 Okay, we're back on YouTube. It's the House Health Fair Committee. It's Tuesday, April 27th, it's about 3.20. And we are pleased to have with us earlier than anticipated our legislative council person, Katie McLinn. And Katie, are you, we're hoping that you can walk us through the changes that you're aware of that are being proposed in the Senate for House Bill 210. Happy to do that. Great. And thank you for... Oh, of course. Thank you for adjusting your schedule. Of course. Katie McLinn, Office of Legislative Council. Would you like me to pull the document up on my screen? Would that be easiest? I think probably it would be. Okay. Okay. Are you seeing draft 3.2? Yes. Okay. So just to kind of let you know where we are in the process, this has not gone to the Senate floor yet. So basically what you're looking at is the Senate Health and Welfare's committee report. And I'm juggling my hard copy where I have the changes noted. So I will kind of juggle both documents here so you can see where I am. So there was a new finding that was added if you remember on there were quite extensive findings in H210. Yes. Let me scroll down to where it is. There we go. So there was testimony on the Senate side that while there are extensive findings on various populations of persons that this bill is aimed at working for, the indigenous populations, there are really no findings that are specific to indigenous populations. So the Senate tried to address that in two ways. First, there's a new subdivision 10, which is a broader finding. It's not specific to Vermont that according to the Indian Health Service, the American Indian and Alaska Native people have long experienced lower health status when compared with other Americans, including a life expectancy among American Indian and Alaska Native people born today that is 5.5 years less than the U.S. All Races population. And then the finding 11 modifies the finding that this committee had added on eugenics to have some language from the House resolution that was discussed and it pulled language right out of the resolution to be a little bit more specific to Vermonters of Native American Indian heritage. So it kind of combines what you had with the resolution that passed in the House. So this now reads as outlined in the resolution, Vermont's state-sanctioned eugenics policies targeted Vermonters of Native American Indian heritage, including French Indian and Abenaki families and persons of mixed ethnicity and of French Canadian heritage as well as the poor in persons with disabilities, among others. These policies, including the state's 1931 sterilization law are examples of past injustices in the healthcare system that continue to impact members of these communities in present day. So those are the two changes in the finding section. And then we move on to section two, which was legislative intent and purpose and there was a change here. You'll see that they'll lead in language to this list that we're going to look at is to this end, the general assembly believes. And so then there was a new subdivision seven added. And just before we look at the language, the context was that I think the committee members were really struggling with what the right terminology to use in terms of definitions throughout the bill, the term non-white is used. And that's very much a reflection of how data is collected in the health department. But there was also a conversation as to how that centers whiteness. And the committee found that they wanted to have some recognition of the fact that we're still working on what the right categories are and the right definitions are. And later on in the bill, at the end of the bill, there's a report back. And we kind of in this subdivision seven cross-reference that report back. But the concept is that this is still a work in progress and we're still looking for feedback from the advisory commission that's created here and from the executive director of racial equity and how to address this issue both in drafting statute but also in collecting data. So the language reads definitions of racial categories and identities can be difficult to agree upon as they often create hierarchies and comparisons that center whiteness, prioritize one group or identity over another or fail to recognize historical equities and oppression. Definitions also shift over time as broader cultural norms change while potentially problematic in order to align with data collection standards and create consistency. This bill does use the term non-white as defined in the next section and also seeks to create new definitions that better reflect racial and ethnic identities and categories pursuant to section six of this act. And in section six is where we have this kind of new report back that really focuses on this issue. So that's it for changes and miss section. And then we move on to the new chapter that's being created. So if you remember there is a chapter on health equity and in this chapter we have definitions, we create the advisory council, there's language on data collection. And at some point in the future this is where the language for the office of health equity will be located. In terms of definitions, there was an addition to the definition of cultural competency. So the lead-in language is at a minimum cultural competency should include the following and this is a new subdivision E, the ability to recognize the importance of communication, language fluency and interpretation in the provision of healthcare services and assist with access to interpretation and appropriate communication services. And then in addition, there is a new definition added that is the definition of cultural humility, meaning the ability to maintain an interpersonal stance that is other oriented and open to the other and relation to aspects of cultural identity that are most important to the client or the patient. So that definition was added and then we have a few and then of course we've renumbered all the definitions and there are a few places where that new definition or the new term has been added. So I'm scrolling along and the next section in this chapter is the Health Equity Advisory Commission and this is where this committee and the Senate really spent a lot of time. So you have the creation language that establishes the commission, you have the membership language and then we have a new member, two new members. Excuse me, I think I'm gonna sneeze. I think I must have allergies, I've been sneezing all day. So let's see, new members. On line 19, we have the Chief Prevention Officer, Debigny and then just if you're not familiar with who the Chief Prevention Officer is, this is a position that was created, I wanna say in maybe 2019, 2018 and this is within the agency of administration and it was enacted as part of a law on substance misuse and it created a Substance Misuse Prevention Council but this position is much bigger or it's much broader than just substance misuse prevention. It deals with all types of prevention across state government. So we could look at that language if the committee is interested and then there's a new subdivision on line 20. So another new member and it's a member appointed by the Vermont Developmental Disabilities Council and we have some renumbering and let's see. So in this subdivision too, this is where we have staggered terms so that not all the members begin at once and because we have two new members, we had to update, pretty much update the math of in this section to make sure that we ended up with the right number. So we have 29 members were not at large. So now we have, let's see, we have 10 members appointed for one year, 10 members appointed for two years and nine members appointed for three years initially to stagger the terms. Okay, then in subsection C, we have the powers and duties of the advisory commission and there's a change in subdivision one and that change is giving a date for when the Office of Health Equity is to be established. The language that came over from the house said that the office would be established. I can't remember the exact language but it had to do with when it was fiscally feasible to do so. And so the Senate put in a date certain, not later than January 1, 2023 that that office would be created. The next change was in subdivision five. This language just adds in general assembly. So the commission is tasked with advising the department meaning the department of health on any funding decisions relating to eliminating health disparities and promoting health equity including distribution of federal money in relation to COVID. So now it's advising the department and the general assembly on funding decisions. Subdivision seven, we've added in this new term that we added a definition for cultural humility. So advising general assembly in efforts to improve cultural competency, cultural humility and anti-racism in the healthcare system through training and continuing education requirements. And I believe those are the only changes for this section. Let me confirm that, yes. So those were the changes for this section. There is a data section and the Senate did not make any changes to this section. The next section of the bill had to do with the executive director of racial equity. This section has not changed since it left the house. This was just adding overseeing the advisory commission to the tasks of the executive director. So that has not changed. And then we still have a report on continuing education. The only difference is again that new term has been added when we're looking at continuing education recommendations for improving cultural competency, cultural humility and racism in Vermont's healthcare system through initial training, continuing education and investments. And then we have the section six report when it left the house, it really only had the subdivision one meaning that as part of the first annual report submitted by the advisory committee, the commission was to add budget recommendations for the continuation of its work in fiscal year 2023 if necessary. And the Senate added this language and for funding the office of the health equity. This is sort of part and parcel with the concept of trying to have the office of health equity off the ground in 2023. So looking for pin of a funding structure and budget recommendations. And then subdivisions two and three are new. Two is recommendations appropriate, sorry, recommendations on appropriate and inclusive terms to replace the term non-white in the chapter we just looked at. And then the second part of that is just aggregating data categories and tabulations beyond non-white and accordance with the data collection language earlier in the bill. So two things. So this subdivision to A, this is supposed to be kind of a companion to the language we looked at in section two, subdivision seven that talked about the challenge of coming up with definitions. So this is where we're asking for more information and for recommendations on how to use more appropriate terminology. And then in subdivision to B, this language about disaggregating data categories and tabulations beyond non-white is referencing the data collection where we're already directing the advisory committee. Where is it right here? The advisory committee and the executive director of racial equity to weigh in on this topic. So that's right here. So we're saying, so I've scrolled back a little bit to the chapter 18 VSA section, chapter six. But right here, we have data related to race and ethnicity shall use separate collection categories and tabulations disaggregated beyond non-white in accordance with recommendations made by the executive director of racial equity and in consultation with the advisory commission. So we're just cross-referencing back to the fact that we're already asking for this. And in section six, this language pretty much just asked for a date certain by which we're getting that information. And that is part of the first annual report from the advisory commission. And then in subdivision three recommendations for the most effective use of funding received by the state through ARPA and a manner that promotes health and achieves health equity by eliminating avoidable and unjust disparities and health on the basis of race, ethnicity, disability or LGBTQ status. So that is also to be part of the first report. And then we have the effective date section. And that's it for changes. Okay. Thank you, Katie. Before we open up for questions, I wanna just two things. One is, first of all, thank you for walking us through this in anticipation of your other work that you're in the midst of as well. And would you, at what point would you be able to give us a highlighted copy of the changes? Do you know what I mean? Yep, I could go through and re-highlight the changes I've just walked through. Depends if I have to go back to the other committee or not, I could get it to you quickly if I'm not needed. No, I wasn't thinking about in that short of term, but I'm gonna do the next day or so. I can have it to you for tomorrow. Yeah, that'd be great. That's all I was asking, because it makes it so much easier for us to be able to put attention on where the changes are. So let me suggest that first we focus questions on checking in with Katie about understanding what the changes are as opposed to broader committee discussion, which we will come back to if we don't have time now, we'll come back to it at another point. So Brian represent, Gina. Yes, thank you. And my questions are really just clarification. It's not meant to, I'll save my editorialization for another time, but just to clarify that, it looks like a specific start date has been proposed at this point, as opposed to it saying when fiscally practical to do so. And I know there was some concerns by community members about the previous language and about there not being a clear start date. So it's correct that this is basically saying now that the plan is by January 1st, 2023 for the office to be open. Is that correct? That's correct. It's setting a date by which the office will be open. Yes. Okay. So the sort of thing I'm not sure about is in the funding report, it says budget recommendations for continuation of its work in fiscal year 2023, if necessary, and for the funding of the Office of Health Equity. So I'm a little confused why they would say if they need money to continue their work because they get stipends and stuff. So they're gonna need, you know what I mean? So do you know what that's about? Like... That was our language. Yeah, the if necessary came over from the house and it just refers to the budget recommendation for the advisory commission, not for the office. Okay, I guess looking back, and I'm not gonna pick about it now, I question why we would say if they need money, when we know they need money. So moving on, yeah, moving on, because we can get into that in discussion. There was one other, I flagged a few things. Oh yeah, the only other thing I wanted to confirm is that my math is right, that there's 10 members of the commission who are sort of government appointed seats, like they're appointed, they're either a commissioner or an agency or employee of the government, but it looks like 19 are appointed by community groups or other organizations or tribes. Does that sound right? The number, like 10 and 19, I tried counting quickly. I haven't counted. I haven't counted, let me like... I'm pretty sure the first 10 are all government people. So I just wanna point that out because even if this group decided to put many more members from the government on, it still fairly has a majority of community members representing the voices of impacted people. And I think that was an important piece of our intent was we wanted this to be a group led by those who are impacted and it's still the case, even though the membership was changed. So just doing due diligence, I wanted to check about that, but it sounds like that's correct, right? 10 and 19? That looks about right. All right, that's it for now. I'll save the rest of my commentary for when we discuss the bill. Okay. Thank you. Thank you. Other questions for Katie in terms of what she's presented to us right now? Okay. Thank you, Katie. And it'll be great to get a highlighted version for us to be able to look at. And of course, as we said earlier, this is in anticipation of what would be a final Senate recommendation, which could change based on actions that haven't... There hasn't been final Senate action is what I'm saying. Excuse me, but this is what we think is likely to come from the Senate on H210. Great. So I'm gonna suggest that we not try to have community discussion on this until we have final language in front of us and give people a chance to have looked it over more. And then we'll be in the position to make a decision really how to respond to a proposal from the Senate, a proposal of amendment. Representative Golden. I'm just curious to know when members of the community give us feedback on their response to the Senate version. Well, that's a good question and not one for which I think there's a clear answer. I think, so let's think about that because there are occasions when actually it's more rare than usual that more witnesses are here at Trump, but that's not out of the question. Let's think together about that. Yeah, I'm not necessarily suggesting more. I mean, I don't know the process, but I've heard in places that there's some disappointment about how it came out of the house and just wondering how we think about that. Well, let's talk and think about what might make sense. I'm not, I don't want to make a decision about that on the spot right now is what I'm saying. Other questions? Okay, thank you. Again, thank you, Katie. And thank you very much for making yourself available prior to the four o'clock timeline. And we'll relieve you of our committee and you can determine where you go next. Okay, very good. Nice to see everyone. I know you're in demand. Okay, thank you, Katie. Very much appreciated.