 This afternoon meeting of the House Appropriations Committee on March the 12th and we are joined for this portion of the meeting by represented Bill Lippert, the chair of the health care committee. And at the suggestion of representative Iacoboni, we invited representative Lippert to come in and help us understand the proposal that was referenced in the committee letter and is going to be part of a bill that we will be seeing. I believe I'm stating that correctly. And representative Iacoboni was concerned about doing justice to this proposal and we thought rather than having a translator in the form of Iacoboni that we would invite Lippert in. And with that representative Lippert, let us turn this over to you for our identification. Great. I'll try to be clear and let me tell you I'm very excited to be here because our committee is very much in the final stages of completion of House Bill 210, which is a bill to address health disparities in state of Vermont and to work toward health equity. In our letter to the committee, we put in a proposed $100,000 to support the work that I'm going to describe. And with several people I've indicated and I in the press of everything is happening. I want to at the outset, say that we are we are going to be recommending $180,000 appropriation for this work that the $100,000 was required. We put it in our letter a few weeks ago and subsequent to that we are we were strongly requesting a revision of that number to $180,000. But let me tell you what it's for and why we have, we have many, many important issues in front of us in terms of health disparities and health inequities in the state of Vermont. But those are the challenges. The good news is we we know where many of those health disparities are focused, and that the work the bill 210 is a work of the Department of Health, who has done work in addressing health inequities, and is completely in alignment with the Department of Health's own analysis of health inequities in the state of Vermont. These health inequities focus on three particular areas, issues of race and ethnicity, issues of the LGBTQ community, and issues of people with disabilities in Vermont. The initial bill h 210 proposed the immediate establishment of an office of health equity within the Department of Health, but we recognize that the Department of Health, we have deep, deep appreciation. They are doing cove it they've been doing cove it 24 seven Monday, seven days a week. And they are not in the position, despite their strong support and interest for health equity issues. They are is is is not realistic and not a fair suggestion to ask the Department of Health to add this to their plate at this time. But we also are fortunate that we have established in Vermont in the past several years, an office of racial equity. And Susanna Davis has staff that office and has been asked to do so many more things than is possible for one, one human being no matter how talented and energetic. So, let me start by saying that our committee strongly supports the addition of the two permanent positions to the office of racial equity. And we see that, and I believe that that's in the governor's budget, although I'm not sure the funding is ongoing, but that we feel like the establishment of those two positions is a prerequisite is a necessary prerequisite to what we're asking for in our bill h 210 what we've what we in the course of testimony. In the course of testimony we came to understand that one of the key components for finding health equity and ending health disparities is to engage the affected communities. In this case, the communities of race and ethnicity the community the LGBT community and the disability community to give their voices and their ability to help shape the solution, rather than for us to impose a solution. This bill h 210 was brought to us help helping to be crafted by members of the affected community. The racial justice alliance had a major role, significant role or primary role in crafting this bill. And in it they create a commission not just the office of health equity, but a commission for health equity, and the commission is made up of members of state government, but also membership of the affected communities again. And also membership from the race and ethnic communities, the LGBT communities and the disability communities. Now this commission is not your traditional commission. It has 27 members. And I know that people are going to roll their eyes and go 27 members. We fully anticipate that. And that you need to understand that what we're talking about here is empowering and impaneling a group of Vermonters affected by health disparities over many, many years, and giving them the voice to help shape, not only the direction of creating this equity, but also advising the advising us the legislature on some of the solutions around medical education that should be a part of the solution as well. In order to achieve this without impossibly asking the Department of Health to take this on. We have turned to the director of race equity, Susanna Davis, and we worked with her collaboratively in fact I've just she just was in our committee in the last hour. And she indicates a willingness and an interest in taking on this additional temporary transitional responsibility. And again I emphasize this is a new added responsibility would be a new added responsibility to her office, but it is a temporary and transitional responsibility, not the addition of a third permanent position. What we're proposing is that we appropriate we the legislature appropriate to her office for this transitional role $180,000 that would be funding it with the equivalent of a senior position, along with the fun, you know, benefits so that we're not trying to do it on the cheap. Recognizing that it takes that that she would she would be able to hire a person or persons or consultants on a temporary basis. Under her direction to help stand up the commission to facilitate the commission's work in advising about how to best proceed with an office of health equity to work with the commission. And determine how best to have medical providers in Vermont have the type of appropriate continuing medical education around cultural competency, and to use them to to to engage these members of the affected community, not just in a full commission meeting but in subgroups. We anticipate that there would be subgroups used to create this work and move this work forward. And of course that we in a previous letter to your committee you already approved some funding for data issues, data issues are very important around health inequities in Vermont. If we don't collect the data we can't analyze the data, but if we collect the data inconsistently, we still can't analyze the data. There's a data, there's a data piece that is previously funded in your in the previous bill, and which involves both the Green Mountain Care Board, the Department of Health, and now would also involve the director of race equity in her new role, her temporary transitional role of standing up this commission of health equity. The proposal is $180,000 to fund the temporary transitional assistance to the director of race equity along the lines of $140,000 for consultants $20,000 for bringing in perhaps expert expert voices to the commission and some administrative services and $20,000 to include whatever per diem was necessary over a period of time both in the full commission and in the small in the work groups. That's the proposal, and we're very excited about it to be honest I mean let me be very clear we think this is, this is an exciting opportunity for us to move forward, the issues of health equity in the state of Vermont and to address health equity. And what we're doing really is be the beginning of creating an infrastructure to effectively do that. Thank you. Thank you, Representative Lippert that was a very helpful high level overview. I'm looking to see if there are any questions, of course we will see the budget. Absolutely. The bill when we see the bill. So thank you. Representative Harrison. Yeah, thank you madam chair and thank you chair Lippert for the overview. I'm just looking on your committee's website and I pulled up draft 3.1 I think it is that I assume this the draft that you work and I was under today's There's a new draft that's probably not posted today. We've been drafting all day and and we have we still have work left this afternoon. We have not yet voted the bill, but I can tell you in anticipation will have strong support from our committee. Okay, but general idea. Yes. Yeah, represent Harrison that would that would give you a broad general idea. Yes. Yep. So, I'm going back to the appropriation that you sort of summarized. And I see where it talks about 180,000 and as you explained, this would be to set up, you know, some of this work and work with the, the new commission that's being anticipated here. I'm curious as to what you. Okay, so we do that for next year because it's one time money. But what's the plan for, you know, fiscal year 23 as you envision it at this point. Yeah, thank you because I there's there's a piece I didn't mention. One of the exciting things about establishing an office of health equity in Vermont is that it provides us the opportunity to apply for grants and receive federal funding for health equity issues. And we anticipate that with the establishment of an office of health equity, we will have new access to federal funds which other states are already accessing in different ways and having an office of health equity will help us to apply for specific roles and powers and duties that's outlined in our bill is that this this office and this commission at this point this commission can both apply for and receive grants, both from this case from the federal government from I think they're also going to be philanthropic area of philanthropic entities who will feel invested in this work. So in part to say, I think there, there, there needs to be a plan for future ongoing funding for an office of health equity, and for the commission to continue its work. But I think there are also, there are also opportunities in front of us. We established this that go beyond just state funding. But at this point we can't, you know, we haven't we haven't put before you a specific proposal but we do know based on testimony that there is that there are opportunities that we can tap into. And frankly, the cost of health disparities to the state of Vermont is enormous. You know, when we know you're going to receive another bill from us. But when we know that someone who's not able to get appropriate prenatal care, and one, one birth that requires extensive hospitalization because of difficulties from failure to have prenatal care can cost our healthcare system enormous dollars, as opposed to getting prenatal care to all mothers who need access to it. So we think, of course, everyone's going to tell you we're going to save you money in the long run, but we genuinely do believe that. But I think in part, there's also federal dollars that we believe will be able to access. Okay. Thank you. That's helpful and hopefully optimistic that we might be able to get help going down the road. But let's just assume we know what we know today, and that the plan is to establish a new office within the health department. That's ongoing funding. And I guess there's a reluctance to make too many commitments for ongoing funding without knowing where that money is coming from. Yeah, I appreciate that. One of the other pieces to this, and this is a complex puzzle, but one of the other pieces to this are represent Harrison is what is that the Department of Health is already investing in health equity. And one of the issues that we believe needs to be looked at as well is how to align the work of staff in the Department of Health, who are already highly and, excuse me, highly invested in working around health equity issues to integrate with what would become the office of health equity. So I think the idea that a full office. It probably would require some additional funding, whether it's from the state or from federal funds. But I think it also requires the creative realignment of some ongoing funding that's already in place in the Department of Health. Thank you. Thank you. Representative shine. Thank you and thanks for all the work representative liver that you and your healthcare committee have been doing on this it seems really important I guess my question to you is, what are the specific outcomes that you expect to achieve as a result of this, you know, what's going to be different. What's going to be better. Yeah, well in the near term in the near term one of the things that first we need to before we can make decisions on how best to address health disparities we need to fully understand what they are. And so I think the funding around data collection and data alignment is an initial very important piece. We expect that addressing health inequities will result in fewer disparities, fewer disparities for the affected communities communities of color, the LGBTQ community, and the disabilities community, the testimony in front of our committee is. And I'm sorry that I really, you know, every committee wishes you could have heard it all, but it's very compelling testimony when we hear about the inability or the fear, the ongoing fear for many, sort of, for example, last few days ago we heard from members of the Abanaki community and from other indigenous members of the Vermont indigenous community in addition to the Abanaki because there are other indigenous Vermonters in addition. And what we hear is the ongoing impact of the eugenics, frankly horror stories, the fear of being identified the fear of going to fear of approaching medical professionals. But we think that we were trying to address this in a number of ways, but our goal, our goal is over time to be able to do outreach to affected communities so they actually secure the health care they deserve, and therefore reduce the not just the disparities but the impact on that community so that the health they get is actually in the interest of all of us as Vermonters. So improved health care improved health for for all of these populations. Absolutely. And it's really one of the long term goals that you're. It is, it's a short term and a long term goal and I would say it's important for us to recognize that this is improved health for an entire this is, there's nothing that if COVID hasn't shown us anything if the most important thing that COVID has done for us as tragic it is, it has shined a light on two things one, the incredible disparity in health care for affected communities particularly around race and other other disabilities. But it is also shine the light on the fact that until we all are healthy until we all have health care until we all are vaccinated until we all feel free to seek health care. We're not all healthy. It's actually in the interest of everyone in the state of Vermont to have healthy Vermonters in every part of the state, and that includes around issues of race issues of LGBTQ status issues of disability. And we are learning that in this COVID emergency. And I think this is a compelling moment in time for us to take steps. And this this frankly I think is a very modest, very modest request. Thank you. But thank you. So, thank you representative lipard I'm not seeing any additional questions and we know that you have work that you need to go so we don't want to detain you any longer. And as you know representative Yakovani is our key our link with you, and we will certainly obviously read with interest your bill when it comes to us but also will do our questioning through through him. Absolutely, I welcome that. And let me let me just say again, how much I appreciate working with representative Yakovani on this and other issues, and we look forward to continuing a strong alliance around health and health care for Vermonters. Okay, thank you with your whole committee. Thank you, and we do also with yours. Yeah. Okay. Thank you very much. Okay. Okay, and no one Jen and thank you for joining us and I think you probably ought to follow rep lipard back to his committees. Thanks for being here on Kimberly. May I ask an unrelated question of Jen or Nolan of the already jump no Nolan is still here. Getting a text about s 117 just past the Senate that maybe there should be better offline this is important for everyone though. This is another bill coming that extends the deadline for a year. The expiration of rules will that is that in your committee already representative liver. Yeah, yeah, well it's it's it's we've been working jointly with the Senate Health and Welfare Committee on this bill. It's actually been crafted in our committee, and we've we've sent it to their committee we agreed that it would come in one bill. It's a priority bill it must be passed. I've spoken with the speaker, it will be at the top of the agenda for next week our committee has not received the bill of course yet, but we will review it early next week. We've been in close contact with Senator Lyons and her committee, and I think we're prepared to move it because it needs. There are a lot of March 31 deadlines that need to be anticipated. And so we've been working since the first week of the session to move this bill through the house through this. We work jointly we took a part of it. We then are putting it in the Senate bill is now become a committee bill 117 is coming to the house, and we will be moving this bill the first part of next week I believe. Okay, excellent. Thank you so much. So, I'm now confused is that related to health disparities. No, it's an entirely different bill is only related it's it's it's the extending of the covert emergency provisions that we did actually a year ago today. Everybody that was a year ago today. We talked about that. The set this morning, and we're remembering what it was like on this day, a year ago, and how hard you worked. And we crafted emergency legislation which we've extended and now we've looked at it carefully and said these are the pieces that should be extended further and that's that's what s 117 does in part. It also addresses addresses some additional additional issues of telehealth. Okay, great. Thank you. Looks like we may have another question. I don't know representative Harrison. Yeah, thank you. Representative Lippert. We certainly appreciate all the work your committee did a year ago. I remember waiting on the house floor all day long as a bill that I was a primary sponsor was in your committee and being reported by your committee. I wanted to find out where you were waiting, because it was being hijacked for all those emergency measures on the first responder training. Yes, and ultimately some other things are done but thank you for your support on that bill last year. I think I think there's going to be some more things around emergency. EMTs and wellness and that you're going to hear from the Senate and via us eventually as well. Great. Great. Thank you. Thank you. Now appreciate your time.