 Okay, this this is the house health care committee. It is Thursday, March 11th, and it's just a little before four three fifty and We are going to walk have a walk through of H2 10 Which is a bill we've been taking extensive testimony on over the past number of weeks. It's the it's in short version the house health equity Bill or house any health disparities bill and before we start I want to Publicly thank our ledge counsel person Katie McLean who's with us to walk through the bill for her both for her initial work with the originators of the bill, but particularly in the last few days for her Attention to read doing this redraft of 210 which tries to bring it Inconsistency with what we as a committee have discussed what we've heard from some witnesses and what I think will make it much more possible to potentially move the bill tomorrow So Katie, thank you, and I would just say this is involved Talking to Katie after the kids are in bed Thank you, Katie your work is very much appreciated in addition to your helping us think about several aspects of it so everyone should have this new redraft and I think I think what Probably makes sense is to first is to do this in several stages to first do a broad Overview rather than a line-by-line review Because we've we've been through this bill before but now it is changed in its structure and I think Rather than listing every word that's changed Katie, I think let's do a broad Overview of section like this section remains similar to this this section has been changed and and I think that would be a first step in terms of understanding what we have in front of us. So with that if and Do folks want to have it was it helpful to have it on the screen or Do is it work better to have it? I think it's good for the public that it's on the screen because if someone's watching on YouTube They might be able to see it to be honest, but I'm not attached Okay, I Needed on the screen because I can't flip Okay, fine, then we'll put it on the screen, but but just particularly right now Katie you're going to need to I guess you can have you you and Colleen working out so you have control over it We're not going to this is not a line-by-line walk through at this point in time. Okay Yes, I yes, I think I think I would thank you Woody for asking I think at this point, that's that's kind of hold your comments make note of them but Let's first walk through to so everyone has a more shared Sense of the structure that is there now as opposed to what had been there previously and then we'll then we'll come back And what we'll start a different type of walkthrough. Does that work for folks? Okay, so with that Katie if you would Put it on the screen and Katie McLean office of Legislative Council and see if I can pull up this document Are you seeing H 210 on your screen? I am Okay, would it be helpful to have this? Can you can you increase the font size a little bit on the screen still? I Think that helps when we're Okay Does that work for folks or do we need it larger? Good, you can also slide the slider thing over and make it larger on your screen. I'm not that's not very instructive. Sorry Okay, I think I think let's start with this and We'll count on others to adjust as they need or request something more. I think I think what she meant was the standard screen You press the standard screen it'll make The bill larger and it'll make all the participants smaller Does that make sense? Well for those for whom it makes sense you go right ahead and the rest of us will just Thank you Woody though. Okay. So what why don't we give it a shot and if we need to and make adjustment we can Okay, so this is draft 2.1 You haven't missed a 1.1. That was just an internal document that I made for myself And in terms of a big picture The first section if you remember was a finding section of the bill is introduced and you'll notice that the findings have not changed Significantly with the exception that there is a new subdivision. So there's a new subdivision 7 Scroll down to find that and that new subdivision 7 has to do with Statistics on LGBTQ youth that come from the youth risk behavior survey. So that's a new language and This isn't the moment for the line by line, but it's right here in subdivision 7 and we're on page 6. So that is the only change to the finding section and this amendment. The next Section of the bill also has not changed the legislative intent and purpose in this section has had no substantive changes to it. So I'll skip past that. Is this can let me just stop intro. I'm just is this working for people to do it at this high level to get a structural idea. Okay. Thank you. I'm sorry continue Thank you. Um, so next we get to section three and I was just going to pause here to maybe give a big picture before we go through each section. So this is the chapter that Pertain specifically to health equity. So this is a new chapter that it would be added to title 18 And the bills introduced. This is where the office was created. This is where the grants were. And so those two pieces have been removed from this draft. What has been retained is a definition section, a data collection section and then probably where the most changes happened is the advisory council piece. And that has changed to reflect the fact that the advisory council is going to have some work to do before the office itself could be created. So that's what you'll see in this section. And I think the idea here with creating a new chapter is the recognition that this is one step in a In a building block one step in the plan for future action. So this is kind of planting a seed in terms of having this chapter codified In the green books for for mending in the future and adding to in the future. So With regard to the definitions all of the definitions and the bill has introduced have been retained. So I won't spend any time there. And then we get to the section on the health equity advisory council. And again, I don't think you want a lot of detail here, but the concept is that the health equity commission. Thank you. That the health equity advisory commission is being created. And its goal is to look at health equity eradicate health disparities and also amplify amplify the voices of impacted communities, but it also has this kind of subcharge, which is to look at what an office might look like provide strategic guidance on the development of that office and provide recommendations. on the structure responsibilities and jurisdiction of a future office. The membership has not changed with the exception that this advisory committee would be led by the executive director of racial equity. And that person will be the chair. Otherwise the subsection B has not changed the terms have each office of each appointee has not changed. The powers and duties have changed quite a bit to reflect the fact that there's kind of a multi year approach. So the first charge of the group is setting up an office or providing guidance on what an office would look like. So that's in subdivision one. And then the rest of the items listed here, kind of look to the advisory commission being kind of an ongoing commission to make recommendations and not just providing short term advice about the office but providing ongoing recommendations. So some of this language is in the bill is introduced. But you'll see in subdivision to this is making recommendations to an office once established, including input on these items. Reviewing and monitoring advising state agencies and current and policies that's from the bills introduced subdivision for is from the bill is introduced. And also, there's the subdivision five advising a general assembly on efforts to improve cultural competency and anti racism in the health care system through training and continuing education requirements for health care providers or other clinical professionals. So, just to flag that this one piece and subdivision five kind of recognizes that there is work to be done with regard to continuing education, but it isn't prescriptive as to what the continuing education requirements would look like if you remember in the bill is introduced there was a section specific to continuing education, education those kind of prescriptive. So this is just saying that this commission is going to give advice on that issue. With regard to assistance. The advisory commission is to have assistance of the agency of administration which is where the executive director of racial equity is housed. There's an annual report that language has not changed since the bill has introduced. We have language about the meetings this has not significantly changed with the exception that the executive director of racial equity is calling the first meeting. And there have not been other changes to this commission. The next section was in the bill is introduced this is the data collection section so this has remained the same with the exception. We've referenced the executive director of racial equity, instead of the, the director of the office that hasn't yet been created that's what the original bill introduced so otherwise this has stayed the same primarily. And then this section for is new. This is existing law about the duties of the executive director of racial equity, and there's been a new duty added to reflect the fact that that executive director now has new responsibilities in the leading the health equity advisory commission and until the office of health equity is established. So that is this new subdivision for excuse me could we go over that slower. If it's new. Sure. Yeah, I mean, we're just looking at this so yep. Yeah, I'm wondering why would this wouldn't be on the line if it was new or this is new into the bill but it's existing language is that what it means Katie. Yes, it's new to the bill. Everything that's not underlined is existing law. And then the added addition is this underlined language. So we're just adding one new duty to existing law. Does that help. Okay. So this section five is also new language that was not in the bill is introduced, and this comes back to the issue of continuing education. So this sets a timeline by which the health equity advisory commission is to provide advice to the general about continuing education proposals so by October 1 of 2022 the commission in consultation with licensing boards professional organizations, providers of all health care and clinical professions. The commission is to submit a written report to this committee and Senate health and welfare with recommendations for improving cultural competency and anti racism in Vermont's health care system through initial training, continuing education and investments. So that's a new reporting requirement. And then six is new this is an appropriation section. This appropriates 180,000 and fiscal year 2022 to the agency of the administration, again, where the executive director of racial equity is currently housed. And this money is coming from the general fund, the purpose of this appropriations to carry out the provisions of the act. Then there's also intent language recognizing that this work is going to be done over more than one year. So this intent language is that the general assembly would be providing similar appropriations and fiscal years and future fiscal years until the office of health equity is established. So the act is taking effect on July 1 of this year. So I will stop sharing so you can see each other. Okay, so this is so that's I think that's helpful and trying, hopefully that's helpful in trying in terms of trying to outline the overarching restructuring of the proposal from what had been earlier a proposal to immediately implement an office of health equity within the Department of Health. And so what we have now is a proposal to use the office of racial equity and the end to work with the director of racial equity on an interim transitional basis. To stand up the commission and to have the commission subsume several of the responsibilities, one of which is to work with the director of racial equity. And I guess what I want to say and be clear about is that this bill provides resources to that office for them to either for them to contract with a person or persons or an entity to assist them so that we're not trying to add a new responsibility to that office with no new resources they already have plenty of responsibilities and elsewhere in budget proposals. There are proposals to staff that office with two other positions, which already have other responsibilities. So this would be not adding a new permanent position an additional permanent position to that office. But because there's these transitional responsibilities to give them the resources to contract with, like I say person persons or an entity. So the direction of the director of racial equity to stand up the commission to work with the commission give the commission the opportunity to give input into the actual structure, location, et cetera, of an office of health equity. And so definitely in this version we took, we also gave the commission the responsibility to advise and create a report on further continuing education for healthcare professionals around cultural competency, etc. I think that is the broad overview. Some of that isn't as spelled out, but that's, that's what the fund, that's what the funding is intended to do. So can we, can we, I'm trying to think about how best to work our way through this I see there are questions. I think what I'd like to do is to first invite questions, comments, suggestions around the larger larger framework rather than like what word is used in page 10 line five. If we can, if we can start by hearing questions about whether this is in fact reflects what our testimony has been whether it's your comments or questions about the breadth the broader structural issues, and we will we'll keep working our way back through the entire document eventually. So, I'm, again, I'm don't know who. I'm not sure it matters who was first in the goldman representative black and then me. Thank you. Thank you. It's just hard on my screen to what I think the way they show up in a list on the game. But, okay, well then so represent golden and represent black and represent down a human will. Well, everyone will get a chance to wait. So there's that's not to be concerned about represent golden. So I'm inferring as this bill is presented that the director of racial equity is taking that on. And I imagine that there's been communication with that office we haven't really heard that the last test. Well, let me let me stop and say that she has actually been in our committee. What's your testimony from her about this. Oh, totally, but not about what her office would be willing to, you know, be the be the temporary place for this or maybe I was sleeping but maybe I was an old woman sleeping and you know whatever but I just missed that that she agreed the last testimony we heard was from someone from the racial alliance who talked about a consultant and maybe having it set up that way and I didn't understand that the director of racial equity was willing to take that on which I think is totally cool. So that's how it landed and I just am. Okay, let me let me fill in some let me fill in some information because in fact I have had conversations directly which outside of the committee but she did in fact in in the committee. I believe when we talk she gave it was very preliminary she gave some maybe I think you know it might work. It was it was preliminary when she discussed and I know you. And I just to be honest, there's so many moving parts right now. It's hard to keep track of it all. But I asked, while we did have this on our agenda we weren't sure when we'd have the draft I did ask Colleen to contact Susanna to let her know that we were doing a walkthrough of this. I can say that she has communicated that but we should see that she is able to communicate about that with the full committee and that's something we should do for tomorrow, because that's important. But thank you Leslie it's it's again it's. Yes, it's implicit but needs to be explicit. So I need to. You're writing down for your list. You just have to bear with me because I know notes and just give me just bear with me. Yeah, I'm sorry I, I thought you were looking for the name of who was up next and then I realized you're putting a note on my question anyways because I had the exact same question. Okay, good. Okay, appreciate. I thought it was the basis for our whole discussion on funding, funding people to do this kind of work is that she original she was the originator of when she said she was willing to do it she said yeah if it's funded. Yeah, exactly. Yeah. So yes I, I, yes, but we will, and we're contacting her as we speak to see when and if she's available tomorrow because that that could be important. Okay. So represent Donnie and then represent Peterson. Yeah, I want, I want to just give a general reaction to the sort of change that we've been discussing and the reformatting. Because I think some people will see it as a step back and be disappointed. Oh, you're not going to do the office. It might be several years who knows it's not clear. I actually think it's so fundamentally important to do it from the ground up in the sense of the people who have the most at stake who are quote unquote advisory and yet who ought to be the ones building from the beginning. And, and I really relate to this from my own experience, you know specifically in the psychiatric survivor community where, you know a lot of times input means, okay this is what we've done. Tell us what you think is good or bad about us, tell us where the curtains should go in the building. To turn that around and say, no, how, you know whether the building even gets built or how it's constructed needs to come with the input and the insights of the people that we're trying to, you know, help address health equities. So I think this is just a really positive and important way to shift that paradigm. And I'm going to step in here and say that I was trying to think why what in addition to the fact that I acknowledge that I have had direct conversations with Susanna Davis on several occasions in the interest of trying to see what might be possible to see what you know thoughts were etc. But I'm recalling that in line with what Representative Donahue was saying that I think one of the important points that she made in her testimony to our committee was the idea of adding process equity to the structure. And that that I think is what another way of describing some of what Representative Donahue is describing which is that this is not just a matter of saying we're going to have. We're going to tell you how many times you meet and we're going to tell you how what you're going to you know how you're going to do it and etc. But I remember that was for me a very important piece of input in her testimony and suggested then in part what I took from that I think some of us took from that was in addition to the suggestions from the Alliance and others. That the commission itself that the standing up of the commission and giving the commission and those affected communities who are on the commission giving them a greater voice in the actual decision about when how and where to sit and whether in fact to establish an office of health equity. And that was partly in response to the suggestion that process equity was also an important element in this so that I think that's to help explain to others why I felt like we had heard from her and that we're following her guidance in part as part of this. Not just her guide input but others as well. Another piece I wanted to comment on is, is, you know, there's, there was a, a connection that I can't imagine why I didn't think of it before but I think Wednesday morning. It was only a day. Judy Dow and she testified and other folks about the eugenics movement in Vermont. And I've been working for many, many years to get a resolution, apology for the eugenics movement and that very day I was being asked to testify and talk about some of that history and the interrelationship of those issues around the barriers to good health care now arising out of what we as a state did not all that long ago was was was a really powerful reminder to me that connection that I failed to make until that the timing. Yes. Okay. Representative Peterson. Thank you, Bill. I want to understand something you just said a few minutes ago so I know what we're doing here far setting this up. The office of racial equity is going to hire a contractor to set up the commission is that is that what we're, is that what you said is that what you mean. They, we are giving I'm this the way is structured right now is that they would we, we as the legislature would be turning to the office of racial equity to, and we give them the resources to hire what whether a consultant, perhaps a consultant is a term or content somewhat a contracted person the distinction I want to make is that it's not a full time ongoing permanent position in their office for this purpose. Right there. A job and then the job is finished. Yes they do a job and then that and when that job went run that this is a construct that we're proposing right now. Things could morph and change but the process worth presents the process worth suggesting right now is that there would be a temporary new duty and temporary new resources to the office of racial equity to assist in to assist in standing what we call it may be standing in the commission, getting the commission underway, facilitating the commission, then in the process of making proposals back to the legislature about the establishment of an office of racial equity. Is that in the bill in the change we just made because I missed that totally. Is it yes I think it is and, and I think we need to be clear that it is but. But no, but no, I think the specific question is the reference to hiring a consultant in the bill. And the answer to that is no, it's simply, it's telling, it's telling the offices of racial equity you, you need to put this together and we can micromanage. Yeah, we're not going to micromanage but it is, but it is, I think it's implied by, and maybe it maybe there's maybe be useful to make it explicit in some other way. But it's implied by the language when it gives the new when the section you were asking about represent Peterson about the new duty given to the director of racial equity, the new underlying section. It deliberately says, temporarily. I don't have it right in front of me but. Yeah, I have it. Yeah, on page 20 and page 20 line 10. It says, temporarily overseeing and chairing the advisory commission. And that that, and that's deliberate, because this is this is not an ongoing responsibility added responsibility of hers. It's because it's Susanna. It's, and it's a transitional responsibility that's how I would, that's how I would describe it. It's a transitional responsibility for the period of time that there is this new duty with some additional resources to assist her in the standing up of this commission, facilitate and I think implied facilitating the commission process. So then have input through a process that they determine through the frequency of meetings as they determine through the, whether it's subgroups or the whole group or, I mean that's really not for us to, I don't think we need to spell that out. Yeah, I'm just here reading. But implicitly, our expectation is that probably the way she would do that with those resources would be to hire and bring in a consultant to help that process. Again, temporary interim transitional. Right. No. And can I say what can I say, because I'll say this is another there's no secrets about this. When we turn to the appropriations committee in say in some other settings or some others. Other committees are saying, we would like you appropriations committee we're recommending that you establish. For instance, I think there's a proposal to establish two new positions in what once was called the criminal justice training council I think it's now called the criminal justice council or something. We need two new positions. They need to be funded. And not only do they need to be funded when the appropriations, the creation of a position you have to appropriate or designate an actual position of state government as well, which is an ongoing commitment to someone filling that job and having it over a period of time. We are not asking for a position. There's language that matters a lot in the appropriations world. We are not asking for a position of state government to be created in this. We're asking for resources that will be used on a temporary transitional basis. So the other thing for new members that maybe just reminder or clarification. We're, we are saying this is how much money we think, or if we pass it in this way this is how much money we think it will take that isn't a decision that we make or that ends up our bill will not go to the floor. It'll go right because of the fact that it includes money in it by rule it goes to appropriations next, they make the decision about whether or how much funding to attach, because they've got to juggle all the other committee bills that are saying, we need money to do this we need money to do that, they have to sort out that process. Yes, thank you that's that's helpful and in fact I should tell you. In a way that this world works in those many part many moving parts I have now been asked to come, even before we have made a formal decision to approve this bill. If you recall, we had to put in our budget memo to the appropriations committee several weeks ago. We had a section in there where we said, we had $100,000 to support this process. A placeholder as a placeholder subsequently. My best judgment is that it should be $180,000 that ultimately will be decided by the appropriations committee, but they have asked me to come in there tomorrow morning at 11 o'clock to explain to them. The funding part of this bill. And so, you know they're they're they're trying to get all their work done so I'm going to go there to explain that part of the bill to them. But that'll be before we've approved a bill, but if we're I mean I'm assuming we're going to approve something but but that but it's it's it's not premature but it's it's preliminary. They need to know they want they're trying to figure some things out. So that that's part of what will happen tomorrow as well. Does that help clarify that at all. Sorry. No, it clarifies it. You know, I just wanted to know what the mechanization was that's good. Yeah, yeah, and your hand is up in case you don't notice but yeah. Okay, other witty representative page. Thank you representative leopard and members of the committee. I have questions that I have. I don't know whether it can be any clearer than it already is. Maybe not. But we talked about the various different levels of research. It. It's confusing reading, reading through the various items. And you don't know, or at least I don't don't really, I'm not really clear on where the research is coming from. Which part are you referring to. So help me out about. You know, one through page one through. You're talking about the findings findings. Yeah. Yeah. Okay. You know, like the findings general assembly finds that research. Okay. Then it goes into according to the 20, 2018 Vermont Department of behavioral risk. It's just. It's very confusing to me. Okay. Can I can I say something about that or I don't want to. It's just a comment, you know, no, but let me, but I think it's, it's worthy of, of asking and I. So, Katie has. Katie, you're there. People move around on the screen. I'm sorry. So, I suggest that we perhaps find a time, probably not right now, but find a time to go through the findings in particular as a separate process for the committee. Because we've never done that, because we've not done that. But also because Katie has assured me that in her work of creating the findings, every finding has a reference. I think is is tied to some document or some point of research or point of some point of documentation. Is that correct Katie is that you want to say something about that just just in the broad. I think it's accurate when I put together findings for any bill, I put together a packet of, of supporting authority in the bill file the official bill file so that travels with the bill as it moves through the process. It's particularly important for somebody reporting a bill when somebody on the floor says, where does that fact come from and then they would have access to it so I think that's. So, so I suggest that we will go through the findings. And Katie can meet. And Katie can help us understand where any particular finding is documented. Because I think those I think that's a very important question you're asking represent page. And it's in it's some of the findings maybe new information to some of us. I mean, to be quite honest, I have to tell you I could not if I could not have recited the findings. I would say that it's my knowledge personally right now that every finding that is here is something I could have recited, but every finding here has a point of documentation. And so some of it is new information to us, and I will suggest a lot of it's going to be new information to our colleagues. And that's why it's important that it is documented. I'm not suggesting that the information is documented. I just, no, I know. No, I understand, but I, but I think I think it's important to put it in the reference point that part of the work of our committee, as with all the other bills is that we end up hearing testimony and learning about things. You know, at a level of granularity or detail. The other others of our colleagues don't have that opportunity to do in the same way that they when they reported some of the bills on the floor today. It may be that I mean I'm just going to speculate here, but it may be that not every one of us was thoroughly familiar with every detail of everything they put before us. But they are, and they're bringing it to us again based on the testimony their committee has heard and the recommendations of their committee. Thanks. Also, I don't know whether this is pertinent or not. When we talk about non white Vermonters. Mm hmm. Who are we talking about. No, are we talking about LGT. Are we talking about two or are we talking about. Are we talking about. It's it's there's a definition of that in the bill. I think Katie could direct us to that, because there's a. Yeah, remember we just did the broad overview we didn't go through it in details for people. I mean we go right into the bill and we start talking about non white Vermonters, I think it would be right up front. But that's, that's. That's just my thoughts. Okay, I will rely on Katie as well as other legislative council in terms of structure, but I think there is a definition section and I think that as an example, I think has a definition in the definition section. Okay. As as does LGBTQ Vermonters. But we will, we will again walk through the definitions section. Okay, I guess I'll just leave it at that right now. Okay. Okay. Thank you. But thank you. Those are, those are actually very important questions. I'm going to turn to and I don't know whether represent China. Why don't you or Leslie whichever might have gone first please. You're, you're, you're muted. Oh, I said I'm not sure who was first was it you representative Goldman. And I'm going to be quick. I just want to echo representative page. I was really confused on the finding section about where that data was coming from. And I don't under, I don't really know sort of the normal structure of a bill and whether you give the citation after every one vote whenever it says research says it's going to people are going to like say really I don't believe you kind of thing so I don't know what the normal but you know get defining that I think and really standing on real data I think is important here. I just want to add one more. I may, but I really want to thank you for taking that on both you Katie and representative lipards so that we can go through that data and have it really clear for our colleagues. I don't know if this is appropriate but you know when we say that. Non white is the language you're using Vermonters is like 6%. Well it turns out to be like 50,000 people. And I think it's important somewhere in there to really put the absolute number of the number of people we're talking about because that's a lot of people. And I think we need to think about that so I'm hoping that somewhere in there we can actually put an absolute number of who we're talking about that was my only comment. Okay. And can I can I ask Katie to comment on the what, what is the protocol for putting documentation within a bill or findings etc. I'm going to turn to you Katie on that. Sure. Sometimes we will put a phrase according to X source, this that and the other because the findings were so extensive, and because sometimes findings for one particular subsection or coming from multiple sources. I can't do that, except with subsection seven. If that's something the committee is interested in I can look to try to integrate some of the references back in, but we don't necessarily need. I don't necessarily think there's a standard practice so long as it's backed up in the bill file, I think either is acceptable. Okay, so, so it could be acceptable to integrate more of the documentation into the findings so that in fact, we weren't having to explain to people that well this has a source, etc. Absolutely. So, I mean that, I mean I know that's asking for a fair amount of integration of information there. But what I'm hearing is that that seems like that might be a helpful piece, but let's, let's, let's think that through before we ask Katie to go do that. I think some head nod. And in terms of, and I think, in terms of communicating with our colleagues and communicating with our public. That's exactly it. That's, that's that has the potential to be helpful and maybe. Yeah, I'm seeing sufficient. I guess I'm seeing sufficient and hearing what do you raise the question initially and I think that that might have helped to answer your question as to, you know, where does these, where are these facts, or if there are facts where they coming from. These are questions which we know we will be asked. So, I would like to be able to explain some of it, where this came from to if that's okay. Yeah, okay. That's why I had raised my hand. That, you know, I created the bill with the racial justice alliance that's how it started I mean that's pretty explicit about that they were the first people to come in and testify. When we were, when we were talking about the issue of disparities in the healthcare system, we actually the the racial justice alliance has data people one of them spoke here. That's Pat Otelio you might remember. I think he was the one white person who spoke, and the data team is constantly looking for studies reports places that the state reports data and like and like analyzing it. And we look to that data when we're trying to hash out like policy solutions to the problems that we're seeing. And so, when we we when we were at when we talked about problems in the healthcare system we had a lot of qualitative data, you know, people's questions which we heard in our testimony, but we understand that you also need to show the numbers. So we reviewed a variety of sources and on Katie and ledge Council's job is to make sure that those sources are valid. And they did that and there's a there are other bills I worked on where the lawyers chose to include citations and when we were working on this bill we just didn't do it and I didn't question it. I think if there's a way to add them in it's fine and at the very least something that I think would be helpful is and I can try to help with this unless it would be easier for me to stay out of it would be to create a list of the of the sources, like in one place that the findings come from and links because a lot of them you can click on a link and get to a report somewhere online. And so Katie I don't expect you to do all this but if I had a list of the sources. I could see if we could create a list that would become part of our record where anyone who wants to see where what these findings are could go on our website. Go to what one of our you know the healthcare page click on the day that it's entered into the record, and they can actually go and explore those sources directly. So I'm just offering that because I do believe that we need to be accountable and transparent to people about why we're making the decisions we're making and that's why the findings were so detailed because we felt it was important to show the numbers behind the stories. So, I really think it'd be nice to have a list. I think what what you what you're talking about Brian in the in the old days would be something that might be left on each person's desk on the house floor, in case they wanted to, you know, right. So, so in the interest of process and moving forward. What I'm trying to have us work on. I think asking Katie to create that list is not reasonable right now but Brian if you or others would be able to create I see that as a an ancillary document or a I'm reaching for the word but something something that would actually be provided to anybody who is wanting that, but I do think the suggestion and I think I'm wish I, but here we are. I think trying to integrate those references into the findings in as much as possible. I think it sounds very clear that that would be a positive addition to strengthening the bill and clarifying that is that achievable. Yes. Okay, well then I'm going to ask as the chair on behalf of the committee to ask you to take that task on. Sure. Okay. And I think that's this is this is again a very helpful part of the process of thinking about how to move forward. So let's let's assume that that's going to happen. That's, and I want to be clear we need to and I, Brian you're the lead sponsor of the bill but I would want to make certain that people are not somehow on, because clearly by I don't mean bias and then make it work, but that you have an investment in this bill. So I but I would ask if you would be willing or to have some if we could find a way, if not for tomorrow. If for at some point that similar listing of references where you, you know these days because you actually can click. And it's amazing you know you could you, whereas otherwise you'd have to be searching all over the place but you could actually have live links to many documents if not all documents. But that's that's a task that I don't want to ask Katie to do in the next period of time, but it could be something that we create in anticipation of taking the bill to the floor, or to other committees. I have no problem doing a little bit of work to create that and I actually feel like as the lead sponsor it's my responsibility to make sure that the committee has the information. That's what I need to make the decision. And people, like I said I will create a list and try to give direct links and then you can feel free to go examine those links and use your own do you know your own diligence to like explore the sources, but you'll see that a lot of it is like state reports and things like that so I think that would be a terrific additional resource to accompany the bill. So that I really like that suggestion and I like, I really like the idea of live links. Yeah. So, I agree I think in this day and age, why not make it as easy as possible for the public to access the information, you know, okay. I see representative Cordes so I'm just going to keep we're going to keep this is I think this is being very helpful. From my point of view represent Cordes and then represent page further questions or thoughts on and I'm at this point on the broad structure still. Okay. Well if it's not I mean this is sort of. It could be a broad question but it's stated in the bill I on page 12 line seven is where the first reference to non white is mentioned and I think I understand the paragraph is explaining why we're using that phrase. But the phrase is still super problematic and that it others, you know, makes the white bodies the norm and everybody else is not sort of like able bodied people and disabled people. And I'm wondering if there's, first of all, if anyone can help me Brian or others remember if the racial justice justice alliance and other folks that helped with this bill were okay with that. Being structured that way or if there's a way to make that make it clear that we are not wanting to normalize the phrase in statute. So we use that we included that definition as a way of acknowledging that this is, we're using that term, because it's in the data it's in the findings like if you look through the reports that's the word that's used. So if we were going to use the word in the bill we wanted to have our own explanation so we define we put our own spin on a definition of what none white means and I think it even got amended a little bit to soften it so. So, if people feel like it needs to be amended further on open to that but I, I think we need to leave it in because if we don't then we're normalizing even further to not explain what we mean by non white and just acting like it's like a yeah, we should all use you know. I'm not saying take it out I understand why it needs to be in there. But I think for more for many people it won't be clear. And I don't want to hold the bill up with with this if this is already been run by the racial justice alliance and all the other people that worked on it. Let's leave that. I think that's not resolved at this point but let's let's let's hold that question open and think about what the implications of that might be for the bill and for represent page. Yes, I found the other the other item that I was looking at on page seven talks about individuals who experience health inequities. And I, and I know I touched on some of our witnesses questions regarding know how they felt when they were meeting with their primary care physician or what have you. And I guess what I'm getting at here is, I like more facts than I do feelings, not that feelings aren't, you know, not that you don't have a sixth sense sometimes about, you know, an individual that you're dealing with. But I don't suppose there are any reports on on on, you know, of individuals and how they, you know, didn't feel that services were provided for them or, you know, things like that. Am I getting my point across. I, I, I think you are. And I'm not sure I'm going to explain those phrases. You can that in in in, I'd have to look exactly at what you're talking about but initially my thought is that you're referring to some of the things that people reported in surveys. And so these are these are these feelings these qualitative feelings were actually in a survey that I believe that that one of them I have to look at which survey it is and soon we'll have the sources for you to see. And look at the actual survey they'll ask people like, do you feel this do you feel this do you feel this and then they do statistics on it and then tell you like this percentage of people who took the survey of this race felt this way and this percent. So that's why it's doing that it's not individuals writing in my understanding is, but I'd have to look before I'm 100% sure but I'm pretty sure. I'm just, I'm just saying that these are individual feelings and, and, and I recognize it okay. But it's, it's, it's different. It's and it's difficult to prove in many ways of, of when you're not being treated well but yet you know, in your heart of hearts that you know you're not. You're treated as well as you perhaps should know. And, and, and do we even know whether these individuals actually did get treated. So I say the last part again, did these individuals that had these these different these different feelings. Did they actually get treated in the end. Were they treated. Did they receive health care. Even though they didn't feel as though they were being. Even though that maybe the sum of the services weren't supporting them as well as they thought they should be. Well, I think I think it's just a thought when I read this, I like to see, as they say just a fax man, you know, and, and I know the feelings are important, but I don't know whether I'm getting my point. Well, and I'm hearing Brian explain as I have seen many surveys, you know, and maybe even have participated in some, any one of us like how did you know whether it's, let's take something more, more neutral. I get a, I get a survey every time I take my car in for servicing at a dealership and said, how did you feel, how did you feel you were treated. Were you treated it was it rated excellent, you know, good. Terrible, I mean, were you, how did you feel you know basically it's a quality it's a qualitative measure based on a survey. And in that instance again, he's like, did your car actually get repaired. Well, maybe the car got repaired, but it didn't get repaired promptly. Maybe it got repaired only because I had to ask five times. Or maybe I waited in line and I was the last person. I mean, so I mean just thinking in a different kind of setting. I think many of us provide that kind of feedback and I think this is maybe akin to something like that. Well, and in many cases of those surveys. You're not being those surveys are not being you're not treating those surveys as, as honestly as perhaps you should. In some cases, if you want your car. You know, that sort of thing that there's a bias. Well, in a way, you know, I get these surveys from my doctor for my primary care physician. And what do I do. Well, I don't know all 10s, you know, because I'm going to see them in another week or two, you know, and, and if I have a issue with them I'll probably say it to personally. I'm going to put it in writing and, and you know what I'm saying. Well, and interestingly, this is actually the reverse issue which is people expressing concerns rather than a bias in over. I don't know why I'm not sure I'm helping this conversation. Yeah, I'm not either. Can I try to go ahead and then I know my hand wasn't up but I'm trying to respond in real time. But I'm paying attention to the time and I think we'll go for a little for longer and then we'll stop for the for today. I mean what what I might be totally misunderstanding but what I'm hearing is that when you're listing findings that findings that are based on how people feel, you don't think are as as key as findings based on what are the facts of outcomes and I think that the distinction is that that it's important to have both. And that what's key in this is that when we start having the actual citations people will be able to link and see okay. This was about how people perceive what they were getting based on this survey, we can assess it when you look at it was it scientifically done, but this is objective facts here. And so, you know, I think we need to look at them separately and see that, you know, some of them are subjective some are objective, and they all. You have to put them together to get a picture. You can't just let anyone stand alone because it wouldn't be adequate to really see what's the scope of the problem that we're trying or we believe needs to be addressed. I think that's helpful but that's, I think that's the key when we start looking through the findings that there are some that are about perception perception can matter the car dealership is potentially going to change how it delivers its based on hearing a lot of perceptions from people that you know they were treated badly even though factually that owner can go and say look, this is how I treat everybody I know they're good but boy if there's a bad perception, I need to try to address it. I think that for how people feel is important. It can't stand alone. You have to have the hard facts also and I think that's what the findings are attempting to do to reflect those different components that create the whole issue. I feel much better when you explain it like that. And I think you, you've hit what I was trying to get at. Thank you. So let's take a few more questions. I think, again, I apologize I don't know who who represent quarters represent golden whoever was. I would like to address what he's concerns because I think they're important. I think it's the tension between qualitative and quantitative research quantitative is numbers it's so clear and statistically significant quantitative qualitative research is not as straightforward, but can be done as statistically significant. And that's why it's important to have the citations, because if we can base our this information on good qualitative then we can use that to inform this legislation. So, I'm not sure if that helps but qualitative research is this whole other arena of how we find out about feelings and experience but when you have a huge number of people reporting the same you can then use statistics to say this is valid. So, that's why this becomes important that we have the site, the site. And you're able to explain it as somebody raises it on the floor. Yes. Yeah, I mean, that's where I'm coming from is yeah this is qualitative but it's statistically significant and well done research that that suggests or proves that these, this is valid. So, Katie is going to work with us to try to integrate citations and that might be, you know, once we see that that might also be helpful to some of the questions that we're raising. Representative Cordes. Oh, sorry. I think it's also really important to step back and appreciate that the qualitative information that we're, we're referring to is human experience by people who are vulnerable within these systems that we're trying to address with health equity. They, people that are already feeling vulnerable that don't have that have a negative experience won't go back. And we know that it prevents them from seeking care when they should. Sometimes it leads to death by suicide because they've, they've had bad, bad experiences and they don't want to seek care. And it's also it's for that reason it's also very important to include that but it also shows that we do care. You know, the people that worked on this legislation do care about that, that input and honor the, the, the lived experiences folks that experience difficulty in our current system. Okay. Ryan, representing. I just want to let you know that I am I have found something that I'll send to Katie that should help you. So I found some I found some a document where there's some, it's in the it'll probably need you to clean it up a little but where there's some references connected with pieces of it so I sent it to Katie and hopefully that helps you. Okay, and then I'll try to extract from that a list of sources. It shouldn't take too much time but I could I so I can have it tomorrow. Oh, that'd be terrific. That'd be terrific. I think this has been a very helpful next step in terms of the looking what's in front of us. Katie, thank you. You are going to be available to us for a good part of tomorrow as I understand it. Is that correct. I believe so I'm I think I'm in and out of the committee in the morning and I have a more solid block of time in the afternoon. Yep. Okay, and unless we stop there for today. So that seemed like a, I mean, in terms of people's time and I think stop there for today. What we're going to look to for tomorrow is see how if Katie is able to integrate some of that. I think we've asked for any other structural changes at this point. But that's important work around the findings and Brian is going to work on a list of references. I think getting to the actual, you know, walk through the bill will be the pro I think probably the next. Yeah, yeah, to really. I agree. Yeah, I agree. So we've agreed that we're going to convene at eight o'clock and we're going to convene first on the other issue that's outstanding in our committee. So, you know, we're going to do a lot of juggling tomorrow, but we as a committee identified that as a priority issue. And given what we have in front of us, we'll do our best to see if we can't bring some closure to that. And then continue with 210 throughout the day. We're going to do our best. We're going to do what we were going to do our best. So let's let's get rest and get some rest tonight. I think we're we have, I think we will rub to the task. So let's work together tomorrow. And try to find our way to an endpoint. Okay, so thank you all.