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A
Good
afternoon
welcome
everyone
to
the
senate
committee
on
Health
and
Human
Services
Madam
Secretary
of
police
proceed
to
call
the
roll.
A
I'm
here
please
mark
Senator,
Stone
and
Senator
Nguyen
as
president
when
they
arrive
they're
they're
in
a
different
committee
meeting
right
now,
good
after
everyone's
president
Madam
Secretary.
Please
indicate
the
members
will
eventually
be
present
with
the
other
two.
Today
we
have
a
bill
presentation
by
the
Nevada
Hospital
Association
and
the
bill
Herring
on
Senate
Bill
419.
A
So
just
as
for
folks
who
are
interested
on
the
agenda
item,
this
is
the
way
that
we'll
do
today's
agenda.
So
we'll
start
off
by
welcoming
the
folks
from
the
Nevada
Hospital
Association
to
present
on
on
uncompensated
care.
After
that,
we
will
move
to
the
next
Regina
item,
which
is
Senate
Bill
419,
and
then
we
will
proceed
with
testimony
Etc
throughout
this
process.
A
We
have
reached
capacity
here
in
this
room
and
there
is
an
overflow
room
as
well.
So
as
folks
are
watching,
the
Bill
presentation
just
pay
attention
to
the
remarks
that
Vice
chairwin
will
give
you
as
to
when
it's
appropriate
for
folks
that
are
in
the
Overflow
room
to
come
into
this
room
and
we'll
try
to
Encompass
everyone.
For
the
sake
of
this
presentation,
a
few
housekeeping
items
that
we
have
specifically
for
today,
first
I,
am
very
excited
to
announce
that
we
do
have
a
Spanish
translator
available
via
Zoom.
A
A
A
In
a
furthermore,
we
asked
that
public
comments
be
kept
to
two
minutes
so
that
everyone
interested
in
speaking,
can
be
accommodated
and
ensure
that
we
can
get
through
the
agenda
in
a
timely
fashion,
and
speakers
are
urged
to
avoid
repetition
of
comments
made
by
previous
speakers.
If
we
have
the,
if
you've
run
into
the
instance
where
you
aren't
able
to
express
yourself
in
those
two
minutes.
Of
course,
you
can
always
submit
your
public
comments
to
our
committee
staff,
who
are
graciously
Staffing
us
here
today.
A
If
you
wish
to
testify,
you
can
please
sign
in
at
the
table
by
the
door
and
provide
a
business
card
to
the
committee
secretary.
If
you
have
one,
if
you
do
not
wish
to
testify,
you
can
also
sign
in
as
well
and
just
know
that
the
chair,
or
a
member
of
the
committee
May
request
testifier
to
submit
documentation
to
support
their
testimony
today.
When
testifying,
please
turn
on
the
microphones
on
to
speak
and
off
to
listen.
A
We
have
listeners
and
viewers
in
Las,
Vegas
and
online
and
recording
this
meeting
as
it
will
be
available
on
a
legislature's
website
later
and
the
reminder
to
all
those
who
testify
pursue
into
NRS
218e.
It
is
unlawful
for
a
person
to
knowingly
misrepresent
facts
when
testifying
before
a
legislative
committee,
a
person
who
not
only
does
so
is
guilty
of
a
misdemeanor.
A
Anyone
who
wishes
to
receive
copies
of
the
committee's
exhibits
should
go
to
the
legislature's
website
and,
finally,
we
ask
that
everyone,
please
turn
off
your
electronic
devices,
especially
cell
phones
and
laptops,
or
put
them
on
silent
mode
throughout
the
meeting.
So
as
we
await
our
committee
members
to
come
from
their
other
committee,
we're
going
to
go
ahead
and
proceed
with
the
presentation
from
the
Nevada
Hospital
Association
I'm,
very
honored,
to
introduce
with
us
Mr
Pat
Kelly,
who
is
the
president
and
CEO
of
the
Nevada
Hospital
Association.
A
C
Mr,
chairman
members
of
the
committee,
thank
you
so
much
for
inviting
me
back
to
speak.
As
you
recall,
I
was
here
a
couple
weeks
ago
talking
about
the
status
of
hospitals
in
Nevada
and
in
that
presentation,
I
had
a
slide
or
two
on
uncompensated
care,
and
the
chairman
asked
me
if
I
could
elaborate
on
that
a
little
bit.
So
that's
my
plan
for
today.
C
In
Nevada,
we
have
about
1.26
billion
dollars
in
under
reimbursed
care
each
year
in
in
our
hospitals
and,
as
you
recall,
the
last
time
I
presented
I
presented
about
19
hospitals
and
the
reason
is
that
under
state
law,
the
largest
hospitals
in
the
state
are
required
to
file
an
information
annually
and
there's
a
hospital
annual
report
and
that's
where
I'm
driving
this
information.
So
we're
not
counting
all
the
hospitals.
Today,
we're
going
to
be
primarily
looking
at
the
19
largest.
C
C
So
this
group
represents
about
75
percent
of
the
care.
That's
provided
in
these
19
acute
care
hospitals,
so
it's
a
significant
amount
and
what
you're
going
to
see
in
the
video
I'm
going
to
show
you
is
that
each
member
of
that
group
doesn't
pay
the
full
cost
of
the
care
that
they
receive.
So
you
know,
there's
a
difference
between
cost
and
charges.
I'm,
not
talking
about
charges.
I'm
talking
about
the
base
cost.
D
If
you
have
private
insurance,
you're,
probably
wondering
why
your
health
insurance
is
expensive,
one
big
reason
is
cost
shifting.
You
pay
the
cost
of
your
Care
Plus
part
of
the
cost
of
care
covered
by
government
programs.
Let's
say
a
procedure
costs
a
hospital.
One
thousand
dollars
to
provide
Nevada
Medicaid
will
pay
on
average
530
dollars
for
the
procedure
or
about
53
percent
of
the
cost.
D
Some
hospitals
receive
a
supplemental
payment
from
the
government,
but
not
all.
Now,
let's
look
at
Medicare
nationally
Medicare
pays
on
average
eight
hundred
and
seventy
dollars
or
about
87
percent
of
the
cost.
Now
you
may
be
wondering
if
both
groups
pay
less
than
the
hospital's
cost
to
provide
the
service
who
makes
up
the
difference?
D
The
answer
union
members,
small
businesses,
families
and
anyone
with
private
insurance.
These
groups
pay
more
than
the
cost
of
their
care.
The
cost
is
shifted
from
government
programs
to
patients
with
private
insurance.
How
big
is
this
cost
shift?
It's
huge.
Approximately
70
percent
of
the
care
provided
by
Nevada
hospitals
is
to
Medicaid
and
Medicare
beneficiaries.
D
Additionally
the
cost
of
care
provided
to
people
who
are
unable
to
pay
their
medical
bills
is
also
shifted
in
all.
Nearly
75
percent
of
care
is
partially
subsidized
by
the
insured
groups.
That's
a
lot
of
shifting
small
businesses
and
families
can't
continue
to
pick
up
the
cost
of
these
government
programs
they're
already
paying
too
much.
Government
programs
should
pay
at
least
the
cost
of
the
care
provided.
C
C
Now
the
thing
in
this
presentation,
Medicare
is
a
program,
that's
a
federal
program,
so
the
state
doesn't
have
a
lot
of
influence
on
it,
but
I
wanted
to
share
with
you
just
that
Medicare
is
a
cost
shifter
because
they
have
to
be
considered
in
all
this.
But
this
is
a
area
that
the
Nevada
legislature
does
not
have
much
influence
over.
So
let's
take
a
look
at
the
areas
where
the
legislature
can
have
some
influence
and
we
have
about
1.1
billion
dollars
in
under
reimbursed
care.
C
That's
offered
each
year,
and
that
goes
to
these
four
groups:
Medicaid
underinsured
and
uninsured
and
undocumented
individuals,
and
we'll
take
a
look
at
each
one
of
them.
So
with
Medicaid,
we
have
about
one
in
three
nevadans
who
are
Medicaid
beneficiaries.
Now.
That
number
is
probably
going
to
change
a
little
bit
in
the
near
future,
because
at
the
end
of
the
public
health
emergency
there's
going
to
be
a
reevaluation
of
whether
people
are
still
eligible
to
apply
for
and
be
serviced
by
Medicaid.
So
what
will
happen?
C
We
hope
is
that
a
lot
of
the
people
who,
during
the
pandemic
lost
their
jobs
and
went
on
Medicaid
will
found
jobs
by
this
point
in
time
and
will
have
some
Private
health
insurance.
But
if
not
they'll
have
to
look
at,
they
may
be
able
to
re-enroll
in
Medicaid,
or
they
will
be
eligible
for
the
Silver
State
Health
Insurance
Exchange
and
get
their
payments
there.
But,
as
we
said
in
the
video
Medicaid
represents
a
huge
cost
shift.
C
It's
51
to
53
percent
of
the
cost
that's
covered,
but
the
rest
is
not,
and
that
is
shifted
on
to
other
groups.
Commercial
Insurance
primarily
now
this
chart's
an
interesting
one,
because
it
looks
at
the
growth
of
Medicaid
rates
and
the
growth
of
Hospital
costs.
So
the
bottom
line
is
the
Medicaid
rates.
As
you
can
see,
it's
not
going
up
dramatically
from
the
90s
and
then
you
look
at
hospital
costs
and
they
have
gone
up
dramatically
and
the
Gap
is
about
50
percent.
C
And
if
you
look
at
the
bottom
line
on
the
Medicaid
rates,
you'll
notice
that
there's
really
only
in
the
last
20
years
about
a
five
percent
increase
in
Medicaid
rates
paid
to
hospitals
and
I'm,
not
talking
about
five
percent
each
year.
This
is
five
percent.
Over
20
years,
this
graph
looks
at
the
contributions
made
by
three
different
entities
towards
Hospital
Medicaid
costs.
So
the
state
contributes
about
14
percent,
that's
matched
by
the
federal
government
at
37
percent,
but
hospitals
come
up
with
49
of
the
contribution
so
they're
much
larger
than
any
of
the
groups.
C
There's
a
category
that's
kind
of
interesting:
it's
called
dual
eligibles
and
these
are
people
who
are
eligible
for
both
Medicare
and
Medicaid,
and
we
have
about
the
78
000
nevadans,
who
fall
into
this
category
and
Medicare
is
the
primary
pair
on
this
insurance
and
Medicaid
comes
in
with
the
co-pays
and
the
deductibles.
But
when
it
comes
to
hospital
care,
Medicaid
does
not
pay
the
co-pays
and
the
deductibles.
That's
the
cost.
That's
absorbed
by
the
hospitals.
C
We
have
to
look
at
insurance
plans
because
they're
starting
to
have
an
impact
as
well.
So
when
we
have
high
deductible
plans,
we
have
people
who
are
getting
plans
that
they
probably
really
cannot
afford
and
they're
hoping
that
they're
not
going
to
get
sick.
The
IRS
defines
a
high
deductible
plan,
as
of
1400
for
an
individual
and
twenty
eight
hundred
dollars
for
a
family,
It's
Not
Unusual,
to
see
five
thousand
dollar
deductibles.
Under
these
plans
for
a
family
and
for
a
working
family,
that's
a
substantial
burden.
C
They
don't
have
five
thousand
dollars
sitting
around
if
they
have
a
medical
emergency.
We
now
have
about
45
percent
of
Nevada's
workers
enrolled
in
these
high
deductible
plans.
So
what
happens
is
when
they
can't
pay
the
five
thousand
dollars?
That's
another
cost
that
the
hospitals
absorb
and
because
these
plans
are
becoming
so
popular,
we're,
seeing
a
lot
more
expense
in
that
category,
another
Health
Plan!
That's
a
concern
are
the
high
Share
Plans.
C
This
is
where
an
insurance
company
will
pay
80
percent
or
seventy
percent
of
a
hospital
bill,
but
the
policy
holder
is
required
to
come
up
with
20
or
30
percent
and
that's
a
huge
amount
of
money
for
a
lot
of
working
families,
and
so
because
they
can't
pay
that
that's
another
cost
that
the
hospital
absorbs
the
uninsured.
We
have
about
13
percent
of
nevadans
who
are
uninsured.
There
was
an
interesting
study
when
they
were
working
on
the
public
option.
C
Every
hospital
has
a
charity
care
policy
and
they
usually
are
based
on
the
federal
poverty
level
and
then
there's
all
typically
a
discount
policy
that
goes
with
it.
So
it's
a
kind
of
a
two
component.
If
you
meet
the
federal
poverty
level
requirements,
then
the
care
can
be
free
in
certain
circumstances.
And
then,
if
you
don't,
then
there's
a
discount
policy
that
applies
as
well.
I
think
I
believe.
There's
a
state
law
too
that
if
you're
a
self-pay
at
a
hospital
you
get
a
30
percent
discount
on
that.
C
Undocumented
individuals:
this
is
an
area
where
we
don't
have
statistics
on
it,
because
we
do
not
track
whether
a
person
is
undocumented
or
not
at
the
hospital.
There
is
a
part
of
Medicaid
that
will
provide
for
a
Medicaid
emergency
services,
but
it's
limited
to
acute
emergency,
medical
conditions,
labor
and
delivery
and
outpatient
dialysis
services.
So
it's
very
limited
in
terms
of
what
it
covers
and
it
only
covers
until
the
person
is
stabilized
and
then
there's
no
no
fund
to
be
able
to
take
care
of
them.
After
that.
C
This
chart
kind
of
shows
the
trends
of
where
things
are
headed.
So,
if
you
look
at
the
left-
and
you
can
just
see
it-
it
went
down
slightly
in
the
middle
and
then
starting
in
2019.
It
starts
to
go
up,
so
you
see
the
the
rate
of
uncompensated
care
for
Medicaid
increasing,
while
the
uninsured,
which
is
the
blue
at
the
top,
is
slightly
decreasing,
but
you
can
see
there's
a
definite
Trend
lined
with
respect
to
Medicaid.
C
Now
one
of
the
things
the
the
chairman
asked
me
said:
well,
if
we
could
help
and
eliminate
some
of
this
uncompensated
care,
what
would
be
the
benefits
of
closing
the
Gap?
Well,
the
first
one
would
be
that
individuals
who
are
on
Commercial
Insurance
would
not
have
to
be
subsidizing
as
much
of
the
care
provided
to
the
groups.
We
just
discussed.
C
I
also
believe
that,
over
a
time
that
people
would
start
getting
better
care
and
being
having
access
to
care
so
that
when
we
see
them
in
the
emergency
room
they're,
not
in
terrible
situation,
we
hope
that
we
could
avoid
that
and
not
have
those
types
of
admissions
coming
in
so
I
think
there
are
a
lot
of
different
different
things
that
would
help
as
we
filled
the
uncompensated
care
Gap.
A
Thank
you
so
much
Mr,
Kelly,
I,
think
for
the
committee
members.
This
is
an
important
conversation.
I
think
the
rising
levels
of
uncompensated
care
is
something
that
we
have
to
address,
because
they're
continuously
increasing
I.
Think
the
there's
a
there's,
a
question
that
I'm
going
to
ask
you.
That
perhaps,
is
the
sentiment
that
we
hear,
which
is
you
know?
How
does
this
play
out
in
terms
of
like
the
actual
spending
of
care
that
is
delivered?
Can
you
explain
to
the
committee
members
and,
of
course,
to
the
general
public?
That's
watching
today.
A
C
Yes,
Mr
chairman,
there
is
a
federal
law,
it's
an
Impala
When
anybody
presents
at
an
emergency
room,
they
will
receive
care
until
they
are
stabilized,
and
that
is
a
strictly
enforced
law
and
all
the
hospitals
follow
that
very
closely.
It's
the
emergency
medical
treatment
and
labor
and
delivery
act
or
something
along
the
Islams.
That's
what
mtala
basically
stands
for.
Thank.
A
C
E
Thank
you
and
thank
you
for
that
presentation.
I
think
we
all
know
that
uncompensated
care
is
a
huge
problem
and
I
may
have
missed
it.
I
apologize
I
was
still
sitting
in
Senate
Judiciary
at
the
time.
You
began
your
presentation,
but
what
does
that
dollar
amount?
Look
like
of
uncompensated
care
within
the
Nevada
hospitals.
C
E
Then
can
I
ask
you
another
question
currently,
obviously
this
we're
talking
about
private
hospitals,
so
are
the
private
hospitals?
How
are
they
handling
that
uncompensated
care?
They
just
I
mean
they're
writing
off
as
like
tax,
like
losses
like.
How
is
that
working
currently.
C
This
includes
the
public
hospitals
too.
Those
19
include
some
of
the
public
hospitals,
so
it's
a
mixture.
Basically,
unfortunately,
we
have
some
hospitals
that
have
some
significant
losses.
We
have
over
half
the
hospitals
and
the
the
the
state
who,
in
the
first
three
quarters
of
last
year,
had
negative
operating
margins,
so
they're
not
being
able
to
shift
all
the
money
they
need
to
be.
Shifting.
C
We've
had
hospitals
that
have
100
million
dollar
losses
in
the
last
reporting
annual
reporting
for
them,
so
I
mean
there's
significant
issues,
but
yes
do
they
try
to
recoup
the
costs
in
other
areas
absolutely
and
if
they
would
have
a
loss
and
they
worry
for-profit,
then
they
would
probably
be
able
to
get
a
little
bit
of
a
tax
write-off.
But
that's
certainly
not
the
goal.
A
Any
other
questions
Mr
Kelly
I,
the
the
question
that
I
wanted
to
ask.
So
you
know
vice
president
mentioned
of
how
a
compensated
care
actually
plays
down,
which
is
someone
has
to
pay
for
it
at
some
point
because,
historically
longer
than
any
of
us
federally,
we
have
designated
that
hospitals
have
to
take
care
of
anyone
that
steps
into
the
emergency
room.
So
I
guess
my
question
is
not
really
on
uncompensated
care,
but
rather
so
the
circumstances
that
your
hospitals
are
encountering
in
the
emergency
rooms
are.
A
Are
there
situations
because
of
uncompetent
care
where
people
aren't
able
to
access,
say
health
insurance
coverage
where
they're
turning
up
to
the
hospitals,
with
more
catastrophic
outcomes,
is
that
does
that
lead
to
your
ER
is
being
more
crowded
like?
What's
the
general
outcome
of
what
you're
seeing
right
now
on
the
ground?
Well,.
C
I
think
what
we're
seeing
is
that
people
who
don't
have
access
to
Primary
Care
Services
often
gets
sicker
and
then
present
themselves
at
the
emergency
room,
so
we're
taking
care
of
a
sicker
group.
We
also
have
the
issue
where,
because
we
don't
have
enough
access
to
primary
care,
that
people
are
coming
to
the
emergency
rooms
for
Primary
Care,
it's
about
the
most
expensive
place.
C
You
could
get
your
primary
care,
but
you
know
we,
as
I
said
we
take
care
of
everybody
and
see
everybody
who
comes
through
and
try
to
help
them
and
get
them
on
their
way.
But
yeah
I
mean
we
need
to
access
in
the
State
in
so
many
different
areas
and
Primary
Care
is
one,
and
even
once
you
identify
a
problem,
we
need
better
access
to
Specialty
Services.
A
C
It's
1.26
billion
annually.
F
Are
you
Mr
Kelly,
very
well?
How
are
you,
sir
sorry
I
wasn't
here
for
most
of
your
presentation?
Thank
you
for
the
notes.
I
look
forward
to
going
over
them
tonight,
1.26
billion
I
think
you
said:
no!
That's
for
people
that
present
at
the
emergency
room
with
urgent
situations
that
need
to
be
stabilized.
F
So
if
the
law
were
changed,
that
anybody
can
go
to
any
doctor
or
any
hospital
for
any
condition
that
doesn't
have
insurance
today,
what
kind
of
a
multiplier
effect
would
you
see
that
1.2
billion?
Would
you
see
it
maybe
four
or
five
times
as
much?
If
people
could
come
to
you
for
a
hangnail
in
the
emergency
room.
C
Which
Senator
that's
a
great
question?
I
I
really
don't
know
because
they
would
be
a
huge
multiplier
effect.
I'd
be
worried
if
I
said
four
or
five
that
that'd
be
too
small
a
number,
because
if
you
start
using,
if
everybody
starts
using
emergency
rooms
as
Primary
Care
Centers,
oh
gosh,
it
would
just
go
crazy.
We
couldn't
handle
the
capacity
with
the
current
infrastructure.
F
F
How
would
we
accommodate
the
existing
Medicaid
population?
Would
you
see
a
dilution
of
services,
because
there's
only
so
many
providers
that
can
see
these
people
and
there's
only
a
finite
amount
of
money
that
the
state
puts
up
that
gets
a
federal
match.
The
state
would
obviously
have
to
put
up
a
significant
amount
amount
of
money
to
accommodate
this
growth
in
the
Medicare
Medicaid
population
and
get
the
federal
match,
which
is
very
important
when
you
say.
F
C
F
G
C
Report
said
that
83
percent
of
of
the
uninsured
are
either
eligible
for
Medicaid
or
for
subsidies
on
the
Silver
State
Health
Insurance
Exchange.
G
Right,
that's
what
I
heard,
and
so
is
there
something
at
when
you,
because
you
get
these
patients
into
the
hospital
all
the
time.
Is
there
a
program
you
have
in
your
hospital
to
try
and
get
them
insured?
Yes,.
C
C
The
representative
will
come
down
and
try
to
work
with
them
to
find
the
the
payer
Source.
You
know.
First,
they
had
identify.
Do
you
have
Commercial
Insurance
when
that
doesn't
happen,
and
they
find
out
that
there
is
no
insurance,
they
would
start
inquiring
as
to
whether
you
would
qualify
for
Medicaid
Silver
State
Health
Insurance
Exchange.
We
can't
do
you
know
right
on
the
spot,
but
we
can
direct
them
to
that
area,
but
they
can
get
become
eligible
for
Medicaid
start
the
process
at
the
hospital.
C
G
H
Thank
you.
Thank
you,
Mr
for
the
Mr
chair
for
the
question,
and
thank
you
for
being
here
today
at
what
point
does
it
become
not
sustainable
and
the
point
I'm
bringing
up
is
if
I
I
in
this
committee
and
others
I've
been
on
I
I,
it's
not
Healthcare
is
not
like
the
Walmart
Walmart
model,
where
you
can
buy
a
bunch
of
batteries
from
China
and
pay.
You
know
Pennies
on
the
dollar,
for
them
and
if
you
sell
millions
of
batteries
at
some
point,
you're
going
to
make
a
profit.
H
If
you
continue
to
get
43
cents
on
the
dollar,
and
you
think
you
can
charge
private
insurance
companies
to
compensate
for
that.
At
some
point,
you
won't
be
able
to
sustain
the
private
insurance.
Even
will
not
be
able
to
sustain
to
reimburse
you
enough
to
keep
your
doors
open
right
now.
Did
you
say
a
third
of
the
you
said?
Let's
see,
75
percent
of
the
costs
are
now
shifted
to
Medicare
or
Medicaid
in
in
Nevada.
Well,.
C
H
C
H
The
laws
I
I
would
I
would
say
that
we
use
a
turn
if
I
might
continue.
Mr
chair,
we
use
a
term.
Are
they
underinsured,
because
I
have
patients
that
have
insurance,
but
they
can't
get
health
care
because
they're
waiting
three
months
for
their
health
care,
they
can't
get
into
a
doctor's
office
or
even
worse,
they
have
a
5
000
or
maybe
now
even
a
10
000
deductible.
H
So
these
folks
have
insurance,
but
they
they
don't
have
care,
and
so
I'm
just
worrying
that
we're
tipping
the
balance
to
such
a
point
where
pretty
soon
we
won't
have
any
health
care
in
Nevada,
because
no
office
can
stay
open.
If
you
I
used
to
tell
my
patients
my
Medicare
patients
that
it's
cheaper
for
me
to
stay,
have
you
stay
home
than
for
you
to
come
and
see
me
in
my
office
because
I
lose
money
every
time
I
see
in
my
office?
So
just
call
me
on
the
phone.
H
Would
you
or
see
me
in
the
grocery
store
come
by
my
house?
Something
because
if
you
walk
in
my
office,
it
costs
me
money,
and
so
they
would
that
get
that
aha
moment,
then
about
what
that
disparity
is
so
anyway.
I
appreciate
you
being
here
today
in
the
presentation
and
one
other
Clarity.
If
I
might,
what
percent
again
for
clarification
of
of
folks
were
eligible
for
Medicaid
or
the
Silver
State
exchange
that
never
apply
that
you
then
have
to
help
them
with
that?
Do
you
have
any
idea
about
what
percent
of
the
population.
H
C
A
Thank
you
so
much
just
one
last
question
so
because
I
work
in
health
administration,
I
always
keep
track
of
utilization
management
Etc
and
how
the
delivery
of
healthcare
services
actually
are.
Currently
you.
This
is
the
last
question
you
you
work
with
Hospital
Executives
day-to-day
you
hear
from
them.
You
know
the
outcomes
that
our
emergency
rooms
are
dealing
with.
A
Would
you
agree
that
the
best
possible
scenario
for
many
of
these
patients
that
go
to
the
emergency
room
perhaps
is
to
get
them
access
to
preventive
health
care
so
that
they
don't
have
to
go
to
the
emergency
room?
Is
that
the
outcome
that
perhaps,
would
probably
make
the
most
sense
for
uncompensated
care.
A
Thank
you
so
much.
That
concludes
a
round
of
questions
and
we'll
go
ahead
and
conclude
this
presentation.
So
thank.
E
Thank
you,
and
at
this
time
I
will
now
open
the
hearing
on
Senate
Bill
419,
which
relates
to
Public
Health,
I'm,
obviously
going
to
allow
our
chair
to
and
his
co-presenters
to
proceed
when
they
are
ready
and
make
their
way
to
the
front
table.
So
if
you
are
presenting
with
Senator
donate,
if
you
could
please
come
to
the
front
table,
that
would
be
great
and
please
begin
when
you're
ready.
A
Thank
you,
Vice,
chairwin
and
good
afternoon
to
the
members
of
the
senate
committee
on
Health
and
Human
Services
for
the
record.
My
name
is
Fabian
donate
and
I
represent
Senator
certain
in
the
heart
of
Las
Vegas
I
come
before
you
today
to
speak
on
Senate
Bill
419,
which
is
an
expensive
piece
of
legislation
that
will
make
various
reforms
to
our
health
care
System.
A
Over
the
last
few
years,
many
of
us
in
the
Healthcare
Community
have
worked
and
dreamed
about
this
moment
a
moment
that
has
taken
away
too
long
to
address
a
moment
that
is
encompassing
of
the
challenges
that
we
have
faced
as
Society.
No
nevadan
is
Left
Behind.
No
one
is
forgotten
in
the
very
first
week
of
the
legislative
session,
I
mentioned
by
intent
to
introduce
legislation
that
would
reform
our
health
care
System
to
better
reflect
and
serve
the
individuals
of
this
state.
A
A
I
lost
my
home
because
of
the
bills
for
my
care
today,
myself
and
other
community
leaders,
Physicians,
Executives
and
folks,
representing
the
community,
are
embarking
on
a
piece
of
legislation
that
will
shape
the
future
trajectory
of
Health
Care
in
our
state
and
it's
one
of
which
I
truly
believe
can
help
establish
a
simple
vision
and
that's
this.
Everyone
deserves
access
to
care,
regardless
of
who
who
they
are
where
they
come
from,
or
their
immigration
status.
A
A
As
you
look
at
this
photo
I
ask
you
to
think
about
some
of
the
words
that
come
to
mind
for
you
and
how
this
visual
makes.
You
feel
I'll
go
first
shocking,
absurd,
confused,
worried,
frustrated
desperation,
sadness,
depression,
hopelessness,
every
day
that
I'm
in
this
building
I
think
about
this
photo
I.
Think
about
the
thousands
of
workers
that
were
laid
off
because
our
broken
Public,
Health,
System,
I,
think
about
the
time
I
had
to
fill
out.
A
My
Dad's
unemployment
form
refreshing
webpage
over
and
over
and
over
and
over
again,
because
that
was
the
only
way
that
we
knew
and
we
wouldn't
know
how
we
would
survive
if
we
couldn't
I
think
about
our
state
I
think
about
what
we
could
have
done.
What
we
should
have
done
to
prevent
this
I
think
about
our
country,
I,
think
about
what
we
could
have
done
to
bolster
our
public
health
system
with
the
right
tools
to
prevent
disease
transmission,
I,
think
about
the
nevadans
lost
their
lives.
A
The
families
that
unexpectedly
found
themselves
having
to
bury
their
relatives
because
we
didn't
have
the
courage
to
build
the
right
capacity
or
fund
the
resources
to
prevent
this.
I
think
about
our
healthcare
workers
and
the
indentations
Left
Behind
around
their
sockets
of
their
eyes,
from
their
surgical
mass
that
they
were
for
hours
because
we
couldn't
dispose
of
them.
Otherwise
we
wouldn't
have
the
resources
to
replace
it.
I
think
about
this
photo
a
lot
all
the
time.
A
It's
what
keeps
me
up
at
night
wondering
where
we
went
wrong
and
where
we
could
go
next.
We've
seen
the
statistics.
We
know
that
there
were
people
in
this
community
in
this
state
that
were
left
behind,
including
my
family
members
that
were
not
treated
equally,
whether
it
was
a
dissemination
of
health
information
or
even
as
something
as
basic
as
HealthCare
coverage.
People
were
left
behind
and
we
continue
to
turn
a
blind
eye
on
the
hard-working
families
that
call
this
great
state
their
home.
A
This
photo
is
a
reflection
of
how
we
felt
and
part
of
today's
Bill
hearing
is
to
never
repeat
this
ever
again.
You
know
for
too
long
residents
in
my
district
have
pleaded
for
help
and
archaic
policies.
Both
in
this
state
and
federally
have
denied
people
the
right
to
live
in
Access,
Health
Care.
We
believe
this
bill
is
an
appropriate
way
to
repair
our
broken
system
and
here's
how
we'll
get
it
done.
A
So,
if
you're,
like
me,
you're,
probably
sitting
down
July
2021
thinking
what
on
Earth
can
we
do
to
fix
our
Health
Care
system
so
like
any
normal
human
being
as
a
healthcare
administrator
that
I
am
I,
created
a
SWOT
analysis,
so
I'm
going
to
walk
through
some
of
the
things
that
what
I
had
visualized
with
our
Healthcare
System,
so
the
streams?
What
does
Nevada
do
right
when
it
comes
to
our
health
care
System,
you
know,
I
think
we
have
a
really
strong
tax
base
and
incentives
to
encourage
people.
A
You
know
to
move
into
the
state,
just
in
general,
I
think
that
is
something
that
has
always
attracted
folks
to
come
here.
Also,
you
know
the
commercial
insurance
plans,
as
we
heard
earlier
today,
have
a
strong
base
too.
We
know
that
there
are
folks
in
this
community
that
have
subsidized
others,
and
you
know
in
general,
I
believe
we
are
approaching
a
level
of
maturity
where
our
Health
Care
system
is
beginning
to
become
more
Innovative
weaknesses.
What
does
Nevada
like
and
why
don't?
We
do
well
well.
A
First,
we
lack
sustainable
Public,
Health
funding,
we've
seen
the
statistics,
our
state,
ranked
last
with
public
health
spending,
and
that's
part
of
the
reason
why
myself
and
my
other
classmates
couldn't
find
a
public
health
job
upon
graduation,
because
the
majority
of
our
Healthcare
Providers
are
for-profit.
You
can
argue
that
our
system's
in
place
right
now
are
siled.
I,
don't
want
to
play
into
that
debate.
I
think
the
reality
is.
A
We
have
failed
to
deliver
on
multiple
things
like
interoperability
and
the
current
structure
that
how
it
exists
to
be
today
and,
of
course,
we
know
that
increasing
our
Medicaid
reimbursement
rate
is
an
issue
that
needs
to
be
immediately
addressed
to
find
sustainable
funding
models,
threats.
What
are
the
threats
that
could
potentially
leave
permanent
damage
to
our
Health
Care
system?
That
is
already
so
fragile,
well
to
start
off,
as
we
had
presented
earlier
to
this,
we
have
a
rising
level
of
uncompensated
care
because
of
the
nature
of
our
federal
government.
A
We
know
that
there
are
folks
that
have
lived
here
for
years
decades
that
have
been
denied
adequate
care,
there's
no
clear
strategy
to
bolster
our
Healthcare
capacity,
which
has
resulted
in
the
workforce
shortages
that
we
see
on
the
front
lines
of
our
health
care
System.
We
are
always
short-handed.
We
look
at
placing
bandages
on
our
wounds
instead
of
focusing
to
prevent
the
injury
in
the
first
place
and
as
a
healthcare
administrator
that
worked
on
the
east
side,
I
have
interacted
with
patients
that
have
been
denied
basic
preventive
services.
A
Our
undocumented
immigrant
population,
including
my
family,
have
been
denied
the
ability
to
receive
adequate
health
coverage
due
to
the
lack
of
access
to
care.
We
deserve
a
system
that
takes
care
of
everyone,
but
if
you
continue
down
this
way,
the
problem
will
worsen
and
more
lives
will
be
lost.
It's
as
simple
as
that
opportunities.
A
The
rates
for
digital
health
is
a
national
conversation
that
can
pivot
our
state
as
an
international
leader,
and
that's
why
we
spent
time
in
this
committee
talking
from
him
earlier
this
session
and
further
I
believe
an
effort
to
help
diversify
our
economy
is
to
attract
more
researchers
to
the
state
that
could
invest
in
biotechnology.
If
we
build
the
right
infrastructure,
Nevada
can
be
a
leader
in
producing
the
next
cure
of
tomorrow
and
last
but
not
least,
we
need
to
do
our
part
to
invest
in
graduate
medical,
education
and
clinical
programs.
A
This
is
the
opportunity
that
we
have
before
us
and
we
need
to
do
a
better
job
at
financing
these
initiatives
once
and
for
all,
and
so
let
me
leave
you
this
with
us.
One
thought:
how
do
we
do
it
all?
How
do
we
address
the
shortages
cover
folks,
who
need
help
the
most
build
on
our
interoperability
and
pave
the
way
to
expand
healthcare
for
people
who
have
been
denied?
That's
the
Hope
act.
A
That's
what
we're
here
for
today,
the
Nevada
Health
opportunities
planning
and
expansion
Act
of
2023
or
for
short
The
Hope
Act,
is
a
role
that
brings
forth
the
necessary
changes
in
our
community
to
provide
preventive
services
and
reduce
the
level
of
uncompensated
care.
It's
an
Innovative
bill
that
looks
at
the
economic
development
trajectory
of
our
state
to
build
on
our
Healthcare
capacity
and
incorporate
health
information
technology,
unlike
ever
before.
A
This
bill
will
set
our
state
up
for
future
generations
to
come,
and
it's
one
that
I'm
most
proud
to
introduce
as
your
colleague,
but
also
as
a
resident
that
believes
in
a
state
so
dearly
a
state
that
deserves
endless
support
and
admiration,
but
that
support
and
admiration
must
come
with
a
commitment
to
change.
The
Nevada's
hope
act
aims
to
do
the
following
number:
one
align
our
health
systems
to
be
a
leader
in
the
21st
century.
A
A
Further
I
think
we
should
have
the
conversation
as
to
what
digital
Health
reimbursement
looks
like
and
last
number
three
building
our
Healthcare
capacity
Nevada
should
not
be
forced
to
go
out
of
state
to
receive
the
care
that
they
need.
We
need
more
doctors
and
more
facilities.
I
firmly
believe
that
investing
in
healthcare
jobs
is
a
good
Financial
investment
for
those
long-term
sustainability
of
our
state.
A
This
bill
will
work
on
introducing
a
new
tax
abatement
program
to
allow
medium
and
large
Health
Industries
to
move
into
the
state
and
support
our
general
infrastructure
and
then
number
four
expand
access
to
health
care
for
all
nevadans.
Historically,
we
know
that
people
have
been
left
behind
and
each
of
these
initiatives
reflected
in
the
built
on
context,
we'll
go
ahead
and
break
it
down
for
you,
so
it
makes
it
easier
to
follow
throughout
the
bill
aligning
our
Healthcare
Delivery
Systems
together.
A
Sb
419
establishes
two
principles:
building
our
capacity
for
data
on
inoperability
and
aligning
ourselves
toward
the
trusted
exchange
framework
and
common
agreement
known
as
toughka
under
Section
6
of
the
bill.
As
drafted,
it
would
require
DHHS
in
consultation
with
our
healthcare
providers
in
third
parties
to
prescribe
a
framework
for
the
electronic
maintenance,
transmittal
and
exchange
of
health
and
electronic
records.
Toughka
is
an
item
that
was
mentioned
earlier
this
session
from
hymns
during
their
presentation
and
it's
part
of
the
work
that
is
being
fulfilled
by
the
national
quarter
coordinator
of
help
I.T.
A
A
Primarily,
the
goal
of
tefka
is
to
establish
a
universal
floor
of
interoperability
across
this
country.
Under
some
of
the
guidelines
established
by
tefka.
There
are
a
few
outline
principles.
Tufka
seeks
to
accomplish
the
following:
the
standardization
of
Health
Data
openness
and
transparency,
cooperation
and
non-discrimination,
privacy,
security,
safety
access
and
equity.
A
To
help
you
understand
what
Teflon
tells
I'm
going
to
describe
a
few
contextual
definitions.
When
a
national
coordinator
of
Health
I.T
received
the
go-ahead
to
begin
this
trusted
exchange
process.
With
the
passage
of
the
cures
act,
they
quickly
identified
a
recognized
coordinated
entity.
You
might
hear
me
say:
rce
a
recognized
coordinated
entity
or
what
has
been
identified
as
a
sequoia
project
will
help
develop,
update,
Implement
and
maintain
the
common
agreement
that
providers
will
participate
in.
A
It
is
responsible
for
soliciting
and
reviewing
applications
of
qualified
health
information
networks
and
I'm
sure
you're,
probably
thinking
what
the
heck
is.
A
qualified,
Health,
Information
Network,
a
qualified,
Health,
Information,
Network
or
qhen
is
originally
Affiliated.
Network.
That
agrees
to
the
common
terms
and
the
conditions
of
exchange.
Q
hens
will
be
Central
the
central
connection
points
when
the
tough
ecosystem
is
set
up,
as
they
will
help
States
route
queries,
responses
and
messages
amongst
entities
and
individuals
and
to
help
close
out
any
potential
coincidence
that
I
may
arise.
A
Tefka
creates
a
common
agreement,
which
is
a
document
that
will
provide
the
governing
approach
necessary
to
scale
the
interconnections
of
Q
hens
throughout
this
country.
The
common
agreement
will
allow
Healthcare
Providers
to
coordinate
with
one
another
and
build
our
our
interoperability
of
data.
Federal
standards
will
begin
to
acquire
alignment.
Nevada's
participation
will
put
our
state
as
a
model
of
implementation.
For
this
conversation,
here's
a
quick
timeline
of
where
toughka
currently
is.
A
You
can
see
from
this
graphic
that
the
Sequoia
project
has
already
released
a
list
of
the
first
approved
Regional
Q
hints,
and
they
will
begin
to
launch
toughka
based
exchanges
fairly
soon
later
on
this
year.
The
federal
government
will
continue
to
process
applications
for
other
Q
hints
to
refine
some
of
the
language
for
the
common
agreement
to
be
utilized
by
States.
A
I
want
to
pause
here,
because
I
know.
This
is
a
point
of
contention,
and
it's
important
for
me
to
reiterate
what
this
bill
does
not
aim
to
accomplish.
Toughka
is
not
a
network,
it's
not
a
technical
standards
body,
a
technology,
a
platform
or
a
data
service.
Fb419
allows
DHHS
with
the
ability
to
begin
prescribing
regulations
on
the
item
set
above,
which
will
include
the
necessary
requirements
to
align
toward
Federal
standards
and
bring
together
our
local
Health
Providers
and
before
I.
Move
on
I
want
to
make
a
quick
point
of
clarification.
A
My
intent
in
section
6
is
not
for
the
state
to
create
our
own
standards
of
interoperability
that
would
be
counter-intuitive
to
this
process.
My
goal
is
to
ensure
our
state
is
aligned
toward
what
is
being
accomplished
federally
with
tefka.
We
should
not
be
creating
more
regulatory
burdens
that
already
exist
and
should
instead
prioritize
the
initiatives.
Our
federal
government
will
seek
to
address
further
I'll
point
on
this
later.
We
do
have
a
conceptual
amendment
that
makes
conforming
changes
into
various
sections,
including
section
one
and
section
six
of
this
bill
with
regard
to
jurisdictions
and
compliance.
A
So
we'll
touch
point
that
later
today,
on
this
slide,
I
have
provided
a
graphic
to
help
introduce
you
what
a
keyhand
looks
like
and
how
the
information
is
distributed
amongst
institutions.
So
the
rce,
the
Sequoia
project,
is
the
main
entity
facilitating
the
transmittal
of
digital
health
information.
The
Q
hens
are
the
mediators
between
the
different
regions
across
the
country.
A
Participants
of
the
Q
hint
can
be
centrally
based
repositories,
health
information
exchanges
or
state-based
utilities,
and
then
sub-participants
in
this
graphic
could
be
in
an
individual
entities
like
UMC
or
other
Hospital
systems
that
operate
in
multiple
jurisdictions,
but
needs
the
flow
of
the
data
to
one
centralized
Qin
further
sp419
establishes
requirements
for
an
EHR
integration
to
continue
our
commitment
to
prioritize
the
interoperability
of
health
information.
This
bill
will
require
that
government
entities,
Health,
Providers
and
administrators
adhere
to
maintain,
transmit
and
exchange
health
information
with
an
EHR
system.
The
deadlines
are
set
here
on
this
slide.
A
Requiring
providers
to
integrate
with
an
EHR
is
not
only
a
good
practice
to
assist
patients
in
relation
to
their
Health
Data,
but
it's
also
a
cost
savings
measure
that
can
reduce
it.
Duplicate,
literally
duplicably,
duplication
of
procedures,
Senate
Bill
57
will
appropriate
general
fund
dollars
to
help
smaller
providers
and
doctors
comply
with
this
requirement,
and
section
6
of
this
bill
also
establishes
a
waiver
that
helps
providers
that
may
experience
difficulty
with
the
interoperability
requirements
so
forth
in
this
provision.
The
reference
that
we
have
is
infrastructure
waivers.
A
Senate
Bill
419
will
allow
DHHS
to
understand
where
providers
stand
with
the
facilitation
of
their
health
records
to
essentially
get
the
lay
of
the
land
which
can
help
us
understand
where
to
spend
future
dollars
on
broadband
and
interoperability
should
federal
grants
become
available
with
teca
and
other
pieces
of
legislation
shaping
the
future
public
health
jobs
of
Tomorrow
throughout
the
covid-19
pandemic.
We
know
that
our
state
felt
behind
with
regard
to
Health
Information
Technology.
A
Earlier
this
session,
you
heard
from
our
public
health
professionals
themselves
that,
in
the
initial
stages
of
the
pandemic,
everything
was
being
traced
through
an
Excel
spreadsheet
as
a
state.
We
can
do
better.
We
deserve
data
points
to
actually
work
and
the
reality
is
we're
already
doing
this
work.
That
is
why
to
build
a
future
health
jobs
of
tomorrow,
we
need
to
enable
the
full
reimbursement
of
digital
health
and
begin
to
modernize
our
outdated
Public
Health
Systems.
A
Under
the
provisions
of
this
bill,
The
Joint
interim
HHS
committee
will
begin
to
explore
the
full
reimbursement
of
digital
Health.
We
had
presentations
in
this
committee
as
to
what
this
could
look
like,
and
it's
going
to
cost.
You
know
some
Financial
circumstances
later
on.
We
need
to
start
the
process
now
as
to
what
that
could
look
like
artificial
intelligence
is
already
mainstream
in
healthcare.
Fun
fact:
I
use
artificial
intelligence
to
help
write
my
remarks
today.
It's
part
of
our
natural
being
it's
happening
already.
You
can
see
in
this
quote
from
the
peer-reviewed
research
study.
A
Cms
is
already
beginning
to
establish
a
national
payment
around
an
authorized
artificial
intelligence
system
that
can
help
make
clinical
decisions
and
support
the
expansion
of
healthcare
delivery.
Further,
we
will
increase
the
use
of
AI
in
virtual
reality.
The
American
Medical
Association
has
already
unveiled
new
CPT
codes
for
these
services,
including
artificial
intelligence
and
virtual
reality.
A
Senate
Bill
419
requires
the
joint
interim
committee
to
review
the
feasibility
of
the
full
expansion
of
digital
Health,
including
remote,
patient
monitoring
and
digital
Therapeutics,
and
as
someone
who
has
worked
in
this
space,
it
is
my
belief
that
Nevada
has
the
opportunity
to
begin
revising
our
payment
models
to
be
more
encompassing
of
Technology.
It
can
lead
us
as
a
way
to
be
Innovative
and
can
begin
to
build
an
infrastructure
cycle
of
research,
qualification,
verification,
investment
and
commercialization.
A
Well,
modernizing
our
Public
Health
System.
Over
and
over
again,
we've
heard
from
constituents
and
public
health
officials,
the
lack
of
capacity
for
our
state
to
carry
through
the
transmission
of
Public
Health
Data,
let's
be
clear,
Public
Health
Data
has
already
been
being
collected
by
our
different
state
agencies
and
departments,
but
because
of
the
nature
of
siloing
work,
the
systems
fail
to
connect
with
one
another
and
that
allows
us
not
to
be
able
to
create
evidence-based
strategies
to
address
social
determinants.
A
The
Innovation
Hub
can
become
a
home
for
public
private
Partnerships
to
be
established
and
finally
eliminate.
The
disparities
that
we
have
seen
based
on
the
social
determinants
of
health
and
to
make
to
make
a
quick
clarification
on
the
intent
of
the
Hub.
My
ultimate
goal
is
to
delineate
the
outcomes
of
this
Hub
toward
Public
Health
Data,
not
Health,
Care
related
data.
The
Hub
should
not
be
a
resource
that
can
provide
for
the
coordination
between
eight
different
agencies
and
jurisdictions
to
improve
outcomes.
A
It's
part
of
the
data
points
that
our
state
already
collects
for
varying
reporting
requirements.
For
instance,
I
see
the
Hub
taking
on
issues
like
the
opioid
epidemic
or
working
with
the
Nevada
Department
of
Education
to
address
social
determinants
with
support
of
income
data
generated
by
our
school
forms.
We
can
work
together
to
solve
major
systemic
issues.
With
the
data
already
collected.
The
goal
should
be
not
to
work
in
silos,
but
to
provide
an
enhanced
level
of
strategy.
This
isn't
a
hub
for
healthcare,
related
data
on
prescriptions,
you're
taking
or
how
your
physical
went.
A
That's
a
separate
conversation
for
another
session.
Most
importantly,
The
Hub
must
align
toward
the
DNA
available
data
points.
We
want
to
ensure
that
patients
continue
to
retain
their
privacy
and
that
it
is
secured
and
that
we
Oblige
by
the
federal
standards
established
by
HIPAA,
which
is
why
this
bill
aligns
towards
this
initiative.
And
lastly,
my
ultimate
vision
for
this
Hub.
Throughout
the
covid-19
study,
we
heard
stakeholders
saying
that
we
failed
to
coordinate
between
different
jurisdictions.
A
The
reality
is
that
most
of
this
will
come
down
to
money
and
resources,
but
we
deserve
a
health
official
in
this
state
that
can
help
provide
us
some
level
of
strategy,
a
strategic
Direction
on
bringing
everyone
together
for
public
health
related
data.
Ultimately,
we
want
to
ensure
that
Nevada
is
positioned
to
take
on
grants
from
the
CDC
and
other
National
groups
to
Pilot
new
initiatives
to
modernize
Public
Health
reporting
structures
in
the
scalable
sustainable
way.
A
Nevada
can
lead
in
that
way,
rather
than
creating
a
singular
solution,
and
that
will
set
us
up
to
succeed
in
the
long
run,
because
Public
Health
Data
on
patients
should
cross
boundaries
and
our
systems
should
work
together.
And,
lastly,
section
59
is
perhaps
one
of
the
most
important
portions
of
this
bill
throughout
the
covid-19
pandemic.
The
staff
at
DHHS
have
been
relentlessly
serving
our
population
to
help
navigate
this
Public
Health
Emergency.
A
Now
that
we
are
in
the
recovery
stage,
it's
time
for
DHHS
to
begin
studying
the
determining
adding,
eliminating
reclassifying
or
revising
the
salary
for
positions
to
either
increase
the
effectiveness
or
efficiency
of
their
state
operations,
building
our
Healthcare
capacity
and
diversifying
our
economy.
A
Throughout
the
campaign
cycle,
voters
reiterated
to
me
their
frustration
with
coordination
of
our
Health
Care
system
and
the
lack
of
providers.
We
can
do
a
better
job
to
attract
more
companies
to
the
state
and
I
firmly
believe
in
bioscience
as
the
ability
to
help
Drive
Nevada's
economy
forward.
Although
we
anticipate
this
bill
to
be
referred
to
the
senate
committee
on
revenue
and
economic
development,
that
is
something
that
we
potentially
could
occur
to
review.
The
concepts
of
the
abatements
I
will
quickly
go
over
some
of
the
adjustments
that
were
made
here
in
this
bill.
A
Sections
31-38
of
this
bill
provide
for
the
abatement
of
cells
and
youth
taxes
for
property
to
provide
health
care
or
conduct
scientific
research,
certain
property
taxes
imposed
on
businesses
and
excise
tax,
on
wages
paid
to
employees
performing
Services,
directly
related
to
addressing
critical
medical
and
scientific
needs
with
a
never-changing
pandemic.
Nevada
has
shown
its
resilience
with
countering
public
health
disasters.
Now
more
than
ever,
Nevada
needs
to
diversify
its
economy.
A
Senate
Bill
419
will
enable
the
governor's
office
of
Economic
Development
to
attract
new
health
startups
and
businesses
seeking
to
find
the
next
cure,
and
at
this
point,
I'll
go
ahead
and
turn
it
over
to
Ms
Gonzalez.
Who
will
share
with
you
the
last
portion
of
this
bill,
which
is
to
ensure
all
nevadans
receive
the
care
that
they
need.
I
You
thank
you,
Senator,
donate
and
good
afternoon,
Vice
chairwen
and
members
of
the
senate
committee
on
Health
and
Human
Services
for
the
record.
My
name
is
Tanya
Gonzalez
and
I'm,
a
fellow
for
the
Nevada
Latino
legislative
caucus.
I
I
want
to
speak
to
you
all
today
about
the
lessons
we
have
learned
since
the
onset
of
the
covid-19
pandemic
and
the
strategies
other
states
have
continuously
taken
to
combat
the
lack
of
Access
to
Health
Care
issues.
So
today,
I
will
quickly
go
over
expanding
access
to
health
care
to
all
nevadans.
The
impact
of
covid-19
similar
legislation
in
other
states,
in
tandem
with
their
outcomes
and
I,
will
conclude
with
a
holistic
bill
summary
now.
The
Nevada
hope
act.
Sb
419
is
an
act
that
relates
to
all
nevadans.
I
Arguably,
everyone
in
this
room
nevadans
need
health
care.
Expanding
access
to
healthcare
is
a
more
is
more
than
fiscally
responsible.
Is
the
right
thing
to
do
so.
That
is
why,
through
Nevada's
hope
act,
we
are
introducing
legislation
for
a
Medicaid
expansion
for
all
nevadans,
regardless
of
their
citizenship
status.
So
in
such
manner
it
will
become
Nevada
public
policy
that
each
resident
of
the
state
who
would
otherwise
be
eligible
for
Medicaid,
if
not
for
their
non-citizenship
status,
it
may
enroll
in
Medicaid.
So
sections
39-49
pertain
to
this.
I
So
it
is
indisputable
that
Nevada
took
a
hit
from
the
covid-19
pandemic.
The
uninsured
crisis
left
Nevada,
uniquely
vulnerable
to
the
pandemic
and,
as
a
result,
communities
of
color
were
disproportionately
affected.
Nevada's
racial
and
ethnic
minorities
were
among
the
hardest
hit
by
the
pandemic
in
terms
of
infection,
hospitalization
and
mortality
rates.
I
I
I
So,
lastly,
here
is
a
visual
that
displays
that
displays
and
adds
to
that
information.
The
total
number
of
native
born
citizens
in
Nevada
is
around
241
000
people
so
which
represents
60.6
of
the
uninsured
population.
So
now
this
is
depicted
by
the
purple
on
the
right,
so
this
combined
with
the
natural
foreign-born
population,
amounts
to
67.6
of
the
uninsured.
I
So
now
what
does
this
mean?
This
means
that
one
in
three
uninsured
individuals
in
Nevada
are
non-citizen
foreign
born.
So
that
said,
while
10.5
percent
of
the
total
Nevada
population
is
uninsured,
almost
half
one
in
two
of
citizens
of
non-citizens
are
uninsured.
So
now
this
is
where
the
44.2
percent
come
from.
I
So
using
this
data
we
estimate
the
Nevada
hope
deck
will
obtain
an
enrollment
of
95
210,
000
nevadans,
so
displayed
in
the
graph.
So
the
graph
illustrates
the
American
states
that,
as
of
2022,
have
passed
legislation
to
expand
in
to
combat,
to
expand
and
to
commit
to
Health
Equity.
So
this
is
not
including
the
recent
passage
of
Colorado
so
highlighted
in
red.
Currently,
nine
states
provide
comprehensive
state-funded
coverage
to
all
income
eligible
children,
regardless
of
citizenship
status.
Those
states
are
California
Illinois,
Oregon,
Colorado,
Washington,
D.C,
Maine,
New,
York,
Rhode,
Island
and
Vermont.
I
Another
10
states,
in
light
blue,
have
used
the
federal
children's
health
insurance
program
to
expand
access
to
children.
So
some
states
in
a
mixture
of
two
have
also
expanded
to
women
who
are
pregnant,
show
now
is
a
timeline
of
the
healthy
Illinois
campaign.
So
seven
years
ago,
Illinois
first
guaranteed
coverage
to
all
kids
up
to
age,
19.
I
I
Now
this
is
California's
timeline
in
the
same
year
as
Illinois
2016
California
established
its
medical
program
guaranteeing
coverage
to
all
kids
who
are
non-citizens
up
to
age
19.
like
Illinois
California,
expanded
coverage
to
different
age
ranges
in
2020
and
each
year
after
that,
closing
all
health
insurance
gaps.
Just
last
year
again
last
year,
California
closed
its
last
Insurance
Gap.
So
on
the
right,
you'll
see
the
uninsured
rate
for
Californians
0
to
64.
I
Before
and
after
the
last
Medicaid
expansion
to
non-citizens,
which
the
group
was
ages
26
through
49.,
so
I'm
talking
about
the
graph
the
graph
displayed
on
the
right
sorry,
so
you
can
see
that
the
undocumented
category
significantly
dropped
by
30
percent.
So
that's
the
green
54
to
27
approximately
now
on
the
left
side
is
a
collective
look
at
California's
enrollment
expansion.
Since
the
start
of
their
campaign.
I
Lastly,
here's
a
graph
synopsis
of
the
aforementioned
declining
rates,
so
you
can
see
the
yellow
medical
line
increasing,
whereas
the
blue,
uninsured
line
decreasing
and
they
diverged
so
moving
on
to
Oregon,
so
Oregon
first
guaranteed
coverage
to
all
kids
who
are
non-citizens
up
to
age
19
as
well,
and
a
couple
years
after
its
implementation,
expanded
to
young
adults,
ages,
19
through
25
and
seniors
55
and
older.
I
I
Now,
the
last
date
that
I
will
cover
today's
Colorado
last
year.
It
too
began
by
covering
income
eligible
kids
who
are
non-citizens
at
the
same
time,
expanded
coverage
to
women
who
are
pregnant
and
up
to
12
months
postpartum.
So
what
with
this,
they
targeted
the
significant
Health
Care
disparity
between
Hispanic
women
and
non-hispanic
white
woman,
which
is
show
shown
on
the
left
of
the
slide.
I
I
So
I
hope
that
by
now,
in
addition
to
seeing
a
trend
among
the
states,
you
are
able
to
see
the
strategy
that
other
states
have
continuously
taken
to
combat
the
lack
of
access
to
care
issues.
That
said,
this
strategy
helps
reduce
Health
disparities.
The
states
I
spoke
to
you
about
today
have
seen
healthier
birth
weights
with
lower
risks
of
infant
mortality,
reductions
of
maternal
mortality
rates,
higher
rates
of
adolescent
immunizations,
lower
rates
of
emergency
room
visits,
less
admissions
for
health
issues
that
could
have
been
prevented
and
simply
just
more
preventative
care.
I
I
section
57,
appropriates
grants
to
assist
with
such
compliance.
Section
60
requires
a
director
to
establish
an
Advisory
Group
sections,
2
6
and
1
mandate,
notice
of
failure
to
comply
and
sets
an
opportunity
to
be
heard.
So
it's
important
to
know
that
this
would
not
be
a
misdemeanor
sections.
9
17,
45,
47,
50
and
53
have
now
been
stricken.
I
I
The
the
1917
45
47,
50
and
53
I
believe
it's
in
the
second
row.
Thank
you.
I
Next
sections,
15,
49
and
54
have
also
been
been
stricken.
They
established
that
the
suspension
is
not
subject
which
formally
established
that
the
suspension
was
not
subject
to
procedures
such
as
suspension
as
licenses,
so
it
was
a
different
type
of
certification
suspension
and
then
the
next
sections,
1
9
17
45
47
1553,
require
a
reinstatement
required
reinstatement
of
the
suspension
of
credential
of
credentials
if
the
holder
complied.
So
again.
I
Section
7
expands
Healthcare
immunity
from
liability
to
providers
who
use
the
interoperability
system.
Section
8
establishes
that
the
exchange
of
electronic
health
practice
is
not
an
unfair
trade
practice.
Sections
22
through
24
South
or
South
in
Nevada
Innovation
Hub,
with
establishes
the
Nevada
Innovation
Hub
with
the
Department
of
Health
and
Human
Services.
Section
23
creates
the
position
of
the
chief
data
officer
to
serve
as
the
executive
of
the
Hub
and
to
advise
Public
Health
agencies.
I
Additionally,
section
24
and
27
requires
that
the
confidentiality
of
personable
of
personal
identifiable
information
maintained
by
The
Hub,
for
which
disclosure
is
prohibited.
An
N
section
61,
has
also
been
completely
stricken.
It
required
the
chief
data
officer
to
submit
a
report
to
the
Joint
interim
standing
committee
on
the
hub's
policies
and
procedures.
I
So
next
section
31
authorizes
partial
abatement
of
Health,
Care
and
scientific
of
health
care
or
scientific
research
and
certain
taxes
and
requires
also
requires
the
applicant
to
obtain
the
approval
of
a
super
majority
of
from
the
board
of
Economic
Development
sections.
35
36
37
established
the
duration
and
amount
of
the
abatements
section,
38
authorizes
abatements
on
certain
machinery.
I
49
section
49
removes
the
requirement
that
a
person
who
is
not
a
citizen
must
be
allowed
by
federal
law
to
receive
Medicaid
section.
41
creates
the
Medicaid
advisory
committee
within
the
division.
Section
42
requires
a
committee
to
advise
the
department
and
publish
a
report
of
its
activities.
Section
49
I
mean
59.
Apologies
requires
the
department
to
assess
the
Workforce
Development
and
submit
a
legislative
report
thereafter.
I
Last
but
not
least,
I
present
the
three
conceptual
amendments
that
were
made
today
so
I've
briefly
gone
over
them.
So
any
licensure,
revocation
penalties
have
been
completely
stricken,
so
any
licensee
that
fails
to
comply
with
the
interoperability
regulations
and
standards
are
instead
now
going
to
be
referred
to
an
appropriate
regulatory
body.
I
The
required
the
requirement
that
the
chief
data
officer
submits
a
report
to
the
Joint
interim
standing
committee
on
the
hub's
policies
and
procedures
is
also
stricken.
And,
lastly,
addition,
the
director
is
newly
required
to
First
apply
for
any
federal
waivers
or
to
take
any
other
actions
necessary
to
obtain
a
federal
financial
participation
for
the
Medicaid
expansion.
I
So
was
it
so,
as
you
can
see,
the
Nevada
hope
act
will
provide
reforms
on
the
interoperability
of
Health
Data
and
provide
incentives
to
build
our
health
care
capacity,
which
includes
the
full
Medicaid
expansion
of
all
nevadans
who
would
otherwise
qualify.
So
it
is
the
right
time
to
do
so.
Is
the
right
thing
to
do
so.
Just
please
help
us
pave
the
way
for
Nevada
to
be
a
national
leader
in
the
space
of
Health
infrastructure
and
access
to
care.
Thank
you.
A
Thank
you
so
much
Tanya,
maybe
nunate
for
the
record
Vice
for
when
I
do
have
other
presenters.
That
will
help
me
with
this
bill
that
will
touch
point
on
some
of
their
personal
experiences
as
health
professionals
in
our
state.
A
few
things
to
note
before
I
turn
it
over
to
our
speakers.
As
you
will
hear
today,
there
is
bride.
There
was.
There
is
Broad
Statewide
support
for
this
proposal.
A
Nevadans
are
already
fronting
the
bill
as
the
levels
of
uncompensated
care
continues
to
increase,
but
rather
than
hearing
it
from
me,
I
want
you
to
hear
from
our
healthcare
providers.
So
to
start
us
off,
I
do
have
two
folks,
so
I
have
with
me:
I
have
with
me
Mr
Todd
slamberg,
the
Chief
Executive
Officer
of
Sunrise
Hospital,
and
then
we
also
have
Dr
John
Hardwick,
who
is
an
emergency
medicine
physician
at
Renown
Health,
so
Dr
Hardwick.
K
Oh
yeah,
all
right,
so
my
name
is
John
Hardwick.
Thank
you
so
much
for
inviting
me,
chair
and
committee,
so
I
am
here
I
I,
think
to
add
context
to
the
conversation
I
worked
today.
I
started.
Work
at
4am
got
off
my
shift
and
immediately
came
down
here,
because
I
think
this
is
an
incredibly
important
issue
that
needs
to
be
addressed
as
an
Emergency
Physician.
K
K
Currently,
the
the
current
Paradigm
of
of
healthcare
reimbursement
results
in
multiple
consequences
when
it
comes
to
the
underinsured
and
the
uninsured
one
that
has
already
been
I
think
brought
up
very
eloquently
is
that
patients
seek
Primary
Care
at
the
emergency
department.
So
what
happens
in
these
cases
is?
Let's
say
you
have
a
diabetic
right.
Someone
comes
in.
They
have
a
history
of
diabetes,
they
come
in.
Maybe
they
don't
know
they
have
diabetes
and
we
diagnose
them
with
that
in
the
emergency
department.
K
I
might
be
able
to
start
them
on
some
oral
medication,
but
my
ability
to
offer
longitudinal
care
is
is
very,
very
difficult.
Right
and
logic.
Internal
care,
especially
in
chronic
illness,
is
incredibly
important
because
it's
very
important
to
monitor
that
disease.
How
is
that
disease
progressing?
How
are
they
responding
to
the
medication
and
without
that
overwhelmingly
these
patients
have
a
decomposition
of
their
disease
and
ultimately
it
leads
to
worse
outcome
for
that
patient
and
more
expensive
care.
So
let's
say
you
have
a
diet:
medication
who
doesn't
seek
or
seeks
care.
They
don't
have
follow-up.
K
What
happens
to
that
patient?
Let's
say
they
develop
a
diabetic
foot
ulcer
right
that
diabetic
foot
ulcer
ends
up
becoming
infected.
They
have
to
come
back
in,
they
lose
their
foot
right,
that's
an
expensive
procedure,
that's
expensive,
hospitalization,
and
then
you
have
someone
who's
now
outside
of
the
workforce.
Who
can
can
no
longer
work?
Senator
Stone,
you
made
a
I
think
a
question
about
antala
right.
What
happens
if
we
had
to
treat
every
single
hangnail
that
came
to
the
emergency
department?
K
K
So,
just
earlier
this
morning,
I
took
care
of
a
ingrown
toenail
right
and
I'm
again
happy
to
do
it,
but
it's
much
better
employed
through
a
primary
care
physician,
but
they
came
to
me
because
they
were
unable
to
get
that
care
at
an
urgent
care
or
at
a
Primary
Care
Physician's
office,
because
they
did
not
have
insurance
right.
So
when
we
talk
about
the
cost
of
these
things
right,
we
talk
about.
K
There's
some
talk
about
it
being
parody
right,
oh
well,
if
we're
already
paying
for
this
in
the
emergency
department
and
and
therefore
you
know,
it
justifies
the
cost-
we're
not
only
paying
for
it,
we're
paying
more
right
now,
all
right
we're
paying
significantly
more
because
these
diseases
progress
and
these
patients
diseases
progress
to
a
point
to
where
the
care
costs
significantly
more
right.
If
we
can
intervene
in
chronic
disease,
it's
significantly
better
to
intervene
that
chronic
disease
early
before
it
progresses.
K
Another
thing
that
happens
is
patients
avoid
care
altogether,
because
they're
worried
about
the
cost
associated
with
it
right.
People
want
to
pay
their
bills
and
they're
worried
about
going
to
the
emergency
department,
because
the
cost
associated
with
the
emerging
Department,
if
they're,
underinsured
or
uninsured
what
happens
in
those
cases,
I
saw
a
very
tragic
case.
Very
recently,
a
gentleman
came
in.
He
had
a
squamous
cell
carcinoma
squamous
cell
carcinoma
is
a
very
simple
cancer,
a
skin
cancer.
Often
you
know
many
people
have
had
it.
K
It's
very
simply
treated
by
just
doing
a
quick
excision
of
the
lesion
right
overwhelmingly,
but
this
gentleman
didn't
have
a
primary
care
doctor.
He
didn't
seek
care,
the
lesion
got
worse.
The
legion
got
worse,
the
legend
got
worse
and
by
the
time
you
saw
me
at
it
invaded
into
his
entire
orbit.
He
lost
his
eye
and
by
the
time
he
was
in
the
emerge
Department
he
was
having
intractable
seizures.
K
He
was
in
a
coma
and
he
was
intubated
placed
in
the
ICU
and,
and
you
can
imagine
the
cost
associated
with
that
right,
not
only
the
societal
cost
and
the
cost
for
that
individual
just
from,
but
also
the
monetary
cost
of
that
of
that
patient
and
not
having
a
system
in
place
that
that
patient
was
able
to
seek
reliable
care.
K
The
you
know
another
issue
with
this
is
that
without
you
know,
re
reliable
reimbursement
for
this
and
as
our
undocumented
population
grows
right.
This
has
already
been
said,
I
think
very
eloquently
before,
but
that
cost
is
passed
through
to
other
payers,
including
you
know,
State
Medicaid
programs,
so
basically
we're
paying
for
it
anyway,
as
a
state
and
also
one
way
that
hospitals
have
to
address
this
right,
they
can't
go
insolvent
right,
they
have
a
they.
K
They
want
to
serve
the
community,
but
that
means
they
have
to
cut
Staffing.
They
have
to
cut
services.
That
means
more
physician.
Burnout
I
mean
for
more
provider
burnout.
That
means
less
services
available,
for
you
know
your
mammograms
for
your
routine
care
right.
So
it's
it's!
This
kind
of
it
perpetuates
the
cycle
that
basically
everything
just
gets
worse
if
we
don't
intervene
early
and
lastly,
it
leads
to
us
not
being
able
to
provide
meaningful
follow-up
for
specialty
services.
K
So
you
know
we'll
have
a
patient
come
in
and
let's
say
they
come
in.
They
have
something
called
SVT
where
your
heart
rate
just
goes
super
super
fast
out
of
nowhere
right
and
that's
something
that
we
can
treat
to
the
emergency
department
with
medications
or
cardioversion
right.
So
we
shock
them
right.
You
can
imagine,
those
medications
are
not
cheap
and
monitoring.
Those
patients
is
is
not
cheap
and
those
patients
there's
a
simple
fix
right.
They
can
get
an
ablation,
but
that
happens
as
a
outpatient.
K
Ablations
is
a
procedure
where
cardiologists
can
go
in
there
just
going
to
burn
that
area
of
of
tissue
in
the
heart.
That's
just
a
little
hyperactive,
but
without
that
the
patient's
discharged,
they
don't
have
a
reliable
means
of
follow-up,
and
so
they
keep
coming
back
and
they
keep
coming
back
and
they
keep
coming
back.
K
So
with
that
I'll
I'll
take
any
questions
and
again
I.
Really.
Thank
you
all
for
having
me
and
letting
me
speak.
L
Good
afternoon
Vice,
chairwin
and
members
of
the
committee,
my
name
is
Todd.
Schlamberg
I
have
the
privilege
being
CEO
at
Sunrise
Hospital
in
Sunrise,
Children's
Hospital
for
the
last
15
years,
and
I
appreciate
the
opportunity
to
spend
a
couple
of
minutes
with
you.
First
I
do
want
to
thank
senator
daniate
for
selecting
a
picture
which
eliminated
my
gray
hair
and
my
my
balding
spot
so
appreciate
that
Senator.
L
But
we
do
thank
the
senator
for
working
on
the
hie
provisions
to
ensure
that
Nevada
is
at
the
Forefront
for
the
exciting
advancements
in
the
interoperability
of
patient
health
records
aligned
with
the
national
standards,
and
we
also
commend
the
senator
for
opening
the
important
conversation
on
the
expansion
of
access
for
care.
Let
me
just
spend
a
moment
sharing
a
little
bit
about
Sunrise,
Hospital
and,
and
one
or
two
you
know
quick
exam
peoples,
Sunrise
hospitals,
the
state's
largest,
acute
care
hospital
at
834
beds.
L
We
have
the
privilege
of
treating
over
250
000
patients
each
year,
175
000,
coming
through
our
emergency
department,
40
000
admissions.
We
also
have
the
privilege
of
being
the
state's
largest
Medicaid
provider,
one
in
five
Medicaid
recipients.
In
the
state
of
Nevada
receive
their
hospital-based
care
at
Sunrise
Hospital,
one
in
four
in
Las
Vegas
receive
their
care
at
Sunrise
Hospital
and
we
are
committed
to
all
patients,
regardless
of
their
ability
to
pay
and
their
residency
status.
L
We
care
for
the
entire
community
about
an
hour
ago,
when
I
touched
base
with
the
hospital
we
had,
850
patients
in
our
Hospital
admitted
patients.
Okay,
we
had
an
ER
of
almost
200
in
the
hospital
each
year
we
care
for
over
two
thousand
undocumented
patients
each
and
every
year,
coming
through
our
Hospital.
L
You
know
many
of
you
have
had
the
opportunity
to
tour
our
hospital
and
spend
some
time
in
Sunrise,
Children's
Hospital
and
specifically
our
neonatal
Intensive
Care
Unit,
and
there's
no
better
place
to
understand
the
impact
of
preventative
care
and
access
to
health
care
than
touring
our
neonatal
Intensive
Care
Unit.
Okay,
just
last
week
when
I
was
up
in
the
unit
had
the
opportunity
to
visit
a
500
gram,
baby
500
grams
is
about
a
pound,
so
think
about
four
sticks
of
butter.
Yeah,
that's
about
a
pound
that
baby
was
born
at
22
weeks.
L
Okay,
no
coverage,
okay,
mom
didn't
have
any
prenatal
care
so,
as
we
think
about
access
to
care
and
the
provisions
that
we're
talking
about
today
that
ounce
of
prevention
will
will
provide
significant
enhancements.
Okay
for
that
baby,
instead
of
being
in
the
neonatal
Intensive
Care
Unit,
okay
for
weeks
for
15
weeks,
okay,
that
individual
would
leave
potentially
leave
a
healthy
life.
L
L
So
as
you
contemplate
the
bill,
you
know
please
keep
in
mind
that
expanding
coverage
to
include
more
of
the
uninsured
is
a
strong
investment.
Most
importantly,
it
increases
access
to
preventative
care,
promotes
overall
wellness
and
leads
to
significantly
Improvement
quality
of
life,
and
today's
hearing
is
just
really
the
first
step:
okay
in
a
voyage
of
expanding
Health,
Care
access
and
services,
and
we
look
forward
to
working
with
you.
Okay,
as
this
bill
moves
forward.
A
Thank
you.
Thank
you.
So
much
Todd
we'll
move
on
to
the
next
presenter
for
this
bill.
Next
I
will
go
ahead
and
introduce
Miss
Luz
Castro
from
Dignity
Health.
She
has
a
few
slides
that
have
been
uploaded
to
Nellis
and
she's
attending
virtually
so
Miss
Castro.
Please
proceed.
M
M
I
think
maybe
hell
St
Rose
Dominican
started
in
1947
after
World
War
II
after
the
basic
magnesium
plan
came
to
a
close,
then
an
Adrian
Dominican
sisters
of
Michigan
traveled
to
Henderson,
with
Bishop
Gorman,
to
purchase
the
hospital
for
a
dollar
a
year
for
25
years.
The
hospital
purchase
is
today
known
as
our
rosalima
campus.
M
M
M
The
red
rose,
the
red
rose
stands
for
responsible
early
detection
program
began
in
2001,
founded
by
Sister
Monica
stancus.
She
wanted
to
ensure
that
women
without
adequate
Insurance
received
the
treatment
they
need
in
their
fights,
Against
Breast
Cancer,
as
well
as
financial
support,
that
they
cannot
withhold
down
a
job
while
receiving
treatment.
M
M
M
M
And
ninety
percent
of
our
red
rose
clients
are
undocumented.
Unfortunately,
there
is
a
lack
of
preventative
health
care
services
for
the
undocumented
community
in
Nevada.
Women
with
breast
cancer,
who
are
uninsured,
need
to
pay
out
of
pocket
for
their
treatments
like
chemotherapy
or
radiation,
and
these
are
these
out
of
pocket
costs
between
600
to
a
thousand
dollars
per
treatment.
M
Our
clients
have
expressed
to
our
Navigators
other
health
related
issues
and
we
strive
to
connect
them
to
your
free
programs
at
big
mini
Health,
but
it's
been
challenging
to
find
more
Community
Resources
to
support
their
needs
by
expanding
Medicaid
to
the
undocumented
Community,
we're
not
only
giving
them
access
to
better
quality
of
life,
but
it
can
mean
saving
someone's
life
at
Big,
maybe
Health.
We
believe
that
Health
Care
is
a
basic
human
right
for
everyone.
A
Thank
you
so
much
for
the
record.
Next
I
will
go
ahead
and
introduce
a
few
other
clinical
providers.
We
always
have
the
question.
Well,
why
can't
fqhcs
cover
this?
So
we
have
folks
that
can
cover
that
answer:
I'm
honored
to
be
joined
by
Dr
Jose,
cucalon
Calderon
and
Dr
Maria
Fernandez
from
the
Community
Health
Alliance,
which
is
an
fqhc
in
Northern
Nevada.
N
If
I
take
my
my
name
is
Jose
cook
along
Calderon,
Jose
and
j-o-s-e,
and
last
name
is
a
two-word.
Last
name
c:
u
c
a
l-o-n
second
word
c-a-l-d-e-r-o-n,
if
I
take
time
and
process
is
because
I'm
translating
actively
translating
Spanish
to
English
in
my
head
before
it
comes
out.
So
I
do
apologize
for
that.
My
I'm
going
to
speak
about
stories
about
stories
that
I
encounter
almost
on
a
daily
basis
that
become
a
lot
more
frequent
during
the
initial
few
couple
of
years
of
the
pandemic.
N
So
that
is
a
long
Continuum
of
a
long
relationship
that
I
have
established
with
a
lot
of
these
families,
since
I
have
been
seeing
their
kids
now
for
close
to
six
years
as
one
of
the
very
few
Spanish-speaking
Physicians,
especially
pediatricians
families,
come
to
me
with
all
sort
of
all
sort
of
questions
asking
about
what
right,
what
choices
are
going
to
be
good
for
their
kids
and
good
for
the
and
good
for
their
kids,
developmental
growth
and
for
them
to
thrive,
and
one
of
the
more
common
answers
that
I
that
I
talked
about
is
well
being
able
to
make
sure
that
you
are
taking
care
of
yourselves
about
being
able
to
contact
Services
being
able
to
get
your
colonoscopy.
N
N
I
also
rendered
an
extremely
busy
newborn
Nursery
up
here
in
Northern
Nevada,
where
the
care
that
we
deliver
to
these
newborns
song
gets
affected
most
not
for
the
better
because
of
the
lack
of
Act,
of
the
lack
of
prenatal
care
and
visits
that
mothers
have
during
their
pregnancy,
which
can
lead
to
significant
Health
consequences.
Just
like
was
mentioned
previously
about.
When
we
talked
about
the
NICU
and
equivalents
Primary
Care
is
live,
it
can
mean
the
life
of
your
family.
N
It
can
mean
the
life
of
multiple
families
and
access
for
everybody
is
something
necessary,
not
only
for
all
the
right
reasons.
It's
going
to
be
cost
effective.
It's
going
to
end
up
expanding
access
to
care
for
everybody
in
the
state,
as
well
as
allowing
people
to
practice
best
medicine
available,
which
is
preventive
care.
Thank
you.
O
O
Medicine
doctor
at
Community,
Health
Alliance,
which
is
an
fqhc
in
Northern,
Nevada
and
federally
qualified
Health
Center
I,
come
here
in
support
of
this
Bill.
Thank
you,
Senator
donate
for
inviting
me
as
a
family,
Med
doc.
I
see
newborns
all
the
way
to
my
patients.
I
have
a
couple
in
the
90s
and,
as
we
know,
as
any
primary
care
provider
knows
that
having
access
to
Insurance
means
that
they
will
actually
come
and
seek
medical
care
before
they
end
up
in
the
emergency
room.
O
Like
my
emergency
room
doctor
shared
I
see
a
lot
of
the
hospital
discharges
after
they
have
had
a
leg
amputation
because
of
uncontrolled
diabetes.
I
can
obviously
I
can
control
their
diabetes.
I
can
work
with
them,
but
the
damage
has
been
done.
They
entered
the
emergency
room
because
they
had
other
priorities.
They
were
paying
for
food,
they
were
supporting
their
family
and
so
absolutely
as
an
fqh
see,
we
provide
services.
We
do
screening,
we
provide
a
lot
of
Grant
programs,
but
sometimes
you
know
because
they
do
not
have
insurance.
A
For
the
record,
next
I
will
go
ahead
and
introduce
two
other
speakers.
I
think
this
is
probably
the
the
part
of
the
presentation
hits
the
most
home
I
think
it's
important
for
you
as
committee
members
and
as
legislators,
to
see
the
most
extreme
cases,
because
the
reality
is
they're
happening
and
we
could
do
something
to
prevent
it.
A
A
Q
Q
Q
He
arrived
to
this
country
with
hopes
and
dreams,
and,
tragically
within
months,
we
learned
that
he
had.
He
had
an
aggressive
form
of
kidney
cancer
and
he
needed
surgery
being
undocumented
and
uninsured
in
Nevada
means
that
you
are
alone
with
nowhere
to
turn
go
to
the
hospital.
They
say
they
can't
turn
you
away
turns
down,
they
can
and
turns
out.
They
did.
Q
My
dad
ended
up
having
surgery
months
later,
but
only
after
we
agreed
to
pay
cash
up
front.
We
were
forced
to
borrow
money
from
friends
and
family
and
we
came
up
with
a
required
five
thousand
dollars
just
to
schedule
the
surgery,
but
unfortunately
we
were
too
late.
He
died
the
day
after
the
surgery.
Q
How
how
could
he
continue
to
keep
us
safe?
This
happens
every
day
right
here
in
Nevada,
after
losing
my
dad,
I
was
determined
to
help
families
just
like
mine.
I
am
now
the
director
of
patient
experience,
I
cure
for
the
kids,
Foundation
and
I
see
families
like
my
own.
Every
single
day,
our
organization
provides
treatment
and
care
for
children
battling
cancer
and
other
diseases.
Q
Q
Q
Her
mom
recalled
hearing
a
diagnosis
and
thinking
okay.
This
is
going
to
be
hard,
but
we
got
this
as
the
navigated,
a
very
broken
Health
Care
System
soon.
She
realized
that
the
hope
of
keeping
her
daughter
alive
was
quickly
fading,
being
uninsured,
brought
problems
that
they
were
not
expecting
at
every
hospital
visit.
The
social
worker
would
have
them
reapply
and
reapply
for
emergency
Medicaid.
Q
Q
Q
Q
Ultimately,
we
were
able
to
help
her
we
put
in
the
work,
and
we
found
a
donor
that
was
willing
to
donate
the
thousands
of
dollars
we
needed
to
purchase
the
drug,
so
we
could
give
it
to
ASU
Mom
cell
first
hand
that
the
simple
fact
that
their
family
was
undocumented
and
uninsured
nearly
killed.
Her
daughter
life
is
precious
at
our
Clinic.
We
fight
every
day
to
keep
children
with
their
families
just
one
more
day.
Q
A
Well,
we'll
come
back.
Let's
move
on
to
the
next
speaker,
I
I
think
you
know,
I
can
sit
here
with
you
and
vaping
another
for
the
record.
I
can
sit
here
with
you
and
talk
about
my
personal
circumstances,
but
that's
not
merely
enough
of
the
problem.
I
want
you
to
hear
as
my
colleagues
the
personal
stories
of
people
who
are
personally
impacted,
so
we
have
Rico
and
then
we'll
go
to
someone
in
Las
Vegas.
R
Good
afternoon,
members
of
the
committee
for
the
record,
my
name
is
Rico
Ocampo,
r-I-c-o
space,
o
c,
a
m
p
o.
I
want
to
start
off
by
thinking
Senator
Fabiano
for
sponsoring
this
life-changing
legislation,
I'm
here
to
tell
you
a
personal
story
of
how
the
current
health
care
system
in
the
United
States
failed.
My
family,
particularly
my
older
brother,
who
we
call
Carlitos.
R
R
R
R
R
R
R
R
A
Thank
you
so
much
Rico
for
the
record.
Next
I
wanna
I
want
the
committee
members
to
hear
from
another
person.
That's
personally
impacted
a
nursing
student.
Someone
please
proceed.
T
T
I
have
been
living
in
the
United
States
since
I
was
just
four
years
old
and
Las
Vegas
Nevada
is
the
only
place.
I
call
home
as
an
undocumented
student
I.
Faced
many
challenges
in
my
life,
but
I
have
always
been
determined
to
succeed.
I
have
always
been
passionate
about
helping
my
community,
and
that
is
why
I
decided
to
pursue
a
career
in
nursing.
T
However,
as
an
undocumented
student,
I
am
facing
a
huge
obstacle:
I
am
unable
to
obtain
any
kind
of
health
insurance,
which
is
preventing
me
from
getting
the
Hands-On
clinical
experience
that
I
need
to
be
a
successful
nurse.
This
is
a
major
setback
for
me
and
it
is
preventing
me
from
achieving
my
goals.
T
It
is
difficult
to
explain
the
frustration
and
sadness
that
comes
with
knowing
that
I
am
being
denied
access
to
something
as
accentual
as
Healthcare,
simply
because
of
my
immigration
studies.
Despite
these
challenges,
I
am
determined
to
contribute
to
this
country
and
to
make
a
positive
impact
on
the
lives
of
those
around
me.
T
We
need
access
to
health
care
in
order
to
succeed
in
our
careers
and
to
continue
serving
our
communities.
No
one
should
be
denied
Health
Care,
simply
because
of
their
immigration
studies.
Let's
work
together
to
make
sure
that
everyone
has
access
to
the
care
they
need
and
deserve.
Thank
you,
members
of
the
committee.
A
Thank
you,
so
much
I
I
believe
there's
some
technical
difficulties
within
that,
so
we'll
try
to
figure
that
out
she's
having
problems
being
muted
and
accessing.
So
if
we
can
come
back
for
her
that'd
be
appreciated,
but
in
general
I
think
we're
ready
to
take
on
the
questions.
As
you
know,
this
is
a
working
Bill
it'll
go
through
multiple
committees.
The
I
would
urge
before
we
ask
any
questions.
I
know
we're
all
eager
to
talk
about
the
financial
piece
of
this
legislation.
E
Thank
you
and
thank
you
for
that
presentation.
This
was
a
pretty
large,
Bill,
obviously
and
I.
Think
I'll
start
with
some
of
the
questions.
If
that's
okay
and
then
I
will
give
everyone
kind
of
a
round
of
questions
and
we'll
come
back
around
through
I
know
that
there
are
lots
of
different
areas
within
this
bill
and
I
want
to
make
sure
that
we're
given
a
sufficient
amount
of
time
to
fully
vet
that
within
our
committee
I,
you
know
we
had
talked
about
or
you
had
talked
about
during
your
presentation.
E
Other
states
that
have
implemented
similar
programs
and
I
noticed.
The
first
thing
that
we
looked
in
that
you
talked
about
is
how
they
all
started
with
covering
children
under
19,
but
then
it
it
clearly
looks
like
they
expanded
them
almost
immediately
to
cover
up
any
of
those
other
gaps.
Can
you
kind
of
explain
more
of
what
the
why
why
that
happened,
and
why
people
weren't
covered
from
the
very
beginning,
like
is
suggested
in
your
bill.
A
Sure,
thank
you
so
much
Vice
Irwin
Fabian
donate
for
the
record,
so
in
general,
I've
had
many
meetings
within
the
last
year
or
so
with
folks
from
throughout
different
states
and
the
the
true
reality
is
it's
incredibly
difficult
to
financially
project
what
the
outcomes
could
be
for
this
population.
A
The
presentation
we
heard
on
uncompensated
care
is
it's
it's
hard
for
us
to
track
how
many
of
these
folks
live
in
this
state,
because
when
they
come
to
the
emergency
room
or
to
our
doctor's
office,
we
don't
include
what
your
citizenship
status
as
part
of
the
form
that
you
have
to
fill
out
when
you
get
to
the
clinic
and
that's
why
it's
incredibly
difficult
for
these
instances?
What
we've
seen
in
other
states
Oregon's
a
good
example
where
it
was
passed
with
bipartisan
support,
and
originally
they
started
off
with
with
kids
and
pregnant
moms.
A
That's
something
that's
similarly
with,
as
we
mentioned
in
Colorado,
and
the
reason
why
they
did.
That
was
because,
because
you
can't
really
project
how
many
individuals
would
qualify
or
would
enroll
you
do
it
in
a
strategic
way
where
you
do
certain
portions
one
by
one
by
one.
There
are
certain
states
that
have
done
different
legislation,
but
California
is
the
one
that
has
expanded
it
for
everyone
so
far,
and
most
of
it
comes
down
to
state
general
funds.
A
The
last
thing
that
I
would
mention
to
your
question:
I
contemplated
it
personally
whether
I
was
going
to
expand
it
as
what
you
have
in
front
of
you
for
everyone
or
if
I
wanted
to
be
I.
Guess
if
you
want
to
use
the
word
strategic
for
kids
and
pregnant
moms
Etc,
but
I
have
family
members
that
are
impacted
by
this
bill.
How
could
I
turn
my
back
to
them?
You
know
I
think
they
deserve
access
to
care
too.
A
That's
part
of
the
reason
why
I
got
elected
there
are
people
in
this
in
my
in
this
building
that
would
be
affected
by
this
bill.
There
are
residents
of
my
district
I
can't
turn
my
back
to
them.
So
that
was
the
reason
why
I
introduced
the
bill
and
I
hope
that
within
reiterations
throughout
this
process,
we
can
have
a
further
conversation
as
to
how
that
looks
financially.
E
And
just
as
a
policy
in
these
other
states,
you
know
we're
not
talking
about
money
per
se,
but
obviously
that's.
It
goes
hand
in
hand,
and
that
will
be
addressed
if
this
makes
its
way
to
any
of
those
money,
committees
or
Revenue
committees.
But
did
does
your
bill
contemplate
or
did
these
other
states
or
do
they
have
a
way
to
track
the
information,
so
they
can
come
back
later
and
say?
Yes,
this
saved
us
a
lot
of
money
to
the
hospitals.
E
I
know
we
had
a
lot
of
testimony
of
supportive
testimony
from
hospitals,
and
maybe
one
of
their
representatives
might
be
able
to
kind
of
answer
that
question
on
how
they
documented
I
guess
these
savings
for
lack
of
a
better
term
or
the
health
discrepancies
how
they
were
improved
once
they
started
covering
people.
Thank.
A
You
so
much
Fabian
nunate
for
the
record,
so
that
is
reflected
in
I
had
the
same
exact
question,
which
is:
let's
make
sure
that
we
measure
that
we're
doing
our
work.
If
we
do
certain
capacities
to
this
initiative,
give
you
see
that
with
the
Medicaid
Advisory
Group
in
this
legislation,
if
I
think
it's
section,
it's
the
section
after
the
state
plan
Amendment.
So
in
essentially
what
you
would
create
is
so
if
the
state
changes
its
eligibility
where
you
can
keep
the
income
thresholds.
A
But
now
you
just
change
the
application
process
as
to
what
requirements
are
required
for
you,
whether
you
segment
portions
of
the
population
or
not
at
that
time
frame.
If
this
bill
passes
to
some
extent,
Medicaid
would
then
have
the
ability
to
create
a
working
group
of
health
professionals,
fqhds
mcos
that
already
have
Outreach
groups
so
for
two
things:
one
to
continuously
monitor
the
enrollment
and
aggregation
of
data
points,
because
we've
heard
the
testimony
what,
if
there's
an
income?
A
What,
if
there's
a
stance
where
there's
a
increase
of
enrollment
and
we're
not
really
sure
how
to
address
that
or
the
reverse?
What
if,
when
we
enact
this
legislation,
regardless
of
how
many
news
articles
come,
people
still
have
a
fear
of
enrolling
as
part
of
this
Medicaid
Program,
and
so
the
bill
covers
the
same
thing
which
was
introduced
in
Oregon,
which
is
there
would
be
a
work
group
for
the
facilitation
implementation
to
track
what
you
mentioned,
which
is
a
cost
savings
enrollment
Etc.
E
And-
and
maybe
this
is
a
question
young
Todd
back-
there
might
be
able
to
answer
or
Mr
Kelly
might
be
able
to
answer
whether
or
not
the
hospitals
also
have
their
internal
like
measurements,
on
whether
or
not
they're
seeing
a
decrease
in
Colorado
or
Oregon
or
Washington,
or
any
of
those
other
places
where
some
of
these
hospitals
might
have
other
facilities.
If
they're
seeing
a
decrease
in
the
number
of
people
that
are
actually
coming
to
the
emergency
room
and
I
saw
I
saw
him
sneaking
up
here.
L
Well,
Todd's
glenberg
For,
the
record.
You
know
great
question
I
think
from
a
hospital
standpoint,
I
will
have
a
limited
ability.
I
think
you
raise
a
good
point
of
looking
at
those
States
being
part
of
a
larger
National
Organization
who
has
a
presence
in
Colorado.
We
could
look
at
that
data
to
see
what
the
impact
is.
I
think
as
Senator
donate.
L
You
know,
reference
we'd
also
need
to
rely
on
the
mcos
and
the
federally
qualifieds
or
other
primary
care
offices
to
help
sort
of
refine
those
numbers
and
the
number
of
number
of
new
patients
being
seen
who
are
undocumented.
Who
register
through
for
Medicaid
who
access
primary
care
I.
Think
that's
going
to
be
a
key
determinant
in
helping
determine
the
successes.
U
F
F
Senator
donate
I
applaud
you
for
wanting
to
do
something
to
enhance
health
care
for
everyone
here
in
the
state
of
Nevada.
I
only
wish
that
you
would
include
us
in
your
passion
to
deliver
the
same.
F
So
I
have
to
say
I'm
I'm
disappointed
that
with
an
issue
that
I
think
is
so
important
to
you,
which
is
so
complementary
to
your
health
care
background
that
you've
excluded
two
of
us
to
make
up
forty
percent
of
this
committee,
where
we
want
to
be
your
partner.
We
don't
want
to
be
your
adversary,
because
we've
heard
a
lot
of
heart-wrenching
stories
here
today
and
I.
Don't
want
people
to
think
that
Republicans
are
heartless
people,
though
we
don't
want
to
deliver
health
care.
F
We
have
hospitals
that
are
going
to
deliver
Health
Care
to
anybody
that
goes
there.
We
have
fqi
qacs
that
are
going
to
do
the
same.
We
all
take
an
oath
to
want
to
help
and
cure
people,
but
we
have
fundamental
issues
here
in
Nevada
that
we
need
to
address
and
I
know.
This
is
not
a
financial
committee,
but
I
think
we've
done
things
in
reverse.
F
This
should
have
gone
to
the
financial
committee
first
and
find
out
what
the
cost
is
and
then
we
can
back
into
the
policies
and
make
sure
we
have
a
deliverable,
Health
System.
What
do
I
mean?
We
have
a
lack
of
providers
throughout
this
state.
Our
providers
are
burned
out
from
covid
most
most
Physicians.
Most
clinics
won't
even
take
Medicare
Medicaid.
Why?
Because
it's
one
of
the
lowest
Medicaid
fees
in
the
entire
country.
You
can't
blame
these
doctors.
They
can't
even
keep
the
lights
on
in
their
offices
to
take
Medicaid.
F
So
why
aren't
we
boosting
our
investment
in
Medicaid
so
that
we
can
pay
the
doctors
more
and
we
can
pay
the
hospitals
more?
So
we
don't
have
them
on
the
brink
of
subsidizing
and
possibly
closing
their
doors,
especially
in
some
of
the
rural
counties.
So
to
say
that
we
don't
have
any
struggling
hospitals,
that's
a
misnomer.
We
do
have
struggling
hospitals
here,
especially
in
the
rural
areas
and
I'm
sure
my
colleague
will
be
happy
to
do
that.
F
I
also
have
received
a
number
of
emails
already
from
people,
even
though
we
didn't
have
this
hearing,
it
was
predicted.
This
was
going
to
show
up
this
morning.
I
was
hoping
that
it
wouldn't,
but
it
did,
and
frankly
many
of
the
emails
are
saying
we
don't
want
to
continue
to
subsidize
yet
more
health
care
for
people
that
are
not
here
in
this
country
illegally,
whether
we
agree
with
the
immigration
policies
of
this
country-
or
we
don't
agree
with
the
immigration
policies
of
this
country.
F
But
we've
learned
just
today
in
the
prior
hearing
that
if
we
want
to
do
the
right
thing
and
that
is
give
everybody
Quality
Health
Care,
including
their
hangnails,
going
to
the
emergency
room,
if
necessary,
it's
going
to
be
a
five
billion
dollar
expenditure
at
a
minimum.
I'll
remind
you
all
our
budget
in
Nevada
isn't
that
gigantic.
We
only
have
a
two
billion
dollar
Surplus
this
year
and
we
have
a
lot
of
needs,
including
teachers
and
Public
Safety
Etc.
F
You
know,
I
don't
want
to
make
this
into
a
partisan
event,
but
you
know:
we've
had
the
greatest
influx
of
undocumented
increments
immigrants
in
this
country
in
the
past
three
years
and
that's
okay.
If
we
do
that's
fine,
but
the
federal
government
needs
to
issue
a
check
so
that
we
can
appropriately
take
care
of
people.
You
could
have
open
border
policies.
F
That's
fine,
but
President
Biden
sent
us
a
check
if
we
have
400
000
on
docs
that
are
going
to
come
into
Nevada
in
the
next
biennium
then
give
us
a
cost
for
if
those
400
000
people
to
take
care
of
their
health
care
costs.
So
we
don't
have
to
depend
on
our
citizens
to
subsidize
and
pay
for
the
same
at
the
expense
of
providing
Health
Care
to
our
citizens,
which
have
trouble
accessing
Health.
F
Foreign
I
think
that
the
technological
technological
advances
that
you
want
to
do
I
think
are
fantastic.
We
tried
it
in
California
you'd.
Be
surprised
how
many
Hospital
Systems
in
California
still
operate
with
paper
paper
charts
that
don't
have
electronic
charting.
It
was
in
the
county
hospital
that
I
that
I
work
for
as
an
elected
official
it
was.
F
It
was
a
priority
to
get
electronic
charting,
which
saves
US
money,
saves
us
efficiencies
and
actually
save
more
mortality,
because
there
were
less
mistakes
that
were
that
were
in
fact
made
so
I
appreciate
what
you're
trying
to
do
in,
in
conformance
with
the
the
federal
model,
but
senator
again
I
know
we
can't
take
cost
into
consideration.
E
Again,
I
will
remind
this
committee.
It
is
a
policy
committee.
This
will
go
if
there
obviously
is
a
fiscal
note
that
will
be
attached
to
it,
and
so
it
will
go
to
that
fiscal
money
committee
to
vet
the
costs
of
whether
or
not
we
can
afford
this
as
a
state
Rica.
F
F
No
one
should
endure
what
you've
gone
through
and
not
only
having
to
see
your
loved
one
pass
away
due
to
lack
of
care,
but
to
have
your
house
taken
away
from
you
to
pay
for
the
medical
bills
to
take
care
of
your
your
loved
one.
That
to
me
is
appalling
and
also
Annette
Parker
cure
for
the
kids.
I
want
to
tell
you
what
a
wonderful
job
that
you
guys
do
at
your
clinic,
I
toured
it.
We
need
to
get
you
on
the
420b
program.
Right
and
listen.
F
F
So
my
challenge
for
Senator
donate
is:
how
are
you
going
to
communicate
to
people
like
me
the
importance
of
this
program
so
that
you
can
get
people
like
me
if
I'm
important
to
the
process
to
you
you're
important
to
the
process,
to
me
to
engage
me
as
an
ally
to
try
to
deliver
the
same.
A
Thank
you
so
much
Vice,
Irwin,
Fabian
nunate
for
the
record.
You
know
I,
understand,
I.
Think
part
of
this
conversation
is
offline.
I,
don't
want
to
take
any
more
time
than
what
the
patients
deserve
to
hear,
which
is
the
policy
aspect
of
this
bill.
I
will
say
that
there
are
colleagues
that
sit
on
this
committee
that
have
seen
reiterations
of
this
bill
before
it
came
today.
A
So
I
don't
want
to
take
this
anymore
longer
than
we
need
to,
but
I
think
for
the
portions
that
you
mentioned
as
to
what
the
cost
could
be,
which
is
I,
will
answer
it
specifically
for
the
sake
of
these
purposes.
A
There
are,
there
are
going
to
be
conversations
that
Medicaid
provides
access
to
what
the
who
is
actually
covered
and
I
think
it's
important
to
cure
it,
for
you
that
Medicaid
expansion
doesn't
cover
everyone.
There
are
folks
that
will
probably
make
too
much
money
for
Medicaid
and
they
want
and
they
could
be
undocumented,
but
they
won't
be
a
part
of
this
bill.
That's
what
separates
us
from
other
proposals
that
you
see
in
other
state
legislation.
A
The
reason
why
we
did
that
was
because
there
are
folks
who,
in
instances
where
you
see
with
these
kids
right
here
with
care
for
the
kids,
if
you're
not
able
to
work,
you
should
still
have
some
level
of
safety
net,
because
it
leads
to
the
level
of
uncompensated
care
that
we're
seeing
with
regard
to
our
Hospital,
Systems,
Etc
and
I
want
to
point
you
back
to
a
slide
which
is
I
recognize.
You
know,
utilization
management,
a
conversation
that
we've
heard
over
and
over
again
right.
A
If
you
we
already
have
a
shortage
of
providers
Etc,
that's
why
my
bill
covers
tax
abatements.
That's
why
I've
worked
to
introduce
legislation
on
other
pieces
of
how
to
expand
the
pipeline
of
healthcare,
how
to
stabilize
what
we're
experiencing
on
the
front
lines?
If
you
look
at
this
slide
from
State
outcomes
of
Colorado,
it
shows
that
the
direct
effect
of
expanding
coverage
can
lead
to
better
indirect
effects
of
how
that
actually
reduces
costs
over
the
long
term.
I,
don't
think
it's
easy
to
say.
A
Well,
if
there's
going
to
be
an
enrollment
of
folks,
there
could
be
an
increased
cost
of
utilization.
You
heard
from
Dr
hard
work
today.
The
utilization
already
exists,
we're
already
paying
for
it.
What
we've
seen
in
other
states
is
this
expansion
can
lead
to
the
decrease
of
costs
when
enrollment
happens
and
I
urge
you
to
look
at
this
slide,
which
is
when
you
enact
legislation,
whether
it's
for
kids
or
pregnant
moms.
Well,
we
see
in
organ,
is
they
end
up
going
to
what
we
want
them
to
go
to,
which
is
primary
and
Specialty
Care?
A
F
The
outcome
that
I
certainly
want
as
well
and
I,
understand
by
share
that
we
have
a
16-week
schedule
here
and
I
understand
that
things
are
condensed,
but
24-hour
notice
would
have
been
great
to
at
least
get
through
the
bill
once
and
maybe
come
see.
You
with
some
questions
and
I
also
will
point
out
that
California,
yes,
provides
a
vast
array
of
services
for
undocumented
immigrants,
they're
also
looking
at
a
40
billion
dollar
shortfall
this
year,
and
it's
going
to
be
interesting
to
see
how
they
plug
that.
E
I
I
will
just
remind
the
people
that
are
in
the
public
and
know
that
there
are
quite
a
few
people
that
are
participating
in
the
legislative
process
for
the
very
first
time,
probably
in
their
life
I
know,
some
people
were
attending
other
Bill
hearings
and
decided
to
come
in.
Here
we
we
are
as
Senator
Stone
mentioned.
We
are
a
we
only
meet
every
other
year
for
120
days.
There
were
I
believe
110
bills
that
dropped
just
yesterday.
E
Unfortunately,
they
do
have
to
make
their
way
out
of
these
houses
by
the
14
or
these
committees
by
the
14th
of
April,
so
less
than
a
couple
of
weeks
away.
So
I
just
you
know,
for
information
for
the
committee,
and
this
is
a
very
Dynamic
process.
As
everyone
knows
here,
and
so
I
know
that
bill
sponsors
are
continually
working
on
amendments
and
meeting
with
you
and
I'm
sure
that
Senator
Stone,
the
chair,
will
meet
with
you
regarding
any
concerns
you
have
regarding
this
bill.
I
will
move
now
next
to
Senator
Titus.
H
Thank
you.
Thank
you.
Madame
Vice,
chair
and
Senator
donate
I,
appreciate
your
passion
for
your
constituents
and
your
District,
recognizing
that
I
am
as
passionate
for
my
constituents,
and
my
districts
and
I
will
tell
you
that
I
as
a
medical
provider
can't
get
my
constituents
or
my
patients
and
to
see
doctors
because
there's
not
enough
of
us.
So
my
concern
is
that
and
just
a
little
just
so
for
all
those
that
presented
their
stories.
I
appreciate
your
sharing
your
family's
stories
and
your
personal
stories.
I'll
share
one
of
mine.
H
My
56
year
old,
brother-in-law,
living
in
Fallon
had
health
insurance.
White
male
healthiest
horse
died
of
covid
in
two
months
of
diagnosis.
Not
getting
care
I
have
a
really
close
friend.
Wake
up,
Christmas
Day,
with
pain
in
the
side,
went
to
the
ER,
like
everybody
does,
because
we
can't
get
them
into
a
provider
with
insurance.
H
Still
no
providers
could
get
them
in
goes
to
the
ER.
Ct
scan
shows
that
he
has
renal
cell
carcinoma
died.
Two
months
ago,
his
diagnosis
was
took
a
month
to
get
into
the
specialist,
so
access
to
care,
or
lack
thereof,
is
not
limited
to
any
person.
No
matter
how
much
you
make
no
matter
what
your
insurance
is,
no
matter
where
you're
from
whether
you're
documented
or
not
I,
as
a
person
who
would
see
anybody
walking
my
in
my
door
couldn't
get
them
referred
to
a
specialist
because
there's
not
enough
of
us.
H
H
So,
in
the
long
run
it
may
hurt
everyone,
the
very
people
you're
trying
to
help.
So
my
my
question
is:
how
do
you
solve
that
access
to
care
when
we
already
don't
have
enough
of
us
and
so
the
question?
Another
question
would
be
when
you
use
States
like
Oregon
and
Colorado
on
what
the
outcomes
were
there
there?
H
What's
their
ratio
of
patient
to
provider
in
Nevada
we're
the
worst
right
we're
in
the
bottom
of
the
list
of
of
providers
to
patients
across
any
states
in
Colorado
and
Oregon?
Are
they
at
the
bottom
or
do
they
already
have
the
access
to
health
care?
So
I
would
appreciate
my
patients
not
having
to
go
to
the
ER
either,
but
I
can't
get
them
in
to
see
the
specialist
either
especially
GI,
like
I,
have
a
person
waiting
three
months
to
get
to
see
a
GI
specialist
they're
fleeing
our
state.
H
Here
in
the
north
we
can't
find
a
gastroenterologist
to
see
people,
so
my
own
husband
has
had
multiple
appointments
canceled
because
the
providers
have
left
to
get
into
a
GI
consultant,
and
none
of
this
solves
that
as
a
matter
of
fact,
I
see
it
just
adding
to
the
problem.
So
it's
awesome,
but
then
I'll
I'll
ask
all
those
fiscal
questions
in
the
future,
because
I
happen
to
have
the
advantage
of
having
being
on
the
fiscal
committee.
H
So
I'll
address
that
when
that
time
comes,
but
this
is
really
about
the
policy
of
care
to
to
the
citizens
of
Nevada.
My
constituents,
who
can't
get
into
care
now
and
you're,
asking
us
to
now
dilute
that.
So
your
constituents
can
get
in
and
see
a
provider
and
at
some
not
something
that
that
I
in
all
good
conscience,
can
see
a
pathway
to
access
to
care.
A
Thank
you
so
much
Vice
chair
when
baby
Ninja
for
the
record
I
want
to
touch
point
on
a
few
of
your
comments.
So
let's
talk
about
the
dilution
right,
if
that's
difference
of
opinion
right
I
think
the
utilization
of
these
Services
already
exists
with
regard
to
Emergency
Care
Services
they're,
already
going
to
the
emergency
room,
I
think
all
of
us
can
can
take
that
into
consideration.
A
A
How
we
can
engage
folks
from
the
Health
Equity
side,
but
the
proposals
that
I
have
are
not
merely
enough
of
what
this
bill
does.
The
reason
why
I
included
tax
abatements
is
to
cover
exactly
what
you're
mentioning
because
oftentimes
you
know
as
chair
of
HHS
I
have
folks
that
come
to
me
and
they
are
providers
that
want
to
move
into
this
state.
A
A
People
always
ask
me:
what
else
can
this
state
do?
I
want
to
move
here?
I
have
the
employees
and
the
resources,
because
I'm
in
Arizona
or
in
Utah
or
whichever
I
want
to
come
to
Nevada,
because
I
believe
you
guys
have
gaps
that
I
have
whether
it's
for
mental
health
services,
but
I
need
help.
There
is
there
something
else
that
this
bill,
that
your
state
can
do?
That's
what
the
tax
statements
do?
A
The
tax
abatements
look
at
Health
Care
capacity
for
individuals
that
want
to
move
to
this
state
for
the
equipment
that
they
have
to
purchase
for
wages,
Etc
and
I.
Think
that's
something
that
will
cover
if
the
bill
makes
it
through
Senate
Revenue,
but
I
think
when
it
comes
to
the
dilution
of
services,
we're
already
seeing
the
utilization
already.
You
had
Dr
Hardwick
mention
that
people
are
already
coming
for
simple
scenarios
where
they
could
have
gone
to
Primary
Care.
P
A
This
is
coming
from
someone
that
also
works
in
Primary
Care.
We
can
do
a
better
job
with
coordinating
with
the
companies
that
want
to
move
here,
and
we
should
because,
when
they
look
at
moving
to
our
state,
they
always
look
at
two
things:
how?
What
do
we
do
in
education?
What
do
we
do
in
healthcare
and
if
they
have
to
go
to
Harry
Reid,
to
receive
the
facility,
the
services
that
they
need
her
to
read?
International
Airport?
That's
not
the
way
our
health
care
System
should
be
ran.
P
A
While
a
lot
of
them
are
my
constituents
for
this
bill,
they're
also
everyone
else's
on
this
committee-
undocumented
immigrants
live
throughout
this
entire
State.
It's
not
just
proportionally
in
mind.
Obviously
there's
a
significant
portion
that
is
encompassing
and
if
you
look
at
my
state
demographics
of
my
district
about
a
quarter
of
the
Latinos
in
my
district
are
uninsured,
so
I
the
issue
could
be
exacerbated
more
in
the
urban
areas,
but
all
of
us
suffer
from
this
system.
They're
your
constituents
as
well
I
think
in
general.
H
Thank
you
and
thank
you
next
question
I
have
is
regarding
insurance
and
the
Health
Care
exchange
and
applying
for
insurance.
So
you
mentioned
and
I
believe
your
testimony
that
many
of
these
folks
wouldn't
necessarily
acquire
qualify
based
on
their
income,
and
so
are
those
folks
then
able
to
purchase
insurance
on
the
exchange
and
just
an
example.
H
We
we
have
because
of
the
uninsured
in
my
mind,
because
of
Obamacare,
which
the
Affordable
Health
Care,
Act
and
I'm
just
going
to
get
on
my
soapbox
and
say
it
was
neither
affordable
nor
about
care.
So
what
has
happened
with?
That
is
that,
as
we
heard
in
earlier
testimony
from
the
hospitals,
the
insurance
companies
are
now
asking
to
cover
a
larger
portion
for
the
uninsured,
and
what
happens
is
those
that
do
have
insurance
are
now
paying
more
for
their
insurance,
where
they're
higher
deductible,
so
I
have
family
patients,
myself
Etc?
H
H
What
is
it
that
prohibits
in
federal
law
or
state
law
from
a
working
person
that
comes
to
America
to
work,
because
we
need
the
workers?
God
knows:
there's
we
want
people
to
come
here
and
work.
So
what
prohibits
them
from
buying
Insurance,
like
the
rest
of
us,
do
on
the
exchange
and
just
explain
that
dynamic.
A
Thank
you
so
much
for
the
record.
So
a
lot
of
this,
of
course,
is
predicated
based
on
what
federal
regulations
are
currently
undocumented.
Immigrants
are
not
eligible
to
enroll
in
Medicaid
or
chip
or
to
purchase
coverage
through
the
Affordable
Care
Act
marketplaces
under
rules
issued
by
CMS
individuals
with
deferred
action
for
childhood
arrivals.
So
that's
DACA
recipients,
they're
not
considered
lawfully
present
for
purposes
of
health
coverage
eligibility
and
they
remain
ineligible
for
coverage
options.
A
Medicaid
payment
for
emergency
services
may
be
on
behalf
of
individuals
who
are
otherwise
eligible
for
Medicaid,
but
for
their
immigration
status
and,
of
course,
I
think
so
when
the
Affordable
Care
Act
was
passed,
it
forbid
our
state
from
doing
that
unless,
if
we
apply
for
a
waiver,
so
you
can
see
in
one
of
the
exhibits
of
this
bill
that
Washington
just
just
did
that
they're.
The
perfect
example
of
applying
for
a
waiver
to
allow
folks
to
go
into
the
marketplace.
A
The
deviation
that
I
would
just
clearly
make
is
I
think
that
can
cover
a
certain
portion
of
people,
those
who
can
afford
the
plans
that
are
on
the
exchange.
Not
everyone
will
be
able
to
have
to
do
the
opportunity
to
afford
that
if
you
are
in
the
most
vulnerable
capacity,
where,
for
instances
of
the
kids
that
we
have
before
us
today,
oftentimes
to
take
care
of
a
child
who
has
been
diagnosed
with
cancer,
who
is
undocumented
and
you
are
forbidden
from
Medicaid.
A
There
are
certain
instances
where
you
have
to
stop
working
to
take
care
of
your
kid,
and
that
is
where
Medicaid
coverage
comes
into
play,
but
that's
oftentimes
because
of
how
Federal
legislation
works.
The
states
have
to
put
that
effort
themselves
to
address
this,
so
we're
kind
of
in
this
flux
right.
We
wait
for
the
federal
government
to
take
action,
but
we
see
this
problem
persisting
over
and
over
again.
A
H
So
thank
you
for
that
clarification
and
and
I
I
would
just
say
that
we
have
a
lot
of
conversation
to
have
afterwards
and
and
appreciate
looking
for
for
forward
to
further
dialogue.
So
I'm
not
going
to
ask
any
more
questions
here
today,
I
think
the
my
points
have
been
I've
discussed.
My
point
of
view.
Thank
you.
E
I'm,
looking
around
I'm
willing
perfectly
willing
to
go
back
around
for
more
questions.
Do
you
have
any
other
questions,
Senator
Stone?
No,
no!
Anyone
else
on
the
committee.
E
Thank
you,
I
I
do
have
one
last
question
again.
Obviously,
we've
seen
some
support
and
I
anticipate.
There
will
be
more
support,
not
only
from
providers
that
provide
our
health
care
providers,
but
also
our
hospitals.
Do
they
see
this?
As
an
I
mean
we
heard
that
previous
just
presentation
on
uncompensated
care.
Obviously
that
is
those
are
huge
numbers
that
these
private
hospitals
are
like
seeing
in
their
things.
E
Do
they
see
this
as
a
way
to
I
guess
decrease
that
those
costs
that
are
being
incurred
by
them
already
under
the
current
model.
A
Thank
you,
Vice
Irwin
I,
don't
want
to
baby
Ninja
for
the
record.
I,
don't
want
to
speak
for
the
hospital
Association
or
for
the
hospitals
themselves,
but
I
think
you
can
see
the
value
of
what
you're
establishing,
because
that
is
why,
oh,
unless
we
could
actually
have
Mr
sunburg,
if
you
wanted
to
speak
on
that
issue,.
L
Todd's
glenberg
For
the
record.
You
know
great
question:
we
really
want
to
focus
the
the
answer
on
access
to
Prime
primary
care
and
preventative
care.
I
think
that's
where
we're
going
to
see
the
savings.
You
know
the
examples
that
we
heard
today
having
access
in
a
broader
Network,
okay
will
reduce
costs
because
we're
going
to
be
able
to
keep
patients
out
of
the
hospital
and
avoid
the
acute
stages
of
medical
needs.
E
Seeing
no
other
questions
here,
I
will
go
to
I.
First
want
to
point
out
that
we
do
have
a
room
full
of
people
that
are
here
in
to
testify
on
this
bill.
I
know:
we've
had
a
very
long
presentation,
I
think
it's
a
very
large
bill,
as
it
was
pointed
out,
that
is
pretty
substantial
policy
conversations
that
we're
having
I
believe
we
have
people
in
the
Overflow
room
too,
as
well.
I
see
a
bunch
of
people
over
there.
So
I
want
to
thank
everyone
for
staying
in
here.
E
I
am
going
to
start
with
support.
Testimony
I
will
just
because
there
are
so
many
people
I
want
to
remind
everyone
that
you
can
always
always
submit
your
testimony.
In
writing.
You
can
submit
it
to
the
committee
secretary
here
in
person
or
you
can
submit
it
online.
The
information
on
the
agendas
which
are
posted
right
there
at
the
beginning
and
also
online
on
Nellis.
You
can
get
those
emails
to
be
able
to
participate
that
way.
There
are
a
lot
of
people
here.
E
So
I
will
remind
you
to
we're
going
to
limit
this
to
two
minutes.
I
know
that
we
have
a
Spanish
interpreter
that
is
available
if
someone
needs
that
person
and
in
my
attempts
to
have
some
fairness
in
this
I
would
ask
if
it's
fine
to
say
Me
too
or
I
support
or
I
oppose.
My
comments
have
been
submitted
in
writing
any
one
of
those
kind
of
things
just
so
we
can
get
through
as
many
people
as
possible,
I'd
like
to
like
incorporate
those
people.
E
I
am
going
to
start
off
with
30
minutes
in
support
I'm
going
to
do
10
here,
10
on
the
phone
lines
virtually
and
10
in
Las,
Vegas
and
then
I
will
move
to
opposition
and
I
will
do
again.
30
minutes
10
here,
10
there
10
online
and
then
do
neutral
and
if
time
allows
I
will
go
back
around
for
a
second
round
to
do
support
opposition
and
testimony
outside.
So
with
that,
I
will
remind
every
speaker
to
turn
on
your
microphone
say
your
name
clearly
for
the
record
and
begin
your
testimony.
W
Thank
you
Vice
chair
and
members
of
the
committee
for
the
record.
My
name
is
Susie
Martinez
and
I
am
the
executive
secretary,
treasurer
of
the
Nevada
state
AFL-CIO
and
on
behalf
of
over
150
000
members
and
120
unions.
The
Nevada
state
AFL
support
Senate
Bill
419,
also
known
as
the
Nevada's
Health
opportunities
planning
and
expansion
hope
act
to
ensure
that
every
nevadan
has
access
to
high
quality,
affordable,
affordable
health
care
that
they
need.
W
The
Nevada
hope
act
will
close
this
Gap
in
care
and
guarantee
that
every
single
worker
that
keeps
our
state's
economy
moving
can
not
only
survive
but
Thrive.
The
future
of
our
state
depends
on
the
health
of
every
single
one
in
our
community
by
expanding
Medicaid
to
all
nevadans,
regardless
of
immigration
or
citizenship
status.
We
can
ensure
that
generations
to
come
are
happy
healthy
and
successful.
I'd
like
to
thank
Senator
donate
and
the
Nevada
Latino
legislative
caucus
for
bringing
up
this
important
issue
and
I
urge
the
committee
to
support
Senate
Bill
419.
X
Good
afternoon
Vice,
chair
Nguyen
and
members
of
the
committee,
my
name
is
Jimmy
lau
and
I'm.
The
vice
president
of
Ferrari
reader
public
affairs,
representing
the
biotechnology
Innovation
organization,
speaking
specifically
in
support
to
the
tax
abatement
and
incentives
package
that
are
included
in
the
bill
a
little
bit
about
bio
bio
is
a
trade
organization
that
represents
thousands
of
members
across
the
United
States
and
some
other
countries,
mostly
in
the
smaller
and
early
stages
of
biotechnology.
X
Development
we'd
like
to
thank
Senator,
donate
for
approaching
us
for
our
viewpoints
on
how
to
encourage
biotech
companies
to
come
into
Nevada
and
we'd
like
to
thank
him
for
including
this
important
piece
of
his
bill,
which
we
feel
is
going
to
help
bring
in
additional
revenues
and
additional
expertise
in
our
state.
Just
a
fun
fact
to
close
this
out.
Approximately
70
percent
of
innovative
therapies
that
are
looked
in
biotechnology
spaces,
particularly
in
Precision
medicine,
come
from
small
early
stage.
X
Y
Z
My
name
is
Paul
Katha,
that's
spelled
c-a-tha
and
I
represent
the
culinary
Workers
Union
Local
226.
The
Culinary
Union
supports
the
goals
of
sb19,
namely
to
expand
Medicaid
to
all
nevadans
and
ensure
people
have
easy
access
to
their
own
health
records,
especially
underserved
populations
that
can
have
the
most
difficulty.
Navigating
the
health
system.
Nevadan
should
be
able
to
quickly
and
easily
access
their
health
information
electronically
and
have
the
freedom
to
do
what
they
want
with
their
personal
medical
information
as
largest
organization
of
immigrants
in
Nevada
and
many
Culinary
Union
members
reside
in
mixed
status.
Z
Households
when
nevadans
are
unable
to
access
medical
care
at
an
affordable
rates
simply
because
of
their
immigration
status.
It
hurts
immigrant
workers
and
it
impacts.
The
state
The
Culinary
Union
believes
that
everyone
has
a
right
to
health
care
when
the
state
excludes
nevadans
for
Medicaid
coverage.
The
state
and
our
health
care
infrastructure
is
negatively
impacted.
Uninsurative
admins
will
likely
not
seek
preventative
care
and
increase
the
burden
on
local
emergency
rooms.
Z
Culinary
Union
members
have
been
heavily
impacted
by
the
provider
shortage
in
Nevada,
and
the
union
supports
efforts
to
bring
high
quality
low-cost,
Health
Care
to
all
nevadans.
We
haven't
had
time
to
fully
review
the
Amendments,
but
the
union
plans
on
having
more
conversations
with
the
senator
and
we
support
his
intent.
Thank
you.
AA
Good
afternoon
members
of
the
committee
and
chair
for
the
record,
my
name
is
Erica
Castro,
e-r-I-k-a-c-a-s-t-r-o
and
I.
Am
the
organizing
director
with
the
progressive
leadership
Alliance
in
Nevada
here
in
support
of
Hope
act.
Sb419
I
first
would
like
to
thank
the
senator
donate
for
bringing
this
legislation
forward
to
help
our
state
expand.
Healthcare
access
for
all
nevadans,
regardless
of
our
immigration
status
or
background
for
the
first
two
decades
of
my
life.
I
was
one
of
those
uninsured
nevadans
that
we
they
spoke
about
earlier,
and
many
of
my
loved
ones
continue
to
be.
AA
We
are
nevadans.
Like
many
of
you.
We
also
pay
taxes
for
the
Public
Services,
even
when
we
don't
have
access
to
them
in
2018,
according
to
the
American
Council
immigrant-led
households
pay
3.1
billion
dollars
in
federal
taxes
and
1.1
billion
dollars
in
state
and
local
taxes.
So
we
are
not
asking
for
freebies
we're
simply
asking
for
our
lives
to
be
cherished
with
dignity,
and
we
will
continue
to
invest
in
this
country.
Both
culturally
and
financially.
I've
lived
here
for
the
past
30
years
and
my
parents
are
getting
older.
AA
I
am
constantly
worried
about
how
they
will
get
the
care
they
need
if
my
brother
and
I
are
not
able
to
pay
for
the
health
care
needs
out
of
pocket
during
the
pandemic.
My
biggest
worry
was
having
my
dad
continue
to
work
risk
his
life
while
being
diabetic
and
having
no
Health
Care
coverage.
I
urge
you
to
support
sb419
to
ensure
that
nevadans,
like
myself
and
my
family,
have
access
to
health
care.
Thank
you.
AB
T-E-R-E-S-A-L-I-E-B-E-R-M-A-N-N-Hyphen
p-a-r-r-a-g-a
and
I'm
the
deputy
director
of
battleborn
progress.
We
are
in
strong
support
of
this
bill
and
deeply
thank
Senator
donate
for
bringing
it
forward,
but
I'm,
not
just
here
representing
my
organization
and
standing
together
with
the
impacted
people
in
this
room
and
providers,
but
also
to
represent
a
little
girl
who
would
have
this
would
have
helped
and
that
little
girl
is
me
before
I.
Finally
got
coverage
and
citizenship
I'm
proud
to
be
part
of
that
influx
of
immigrants
that
make
Nevada
in
this
country
great
and
we
need
this
basic
coverage.
AB
I
grew
up
undocumented
and
with
that
came
growing
up
without
access
to
much,
especially
Medical,
Care
and
coverage.
It
many
years
of
my
childhood
for
my
mom
to
find
a
job
that
could
provide
insurance,
at
least
for
herself
and
then
for
me,
when
I
finally
became
a
citizen
shout
out
to
The
Culinary
Union
for
that
coverage.
AB
A
kid
or
anyone
should
not
have
to
spend
years
without
access
to
important,
Health
Care
coverage,
because
I
missed
out
on
a
lot
that
I
now
am
suffering
from.
So
please
pass
this
bill.
AC
Good
evening,
members
of
the
committee,
my
name,
is
for
the
record.
My
name
is
Isabel
Bento
and
I'm,
a
student
at
the
University
of
Nevada
Reno
working
to
get
my
bachelor's
in
social
work
and
hoping
to
get
my
Master's
in
macro
social
work.
This
is
my
first
time
being
at
any
legislative
hearing,
and
this
is
my
first
time
speaking.
I
do
want
to
address
that
I'm
speaking
as
a
person,
a
privilege
and
that
person
that
privilege
being
a
national
born
citizen.
While
my
father's
side
is
Portuguese
and
Thai.
AC
My
mother's
side
is
Irish
and
have
been
as
been
citizens
of
the
United
States
of
America
for
Generations
social
workers
have
a
code
of
ethics
which
you
can
find
on
the
nasw
website,
and
these
ethics
include
service,
social
justice,
dignity
and
worth
of
a
person,
importance
of
Human,
Relationships
integrity
and
competence
and
I
believe
these
codes
of
Ethics
should
not
reside
in
all
and
just
social
workers,
but
in
all
people
in
all
professions.
AC
My
mom
avoided
going
to
the
emergency
room
when
she
had
extreme
abdominal
pain
and
it
wasn't
until
she
she
was
pushed
by
her
boss
to
go
to
the
ER
where
she
found
out
her
appendix
was
about
to
explode,
and
if
she
came
in
any
later
she
would
have
died.
My
mom's
story
is
not
unique
and
fortunately
she
was
able
to
get
the
care
she
needed,
but
this
is
not
the
case
for
thousands
of
people,
especially
for
those
who
are
unrepresented
for
those
who
are
marginalized
and
for
those
who
are
the
most
vulnerable.
AC
AD
Good
afternoon,
chair
and
members
of
the
community
for
the
record,
my
name
is
Jose
Macias
and
I've
been
a
long
time.
Community
leader
working
with
the
Immigrant
Community
here
in
Nevada
today,
I'm
here
to
urge
you
to
support
SB
419
The
Hope
act
after
the
pandemic.
We
all
learned
the
importance
of
being
healthy
and
making
sure
that
not
just
our
families
are
healthy,
but
our
entire
communities
are.
If
one
of
us
gets
sick,
it's
important
to
make
sure
we
take
the
right
steps
to
ensure
not
everyone,
not
everyone
else
gets
sick
too.
AD
This
bill
will
allow
our
state
to
expand
health
care
for
everyone.
In
times
when
China
Killers,
like
diabetes
and
high
blood
pressure,
are
an
r
at
an
all-time
high
in
our
community
communities.
We
have
to
make
sure
people
have
access
to
preventive
care
and
not
and
not
wait
until
it's
about
life
or
death.
Personally
I've
been
lit,
I
lived
through
this
with
my
mother,
who
never
had
access
to
care
or
even
crossed
her
mind.
That
Healthcare
was
something
she
will
be
able
to
get.
AD
AD
It's
been
nine
years
and
many
families
in
Nevada
are
still
in
the
same
shoes
as
my
mom
and
my
family.
Nine
years
later,
and
once
again,
this
Thursday
I'll
be
putting
to
rest
my
Aunt
Rosa,
who
passed
away
last
week
from
diabetes
today,
at
this
very
moment
in
Las
Vegas.
My
dad
is
at
home
figuring
out
if
he
can
make
it
to
his
chemotherapy
appointment
for
cancer
because
he
doesn't
know
if
we
have
enough
cash
to
afford
it.
AD
Since
we
pay
hundreds
of
dollars
out
of
our
pockets
to
make
sure
he
gets
his
health
care
needs
met,
no
one
should
be
worried
about
having
access
to
chemo
as
access
to
a
checkup
or
just
access
to
being
healthy
and
able
to
thrive
in
dignity.
Life
is
not
about
blue
or
red.
It's
about
human
rights.
Rosa
Rivera
is
my
aunt's
name
I.
Ask
you
that
you
don't
forget
about
her
when
voting
for
this
bill.
Tomasa
Macias
is
my
mom's
name
I
urge
you
to
not
forget
about
her
when
voting
for
this
bill.
AD
AE
AE
AF
Yes,
just
as
I'm.
P
AE
AE
AE
AG
AE
AE
AE
AE
AF
I
I
can
I
can
honestly
say
that
I
still
have
secondary
effects
from
having
experienced
post-traumatic
post-traumatic
stress
from
that
trauma.
It
has
changed
my
life.
AE
AE
AF
AE
AF
So
I
have
sons,
and
even
with
my
sons
I
can
we
cannot
pay
the
medication.
If
and
we
all,
we
all
have
people
that
we
know
that
if
they
don't
have
their
medications,
the
situation
only
gets
worse
with.
Even
if
I
cannot
receive
this,
my
medications,
my
diabetes,
is
going
to
get
worse
and
I
will
not
be
able
to
control
the
diabetes.
AE
AE
AF
I've
worked
for
this
country
for
20
I
worked
in
this
country
for
22
years
and
I've
paid
my
taxes,
just
as
a
citizen.
We
all
deserve
the
basic
medical
attention
and
I
want
to
live
a
dignified
life.
That's
why
I
I
ask
for
you
to
to
vote
Yes
on
114
that
way,
I
can
continue
to
work
and
have
it
dignified
life.
AF
E
Just
I
don't
know
if
anyone's
moving
I
see
people
walking
around,
but
I
don't
know
if
they
are,
but
if
you
can
just
kind
of
keep
them
full
again.
I
would
remind
everyone
that
you
can
say.
Yes,
me
too
I
support
this
and
again,
please
limit
your
testimony
to
two
minutes
and
go
ahead
and
begin
when
ready.
AH
Good
afternoon
everyone,
my
name,
is
Fabio
Diaz,
Ortega,
certified
medical
interpreter
and
patient
experience
associate
I
care
for
the
kids
Foundation.
Let
me
tell
you
about
Francisco
at
the
age
of
five.
He
would
happily
run
jump
and
play
until
one
day
he
couldn't.
He
complained
to
his
mother
Beatrice
that
his
legs
were
hurting
the
very
next
day
he
was
unable
to
walk
thinking.
Nothing
of
it.
Beatrice
took
her
son
to
the
pediatrician
to
hopefully
resolve
this
issue.
It
wasn't
a
quick
fix.
It
was
acute,
lymphoblastic
leukemia
when
it
all
started.
AH
Batteries
didn't
know
where
to
begin
what
his
future
will
look
like.
Will
he
die?
Will
he
live
and
will
we
get
the
help
that
he
needs
be
an
undocumented
batteries
found
the
last
question
to
be
a
penumbra
of
pain
as
she
watched
her
son,
relieve
countless
spinal
taps
and
chemotherapy,
often
she'd,
be
in
the
exam
room.
Listening
to
the
oncologist
prescribed
medications,
she
was
sure
she
could
not
afford,
regardless
of
the
discount
prescription
cards
and
co-pay
programs
offered
by
drug
manufacturers,
hospital
stays
brought
on
their
own
set
of
challenges.
AH
Beatrice
remembers
vividly
creating
payment
plan
after
payment
plan
to
provide
her
son
with
the
care.
He
truly
deserved
care.
He
could
only
find
in
the
battleborn
state
but
had
limited
access
to
to
immigratory
status.
So
we
ask
you,
on
behalf
of
all
the
undocumented
children,
on
behalf
of
cure
for
the
kids
Foundation,
that
the
state
of
Nevada
passed
the
Hope
act
for
all
Warriors
and
if
home
really
means
Nevada,
let's
take
care
of
our
families.
AI
My
name
is
Maria
farmer
I'm,
a
patient
financial
counselor
at
care
for
the
kids
Foundation.
Our
children
not
only
need
chemotherapy
infusions,
they
need
like
also
other
Specialty
Care,
such
as
physical
therapy,
Dental
Care
things
that
they
just
do
not
get
because
of
their
immigration
status
and
we
treat
we
try
to
treat
the
whole
child
not
just.
Oh
a
certain
part.
AI
AI
AJ
Foreign
hello
members
of
the
committee,
my
name
is
Paola
Avila,
it's
spelled
p-a-o-l-a-d-a-v-I-l-a
and
I
work
in
early
intervention.
I'm,
a
development
specialist
in
the
state
of
Nevada
I
have
lived
in
Las
Vegas
for
18
years
I'm,
a
current
resident
of
Assembly
District
11
and
a
Senate
District
2..
Here
in
the
support
of
Bill
SB
419
hola
members.
My
name
is.
AJ
I
am
an
immigrant
and
I
have
been
lucky
to
graduate
from
UNLV
I,
am
fortunate
to
work
in
early
intervention
and
provide
services
and
support
for
children
with
developmental
delays
and
disability,
as
well
as
their
their
families.
A
lot
of
these
families
are
uninsured
immigrants
and
struggle
to
receive
the
help
and
care
they
deserve.
So
immigrante.
Yes,.
AJ
While
part
C
and
Part
B
are
provided
by
the
state,
children
in
early
intervention
benefit
exponentially
from
private
therapy,
since
the
first
three
years
of
their
lives
are
the
most
important
in
development.
In
addition,
some
require
therapy
throughout
their
lives.
Private
therapy,
as
we
know,
requires
insurance,
which
creates
a
barrier
that
impacts.
Children's
development
and
quality
of
their
life
is.
AJ
Yours
and
mine
and
our
families
are
hard-working
Nevadas
that
want
the
best
for
our
communities.
Children
of
Nevada
and
their
families
deserve
to
have
access
to
health
care,
regardless
of
their
status.
I
urge
you
to
support
sb419
and
change
the
life
of
immigrant
families
and
their
children,
especially
the
those
with
development
delays.
E
AK
Attorney
of
the
UN
lvms
Boyd
School
of
Law
I'm,
also
a
member
of
the
Nevada
immigrant
Coalition
for
clarity,
I'm,
not
speaking
on
behalf
of
UNLV
or
NG
today,
but
I
do
want
to
express
the
importance
of
sb419
for
our
clients
and
other
undocumented
folks.
Imagine
an
asylum
Seeker
whose
government
persecuted
and
tortured
him
who
fled
his
native
land,
leaving
everything
and
everyone
he
has
ever
known
behind
to
save
his
life.
Imagine
that
he
presented
himself
to
the
U.S
and
lawfully
sought
protection
through
Asylum.
Now.
AK
Imagine
that,
due
to
the
ever-increasing
backlogs
in
Immigration
Court,
not
to
mention
the
delays
caused
by
a
global
pandemic,
he
will
have
to
wait
years
and
years
for
the
adjudication
of
his
Asylum
claim.
If
eventually
granted.
He
will
receive
Refugee
benefits
which
will
include
Medicaid,
but
while
he
waits
contrary
to
popular
belief,
he
will
not
receive
any
Refugee
or
other
public
benefits.
AK
This
Asylum
Seeker
who
fled
horrific
torture
in
his
home
country
and
who
is
suffering
the
physical
and
mental
effects
of
state-sponsored
abuse
has
to
wait
years
before
he
can
receive
medical
coverage
to
treat
those
ailments.
Meanwhile,
his
conditions
are
worsening
to
the
point
of
requiring
emergency
medical
care
without
access
to
medical
coverage.
He
and
other
undocumented
folks
in
our
community
are
left
to
suffer
from
treatable
conditions
that
could
have
been
prevented
with
timely
medical
attention.
AK
Currently,
all
about
all
persons
in
Nevada
are
eligible
for
emergency
Medicaid,
regardless
of
status,
and
that
treatment
is
expensive,
I
hope
we
can
all
agree
that
preventative
care
is
more
cost
effective
than
treating
serious
or
chronic
conditions
in
the
er.
Er
I
asked
the
legislature
to
vote
in
favor
of
sb419,
not
just
for
our
clients
and
other
undocumented
folks
in
the
community,
but
for
the
benefit
of
Nevada
as
a
whole.
Thank
you.
So
much.
AL
For
the
record,
my
name
is
Amber
Williams,
McGee
and
I
am
a
health
care
worker
at
cure
for
the
kids
Foundation
I
am
here
to
clearly
stay
cure
for
the
kids
foundation's
strong
support
of
SB
419
in
our
business.
We
understand
the
massive
need
for
this
type
of
Reform,
as
we
see
so
many
cases
of
undocumented
children
not
receiving
the
life-saving
care
that
should
be
the
most
basic
of
Human
Rights.
All
of
the
organizations
we
heard
from
today
take
on
the
burden
of
this
care,
which
should
be
handled
by
the
state.
AL
C4K
handles
the
majority
of
care
for
children
with
rare
diseases,
but
it
is
certainly
not
an
option
for
the
undocumented
population
as
a
whole.
Daily,
we
see
firsthand
the
damage
of
what
not
being
insured
does
to
our
hard-working
undocumented
families,
who
are
just
left
alone
to
suffer.
I
want
to
thank
Senator
John
donate
for
bringing
this
important
initiative
to
the
table
for
discussion.
Our
state
can
do
better.
Our
people
deserve
better.
Let's
change
our
state's
reputation.
Let's
start
to
take
steps
to
put
Nevada
on
the
map
regarding
health
care
for
everyone's
sake.
AL
E
AM
AG
AN
The
reason
I
support
this
bill
because
today
I
identify
myself
as
an
undocumented
immigrant
and
I'm,
certainly
hoping
that
this
health
insurance
is
better
than
what
my
employer
gives
me
and
please
expand
language
services
to
Persians.
While
you
can
and
also
can
you
tax
the
casinos,
not
the
middle
class
people
and
let's
expand,
extend
towards
Medicare
for
all,
because
I
think
everybody
should
be
covered
yield.
My
time.
AO
Good
evening
this
is
Maya
Holmes
on
behalf
of
The
Culinary
Health
Fund.
We
want
to
thank
Senator
donate
for
bringing
the
Hope
act
forward,
we're
in
discussions
with
the
senator
on
a
few
aspects
of
the
bill
that
we're
trying
to
understand
better,
but
we
absolutely
support
efforts
to
ensure
medical
record
interoperability
and
patient
access
to
their
medical
records.
So
they
and
their
providers
can
seamlessly
access
retrieve
and
send
the
records
where
they
need
to
and
when
they
need
to.
AO
Moreover-
and
you
know
more
fundamentally,
we
also
support
the
Medicaid
expansion
to
all
residents
of
Nevada,
regardless
of
their
citizenship
status,
which
will
strengthen
our
Health
Care
system
as
a
whole,
improve
the
overall
health
of
the
residents
in
our
state
and
ensure
no
member
of
our
community
is
Left
Behind
and
cannot
receive
the
health
care
they
and
their
family
needs.
Thank
you.
AP
Good
evening
Vice,
chair
Nguyen
and
members
of
the
committee,
this
is
Holly
Wellborn
executive
director
of
The
Children's,
Advocacy
Alliance,
testifying
in
support
of
SB
419,
with
his
crucial
legislation
for
expanding
and
encouraging
access
to
care
for
Nevada's,
most
vulnerable
community
members.
I
have
a
bunch
of
stats
here,
but
I'll
just
focus
on
a
couple.
42
percent
of
eligible
foreign-born
children
in
the
U.S
are
ineligible
for
Medicaid
or
chip
benefits
and
children
who
are
eligible
often
do
not
get
care
because
their
ineligible
parents
are
too
afraid
to
access
it.
AP
E
E
I'm
going
to
now
begin
opposition
testimony
again,
I'd
ask
people
to
come
up
to
the
front
and
fill
in
those
chairs
again
remind
everyone
that
please
limit
your
testimony
to
two
minutes
and
please
state
your
name
clearly
for
the
record
and
begin
when
you
are
ready
and
again,
I
will
allow
another
30
minutes
for
this.
AQ
It
is
of
my
opinion.
This
is
Casey
Rogers.
It
is
of
my
opinion
that
I
actually
feel
this
is
more
of
like
a
power
grab
on
the
medical
digital
side
of
things
that
I
don't
agree
with.
I
think
there
could
be
nefarious
reasons
for
it
for
digital
tracking,
which
leads
to
digital
dollars,
which
leads
to
digital
humans,
actually,
where
you
can
turn
on
and
off
certain
aspects
of
people's
lives.
AQ
AQ
AR
Good
evening
Madam
chair
members
of
the
committee,
my
name
is
Janine
Hansen
I'm,
the
State
president
of
Nevada
families
for
Freedom.
We
have
several
concerns
about
this
bill.
One
is
the
issue
of
the
connectivity
and
the
networks
there's
no
guarantee
of
privacy
or
safety
or
Security
in
government
Networks.
AR
This
is
supposed
to
be
a
state
Network.
Well,
it's
going
to
be
connected
to
a
federal
network.
Will
it
also
be
connected
to
the
global
World
Health
Organization?
We
have
considerable
concerns
for
privacy
and
health
freedom
in
Nevada.
When
we
had
the
vaccine
Madden
dates,
we
could
show
how
some
of
these
networks
might
be
abused.
AR
People
were
who
refused
to
get
the
vax
lost,
their
jobs
were
retaliated
against,
were
denied
Health
Care,
even
life-saving
health
care,
and
so,
if
your
name
is
in
a
government
database-
and
they
know
what
your
health
care
decisions
are,
you
could
be
retaliated
against
and
lose
your
opportunity
for
health
care,
so
we're
concerned
about
that
with
this
network,
that's
going
to
be
in
this
particular
Bill.
We're
also
concerned
about
the
cost
paying
for
illegal
aliens
through
the
insurance.
AR
Insurance
is
bad
enough,
but
using
tax
dollars
is
far
more
expensive
and
less
efficient
and
creates
more
bureaucracy
and
more
government
jobs.
We
simply
can't
afford
it:
foreign
to
The
Institute
for
policy
innovation
in
the
United
States,
the
total
U.S
tax
burden,
including
federal
state
and
local
taxes
and
hidden
taxes,
is
equal
to
56
percent
of
annual
personal
consumption
spending.
56
percent
is
more
than
a
person
spends
on
housing,
food,
Health,
Care,
Transportation,
education
and
Recreation.
How
can
people
possibly
take
care
of
themselves
and
our
families?
AR
AS
Madam,
chair
and
committee,
my
name
is
Lynn
Chapman
and
I'm.
The
state
treasurer
of
the
independent
American
party,
five
billion
dollars,
startup
money
and
that's
a
lot
of
money,
especially
for
people
like
me,
who
are
on
a
fixed
income.
We
have
bills
before
our
state
legislature
for
affordable
housing,
asking
for
hired
property
taxes.
Schools
want
more
money,
higher
taxes,
now
medical
care
for
everyone
who
comes
here.
We,
the
taxpayers,
can't
afford
it.
We
just
don't
have
enough
money,
so
please
vote
no
on
SB
419.
Thank
you.
AT
Good
evening,
Senators
joy,
truchinski
t-r-u-s-h-e-n-s-k-I
for
the
record
first
I
want
everybody
to
know.
I
support
legal
immigration,
however,
I
oppose
SB
419,
which
gives
gives
taxpayer-funded
Medicaid
Insurance
to
illegal
aliens.
Currently,
citizens
are
suffering
due
to
high
taxes
for
everything
due
to
government
caused
inflation.
They
cannot
afford
to
give
illegal
aliens
Medicaid,
along
with
welfare
payments,
housing,
food,
education
and
so
much
more.
Giving
free
stuff
will
only
encourage
more
illegals
coming
over
our
unsecured
borders.
This
is
a
national
security
issue,
as
people
are
not
being
vetted.
AT
I
also
am
strongly
opposed
to
a
centralized
government,
Health
Care
database
of
all
health
records,
which
includes
whether
or
not
you
took
the
untested
dangerous,
coveted
19
vaccines.
This
bit
of
the
bill
is,
in
my
opinion,
communistic
and
like
big
brother,
is
going
against
freedom
and
personal
privacy
privacy.
AT
AU
Good
evening,
Madam,
chair
and
Senators
Susan
Rue
for
the
record
I'm
deeply
concerned
that
the
nevadans
cannot
afford
this
legislation.
Many
people
who
are
actual
citizens
of
our
of
our
state
can't
afford
their
premiums
due
to
Obamacare.
They
can't
afford
their
deductibles,
because
the
insurance
companies
must
charge
more
to
cover
the
Medicare
and
Medicaid
costs.
AU
AU
J
I
also
had
a
special
needs
granddaughter
who
needed
a
pediatrician
and
I
called
every
pediatrician,
literally
in
Reno
and
Sparks
and
Carson
City,
and
finally
found
one
in
Carson
City
who
would
take
Medicaid,
but
then
he
dropped
her
I
had
I
have
insurance,
but
during
Obamacare
I
will
tell
you
that
it
went
up
so
Sky
High
as
a
single
parent.
It
did
create
financial
difficulties
for
me,
I
think
given
also
I
think
given
the
situation
at
the
border.
Currently,
it
is
not
a
good
time
to
pass
this
bill.
J
I
believe
the
legal
citizens
in
Nevada
need
to
be
a
priority,
and
this
just
sounds
extremely
costly
at
this
moment
and
lastly,
I
just
want
to
say
that
decisions
and
I'm
not
being
mean,
but
as
I
always
told
my
kids,
decisions
have
consequences
and
making
a
decision
to
move
to
Nevada
doesn't
necessarily
mean
one
deserves
something.
J
AV
AV
The
mic
I
go
every
time,
I'm,
sorry,
Barbara
Jones
for
the
record.
I'm,
really
sorry,
I
go
back
thinking
of
my
own
past
working
all
my
life
and
from
84
to
when
I
retired
I
had
no
insurance
working.
You
know
my
whole
life,
not
on
welfare
and
so
actually
for
those
that
are
sick
and
needing
I
sympathize
with
that
need
help.
AV
But
all
of
my
issues
went
to
Jesus
to
be
honest
and
I
got
healed
of
back
trouble.
I
got
healed
of
carpal
tendon,
a
cancer
on
my
breast
and
with
Medicare
I
guess.
I
didn't
have
to
rely
on
him
as
much
and
I
did
have
two
hospital
visits
because
somebody
was
paying
the
bill,
but
I
had
to
pay
my
own
bills
or
you
know
not.
AV
Do
it
and
I
I
think
that
if
we
called
on
that
him
for
those
here
that
are
sick,
I
sympathize,
it's
not
fun,
but
the
mechanical
aspect
is
so
dangerous.
We
have
bills
now
and
the
children
that
were
put
in
the
database,
the
vendor
sold
it
to
China.
So
your
kids
information
is
in
China
and
you
don't
even
know
what
they
have
on
you
and
it's
the
same
thing
with
your
health
care
and
it's
the
same
thing
with
voting.
So
thank
you.
Please
vote
against
this
Bill.
Thank
you
for
your.
E
Time,
thank
you
for
your
testimony.
At
this
time.
I
don't
see
anyone
in
Las
Vegas,
but
I
am
going
to
ask
if
anyone
is
there
to
testify
in
opposition
to
this
bill.
If
you
could
come
up
to
the
table
right
now,
I
see
some
movement,
but
I
don't
know
if
it's
moving
up
to
the
table.
Yes,
I
see
someone
I'll
just
remind
you
to
please
state
your
name
for
the
record
and
begin
your
testimony.
Make
sure
you
press
that
microphone
and
again
limit
your
testimony
to
two
minutes.
Please.
AW
AW
Oh
goodness,
gracious
did
I
forget
Susan,
profit,
I'm,
the
vice
president
of
the
Nevada
Republican
Club
and
I'm,
going
to
speak
for
myself
today,
because
I've
heard
a
lot
of
emotion
on
the
other
side
and
in
this
particular
case
I
can
speak
from
experience.
It
has
devastated
my
family
devastated
to
the
point
where
we
almost
left
the
state
foreign.
AW
I
mean
I
really
do
we
need
immigration,
but
we
need
it
to
be
done
in
a
logical,
Manner
and
I
do
believe
that
we
have
a
lot
of
issues
that
can
be
addressed
if
you
will
take
the
time
to
look
at
all
the
aspects
that
have
added
to
the
situation
instead
of
coming
up
with
this
particular
bill,
because
this
one
creates
a
lot
more
issues
for
many
many
people,
and
so
thank
you
for
addressing
this,
and
thank
you
very
much,
Senator
Stone
and
Titus
for
your
astute
understanding
of
this
hot
mess
and
this
bill
will
create
and
and
and
so
I
oppose,
SB
419
because
it
doesn't
resolve
the
problem.
AW
It
magnifies
the
mistakes
of
our
government
when
they
forced
Obamacare
on
Americans
and
they
didn't
plan
properly
and
they
didn't
implement
it
properly,
and
so
it
has
created
a
nightmare
for
me,
my
family
and
many
others,
socialized
medicine
sound
like
a
wonderful,
wonderful
thing,
but
I'm
telling
you
the
road
to
hell
is,
you
know,
really
paved
with
good
intentions
and
I
know
you
have
good
intentions,
so
I
don't
mean
to
insult
anyone
today.
AW
E
And
I'm
sorry
can
I
get
you
you're
you're
a
little
over
two
minutes,
so
if
I
can
have
you
wrap
up,
that
would
be
great
and
please
submit
your
writing
your
testimony
and
writing.
If
you'd
like.
E
AW
I
have
not
had
two
minutes:
okay,
I
am
a
handicapped
senior
citizen
on
a
fixed
income,
I
paid
500
a
month,
it
Rose
to
24
000
a
year
by
the
time.
I
was
old
enough
to
get
on
Medicare,
which
I
paid
for
all
my
life.
When
my
husband
got
lung
cancer,
he
was
forced
to
wait
a
year
in
Nevada
for
surgery
and
he
was
spitting
up
blood
the
entire
time
after
having
his
a
third
of
his
lung
removed,
the
cancer
returned
so
Senator
Titus
and
Senator.
AX
AW
AM
AG
AY
AY
Many
of
these
stories
would
not
have
happened
if
you
just
come
here
legally
to
give
Medicaid
to
the
folks
here,
illegally
flies
in
the
face
of
all
Nevadas.
We've
been
taxed
to
death,
to
pay
for
program
after
program
for
people
who
don't
contribute
and
for
those
who
are
here
against
the
laws
of
our
land
and
for
this
body
to
reward
this
lawlessness
by
making
me
and
my
family
to
pay
their
ways
in
absolute
insult
in
the
HIPAA
law
provides
protection
for
all
of
our
health
information
to
remain
private.
AY
For
you
to
want
to
volunteer
to
put
us
on
a
United,
States
federal
government
database.
Why
is
in
the
face
of
the
Constitution
you're,
taking
away
our
autonomy
and
our
privacy,
you
swornos
to
protect
our
Constitution
and
from
enemies
foreign?
You
want
to
give
a
handout
to
those
who
flaunt
our
laws?
Are
they
too
subjected
to
these
socialist
treatment,
I'm
all
for
people
coming
to
this
great
country,
but
come
in
the
front
door,
contribute
to
society
and
feel
pride
in
your
ability
to
do
so
like
the
rest
of
us,
this
is
a
socialist
bill.
AY
It's
unconstitutional,
it's
anti-American
and
unsustainable
and
I
have
to
say,
I,
really
resent
the
fact
that
there's
people
wearing
signs
holding
signs
in
shirts
in
the
camera
view,
whereas
there
was
a
bill
last
week
on
abortion
that
was
not
allowed
for
that
to
happen.
This
one-sidedness
really
needs
to
stop
within
our
legislature.
Thank
you.
AZ
Additionally,
this
bill
could
end
up
being
a
huge
financial
burden
to
our
state.
Nevadans
are
already
experiencing
the
strain
of
rising
inflation,
which
is
unlikely
to
reverse
course.
For
the
foreseeable
future,
the
Nevada
Globe
stated
in
an
October
14
2022
article
that
inflation
in
Nevada
has
reached
16
percent
and
hitting
Nevada
households
the
hardest
Rising
prices
are
costing
Nevada
households
an
additional
867
dollars
a
month
or
10
402
dollars
a
year
since
January
of
2021.
AZ
and
the
Daily
Mail
reported
that
in
2021
Americans
spent
more
on
combined
taxes
than
they
did
on
food
clothing
and
health
care.
Lastly,
I
have
concerns
that
this
bill
would
contribute
to
a
centralized
government
Health
database
that
will
violate
the
privacy
and
Nevada's
and
put
bureaucrats
between
doctors
and
patients.
AZ
Would
this
not
violate
the
standard
of
confidentiality
that
exists
between
them?
Could
we
see
social
credit
scores
to
receive
goods
and
services?
It's
for
these
reasons
that
I
ask
you
to
please
oppose
Senate,
Bill,
419
and
I
want
to
thank
Senators,
Titus
and
stone
for
their
excellent
interactions
on
this
bill
and
the
great
testimony
and
information
that
they
have
provided
thanks
again.
E
And
at
this
time,
I
am
going
to
close
this
first
round
of
opposition
testimony
and
just
for
the
record
I
I've
looked
around
and
I
don't
see
any
signs.
I
know
there
was
a
color,
but
I
want
to
make
it
very
clear
that
I
haven't
seen
any
signs.
I
know
that
Senator
Titus
would
have
pointed
it
out
immediately
if
there
were-
and
she
is
also
indicated
she's
nodding
here-
that
we
did
not
see
any
signs
so
I
just
want
to
make
that
very
clear.
That
I
did
not
see
any
signage.
E
It
posted
here
in
this
room.
At
this
time,
I
will
go
to
testimony
in
neutral.
So
if
you
have
neutral
testimony,
please
come
up
to
the
table.
E
E
AM
AF
AF
AF
E
Thank
you.
So
we
will
begin
support
testimony
again
again.
I
will
remind
everyone
there.
If
there's
anyone
else
in
overflow.
It
asks
you
to
come
into
the
main
committee
room
and
if
we
can
just
fill
in
those
seats,
if
you
do
have
something
in
writing,
please
feel
free
to
submit
that
and
if
you
do
need
a
Spanish
interpreter,
if
you
can
just
kind
of
wave
at
me
and
I
can
make
sure
I
can
get
that
person
on
our
line,
go
ahead
and
begin
when
you're
ready
foreign.
U
AF
U
AF
This
affects
me
personally.
AF
I
was
told
that
when
this
this
cellular
cancer
was
discovered
in
my
pelvis
area,
that
it
was
a
very
silent
killer
and
it
had
if
it
hadn't
been
discovered.
AF
So
it
was
very
where
it
was
diagnosed
or
they
found
it
was
in
a
free
checkup
that
I
went
to
and
when
I,
when
they
discovered
it,
I
asked
okay
what's
next
and
they
as
far
as
treatment
goes.
So
it
was
very
difficult
for
me
to
find
any
type
of
treatment
or
find
any
other
treatment.
That
would
give
me
a
more
clear
diagnostic.
AF
AF
AF
So
until
when
the
doctor
told
me
that
I
needed
one
more
I
needed
a
certain
treatment
because
he
said
those
those
cancerous
those
can't
their
cells
that
are
cancerous
can
spread
to
your
internal
organs.
U
AF
U
U
AF
U
U
AF
So
I
feel
like
I,
have
not
been
hurt
and
our
stories
need
to
be
heard
because
I
feel
like
even
in
my
story
and
my
situation.
What
if
one
day
my
kids
are
without
their
mother.
U
U
BA
BB
BA
BA
BA
BA
BA
BB
BA
BA
BA
BB
BA
V
Good
afternoon
chairwoman
and
members
of
the
committee,
my
name
is
Victoria
Ruiz,
that
is
v-I-c-t-o-r-I-a
last
name.
R-U-Y-Z
and
I
am
a
constituent
of
Clark
County
I'm
here
to
thank
Senator
donate
for
sponsoring
sb419
and
to
ask
you
to
ensure
that
it
moves
forward.
As
an
immigrant
woman
who
has
called
Nevada
home
since
I
arrived
in
the
U.S
at
the
age
of
eight
I
felt
firsthand
the
effects
of
not
being
able
to
access
health
care
that
I
needed
and
have
had
to
support
others
in
my
community
during
similar
moments.
V
I
think
you've
heard
several
stories
today
illustrating
the
need
for
this
Healthcare.
No
one
should
go
without
the
necessary
preventative
care
or
medical
treatment
that
they
need
over
something
like
status,
especially
in
a
state
where
immigrants
have
been
part
of
the
state's
fabrics
for
decades
and
played
a
critical
role
in
our
economic
recovery.
After
the
covid-19
pandemic
or
outbreak,
there
simply
would
be
no
recovery
without
immigrants.
The
reality
is
that
a
person's
immigration
status
is
absolutely
no
relevance
to
a
medical
professional's
ability
to
provide
care.
V
In
addition,
the
Social
and
Health
disparities
amongst
immigrants
in
this
country
and
state
are
by
Design,
as
is
the
case
for
several
other
issues
that
disproportionately
affect
us
at
this
moment.
You
have
the
power
to
do
something
about
it
and
make
good
on
your
values
of
making
Healthcare
accessible
immigrants
across
our
state,
who
are
just
as
much
Nevada
as
the
next
person
and
who
also
pay
taxes
since
1996,
when
the
IRS
figured
out
how
to
do
that
through
individual
taxpayer.
V
Numbers
are
looking
to
you
to
deliver
on
this
bill
and
recognize
that
our
lives
and
wellness
are
worth
taking
definitive
action.
I
think
I
also
want
to
mention
that
for
many
constituents,
no
matter
the
site
of
the
issue
that
we
stand,
we
want
to
see
our
elected
officials
spending
precious
time
discussing
real
solutions
and
not
on
strategic
colleagues
call
outs
that
should
be
happening
behind
closed
doors.
So
thank
you
for
allowing
me
to
testify
today.
I
hope
that
the
conversations
remain
productive
and
not
strategic.
Thank
you.
E
And
I'm,
looking
in
Las,
Vegas
I,
don't
see
anyone
in
that
room.
So
do
we
have
any
other
testimony
in
support?
I
will
go
again
to
testimony
oh
broadcast
Services.
Is
there
anyone
on
the
line
to
testify
in
support.
AG
E
AY
Hi,
my
name
is
Lisa
parties
and
Paul
A,
R,
Kids
and
Tom
e
e
I
am
the
one
who
mentioned
the
signs
and
the
stickers
on
the
earlier
call.
They
were
down
in
Las
Vegas.
There
was
a
girl
in
the
audience
with
a
sign.
There
is
a
girl
in
the
Carson
City
location
that
was
passing
out
stickers,
obviously
down
in
Vegas
too,
as
I
saw
stickers
down
there.
So.
P
AY
BC
Good
evening
committee
I'm
Jim
degraffenreed
National
Committee
man
for
Nevada,
in
opposition
to
SB
419
on
behalf
of
the
Nevada
Republican
party.
Our
platform
specifically
opposes
government
benefits
or
other
special
treatment
for
those
who
enter
our
country
illegally.
Proponents
spoke
today
about
how
similar
legislation
has
reduced
uninsured
rates.
Does
a
health
insurance,
professional
I
know
these
statistics
are
often
meaningless
being
insured
with
a
plan
you
can't
afford
to
use
due
to
high
deductibles
is
effectively
the
same
as
having
no
insurance.
BC
The
Affordable
Care
Act
broadly
quadrupled
health
insurance
premiums,
increasing
insurance
company
profits,
while
passing
most
of
the
cost
down
to
taxpayers.
Support
for
sp219
from
the
hospital
industry
is
reminiscent
of
those
debates,
as
sp219
provides
a
huge
financial
benefit
to
Medical
corporations
to
taxpayer
expense.
The
discussion
of
how
the
pandemic
exposed
problems
with
Healthcare
delivery
and
payment
is
also
disingenuous
photos
of
an
empty
Las
Vegas
strip.
BC
Don't
have
anything
to
do
with
Health
Care
delivery
Medicaid,
which
is
the
solution
proposed
in
SB
419,
was
massively
expanded
during
the
pandemic
and
in
fact
this
increase
has
assisted
well
past
the
end
of
the
so-called
Public
Health
Emergency,
and
won't
even
begin
to
be
addressed
until
April
1st
of
this
year.
The
proposal
to
transfer
the
cost
of
care
for
non-citizens,
from
hospitals
to
taxpayers,
Via
Medicaid,
has
unintended
consequences.
Nevada
encourages
illegal
immigration
when
we
offer
welfare
benefits
that
other
states
do
not.
BC
That
already
has
among
the
highest
proportion
of
the
illegal
immigrants
of
any
U.S
state,
even
without
this
incentive.
So
it
seems
reasonable
that
the
cost
will
be
much
higher
than
the
estimated
78
million
potentially
billions
of
dollars
in
section
39,
SB
419
incredibly
suggests
that
there
may
be
federal
funds
available
to
help
Nevada
pay
for
this
Insanity.
While
eight
U.S
code,
section
1621,
does
allow
states
to
pass
laws
giving
non-citizens
benefits.
The
majority
of
that
federal
law
is
devoted
to
saying
that
aliens
are
not
eligible
for
government
Aid.
BC
So
the
chances
of
federal
government
supporting
this
scheme
to
encourage
more
illegal
immigration
into
Nevada
are
slim
to
none.
This
bill
is
a
major
Financial
giveaway,
benefiting
corporations
at
the
expense
of
taxpayers.
We
should
not
discuss
a
single
penny
of
taxpayer
money
going
to
aliens
until
every
last
homeless,
veteran
is
sheltered.
Every
American
citizen
in
foster
care
has
found
their
forever
home
with
a
loving
family
and
every
nevadan
lives
in
a
neighborhood
free
of
crime.
We
urge
this
committee
to
work
for
nevadans
and
oppose
SB
419.
Thank
you.
AY
Good
evening
Madam,
chair
and
esteemed
members
of
this
committee,
my
name
is
Charlotte
Stewart
and
I'm
a
resident,
a
parent
and
a
board
member
of
Health
Freedom
Nevada.
We
are
a
non-partisan,
Grassroots,
all
volunteer
organization
representing
approximately
5,
000
Nevada
families,
and
we
serve
as
the
Nevada
affiliate
of
both
Children's
Health
defense
and
stand
for
health
freedom,
National
organizations
whose
missions
align
with
our
own.
AY
Our
founding
principles,
include
the
right
of
every
citizen
and
every
parent
or
Guardian
in
the
case
of
a
minor
child
to
true
and
full
informed
consent
to
any
and
all
medical
and
pharmaceutical
interventions,
religious
freedom
and
parental
rights
in
all
personal
health
care
decisions.
Health
Freedom
Nevada
strongly
opposes
SB
419.
We
are
strongly
opposed
to
the
expansion
of
Public
Health
measures
that
have
failed
us
miserably
in
the
last
couple
of
years.
Please
vote
no
on
sb419.
Thank
you.
E
BD
Yes
ma'am:
this
is
John
Carlo.
The
young
gentleman
from
Las
Vegas
I've,
been
in
this
meeting
for
over
three
hours,
just
to
testify
and
to
say
I
am
a
Hispanic.
My
dad
is
from
Mexico
I
speak
Spanish
and
another
Asian
language
I'm,
a
union
member
also
and
I,
want
to
thank
the
Senators,
Mr
Stone
and
Mrs
Titus,
and
really
Mr
stone
for
being
the
voice
of
reason
and
on
this
committee.
Health
Care
is
not
a
basic
human
right.
BD
Ab
419
goes
against
union
jobs
and
basically
I
have
been
struggling,
finding
a
job
because
there's
so
many
legal
immigrants
taking
construction
jobs
and
then
I
I
like
for
you,
guys
to
recognize
Caesar,
Chavez
and
I
think
you
guys
are
renaming
Northern
Pecos,
Cesar
Chavez,
who
originally
fought
against
illegal
immigration,
any
unionized
farmers
and
so
I'm
against
AB
416,
for
the
fact
of
it
is
enticing
the
criminal
act
of
illegal
immigration
to
this
country.
BD
I
quote
from
the
Cornell
Law
School,
the
eighth
U.S
code,
1324a
as
it
speaks
to
the
unlawful
employment
of
aliens
and
basically
I
mean
this
is
like
two
plus
two
basically
is
where
we're
saying
come
to
Las
Vegas.
We
will,
we
will
take
care
of
your
medical
needs,
I,
say
lower
the
cost
of
education
and
stop
voting
for
Senate
Federal
Senators,
who
are
funding
Wars
on
the
other
side
of
the
world.
We
are
facing
an
unbalanced
amount
of
power.
BD
AG
AY
BE
Yes,
I
oppose
health
care
for
illegals.
There
are
too
many
people
on
the
street,
I
talk
to
them
every
day.
None
of
these
people
have
health
care,
insurance,
I,
don't
wanna
any
taxpayers
that
have
to
pay
for
health
care
for
illegals,
and
you
go
into
the
doctor's
office,
the
emergency
rooms.
BE
These
places
are
flooded
with
them.
Sometimes
you
can't
get
care
for
12
or
more
hours
because
of
the
fact
that
these
emergency
rooms
are
flooded
with
them.
This
isn't:
fair
I've
been
a
United
States
citizen,
all
my
life
well
over
55
years
and
I've
never
seen
anything
like.
What's
going
on
right
now,
I
oppose
this.
E
E
You
and
I'm
looking
here.
Finally,
in
neutral
I,
don't
see
anyone
coming
to
the
table
in
Las
Vegas
or
in
Carson
City,
and
it
doesn't
appear
that
there
is
anyone
on
the
lines
to
testify
in
neutral.
So
at
this
time,
I
will
ask
the
bill
sponsor
to
come
back
to
the
table.
Oh
no
he's
waving
any
closing
statements,
so
at
this
time
I
will
close
testimony
on
and
close
the
hearing
on,
Senate
Bill
419
and
turn
the
gavel
back
over
to
our
chair
to
begin.
Our
last
agenda
item.
A
AN
Lot
of
relatives
out
here
that
there's
a
lot
of
elected
officials
that
have
relatives
who
have
not
come
here,
the
proper
way,
I'm
hearing
a
lot
of
people
express
pain
and
frustration
over
the
covet
period
during
the
lockdowns
and
everything.
Well,
now
I
see
the
true
colors.
You
guys
try
to
portray
yourself
as
victims.
You
have
job
losses,
Financial,
turmoil,
inflation;
well,
here's
the
sad
truth!
A
lot
of
these
paid
activists,
organizations
and
I
can
go
on
and
on
there's
so
many
out
there
they're
the
ones
who
supported
the
lockdowns,
the
math
mandates,
the
vaccines.
AN
A
lot
of
people
got
harassed
fact
that
there
were
a
lot
of
politicians.
They
continued
to
promote
this
stuff
and
have
we
gotten
a
report
that
whether
these
efforts
actually
were
so
if
this
is
just
based
on
lies,
deception
and
everything
else?
In
fact,
you
guys
use
social
justice.
This
system
made
a
lot
of
wealthy
white
males,
incredibly
Rich
a
lot
of
Casino
Executives
profited.
We
can
see.
This
is
all
part
of
the
whole
political
machine
of
casinos
unions.
This
political
Dynasty
and
congratulations
you've
exposed
that.
We
see
the
global
agenda.
AN
It's
the
Destroyer
Traditional
Values,
destroy
the
middle
class,
promote
foot
soldiers.
This
is
what
we
see
from
open
borders
and
when
are
we
going
to
get
some
accountability
for
all
this?
We
know
fauci's
in
trouble
right
now
think
about
it.
Yeah
and
you
see
in
Casino
taxes,
don't
go
up
middle
class.
People
have
to
pay
for
this.
Financial
system
isn't
crumbling,
Nevada
used
to
be
the
fastest
growing
State,
the
lowest
unemployment,
and
now
it's
no
longer
in
the
top
10
fastest
growing.
The
unemployment
is
among
the
highest.
This
is
clearly
going
in
the
wrong
direction.
BD
Yes
I'm
here
this
is
John
Carlo
and
basically
I
do
ditto
Cyrus.
He
has
a
lot
of
good
things
to
say,
and
there
are
the
lockdowns
destroyed
us,
but
basically
there's
just
not
jobs
here,
I
mean
I,
know,
there's
going
to
be
hearings
tomorrow
and
I
mean
where
the
jobs
are
being
comp
are
coming
here
and
then
it
came
out
in
the
meeting
today
that
we
don't
know.
AY
BD
Many
illegals
exist
in
this
state
and
that's
another
problem.
I
mean
what
you
guys.
These
are
you
guys
are
supposed
to
be
the
leaders
of
this
state
and
making
good
policies
and
I'm,
depending
on
you
guys
to
audit
PTSD
for
Public
Safety
and
all
these
things
I'm
really
depending
on
you
guys
to
make
the
best
decisions
and
these
decisions
are
going
to
have
detrimental
effects
on
this
state,
and
we
are
speaking
we're
volunteers.
BD
Here
we
are
speaking
from
our
hearts,
we're
speaking
from
our
experience
and,
what's
going
on
in
the
state,
like
I
told
you
guys,
I
have
been
struggling
finding
a
job
now
and
I
will
tell
you
in
my
industry
there
are
many
illegal
immigrants,
and
this
is
what
Cesar
Chavez
fought
for.
Cesar
Chavez
fought
against
illegal
immigration
and
I
can't
believe
that
his
name
is
being
used
and
abused
by
the
Democrats
I
hope
you
guys
have
a
good
night.
Thank
you.