g,
representing
one
apia
in
nevada,
grassroots
advocates
for
our
asia
and
pacific
islander
communities
here
in
nevada,
want
to
thank
leader
kanzaro
for
proposing
the
public
option
proposal
as
part
of
our
grassroots
organizing
we've
knocked
more
than
30
000.
Doors
talked
to
more
than
2
500
asian
pacific
under
families
in
the
state
of
nevada.
J
Healthcare
is
the
number
one
issue
for
our
community,
regardless
of
income,
language,
ethnicity
or
when
they
moved
here
when
they
immigrated
people
are
concerned
about
health
care.
They
want
to
ensure
coverage,
even
if
someone
loses
their
job,
especially
after
our
community
is
being
hit.
The
one
of
the
hardest
during
covet
on
the
small
business
ends.
We
have
also
recruited
more
than
30
prominent
asian
and
pacific
under
small
business
owners,
to
sign
up
for
our
support
letter
which
we'll
submit
for
the
committee
on
the
community
member
end.
J
A
B
B
E
E
C-H-R-I-S-T-I-N-E-S-A-U-N-D-E-R-S,
I'm
the
policy
director
of
the
progressive
leadership
alliance
in
nevada
in
support
of
senate
bill
420.
Today
I
submitted
written
testimony
for
the
record,
but
I
actually
want
to
share
a
brief
personal
story
with
you.
Next
wednesday
is
actually
my
fifth
wedding
anniversary,
which
I
will
note
I
recently
learned
is
the
wood
anniversary.
E
E
A
policy
like
a
nevada
public
option
would
have
made
a
huge
difference
when
I
was
struggling
to
ensure
I
was
still
going
to
be
able
to
have
access
to
my
medical
care
for
my
chronic
illnesses
into
the
prescriptions
I
take
every
day
and
in
fact
it
probably
would
have
been
more
affordable
coverage
for
both
my
husband
and
I,
rather
than
utilizing
his
high
deductible
insurance
plan
on
behalf
of
plan
and
myself,
I
urge
that
you
support
this
legislation.
Thank
you.
B
O
Good
afternoon
show
ready
and
honorable
members
of
the
committee
for
the
record,
my
name
is
clinton,
fabwa,
q-u-e-n-t-I-n,
favor
s-a-v-w-o-I-r,
I'm
the
deputy
director
at
make
it
work
nevada.
We
organize
black
women
and
black
families
to
build
power
towards
economic,
racial
and
reproductive
justice,
and
we
support
sb
420.
by
now.
You
all
know
very
well
how
covet
19
has
ravaged
our
state
and
exposed
the
seemingly
countless
vulnerabilities
that
we
face
as
nevadans.
O
What
you
may
not
know
are
the
stories
of
our
community
members
that
have
lingering
effects
of
coca-19
the
ongoing
loss
of
taste
and
smell
the
ongoing
body,
aches
and
mental
fogginess,
the
chronic
exhaustion
and
of
all
these
people.
They
have
nowhere
to
turn
because
they
lack
insurance
or
their
current
plan
is
far
too
expensive
to
afford.
O
But
even
before
covet
19,
we
were
facing
a
health
care
crisis
in
our
state.
When
we
surveyed
black
women,
we
learned
that
more
than
20
percent
of
them
put
off
visits
to
the
doctor,
because
either
one
they
can't
afford
to
take
the
time
off
from
work
to
go
to
the
doctor
or
two.
They
can't
afford
the
co-pay
or
deductible
that's
associated
with
their
current
insurance
plan.
O
We
heard
stories
from
women
in
our
community
like
dee,
who
experienced
chronic
pain
for
decades
regarding
it,
as
the
growing
pains
of
becoming
a
woman
is
what
she
described
because
she
couldn't
afford
to
go
to
the
doctor.
This
pain
only
got
worse
with
this
pain,
only
got
worse
and
more
severe
as
the
years
passed
by
the
time.
Dee
had
both
an
affordable
insurance
plan
and
a
job
that
provided
her
paid
sick
time.
She
learned
that
she
could
no
longer
have
children
because
of
her
diagnosis.
O
Sb
420
will
help
mitigate
one
of
these
two
barriers
as
we
rebuild
our
lives
in
this
call
the
19
environment.
It's
fiercely
important
that
our
fellow
nevadans
have
access
to
health
care.
Considering
this,
it
is
absolutely
imperative
that
all
of
our
families
have
access
to
quality,
affordable
health
care
insurance
plan,
especially
black
and
brown
families,
as
they
have
borne
the
brunt
of
hospitalizations
and
deaths
during
the
cold
at
19
pandemic.
O
B
C
Good
afternoon,
madam
chair
members
of
the
committee
for
the
record,
my
name
is:
barry
gold,
b-a-r-r-y
g-o-l-d
and
I'm
the
director
of
government
relations
for
aarp
nevada.
My
full
testimony
is
on
nella,
so
I'll.
Just
briefly
highlight
it.
Aerp
nevada
believes
that
people
of
all
ages
should
have
equitable
access
to
quality,
affordable
health
care.
We've
already
heard
about
the
significant
disparities
in
our
current
health
care
system,
both
in
terms
of
access
and
outcomes.
We
do
support
health
care
reforms
that
significantly
improve
access
to
affordable
and
quality
coverage.
C
Many
many
people,
many
people-
have
the
health
insurance
costs
impact.
How
many
people
approach
their
life
decisions?
Many
people
have
kept
the
job
just
specifically
to
retain
their
health
insurance
and
many
others
have
retake,
have
delayed
retirement
just
to
keep
their
health
care.
People
often
may
understand
the
need
for
having
health
insurance,
but
for
many
the
cost
can
put
it
way
out
of
their
reach.
Everyone
deserves
access
to
quality,
affordable
health
care
and
sb
420
contains
proposals
that
move
nevada
closer
to
this
vision.
C
B
E
Thank
you,
madam
chair.
My
name
is
katie
robbins
k,
a
t,
I
e
r,
o
b
b
n-
and
I
am
here
on
behalf
of
planned
parenthood
votes
nevada.
We
are
proud
to
support
sb
420
and
thank
senator
canazzaro
for
bringing
this
important
bill.
Nevada
has
one
of
the
highest
uninsured
populations
in
the
nation,
and
the
nevada
public
option
will
provide
higher
quality
lower-cost
care
to
people
across
the
state.
E
The
public
option
will
also
help
address
the
disparities
people
of
color
and
low-income
nevadans
face
when
trying
to
find
affordable
quality
care
for
themselves
and
their
families.
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's
support
of
sb420.
B
I
Good
evening
committee,
my
name
is
jim
sullivan
j-I-m-s-u-l-l-I-v-a-n
and
I'm
representing
the
culinary
union.
The
culinary
union
supports
senate
bill
420
with
the
conceptual
amendment,
because
we
believe
that
healthcare
is
a
human
right.
This
bill
is
a
good
first
step
towards
making
sure
that
all
nevadans
get
quality
and
affordable
health
care.
We
know
that
nevada
has
one
of
the
highest
uninsured
rates
in
the
country
which
this
bill
addresses
by
creating
a
public
option
for
working
families
who
are
either
not
eligible
for
a
health
care
plan
or
simply
can't
afford
it.
I
B
N
Good
afternoon,
madam
chair
and
committee
members,
thank
you
for
the
opportunity
to
testify
in
support
of
sb
420
for
the
record.
My
name
is
evan
louis
e-v-a-n-l-o-u-I-e
and
I'm
a
small
business
owner
executive
and
port
advisor
to
several
asian
american
pacific
on
our
own
companies.
I
just
returned
from
api
lobby
day
from
carson
city
and
thankful
to
our
elected
officials
for
meeting
with
leaders
in
our
community
in
honor
of
asian
pacific
american
heritage
month.
I
also
serve
as
the
executive
advisor
to
don't
tell
mama
llc
doing
business
as
kamu
ultra
karaoke.
N
It
is
a
12
million
dollar
project
in
the
grand
canal
shops
and
the
largest
karaoke
establishment
in
the
united
states.
We
currently
employ
25
people
in
nevada.
Thank
you
to
senator
majority
leader
conozaro
for
presenting
sb
420,
a
sorely
needed
bill
for
nevada,
kama,
ultra
karaoke
and
ex-potter
neighbors
in
the
grand
canal.
Shops
x-pot
is
a
7
million
dollar
high-end
hot
pot
restaurant
due
to
delays
and
constructions
both
opened
in
july
2020.
During
the
pandemic.
They
both
incurred
severe
revenue
loss
in
the
name
of
millions,
but
provided
but
providing
affordable.
N
Health
insurance
is
important
to
their
businesses.
Both
have
struggled
financially
just
to
retain
their
employees
seeing
little
to
no
foot
traffic
their
establishment.
Since
the
early
phase
of
the
pandemic,
it
only
makes
sense
to
have
insurance
providers
compete
with
public
option,
which
will
in
turn,
provide
lower
premiums
and
expanded
coverage.
I
also
read
a
recent
study
by
commonwealth
fund
listed
nevada
as
the
48th
in
the
nation
for
overall
health
care
and
the
highest
uninsured
rate
of
the
medicaid
expansion
states.
As
a
personal
story,
my
late
wife
was
diagnosed
with
brain
cancer.
N
Four
months
after
we're
married
and
seven
half
months
pregnant
with
my
daughter
siobhan,
I
just
stopped
running
my
business
and
live
in
hospitals
taking
care
of
my
wife
and
newborn
premature
daughter.
We
barely
could
survive
just
keeping
up
with
the
cobra
premiums
and
health
care
costs,
with
severe
income
loss
and
our
cost
of
living
after
my
wife's
passing,
affordable
health
care
is
something
I
have
become
extremely
passionate
about
as
a
small
business
owner.
I
know
that
competition
drives
innovation,
but
having
more
options
is
better
for
everyone.
I
urge
you
to
support
sb
420.
Thank
you.
E
N
B
P
D-A-N-I-E-L-G-O-R-O-N-A
and
I'm
calling
in
support
of
sp
420
tonight
in
the
summer
of
2017,
it
was
announced
that
nevada's
14
most
rural
counties
would
have
no
insurance
option
through
the
nevada
health
exchange.
Thousands
of
nevadans,
including
myself,
who
received
health
insurance
on
the
exchange,
would
simply
be
out
of
luck.
Thankfully,
state
leaders
were
able
to
avert
a
disaster
and
secure
health
insurance
for
rural
nevadans
at
the
last
minute.
The
threat
of
no
available
health
insurance
through
the
exchange
still
loses
the
yearly
prince
rural
nevada.
P
However,
thanks
to
majority
leader
camazaro,
there
is
potential
for
an
actual
long-term
solution
through
sb
420,
which,
if
passed,
will
be
one
of
the
most
comprehensive
and
robust
public
health
insurance
plans
in
the
country.
For
the
first
time
ever,
nevadans
in
the
most
rural
areas
of
our
state
would
be
guaranteed
access
to
affordable
coverage
through
a
statewide
public
option.
P
This
means
rural
providers
and
hospitals
will
also
be
guaranteed
reimbursement
for
patients
enrolled
in
the
nevada
public
option,
which
would
be
a
game
changer,
as
our
rural
hospitals
provided
nearly
30
million
dollars
in
uncompensated
care
in
2020
alone
eating
those
costs
has
been
crushing.
Nevada's
rural
hospitals
and
is
a
major
factor,
and
why
so
many
have
recently
closed
their
doors?
P
Sb
420
would
also
provide
rural
nevadans,
a
statewide
network
of
doctors.
They
could
receive
in-network
care
from,
even
if
those
providers
are
outside
the
patient's
home
county.
This,
along
with
the
fact
that
the
nevada
public
option
will
be
offered
to
individuals,
families
and
small
businesses
is
why,
as
someone
who
receives
health
insurance
through
the
exchange
and
as
the
mayor
of
west
windover,
a
rural
community
that
struggles
yearly
with
access
to
affordable
care,
health
care,
I
stand
in
strong
support
of
sp
420
and
urge
this
committee
to
do
the
same.
Thank
you.
B
O
O
I
urge
our
state's
policymakers
to
expand
health
care
access
by
passing
the
nevada
public
option,
which
can
reduce
costs
and
make
comprehensive
health
care
affordable
for
all
nevadans.
Expanding
health
care
is
especially
essential
to
the
health
and
well-being
of
low-income
and
rural
residents.
As
a
physician,
I
see
close
up
the
hurdles.
My
patients
face
to
getting
health
care
cost
is
a
major
hurdle.
O
Comprehensive
care
is
another
and
so
is
getting
specialized
care
to
specific
populations
and
underserved
communities.
I
witness
too
many
nevadans
struggle
to
get
the
care.
They
need
to
stay
healthy
work
and
care
for
their
families.
They
have
few
options.
Low-Income
and
rural
families
often
can't
afford
co-pays
and
out-of-pocket
costs
that
seem
to
go
up
every
year.
Even
as
these
families
get
fewer
services,
the
public
option
can
address
these
challenges.
O
O
It
will
also
expand
critical
services
such
as
maternal
and
pregnancy
care
access.
A
public
option
can
improve
the
health
and
save
the
lives
of
all
nevadans,
regardless
of
where
they
live.
A
public
option
can
reduce
the
burden
on
small
businesses,
who
want
to
help
pay
for
health
insurance
for
their
employees,
but
can't
afford
to
a
nevada.
Public
option
can
provide
families
with
the
protection
and
the
peace
of
mind
they
deserve.
A
Thank
you
all
right.
We
have
time
for
two
more
to
testify
and
support
if
you
are
still
on
the
line
to
testify
and
support
we're
going
to
take
two
more.
If
you
don't
make
it
through,
you
can
send
your
written
testimony
to
sen
hhs
at
sen.state.nv.gov,
which
is
the
email
address
that
is
on
the
agenda,
and
you
can
also
submit
your
opinion
on
a
bill
of
resolution
using
the
opinions
application.
There's
a
web
link
on
the
agenda
as
well,
so
we'll
take
two
more
in
support
and
then
we'll
move
on
to
opposition
bps.
Next.
B
E
E
I've
long
been
an
advocate
for
a
public
option
and
to
fix
the
problems
that
the
aca
was
unable
to
address
initially
and
not
having
a
public
option
was
one
of
the
main
barriers
to
accessing
affordable
health
care
for
everyone
nationwide,
and
we
see
it
specifically
here
in
nevada,
as
many
people
have
already
stated,
the
high
number
of
uninsured
patients
in
in
our
state,
I
believe
a
public
option
would
help
address
some
of
the
costs.
I
also
would
strongly
advocate
that,
while
drafting
a
bill,
we
also
deeply
look
at
out
of
max
out-of-pocket
rates
and
deductibles.
E
So
I
know
quite
well
the
the
struggles
that
that
patients
go
through
every
day
and
so
again
I
think
everybody
on
the
committee.
I
think
the
senator
for
drafting
sb
420
and
I
hope
that
we
can
do
the
right
thing
and
create
more
affordable
and
accessible
health
care
to
all
nevadans.
Thank
you.
So
much.
B
O
Good
afternoon
my
name
is
ender
e-n-d-e-r
austin
a-u-s-t-I-n,
the
third
good
afternoon
chairwoman
ready
my
soror
chair
vice
chair
spearman
and
members
of
this
committee.
O
As
I
previously
stated,
my
name
is
ender
austin
iii
and
I'm
the
southern
nevada
regional
director
for
faith
in
action,
nevada,
a
nonprofit
that
seeks
to
organize
people
of
faith
to,
as
our
name
says,
put
our
faith
into
action,
and
I've
come
this
afternoon
to
speak
on
behalf
of
many
of
our
leaders
across
the
state.
Who've
expressed
reasons
why
they
support
sb
420.
O
O
I
can
share
a
couple
of
our
leaders,
testimonies
or
stories
in
the
short
time
that
we
have
today,
alita
flue
ellen
shared
that
access
to
health
care
allowed
her
mother,
who
was
dying
to
be
able
to
live
a
dignified
life
in
her
final
days
of
life.
This
was
so
important
that
her
mother
maintained
a
sense
of
normalcy,
even
as
her
illnesses
were
progressing.
Deacon
david
ross
spoke
to
me
about
the
importance
of
health
care
when
he
faced
a
heart
procedure
that
cost
250
000.
O
If
he
didn't
have
health
insurance,
he
would
have
absolutely
been
put
in
debt
that
he
would
not
have
been
able
to
take
to
take
care
of
pastor.
Joe
harris
spoke
vigorously
about
the
importance
of
health
care
for
black
men
who
who
face
unique
health
disparities,
er
exacerbating
choosing
by
a
lack
of
access
to
health
care,
because,
yes,
in
2021,
if
america
catches
a
cold
black
america
has
the
flu.
O
Furthermore,
pastor
donnesha
mingo,
who
is
a
mental
health
professional,
spoke
about
the
importance
of
her
patients
being
able
to
keep
their
health
insurance
when
they
transition
from
job
to
job.
To
ensure
this
sb
24
240,
it's
420
excuse
me
allows
folks
to
carry
their
health
insurance
from
from
one
job
to
another,
seeks
to
alleviate
some
of
the
challenges
that
we
have
with
racial
barities
and
ensures
that
there's
a
better
quality
of
life
for
many
others,
as
well
as
providing
financial
security.
O
A
Q
Q
My
name
is
tom
clark,
I'm
here
on
behalf
of
the
nevada
association
of
health
plant.
I
come
before
you
in
opposition
to
senate
bill
420,
and
my
opposition
is
primarily
to
the
sections
that
deal
with
the
public
option.
I
represent
the
private
insurance
companies
that
operate
in
nevada,
and
so
we
want
to
talk
about
the
impact
that
this
legislation
will
have
specifically
on
nevadans.
Q
Q
Q
Surprise
billing
from
last
session
was
a
very
good
example
of
that,
so
the
health
care
system
in
nevada
is
a
system,
and
when
you
look
at
insurance,
it's
broken
down
into
a
number
of
different
ways.
You
have
large
groups,
small
group
and
individual
market,
you
have
the
self-funded
plans,
you
have
medicare
and
of
course
you
have
medicaid
and
has
been
testified
previously
about
11
of
those
folks
are
the
uninsured.
Q
Q
So
there
was
discussion
about
cost
shift.
We
contemplate
that
under
this
legislation
there
will
be
a
cost
shift
where
you
may
see
under
the
public
option,
a
set
price,
but
those
folks
that
are
in
those
other
elements
of
insurance
will
see
an
increase
in
the
cost
of
theirs.
There
was
mentioned
earlier
about
the
manat
study.
I
won't
go
into
a
lot
of
detail
on
that.
Simply
that
you
know
they
brought
forward
to
two
options.
We
were
hoping
to
deliberate
and
discuss
those
options.
Q
Q
Q
What
does
420
not
contemplate
the
increasing
price
of
pharmaceutical
drugs
at
network
adequacy,
something
that's
very
close
to
my
heart,
because
we
have
been
working
as
insurers
for
years
to
increase
the
number
of
providers
that
we
have
rural
urban
across
the
board
as
far
as
discipline
to
bring
them
in.
We
fear
the
impact
that
this
particular
piece
of
legislation
will
have
on
network
adequacy
will
be
detrimental.
Q
Thank
you,
madam
chair.
Under
this
proposal,
the
healthcare
delivery
system
access
will
be
impacted.
An
experience
tells
us.
Even
the
monox
study
told
us
a
public
option
of
this
nature
will
be
expensive
and
health
care
costs
for
all
nevadans
will
increase
access,
will
decline,
and
with
that,
thank
you,
madam
chair.
L
Thank
you,
madam
chair
members
of
the
committee,
for
the
record.
My
name
is
jim
wadhams.
I'm
here
today
representing
nevada
hospital
association
and
appreciate
the
privilege
of
being
here
in
person.
I'll
try
to
be
brief.
We
we
totally
support
the
notion
of
a
public
option.
However,
we
have
issues
with
this
bill
and
we'll
try
to
be
brief,
but
put
those
on
the
record.
L
The
one
element
that's
missing
in
the
bill
is
a
is
a
prerequisite
for
an
actuarial
study.
This
population
needs
to
be
analyzed,
needs
to
be
studied
so
that
the
the
morbidity,
if
you
will,
that
is
the
healthcare
characteristics,
can
be
understood
that
shouldn't
be
too
terribly
difficult.
If
portion
of
this
population
is
already
medicaid
eligible
and
and
is
available,
just
simply
getting
them
enrolled.
That
will
cut
this
approximately
by
a
third
to
a
half,
depending
on
how
you
calculate
that.
L
When
costs
exceed
the
revenues,
then
adjustments
will
have
to
be
made.
It's
either
passed
on
typically
passed
on
to
the
commercial
market,
that
is,
the
employers
that
are
not
eligible
to
participate
will
have
to
begin
picking
that
up
or
unfortunately,
it
can
impact
into
the
workforce
and
jobs,
which
is
the
largest
cost
factor.
L
That
would
have
been
a
problem.
My
last
comment
is
just
please,
as
you
review
this
bill.
Remember
that
that
cost
comes
in
different
components.
It's
the
cost,
the
out
of
pocket
to
the
consumer,
it's
the
cost
of
insurance
and
ultimately,
it's
the
cost
to
deliver
this
health
care
service
by
the
providers.
L
So
we've
got
to
make
sure
that
we're
sensitive
to
where
all
of
those
costs
go
appreciate.
The
opportunity
to
address
this
bill
certainly
willing
to
continue
to
work
on
a
very
important
issue
and
appreciate
senator
canisaro
bringing
to
bill,
but
we
do
have
those
concerns.
Thank
you,
madam
chair.
Thank.
R
Good
afternoon,
chair
ratty
and
members
of
the
committee,
my
name
is
jaren
hildebrand
and
I
am
the
executive
director
of
the
nevada
state
medical
association.
R
We
do
share
the
priority
of
improving
health
care,
improving
access
to
and
affordably
of
health
care
insurance
covering
the
uninsured
and
improving
health
care
outcomes
and
affordability
has
a
long-standing
priority
with
the
nevada
state
medical
association.
Again,
I
want
to
stress
that
we
are
not
opposed
to
in
a
public
option.
However,
today
we
are
in
an
opposition
to
sb420
as
written.
R
I
I
sent
most
of
my
comments
in
a
letter,
so
I
won't
go
through
the
whole,
the
whole
thing,
but
just
to
just
to
touch
on
quickly
the
payment
parity
piece
we
we
do
have
some
concerns
with
some
some
of
the
the
payment
parity
with
respect
to
doulas
midwives
and
nurse
practitioners,
and
I
know
this
isn't
an
apples-to-apples
organization
comparison,
but
I
do
believe
you
know
there's
a
few
lawyers
in
in
the
room
here
and
I
don't
feel
I
don't
know
how
they
would
feel
if
a
paralegal
was
getting
the
same
pay
as
as
as
a
physician
would
or
as
a
lawyer
would
for
that.
R
For
example,
I
will
quickly
touch
on
two
of
our
issue:
major
issues
with
this
bill,
the
the
mandate
in
section
23.
We
support
physicians,
freedoms
of
choice
when
it
comes
to
health
care
plan
participation
and
and
therefore
we
oppose
the
effort
to
require
physicians
participation
in
a
public
option
by
trying,
by
tying
it
to
the
participation
of
other
state-based
programs.
R
There
are
many
reasons
as
as
to
why
a
practice
may
not
participate
with
the
plan,
burdensome
administrative
policies,
saturation
of
practice,
resources,
physician
time,
engagement
and
alternative
payment
models,
pending
retirement
and
so
on.
It
is
critical
that
that
the
physicians
are
able
to
weigh
in
on
the
contract
contract
options
and
make
it
and
make
the
decisions
what's
best
for
them
and
the
practice
and
their
patients
and
their
staff.
R
I
would
like
to
just
discuss
the
medicare
reimbursement
rates
in
section
14
of
this
bill.
We
would
just
that
would
establish
provider
payments
using
medicare
rates
as
a
floor.
While
we
appreciate
the
medicare
rates
being
meant
to
serve
as
a
starting
point
and
not
the
targets
for
negotiations,
but
between
providers
and
plans,
rightfully
we
fair
these
rates
will
become
a
de
facto
rate
for
all
public
option
contracts.
R
Simply
medicare
rates
have
not
covered
cost
of
providing
care
in
in
the
commercial
market.
In
fact,
according
to
data
from
the
medicare
trustees
and
and
medicare
physicians,
pay
has
barely
increased
in
nearly
two
decades.
It
has
just
increased
in
just
seven
percent,
from
2001
to
2020.
or
just
1.3
percent
per
year
on
an
average
rate.
At
the
same
time,
costs
of
running
a
medical
practice
have
increased
over
30
37
percent
between
2001
and
2020.
R
K
Thank
you,
madam
chair,
michael
hillerby.
I
represent
renowned
health
and
our
insurance
division,
hometown
health.
We
are
a
local,
non-profit,
integrated
health
care
system.
While
we
support
the
concept
of
a
public
option
focused
on
providing
coverage
for
the
uninsured,
we
do
oppose
sb
420,
but
we
want
to
work
with
you
and
others
to
see
if
we
can
design
a
program
that
works
for
nevada
without
jeopardizing
access
to
care
or
the
current
options
for
coverage
as
an
integrated
healthcare
delivery
system.
K
With
a
health
plan,
we
are
acutely
aware
of
the
importance
of
the
payer
mix
as
we
strive
to
manage
costs
and
make
the
most
efficient
use
of
public
and
private
dollars.
We
know
that
when
the
number
of
patients
increase
in
medicaid,
medicare
and
other
programs
that
reimburse
below
cost
or
for
those
who
are
uninsured,
the
cost
burden
shifts
to
providers
and
private
health
insurance
patients
that
impacts
the
number
of
providers
willing
to
enroll
in
these
programs
and
see
new
patients.
K
We
are
all
aware:
nevada
ranks
very
low
in
physicians
and
nurses
and
other
primary
care
providers
per
capita,
and
we
have
among
the
lowest
medicaid
reimbursement
rates
for
hospitals
in
america.
Our
delivery
system
is
fragile
and
sensitive
to
even
small
changes
in
the
payer
mix,
and
the
same
is
true
for
the
private
insurance
market
for
businesses
and
individuals.
K
We
cannot
implement
a
new
public
option
before
we've
studied
and
addressed
the
risks
of
losing
providers
in
our
current
system
or
making
nevada
a
less
attractive
place
to
practice.
Medicine
sb
420
seeks
to
address
in
part
the
large
population
of
patients
who
are
eligible
but
not
enrolled
in
medicaid
or
subsidized
exchange
plans.
37
are
eligible
for
medicaid
as
you've
already
heard
and
20
or
more
for
subsidized
coverage
on
the
exchange.
We
should
focus
on
these
areas
before
implementing
a
new
public
option.
In
the
waning
weeks
of
the
session.
K
We
would
like
to
work
with
you
in
the
larger
healthcare
community
to
continue
the
work
done
on,
for
example,
the
scr
10
study,
the
patient
protection
commission
and
the
committee
to
study
the
cost
of
prescription
drugs.
If
we
are
to
build
a
public
option
that
addresses
the
unique
nevada
marketplace,
we
believe
work
first
needs
to
be
done
in
the
following
areas:
increase
presumptive
eligibility
options
to
better
capture,
more
medicaid
eligible
patients
and
help
them
complete
full
enrollment,
explore
expanded
exchange,
enrollment
opportunities,
for
example.
K
At
point
of
care,
could
we
create
something
like
medicaid
presumptive
eligibility
for
the
exchange?
The
actuarial
study
allowed
in
the
bill
must
be
mandatory
if
we
are
to
understand
the
risk
pool
and
the
viability
of
any
public
option
to
avoid
the
results
seen
in
the
state
of
washington.
This
was
also
reflected
in
the
early
years
of
our
own
exchange
and
the
lack
of
coverage
in
rural
counties
also
remove
the
small
employer
eligibility
provisions.
This
will
exacerbate
the
cost,
shifting
problem
and
create
more
uncertainty
in
a
small,
fragile
private
insurance
market.
K
We
must
also
address
medicaid
rates,
including
the
cuts
made
last
summer.
We
need
to
align
medicare
reimbursement
with
value-based
care
and
patient
outcomes,
helping
drive
better
access
to
the
best
care
in
the
appropriate
setting.
We
believe
this
is
a
crucial
step
to
deal
with
both
access
and
the
very
real
budget
realities
that
you
face
every
day.
K
E
It
was
mentioned
earlier
in
the
comments
that
35
of
eligible
nevadans
people
who
are
eligible
for
medicaid
are
not
enrolled
in
medicaid.
Why
is
that?
We
need
to
figure
out
why
we
keep
cutting
up
the
piece
looking
to
cut
up
the
piece
of
the
pie
and
nobody
is
eating
that
pie
and
that's
what
we
need
to
figure
out.
E
We
have
a
lot
of
the
reason
why
people
are
not
signing
up,
for
it
is
because
doctors
are
not
accepting
any
more
medicaid
patients,
doctors
who
can
choose,
but
unfortunately
we
have
doctors
who
cannot
choose,
and
so
they
do
take
medicaid
patients
and
they're
losing
money
in
their
practices.
We
have
nationwide.
E
E
Our
anesthesiologists
here
in
nevada,
our
big
provider
groups,
work
very
hard
to
try
to
recruit
more
anesthesiologists
into
the
state,
we're
not
afraid
of
competition.
We
cannot
get
more
anesthesiologists
to
come
here
because
of
the
low,
very
very
low
medicaid
rates.
We
have
submitted
a
letter
that
has
a
lot
of
comments
in
there
in
some
more
detail.
I
won't
read
all
over
the
letter,
but
we
are
opposed
to
this
bill,
it's
well-meaning,
but
we
need
to
figure
out
why
people
are
not
using
the
programs
that
we
have
now
first
and
fix
those.
Thank
you.
A
B
B
C
Go
go
ahead
good
afternoon,
chair
ready
and
members
of
the
senate
committee.
My
name
is
ann
silver
a-n-n-s-I-l-v-e-r
and
I
serve
as
ceo
of
the
reno
sparks
chamber
of
commerce
and
a
co-director
of
the
silver
state
chambers
of
commerce
which
include
12
other
nevada
chambers.
I'm
before
you
today,
in
opposition
to
senate
bill,
420.
C
sb420
would
increase
costs
to
our
chamber.
Businesses
and
their
employees,
reduce
competition
and
choice
for
working
nevada
families
and
might
possibly
deter
physicians
from
establishing
a
much
needed
practices
in
our
state.
We
do
support
decreasing
insurance
costs
and
increasing
availability,
so
we're
proud
of
the
reno
sparks
chambers
association,
health
plan
able
to
offer
affordable,
comprehensive
vision,
dental
medical
and
life
insurance,
life
insurance
plans
to
any
small
business
with
between
2
and
50
employees.
This
plan
currently
covers
thousands
of
lives
across
the
state.
Sb
420
would
not
reduce
the
high
cost
of
health
care
in
nevada.
C
It
would,
however,
demand
insurance
premium
reductions
for
a
finite
number
of
nevadans
and
increase
the
cost
to
a
larger
proportion
of
the
population.
Your
help
is
needed
in
creating
incentives
for
medical
residencies,
encouraging
and
funding
health
care.
Credentialing
and
refraining
from
establishing
arbitrary
government
set
reimbursement
rates.
Your
priorities
should
include
encouraging
doctors
to
work
in
our
state
and
re
rewarding
students
who
choose
careers
in
health
care.
We
respectfully
ask
that
you
rethink
this
bill
and
instead
establish
a
task
force
to
explore
health
care,
affordability
and
existing
products
in
the
nevada
market.
C
B
I
It
is
a
proven
market
driven
solution
based
on
low
premium
costs
and
comprehensive
benefits,
bulk
buying
power
for
small
business.
We
are
extremely
troubled
by
both
the
impact.
This
proposal
will
have
on
nevada's
families
currently
receiving
employer-provided
health
benefits
and
the
inverse
adverse
impacts
to
access
and
care
nevadans
need
from
their
health
care
network,
in
effect
pushing
doctors
or
health
care
heroes
out
of
the
nevada
market.
Sb
420
would
create
a
new
government
control
program
that
will
ultimately
provide
fewer
options
and
benefits
while
eroding
existing
private
insurance
plans.
I
It
will
predictably
shift
remaining
health
care
costs
not
covered
by
the
state
to
the
nevada
families
who
choose
to
receive
employer
coverage,
increasing
health
care
costs
for
many
hospitals
and
doctors
will
be
paid,
medicare
rates
which
are
below
the
cost
of
providing
services
again.
Hospital
and
doctors
will
be
paid
rates
lower
and
below
the
cost
of
providing
services.
I
Additionally,
sb
420
was
assembled
with
no
input
from
those
health
per
care
providers
and
administrators
in
the
marketplace
that
are
meeting
consumer
needs
at
cost-effective
premiums.
There
is
not
a
one-size-fits-all
solution
to
health
care
and
sb.
420
is
not
the
answer.
This
proposal
puts
costs
and
access
to
care
in
jeopardy
for
thousands
of
nevadans.
We
urge
your
opposition
on
this
critically
important
issue.
Thank.
B
P
We
thank
majority
leader
cannizzaro
for
bringing
for
briefing
us
on
this
bill
and
appreciate
her
medicaid
enhancement
ideas,
particularly
for
pregnant
women.
However,
we
still
oppose
senate
bill
420.
As
written.
We
worry
that
the
current
public
option
proposal
will
not
work
for
nevada's,
unique
health
care
environment
and
will
have
negative
consequences
for
both
patients
and
providers
at
sunrise
hospital,
which
is
the
largest
provider
of
medicaid
services
in
our
state.
16
of
our
patients
are
covered
through
commercial
or
managed
care
insurance.
P
Any
shift
in
patients
from
commercial
plans
to
a
public
option.
They
would
almost
certainly
reimburse,
at
a
far
lower
rate,
threatens
the
ability
of
hospitals,
like
sunrise,
to
offer
services.
The
most
vulnerable
members
of
our
community
rely
upon
so
heavily.
We
believe
there
are
other
ways
to
expand
health
insurance
coverage
in
nevada.
First,
over
50
of
uninsured
nevadans
are
eligible
for
medicaid
or
subsidies
on
the
exchange
but
not
enrolled.
We
should
increase
efforts
to
ensure
these
folks
are
enrolled.
Second
nevada
has
the
highest
share
of
those
ineligible
for
coverage
due
to
immigration
status.
P
If
we
truly
want
to
expand
insurance
coverage,
we
as
a
state
should
ensure
that
all
of
those
who
would
otherwise
qualify
for
coverage
are
eligible
for
medicaid.
President
biden
is
currently
proposing
a
permanent
extension
of
expanded
premium
subsidies
available
for
private
insurance
through
the
public
marketplace.
The
idea
is
to
build
on
the
affordable
care
act.
We
encourage
you
to
support
president
biden's
approach
to
make
health
care
more
affordable.
Additionally,
we
hope
that
this
body
will
consider
expanding
coverage
through
enhanced
enrollment
efforts
and
coverage
to
otherwise
ineligible
nevadans.
P
B
E
Good
afternoon,
chair
ready
and
members
of
the
committee
for
the
record,
my
name
is
mary,
beth
seawalled
spelled
s-e-w-a-l-d
and
I'm
the
president
and
ceo
of
the
vegas
chamber,
the
vegas
chamber,
absolutely
shares
the
goal
that
every
nevadan
should
have
access
to
affordable
health
coverage.
That's
why
we
and
other
chambers
and
trade
associations,
as
you've
heard
successfully
cover
thousands
of
lives
and
keep
insurance
more
affordable
through
association,
health
care
plans
for
our
small
business
members,
based
on
our
review
of
sb
420
feedback
from
our
small
and
large
members
and
what
has
happened
in
other
states.
E
The
vegas
chamber
is
opposed
to
the
bill.
This
bill
will
not
reduce
health
care
costs;
rather
it
will
shift
costs
onto
other
nevadans.
Also
mandating
a
state
insurance
plan
to
offer
a
rate.
Five
percent
lower
than
commercial
rates
is
another
cost
shift.
Evidence
from
other
states
that
have
implemented.
Similar
programs
confirms
that
cost
that
insurance
costs
went
up,
which
is
very
concerning.
E
So
what
will
it
do
in
nevada?
This
question
should
be
answered
before
this
bill
is
passed.
Let's
conduct
a
thorough
actuarial
study
and
find
out.
There
are
also
concerns
about
requiring
health
care
providers
to
accept
government
set
reimbursement
rates.
These
are
currently
below
the
actual
cost
of
providing
care.
In
our
opinion,
this
is
not
tenable.
It
will
reduce
providers
who
accept
medicaid.
It
will
push
doctors
out
and
make
it
more
difficult
to
find
a
physician.
E
So
what
will
ensure
more
nevadans?
Let's
expand
on
what
we
already
have
enroll
more
people
into
medicaid
the
state
exchange
and
association
health
care
plans
of
the
current
pool
of
uninsured
nevadans,
as
we've
heard
at
least
30
percent
are
medicaid
eligible.
Enrolling
them
in
medicaid
now
would
automatically
reduce
the
uninsured
population
by
more
than
100
000
lives,
raising
reimbursement
rates
and
addressing
shortages
of
health
care
providers
are
also
solutions
that
will
help
cover
more
nevadans.
I
appreciate
your
time
and
I
urge
you
not
to
pass
sb
420..
Thank
you
very
much.
A
Thank
you.
Okay.
We
have
time
for
two
more
callers
in
opposition,
so
again
as
a
reminder,
if
you're
on
the
line
and
hoping
to
testify
in
opposition,
we're
going
to
take
two
more
callers,
but
there
is
the
email
address
on
the
agenda
and
if
you
send
written
testimony
before
midnight
tonight,
we
will
record
it
as
part
as
an
exhibit
for
this
hearing.
So
again,
two
more
callers
next
caller.
B
O
O
B
O
Marcos
lopez,
m-a-r-c-o-s,
l-o-p-z,
americans
for
prosperity,
nevada.
We
rise
in
strong
opposition
to
sb420
if
the
cloven
19
crisis
has
shown
us
anything.
It's
that
doubling
down
on
today's
bureaucratic
approach
to
health
care
won't
work.
In
fact,
we've
seen
a
glimpse
of
what
is
possible
if
we
take
a
different
approach,
one
that
trusts
doctors,
nurses
and
medical
researchers,
rather
than
holding
them
back,
whether
it
was
the
fda
listing
bans
and
on
and
unnecessary
rules
for
coveted
test
development
or
governor
syslak
issuing
emergency
directive
zero.
O
Eleven
across
the
country,
we
saw
the
easement
of
regulations
of
barriers
that
stood
in
the
way
of
innovating
delivering
care.
The
results
were
clear:
businesses
delivered
vaccines
and
therapeutics
in
record
time.
We
believe
sb
420
is
doubling
down
on
a
bureaucratic
approach
that
we
know
will
make
many
of
the
biggest
challenges
in
our
health
care
system.
Worse,
centralized
approaches
to
health
care
like
medicaid
expansion,
medicare
for
all
or
a
public
option,
cannot
give
americans
what
they
need
and
what
they
deserve:
affordability,
consumer
choice
and
peace
in
mind.
O
That
is
why
we
advocate
and
urge
lawmakers
in
all
levels
of
government
to
advance
what
we
call
a
personal
option.
The
personal
option
is
a
portfolio
of
policies
that
expand
choice,
reduce
costs
and
guarantees
universal
access
by
enacting
reforms
that
focus
on
increasing
the
supply
of
health
care,
reducing
costs,
increasing
consumer
choice
and
protecting
consumers.
O
Americans
will
prosper
will
continue,
collaborating
with
a
diverse
coalition
of
health
care
professionals,
health
scholars,
policy
makers
and
business
leaders
and
citizens
concerned
about
their
health
care
and
their
country
to
make
changes
to
improve
our
system.
We
urge
all
aisle
makers
to
oppose
sb
420..
Thank
you.
A
B
P
Good
afternoon,
everyone,
my
name-
is
cyrus
hojatti
c-y-r-u-s
h-o-j-j-a-t-y,
I'd
like
to
first
of
all
thank
the
majority
leader,
kinda
zaro,
for
bringing
a
public
option,
I'm
very
confident
that
it's
going
to
reduce
costs,
bring
some
competition.
It
certainly
would
be
great
if
we
could
have
that
for
the
housing
market.
P
P
The
other
issue
is
is
that
it's
also
about
immigration
status.
I'm
just
concerned
that
non-citizens
could
take
more
than
to
actually
pay
back
in,
so
this
could
create
an
unequal
situation
and,
speaking
of
evidence,
I
want
to
keep
in
mind
that
the
aca
has
not
lowered
premiums.
It's
jacked
up
premiums
a
lot.
The
repeal
of
the
1973
hmo
act
has
certainly
skyrocketed
premiums
more
than
adjusted
for
inflation,
more
benefiting
wall
street.
P
P
It
is
not
just
health
insurance
that
really
concerns
me
I'd
like
to
also
make
sure
that,
hopefully,
this
bill
understands
that.
Why
are
people
getting
so
sick
for
an
example?
We
have
very
high
alarming
obesity
rate.
We
need
to
understand
what
is
causing
these
types
of
illnesses
and
speaking
of
senator
carnazaro,
the
district
that
she
represents
is
a
very
car
dependent
landscape
of
urban
planning.
Maybe
that
is
what's
increasing
the
illness.
P
The
stress
the
obesity,
a
lot
of
other
different
concerns,
so
we
need
to
focus
on
that
and
in
addition
to
whether
this
plan
has
even
worked
or
not
I'd
also
like
to
know
is
there
a
lot
of
wall
street
health
care
lobbyists
that
are
pushing
against
this
plan,
and
if
there
is,
then
I
would
perhaps
change
my
stance
to
support,
because
we
know
that
these
are
sons
but
other
than
that.
I'm
just
really
concerned
about
waste.
I
think
competition,
however,
is
very,
very
important,
so
I'm
just
kind
of
concerned,
but
optimistic
and
other
than
that.
P
B
E
Good
afternoon,
chair
ready
and
members
of
the
committee,
my
name
is
nancy
bowen
n-a-n-c-y-b-o-w-e-n.
I
am
the
ceo
of
the
nevada
primary
care
association.
We
represent
federally
qualified
health
centers
serving
more
than
107
000
nevadans,
with
integrated
primary
care,
behavioral
health
and
dental
services.
E
Nvpca
supports
affordable
quality
health
care
for
all
the
values,
and
we
believe
that
a
public
option
could
be
an
important
tool
to
expanding
access
to
underserved
communities.
We
we
appreciate
senator
countezera's
efforts
to
include
fqhcs
in
this
policy
and
that
sp
420
establishes
payment
for
our
health
centers
on
par
with
what
they
receive
for
medicare
or
medicaid.
E
We
also
support
the
expansion
of
medicaid
coverage
to
pregnant
women
above
the
current
income
eligibility
level
and
for
doulas
and
community
health
workers
to
extend
the
abilities
of
our
health
centers
to
provide
care
outside
the
clinic.
We
have
long
advocated
for
the
expansion
of
managed
care
so
that
our
rural
patients
can
act
as
specialists
in
the
cities
and
in
rural
population
centers,
and
we
are
grateful
to
see
this
policy
in
the
bill.
E
We
have
concerns
about
the
effect
of
sd
420,
on
the
future
of
managed
care
in
the
state
and
on
the
viability
of
our
hospital
and
other
referral
partners.
We
have
heard
the
concerns
from
these
essential
community
partners
and
we
are
withholding
our
support
until
we
understand
more
about
the
likely
impact
of
this
bill
on
them.
Thank
you
for
your
time.
B
B
E
The
treatment
of
bleeding
disorders
and
clotting
disorders
in
the
state,
for
example,
currently,
smart
choice,
medicaid
and
erisa
plans
such
as
culinary
continued
to
deny
access
to
their
members
to
the
state's
only
federally
recognized
hemophilia
treatment
center
in
nevada
and
their
members
continue
to
pay
cash
to
access
care.
We
have
provided
research
to
both
of
these
payers
that
this
specialized
care
delivered
as
a
hersa
program,
reduces
mortality
and
morbidity
by
40
at
a
cost
savings.
This
data
is
published
in
a
peer-reviewed
journal.
It
has
not
made
a
difference
as
currently
written.
E
This
bill
does
not
clearly
require
mcos,
providing
care
for
medicaid
recipients
or
those
who
will
be
offering
a
public
option
to
contract
in
good
faith,
with
all
willing
providers
who
already
contract
the
fee
for
service
medicaid.
We
have
been
willing
to
accept
any
contract
made
in
good
faith.
However,
we
have
been
denied
by
such
insurances,
stating
they
have
an
adequate
network
despite
having
no
federally
recognized
hemophilia
treatment
center
in
their
network.
One
provider
that
is
not
required
to
meet
federal
outcomes
is
not
network
adequacy.
A
All
right,
thank
you.
We're
going
to
go
ahead
and
close
public
testimony.
I
will
just
pause
for
a
moment
here
to
say
that
we
never
like
to
have
to
cut
off
public
testimony,
but
I
do
believe
that
we
did
a
decent
job
today
of
developing
a
record
on
this
bill
for
understanding
where
folks
positions
are.
A
My
email
has
been
very
active
to
see
the
folks
who
are
sending
in
their
written
comments
and
so
just
encourage
folks
to
continue
to
do
so
to
the
email
on
the
agenda
and
again
we
will
post
anything
that
comes
in
by
midnight
tonight
as
an
as
an
exhibit
so
that
it
will,
as
long
as
it
doesn't
have
any
of
the
precluding
items
in
it.
F
Thank
you,
madam
chair
and
members
of
the
committee,
nicole
cannazaro
senate
district
six.
I
first
want
to
just
thank
the
committee
for
taking
the
time
today
to
hear
this
bill
and
for
going
diligently
through
the
testimony
and
for
everyone
who
has
engaged
on
this
since
gosh
prior
to
even
the
2019
legislative
session.
You
know,
one
of
the
things
that
was
brought
up
is
that
we
really
should
just
look
at
why
there
are
people
who
are
uninsured.
F
F
We
should
figure
out
why
people
aren't
accessing
health
care
because
that's
a
question
that's
been
raised
for
as
long
as
I've
been
in
this
building
and
while
that's
not
as
long
as
some
it's
a
long
enough
period
of
time
for
me
to
know
that
it's
time
to
take
action
and
that's
what
senate
bill
420
is
trying
to
do.
You
know
we.
We
talked
about
and
looked
at
prior
to
the
2017
session,
the
medicare
buy-in,
and
there
was
issues
with
that
and
that
needed
to
be
looked
at
further.
F
There
was
some
additional
analysis
done
in
the
last
legislative
session.
There
was
proposed
legislation
and
that
quite
wasn't
hitting
the
mark,
and
so
we
should
do
some
more
looking
at
it.
We
passed
scr10
and
did
an
actuarial
analysis
during
the
interim
that
came
out
with
some
data.
We
know
who
the
people
are,
who
are
uninsured
and
now
the
question
is:
what
do
we
do
to
try
to
get
them
insured,
and
that
is
exactly
what
we
are
trying
to
do
this
bill.
F
F
One
of
the
things
that
has
come
up
a
lot
is
this
cough
shifts.
I
again
want
to
emphasize
that
when
we
are
talking
about
the
individuals
who
are
qualifying
for
these
kinds
of
plans,
most
of
them
are
uncompensated
care.
Right
now,
those
cost
shifts
are
happening
in
the
market.
Right
now
and
yes,
there
will
be
cautious
we're
dealing
with
health
care.
We
know
that
even
under
multi
national
employer
plans
that
are
the
best
plans
that
you
can
have
and
you're
paying
premiums
or
your
employers
helping
to
pay
those
premiums
and
providing
that
health
care.
F
F
We
should
do
nothing
to
help
these
folks,
who
don't
have
care
who
aren't
accessing
it,
and
so
the
question
is
really
when
we
talk
about
cost
shifts,
because
that
is
a
current
reality
of
ours
of
our
system.
There
are
there's
plenty
of
money
that
is
being
made
in
the
healthcare
space,
and
so
when
we
talk
about
cost
shifts.
F
What
are
we
talking
about
here?
We
are
talking
about
people
who
are
not
accessing
that
care
because
they
don't
have
health
insurance
and
that's
what
senate
bill.
420
is
getting
at
so
one
of
the
things
that
has
come
up
and
it,
and
it's
a
little
perplexing
to
me
that
the
biggest
argument
is
what
we
really
should
be
doing,
is
expanding
people
on
medicaid.
F
My
my
next
point
briefly,
madam
chair,
adding
people
to
medicaid
and
saying
well,
I
would
take
more
medicaid
patients
and
get
reimbursed
at
a
medicaid
rate
and
that's
what
we
should
do.
Instead
of
implementing
health
insurance
and
yet,
in
the
same
breath,
making
the
comment
and
the
argument
about
cost.
F
Shifting
is
perplexing
to
me
because
medicaid
rates
are
low
and,
if
we're
talking
about
implementing
something
where
you're
getting
reimbursed
at
higher
than
medicaid
rates,
why
that's
a
reason
to
oppose
this
bill
is
just
a
one
that
I
have
struggled
to
to
understand
in
every
sense
of
the
word,
with
respect
to
the
medicare
rates,
and
the
comment
was
made
that
the
government
is
setting
the
rates
and
that
this
is
only
medicare
compensation.
F
What
this
should
do
and
what
this
is
intending
to
do
and
with
the
ability
of
the
state's
purchasing
power
and
the
ability
to
apply
for
waivers
and
subsidies
to
help
buy
down.
Those
costs
is
that
the
health
insurers
should
be
negotiating
with
providers
for
those
rates.
Knowing
that
that's
the
floor,
but
should
be
negotiating-
and
these
are
folks
who
negotiate
for
a
living,
I
understand
that
this
is
something
that
is
going
to
incentivize
them
to
provide
those
value-based
plans
that
are
actually
showing
real
health
outcomes.
And
so
again
this
isn't
the
government
setting
rates.
F
It's
not
a
state.
There
was
another
piece
of
opposition
that
this
is
a
state-run
program
that
is
being
subsidized
by
the
taxpayers.
This
is
allowing
the
state
to
get
creative
and
to
get
innovative.
Because
again
we
can't
study
this
anymore.
That
time
has
come
and
gone
and
we
have
the
studies
and
we
have
the
data
even
so,
and
the
other
point
I'll
make
madam
chair
before
kind
of
wrapping
up
here
is
that
in
this
bill
there
is
the
provisions
that
would
allow
for
actuarial
analysis.
F
A
1332
waiver
is
going
to
require
that,
so
that
is
also
part
of
the
bill.
If
we
were
going
to
do
that
1332
waiver,
there
would
have
to
be
some
actuarial
analysis
to
go
along
with
that
in
order
to
support
that,
and
if
that's,
what
gives
people
more
assurance,
I'm
happy
to
negotiate
on
the
terms
of
the
bills
to
ensure
that
that
does
happen,
because
that
is
our
our
intent.
F
You
know,
we've
talked
about
the
percentages
of
the
premiums.
One
thing
I
wanted
to
point
out
was
that
in
colorado,
in
their
legislation
in
the
more
negotiated,
moderate
compromise
version
with
the
health
care
industry
for
their
bill
was
18
percent
reduction
in
premiums
starting
in
2022.
F
we're
giving
lead
time
we're
at
15
over
four
years
after
the
plan
is
enacted.
So
I
think
that's
worth
consideration
and
with
respect
to
the
concerns
about
the
provider
participation
pieces,
those
provider,
participation,
requirements
have
worked
in
minnesota,
so
we
have
data
that
that
does
work,
and
I
think
that
this
is
absolutely
not
only
the
right
thing
to
do,
but
also
something
that
is
going
to
provide
that
additional
piece.
F
F
That
has
got
to
tell
you
a
lot
about
whether
or
not
there's
an
issue
here,
whether
or
not
there
are
sufficient
choices
and
what
we
should
be
doing
about
it
again.
This
does
not
affect
employer-based.
Health
plans
doesn't
affect
association
health
plans.
So
those
are
not
what
we're
talking
about
here,
but
what
we
are
talking
about
is
how
do
you
provide
affordable
and
accessible
health
care
to
nevadans
when
we
know
that
there
is
an
issue,
and
I
think
that
this
is
a
step
in
the
right
direction.
F
There
are
some
folks
that
we
are
still
working
on
with
amendments.
We
will
continue
that
work
and
I
will
stop
there,
but
thank
you,
madam
chair,
very
much
for
the
in
the
very
generous
amount
of
time
that
you
have
allowed
for
us
to
present
what
I
believe
to
be
a
very
important
issue.
A
Thank
you
majority
leader,
all
right
with
that.
I'm
going
to
close
the
hearing
on
senate
bill
420
thank
the
majority
leader
for
bringing
the
bill
by
way
of
logistics
team
we're
going
to
take
a
five
minute
break,
which
will
also
allow
those
of
you
who
only
had
an
interest
in
420
to
exit,
because
I
know
there
are
some
folks
who
would
like
to
come
in
for
the
next
bills
that
we
are
hearing
so
folks,
let's
be
back
at
6
10.
A
A
A
All
right,
I'm
going
to
bring
us
back
into
session.
We
are
going
to
move
on
and
open
up
the
hearing
on
ab205
and
invite
assemblywoman
cohen
to
present
the
bill.
S
Leslie
cohen
assembly
district
29,
thank
you,
chair
and
committee
for
hearing
ab205
presenting
with
me
is
trey
delapp
from
group
six
partners.
Mr
g-lab
has
worked
in
behavioral
health
addiction
and
recovery
policy
for
years
and
specializes
in
advocating
in
the
spaces
where
they
converge.
So
he's
going
to
give
us
some
information
about
opioid
use
very
briefly
and
quickly.
T
Good
evening,
madam
chair,
my
name
is
troy
d
lapp
for
the
record
david,
easy,
lincoln,
adam
paul.
Thank
you,
assemblywoman
cohen,
for
assembly
205.
This
deals
with
naloxone
in
schools
and
what
I
want
to
do
is
give
some
background
data
information
for
the
committee's
consideration.
T
Or
especially
for
young
people
under
17.,
all
deaths
recorded
here
or
in
2020
were
unintentional
opioid
overdose
deaths
attributable
to
fentanyl
the
synthetic
opioid.
Overall,
the
state
saw
29
percent
increase
in
the
death
by
overdose
of
opioids
in
the
adult
population,
and
the
synthetic
opioids
account
for
two
times
the
overdose
deaths
of
heroin.
T
The
death
rate,
the
num,
the
number
of
young
people
who
die
by
overdose
of
synthetic
opioids
equals
double
the
peak
year
of
the
opioid
epidemic,
considered
to
be
2011..
T
The
sum
of
in
2020
alone,
the
opioid
overdose
death
in
the
8
to
17
population
was
a
third
of
the
total
number
of
the
same
population
in
the
last
decade.
It's
a
it's.
A
significant
spike
prevalence
of
opioids
among
young
people
is,
is
relatively
high
and
young
people
are
having
access
and
using
illicit
drugs.
34.7
percent
of
young
people
in
grades,
8
10
12,
have
used
illicit
drugs
during
their
lifetime.
27
percent
of
those
have
used
them
in
the
preceding
year.
T
T
This
gives
us
pause
to
sort
of
take
a
look
back
at
what
the
opioid
epidemic
has
been
and
how
how
this
has
been
evolved,
and
I
want
to
take
a
a
moment
to
think
to
note
the
year
1995
1995
was
the
year
oxycontin
hit
the
market.
1995
was
the
year
that
the
fifth
vital
sign
was
designated
as
the
one
to
ten
of
pain
in
1995.
T
I
was
a
junior
in
high
school
working
at
boulder
city
hospital,
and
this
was
a
change
that
was
going
on
there
so
also
in
1995.
The
nevada
board
of
pharmacy
activated
one
of
the
first
in
the
country,
prescription,
monitoring
programs.
This
was
the
brainchild
of
keith
mcdonald
and
it
was
considered
to
be
very
innovative
at
the
time
so
between
1995
and
2015,
an
opioid
epidemic
erupts
and
then
the
first
piece
of
legislation
that
the
nevada
legislature
enacts
is
the
good
samaritan
bill
in
2015.
T
The
first
thing
the
nevada
legislature
did,
in
response
to
the
opioid
epidemic,
was
to
create
a
harm
reduction,
safe,
harbor
encouragement
for
people
to
intercede
when
opioid
addiction
overdose
is
occurring.
This
was
a
key
piece
of
legislation
in
2017,
a
comprehensive
overhaul
of
prescribing
occurred
and
the
pmp
became
mandatory,
and
one
part
of
this,
too,
is
that
this
is
these
are
nevada
things.
But
when
we,
when
we
look
at
opioids
globally,
the
united
states
is
the
largest
consumer
of
morphine
accounting
for
almost
40
percent
of
the
world's
consumption
of
morphine.
T
T
T
The
number
of
overdose
deaths
from
heroin
between
1999
and
2019
dropped
approximately
20
percent
fewer
deaths
from
heroin,
but
those
deaths
were
picked
up
by
fentanyl
overdoses,
which
was
again
29.
With
regard
to
the
specific
impact
on
children.
1.
2.2
million
children
have
a
direct
impact
with
someone
in
their
family
that
has
opioid
disorder.
They
have
loss
of
parent
of
these
170
000
young
people
have
overdosed
on
opioids
that
were
in
the
house.
T
T
Two-Thirds
or
41
percent
are
five
or
younger.
Another
third
are
between
the
ages
of
6
and
11,
and
27
are
between
the
ages
of
12
and
17..
Now
things
have
changed.
I
mentioned
earlier
that
in
2017
the
pmp
the
prescription
drug
monitoring
program
became
mandatory,
and
this
was
this
was
designed
to
target
the
first
phase
of
the
opiate
epidemic,
which
was
over
prescribing,
so
the
pmp
becomes
mandatory
due
and
have
we
seen
a
drop
in
opioid
prescriptions.
We
have
seen
a
drop
in
opioid
prescriptions.
T
T
Also,
innovations
with
regard
to
the
house
of
medicine
and
its
response
to
the
opioid
epidemic
is
the
co-prescribing
of
naloxone
and
narcan.
The
va
has
been
doing
this
for
a
while.
If
they
write
prescriptions
for
opioids,
they
also
write
prescriptions
for
narcan
and
or
monoxone
and
will
educate
others
in
the
household
on
its
use.
T
T
T
This
again
connects
to
the
availability
of
of
opioids,
so
opioids
may
be
available
in
the
house
for
whatever
reason,
and
then
kids
are
able
to
get
access
to
them
and
then
there's
also
the
strong
market
and
demand
the
profitability
of
synthetic
fentanyl
is
is
tremendous.
T
If
a
drug
dealer
has
one
kilogram
of
the
source
material,
they
have
two
choices:
they
can
make
a
kilogram
of
heroin
or
they
can
make
20
kilograms
of
fentanyl.
The
kilogram
of
heroin
will
yield
80
000
in
revenue.
The
20
kilograms
of
synthetic
fentanyl
opioids
will
yield
1.6
million
in
revenue,
so
the
there's
demand
in
the
prevalence
demand
and
the
use
and
awareness
and
there's
certainly
a
profit
motive.
Southern
nevada
has
seen
this
spike
and
is
doing
what
they
can
with
public
education.
T
T
All
of
this
information
suggests
that
we
should
do
something.
The
opioid
epidemic
has
been
an
all
hands
on
deck
response,
and
there
have
been
things
that
that
are
are
working
and
we're
still
doing
things
and
tweaking
things
and-
and
so
this
is
an
important
piece
of
legislation
and
I'll
yield
there
to
assembly
women,
cohen
and
the
committee.
Thank
you,
madam
chair.
S
Thank
you
again:
leslie
cohen
assembly,
district
29
and
we've
the
nevada
health.
The
health
department
has
reported
the
the
age
range
of
use
of
opioids
in
nevada
is
falling
to
such
an
extent
that
the
average
age
has
fallen
from
49
years
old
to
29
years
old,
the
federal
government
in
an
effort
to
stop
the
health
crisis,
has
been
giving
out
opioid
antagonists
to
prevent
overdose
and
that's
without
qualification.
S
In
fact,
the
nevada
osteopathic
medical
association,
national
association
of
school
nurses
and
substance
abuse,
mental
health
service
administration
of
the
us
department
of
health
and
human
services
have
confirmed
that
narcan
is
safe
and
can
be
given
without
harm
according
to
the
nevada.
Osteopathic
medical
association
quote
naloxone
or
narcan
is
safe
and
effective.
S
S
So,
to
be
clear,
if
someone's
overdosing
from
an
opioid
they're
going
to
die
without
intervention
right
often
lives
are
lost,
waiting
for
the
ambulance
to
arrive
and
naloxone
administered,
while
waiting
for
the
ambulance
saves
lives,
it's
safe,
it's
more
benign
than
epinephrine
and
it's
administered
to
someone
who
is
not
overdosing
or
one
administered
to
someone
who's,
not
overdosing.
It
doesn't
harm
them
because
it's
it's
a
blocker.
S
So
at
different
times
I
and
other
legislators
have
distributed
to
different
people
in
the
building.
Naloxone
kits
like
this.
With
money
from
the
federal
government,
the
nevada
state
opioid
response
reports.
They
have
distributed
13,
185,
kids
and
932
reversals
from
the
use
of
naloxone,
that's
932
nevadans,
who
would
have
died
if
they
didn't
receive
naloxone.
S
How,
however,
organizations
such
oh
and
then
this
kit
I
have
is
from
partnership,
carson
city
there's,
gloves
some
information
on
opioids
instructions
and
a
couple
of
naloxone
sprays,
but
you
really
don't
have
to
have
training.
You
can
just
read
the
pamphlet
and
you
can
save
someone's
life
organizations
such
as
partnership,
carson
city
provide
free
monthly
training.
Training
takes
about
30
minutes
to
an
hour
and
in
the
training
administration
of
the
naloxone
itself,
takes
about
10
minutes.
S
The
training
also
stresses
calling
for
medical
help.
So
what
we
have
is
that
there's
a
problem
there's
a
way
to
solve
it
and
that
way
to
solve
it
will
do
no
harm
and
our
children
are
beginning
to
overdose.
On
opioids,
more
and
more
it's
you
know.
Eight
unintentional
overdoses
in
nevada
is
the
number
that
we
have
right
now
and
that's
a
300
percent
rise
in
numbers.
Also.
A
There's
no
mandate,
no
mandate
enabling
language
great.
Thank
you
all
right.
Thank
you
for
the
president
presentation,
assemblywoman
cohen
members
of
the
committee
questions.
A
I
I
can
see
it's
built
on
the
very
beautiful
work
of
senator
debbie
smith,
with
the
epipen
legislation
and
so
high
level
of
confidence
that
it
can
work
and
save
lives.
If
that's
the
framework
that
it's
built
on,
I
don't
have
any
questions
either.
So
we're
going
to
go
ahead
and
open
up
public
testimony.
A
B
A
S
Leslie
cohen
assembly
district
29.
I
would
also
like
to
say
that
this
is
also
built
on
the
work
of
speaker
hambrick
in
the
last
session.
The
bill
just
wasn't
quite
there
at
the
end
of
session
with
that,
thank
you
and
if
you
could
just
pause.
A
E
Yes,
I
was
just
I
was
just
going
to
say
best.
She
was
reading
the
deal.
I
thought
about
center
smith
and
especially
know
that
the
work
she
started
was
to
continue.
A
S
Thank
you,
leslie
cohen
assembly
district
29,
and
thank
you
for
hearing
assembly
bill
96.
S
S
I
heard
a
radio
news
story
about
a
program
for
peer
support
for
first
responders
in
another
state
that
was
just
having
great
results,
and
one
of
the
people
interviewed
spoke
about
how
most
of
us
run
away
from
bullets
run
away
from
fire.
So
when
the
people
who
run
toward
fire
and
bullets
when
they're
in
crisis,
it's
easier
for
them
to
open
up
to
people
who
know
what
that's
like,
which
which
is
pure
support-
and
they
do
need
to
open
up
to
get
support.
S
S
Moreover,
the
white
paper
noted
that
firefighter
behavioral
health
alliance
estimates
that
firefighter
suicides
are
substantially
underreported
on
top
of
all
of
that,
first
responders
are
at
risk
for
ptsd,
depression,
substance
abuse
and
suicide.
Ideation
and
attempts
both
natural
and
technological
disasters
were
found
to
be
associated
with
increased
risks
of
these
conditions,
and
a
technological
disaster
is
a
catastrophic
event.
That's
caused
by
either
human
error
in
controlling
technology
or
a
malfunction
of
a
technology
system
and
there's
as
serious
as
natural
disasters
like
bridge
collapse.
S
That
type
of
thing
emergency
medical
service
personnel
are
not
immune
to
mental
health
issues
either.
According
to
the
bulletin,
one
of
the
core
risk
factors
for
first
responders
is
the
pace
of
the
work.
One
study
noted
and
the
bulletin
found
that
90
69
of
ems
professionals
have
never
had
enough
time
to
recover
between
traumatic
events,
the
results,
the
results
is:
depression,
stress,
ptsd,
suicidal
ideation
and
other
functional
relational
conditions
being
reported.
S
So
the
good
news
is,
since
I
started
thinking
gee,
we
should
do
something
first
responders.
Their
supporters
and
mental
health
professionals
have
started
to
do
something
which
is
part
of
why
I
substantially
amended
ab96
in
the
assembly,
so
we
can
help
first
responders,
while,
frankly,
not
spending
funds,
we
don't
have,
and
the
legislation
won't
counteract
any
of
the
good
work.
That's
been
done
by
first
responder
peer
support
groups
and
I
hope
in
the
future
we
will
have
the
funds
to
be
able
to
do
more.
S
I
won't
do
the
walkthrough,
because
you're
good
readers,
and
but
I
will
let
you
know
that
with
us-
is
margo
chapel,
the
deputy
administrator
of
regulatory
and
planning
services
of
the
division
of
public
and
behavioral
health
she's
available
to
answer
any
questions.
S
Her
office,
she
and
her
office
were
extremely
helpful
kind
of
narrowing
down
the
bill,
so
we
could
get
rid
of
the
big
fiscal
and
again
it's
not
a
big
bill,
but
it
does
kind
of
do
some
important
things
like
data
collection
and
getting
that
information
about
peer
support
first
responders
out
there
and
kind
of
sets
the
scene
for
us
being
able
to
come
back
later
and
and
maybe
provide
some
financial
assistance
in
the
future.
When
we're
able
to.
As
first
responder
peer
support
for
first
responder
grows
throughout
the
state,
so.
A
A
I
will
just
ask
we're
seeing
a
lot
of
bills,
this
session,
which
are
have
the
language
of
within
the
limits
of
available
money
or
as
money
is
available,
and
so
I
guess
my
question
may
be
more
for
miss
chapel
I
mean.
Is
there
anything
that
we
are
currently
doing
out
of
the
office
of
suicide
prevention
or
out
of
any
of
the
behavioral
health
initiatives
through
the
block
grants
or
anything
along
those
lines
that
does
align
with
this
or
what
other
efforts?
A
B
Thank
you,
margot
chapel,
for
the
record
there
are
there
may
be.
And
frankly
I
I'm
sorry,
we
don't
have
dr
woodard
on
the
line
to
answer
the
question
about
samsa
and
some
of
those
others,
but
we
are
looking
at
the
fees
for
license
our
ems
folks
and
the
advisory
committee
will
be
given
an
opportunity
to
increase
those
fees.
B
That's
one
of
the
opportunities
we're
looking
at
for
being
able
to
contribute
to
this
and
and
fund
that,
however-
and
I
really
don't
know
how
the
gentlemen
who
are
offering
the
program
currently-
and
I
say
that
because
they
they
are
men,
but
there
could
be
women
who
do
the
same
job,
but
just
right
now
they
it's
men
who
are
doing
it
and
and
they,
but
they
I
don't
know
how
they're
funding
it
right
now
and-
and
they
may
have
some
ideas
as
well.
B
A
S
Leslie
cohen
assembly
district
29,
yes,
there
like
I,
was
saying,
as
as
I
was
kind
of
like
two:
we
should
do
something
they
actually
did
start
doing
something,
and
so
there
is
a
program
I
know
they're
in
the
north.
S
A
I
will
acknowledge
that
I'm
getting
a
little
skeptical
about
to
the
extent
money
is
available
bills
this
session,
but
I
hope
that
we
actually
make
find
a
path
to
do
some
meaningful
work
here.
S
Leslie
cohen,
is
on
my
district
29.
I
I
agree
exactly
and
and
there's
also
the
pieces
about
getting
the
information
out
having
the
place
for
information
to
to
flow
through
that
type
of
thing.
So
so
it's
not
just
coming
from
from
a
not-for-profit,
but
that
the
the
state
is
providing
that
information
to
people
who
might
be
looking
for
it.
A
Great,
thank
you
any
other
questions
or
comments.
Seeing
them
we'll
go
ahead
and
open
up
public
testimony
on
assembly
bill
96.
those
who'd
like
to
testify
and
support
bps.
Please
help
us
out
two
minutes.
Two
minute
limit.
B
I
Good
afternoon
committee
and
chair
ready,
this
is
tony
yarbrough
for
the
record.
That's
spelled
tony
tony
yarborough
y-a-r-b-r-o-u-g-h.
I
I
am
representing
about
9
000
members
of
the
veterans
of
foreign
wars
of
the
department
of
nevada,
and
I
also
represent
roughly
one
half
million
members
of
the
united
veterans
legislative
council.
As
a
past
officer.
I
And
for
that
reason
we
we
recognize
that
one
of
the
biggest
challenges
that
we
face
today
is
the
fact
that
we
have
a
very
high
rate
of
suicide
among
our
our
members
and
that's
also
true
in
the
same
situation.
I
It
helps
to
identify
the
causation
as
well
as
the
prevention,
and
for
that
reason
we
believe
that
this
is
a
good
start,
because
we
know,
as
we
already
know,
we
haven't
been
able
to
stop
stop
suicides.
All
we
can
do
is
try
to
prevent
it.
So
we
go
through
a
combination
of
training.
We
go
through
a
combination
of
exercise,
counseling
and
and
peer
advocacy,
and
with
that
I
will
say
please,
please
support
this
bill.
I
really
thank
you
for
your
time.
B
B
A
All
right,
I
just
wanted
to
check
in
with
senator
spearman
senator
spearman.
Did
I
miss
you
on
questions
or
comments
on
this
one.
E
One
of
the
things
and
I
sent
to
mr
mossy
a
a
link,
one
of
the
things
that
the
va
has
done
in
order
to
help
carry
the
load
is
they
have
trained
and
fielded
pure
peer-to-peer
specialists
and
supports
people
so
to
the
extent
that
money
is
available,
but
I
think
there
might
be
some
collaboration,
we
might
be
able
to
do
with
the
department
of
veterans
affairs,
at
least,
if
not
at
the
federal
level,
we
should
probably
be
able
to
do
something
with
our
department
of
veterans
services
here
in
nevada.
E
A
S
Thank
you,
madam
chair,
for
the
record,
I'm
leslie
cohen
assembly
district
29,
I'm
here
to
present
assembly
bill
217,
which
came
out
of
the
2019-2020
interim
legislative
committee
on
healthcare,
so
our
your
own,
miss
komblasi
had
a
lot
to
do
with
helping
making
soup
with
it.
S
So
it's
the
result
of
a
study
which
was
ab
131
of
the
2019
legislative
session,
and
it
requires
the
committee
to
examine
issues
related
to
training
for
non-medical
caregivers,
who
provide
care
at
certain
facilities,
compare
training
standards
and
determine
whether
certain
unlicensed
employees-
and-
let
me
be
clear,
so
it's
unlicensed
employees
and
contractors
should
be
required
to
complete
a
minimum
amount
of
training.
S
The
study
specifically
addressed
the
training
for
the
unlicensed
staff,
who
provided
care
for
clients
and
patients
in
non-medical
facilities
such
as
assisted
living
and
community-based
living
arrangements,
as
well
as
unlicensed
individuals
who
work
in
medical
facilities,
and
these
individuals
provide
a
range
of
services.
So
it's
from
helping
with
medication
administration
to
assisting
with
activities
of
daily
living
like
helping
with
bathing
lifting
someone
helping
them
eat,
helping
them
get
dressed,
helping
them
get
on
a
bus
and
again
the
key
is
unlicensed.
So
not
certified
nursing
assistants,
not
dietitians,
not
registered
physical
therapy.
S
So
ab-131
built
off
a
2017-2018
study
by
the
legislative
committee
on
seniors,
vets
and
adults
with
special
needs
which
considered
many
of
the
same
issues,
but
it
found
some
of
the
biggest
issues
couldn't
be
resolved
with
training
or
some
of
the
it
found
that
some
of
the
biggest
issues
that
could
be
resolved
with
training
was
also
related
to
sterilization
procedures,
sanitation
infection
control
and
appropriate
care
and
treatment,
and
that
obviously
became
a
big
issue
during
covid.
S
So
what
the
committee
ultimately
decided
is
the
best
way
to
ensure
unlicensed
caregivers
receive
appropriate
training,
is
to
have
the
state
board
of
health,
adopt
regulations
prescribing
these
requirements,
and
this
will
allow
training
requirements
to
be
more
flexible
and
nimble
than
if
they
were
established
in
legislation.
S
It
will
also
allow
the
state
board
of
health
to
revise
requirements.
As
new
issues
emerge,
I
can
skip
the
walk
through
I'll,
let
you
know
well
and
and
also
I'm
sorry.
I
was
remiss
I
for
didn't
mention
that
mr
robbins
also
had
a
hand
in
in
the
interim
committee
and
making
sure
we
got
the
bills
ready
to
present
to
you.
S
So
with
us
is
margo
chapel,
again,
deputy
administrator
of
regulatory
and
planning
services
of
the
division
of
public
and
behavioral
health,
and
I
believe
she
has
actual
testimony
and
is
not
just
here
for
questions,
so
I
will
pass
it
off
to
deputy
administrator
chapel.
Miss
chapel.
B
Thank
you
for
the
record
margo
chapel.
During
the
pandemic,
we
witnessed
quite
a
few
citations
during
the
in
in
facilities
where
they
had
unlicensed
caregivers
working,
and
we
would
just
to
give
you
a
couple
of
examples.
We
would
see
people
working
in
the
kid
in
the
kitchen
who
would
think
since
nobody
was
around,
they
could
take
their
mask
off
so
they're
preparing
food
without
a
mask
on
or
some
other
violations
that
were
really
in
that
untrained
unlicensed
caregiver
role,
so
just
wanted
to
make
sure
that
that
got
added
to
the
record.
A
A
B
B
C
Good
evening,
madam
chair
member
of
the
committee
for
the
record,
my
name
is
still
barry
gold
and
I
am
still
the
government
relations
director
for
aarp
nevada,
I'm
very
pleased
to
have
worked
with
assemblywoman
cohn
on
this
concept,
for
this
bill
all
the
way
since
the
2017
session.
As
I
said
before,
and
I'll
say
it
again
now,
sometimes
the
state
of
nevada
is
very
good
for
these
unlicensed
personnel.
We
fingerprint
them,
we
background,
check
them
and
we
tv
test
them,
but
that
sometimes
is
all
we
really
require.
C
So
we
don't
not
know
what
they're
doing,
but
in
terms
of
what
she
was
talking
about,
the
data
a
lot
of
these
facilities,
whether
they're
hercks.
For
those
of
you
who
don't
know
what
a
hurt
is:
it's
a
home
for
individual
residential
care
or
some
of
these
adult
care
homes,
the
overnight
staff,
the
people
that
just
stay
overnight,
the
people
that
do
different
things,
the
people
that
might
work
in
the
kitchen,
the
people
that
do
different
things
that
do
have
some
caregiving
responsibilities.
C
C
So
we
know
exactly
what
they're
being
done
this
bill
after
a
lot
of
work
is
actually
the
best
way
to
make
this
happen
by
regulation,
deciding
which
facilities,
which
staff
in
which
training
and
by
not
putting
it
in
statute,
it
becomes
flexible
to
develop
whatever
the
current
needs
are.
So
I
think
that
is
just
a
great
idea
and
I'm
really
pleased
where
this
has
gone.
So
I
commend
assembly
woman
cohn
for
sticking
with
this
concept.
C
A
J
A
S
You
it's
just
a
modicum
of
some
regulation,
some
or
monochrome
of
training
for
people
who
are
dealing
with
our
most
vulnerable
population,
whether
it
is
infectious
disease
control
or
you
know,
helping
get
someone
onto
a
bus
without
hurting
them.
So
thank
you.
A
Thank
you,
assemblywoman.
I'm
afraid
we
learned
a
lot
of
lessons
the
hard
way
over
the
last
many
months
of
this
pandemic,
and
I
appreciate
the
effort
all
right,
we're
going
to
close
the
bill
on
the
hearing
on
abc
217,
our
last
item
of
business.
Before
we
go
to
public
comment,
we'll
just
say
that
we
will
be
meeting
on
thursday.
We
have
three
bills
on
the
schedule:
ab287,
ab-326
and
ab374.
A
B
B
A
Thank
you
again.
I
will
just
express
my
gratitude
to
the
team
at
bps
who
keeps
us
going
with
all
this
wonderful
technology,
we're
using
this
session,
our
legislative
council
bureau
staff,
ms
komasi
and
mr
robbins
and
everybody
who
you
don't
see
behind
the
scenes
that
helps
them
out,
as
well
as
our
senate
staff,
nicole
flanges,
vicky
palzin
and
norma
mallett,
who
have
done
an
outstanding
job
this
session
and
folks
just
don't
get
to
see.
A
So
thank
you
to
everybody,
as
well
as
just
all
of
the
staff
who
are
keeping
this
building
functioning
in
the
midst
of
a
very
strange
time
with
that
we
are
adjourned.