 Good afternoon, and this is part three of the Vermont House Human Services Committee on Wednesday, April 28th, and committee my this is an extra time on some level because I thought that maybe the House floor was going to take longer today. I think based on where we got this morning. In terms of s 20 I just want to repeat that. We'll be taking it up again Thursday morning around 1030 or 11 depending upon how long. Around 1030 and at that time, if anyone has amendments to bring it there. I think we can. I think we are finally at a point where we can take action on the bill. And so we will do that tomorrow. And that will then give Katie whatever time she needs to put it together so that it would be assuming there is a majority of the committee that supports passage of the bill. On the calendar next week. But I thought I would bring us together in terms of just having a little having a little bit of a discussion about the resolution that is now a bill. We had some great, great discussion and testimony this morning. I do want to let folks know that I think it's rights and democracy. I'm now going to forget the group is having a quote unquote lobby day on Wednesday. So for those of you for I want to say for Taylor and Dane if we had been in the building when groups come in and they bring their members. We have a public health care group or whether it is people with disabilities or other groups like this. They oftentimes ask for time in front of the committee and we give them as much as we can, we give them the opportunity to, to present themselves and to testify. So they are coming next Wednesday, and I received an email saying that they would like some time in front of our committee to talk about. And to have individuals who are members in particular of the BIPOC community to share their views on legislation in front of us. And so I took them up on that and said please come at forget whether it's 11 or 1115 next Wednesday. And thinking that they might have comments on the resolution. I gave them the list of the bills that we have considered. And then also said, if there are other issues that relate to human services for them to do that but so we'll have about, I suggested in talking and emailing the director that for individuals to plan on no more than half an hour of comments because knowing us. We like to ask questions or at least acknowledge and say something. So I say that in terms of as we think about the resolution I'm not asking us to be making a vote on it right now, but I think we should talk about what we're doing. What was the name of that group again, Madam chair. Julie, I think it's rights and democracy. Right Vermont rights and democracy and RAD is their acronym. Thank you. And actually as we're talking about business before we do that. Various of us, not me, have had interns during the year and done some research or things like that. And Jessica has asked one of one of Jessica's interns or Jessica's intern has been. Jessica's intern has actually been looking at what the Senate did with our childcare bill. And so I was thinking, I think Jessica you asked if she could come on Wednesday. Maybe if she could come when is that what you asked for. Yeah, and I was willing though anytime I just put that out there as a time for a few minutes. Well, why not Wednesday morning. Okay. Okay. So we're going to start at nine. So to start out and Dan I know that you have an intern. Do you want to introduce your, would your intern like to have their five minutes of YouTube fame and to come on to in the committee room. I think that would be fantastic. I'd love to invite him. Thank you. I think you could have have him come at on Wednesday morning as well. Yeah, I will send him an email. Does anyone else have interns. Okay. And then we'll figure out the rest of the schedule. Okay, so the resolution treated as a bill. There's been there's been some testimony in terms of and there's been some questions from from topper and others and there's been some testimony about maybe looking at what the where as is are. And at the same time, there's also been a suggestion to just sort of leave it as is so I'm curious as to where people are. I'm happy to start this one off. I am happy with the resolution as is and the reason behind that is that this is coming directly from black members of our community, who have done this research who have cited their sources who used a majority of Vermont data to how these health inequities look like already in our state. And I think the most compelling testimony that we've received so far was from Commissioner Levine, and talking about the direct impact that it had at the Department of Health. They made this declaration of racism as a public health emergency. And what emerged from that was a health equity group that helped them with their covert response to be more directed and understanding that we don't have the data here in the state and being able to support folks across racial identities and a majority of the time we just default with whiteness. And so that's what we saw with the Department of Health, but when they made that declaration we saw significant improvements, as I mentioned right here when you see, we saw pop up sites we saw a multi generational vaccine clinic and understanding how housing is set up for various communities. And I think this is just us, not only falling in line with our Department of Health, who are the experts when it comes to social determinants of health and the health of all Vermonters, but also recognizing that it, it will push us farther in the work that we're doing here in the legislature to make sure that we are being considerate and an understanding of the various communities that we have historically ignored, I would say. Thank you Taylor. Carl, you have your hand up. Thank you Madam Chair. I just thought the point of interest. We I think we all received a line was referred by somebody else but a letter from Robert Richard, who is tribal councilman of the abnaki nation of missus boy. And he's, he's making a point here about not treating all of the minorities, the same by the use of BIPOC. I don't know if you've seen this letter but it's a, it's addressed all while it sent to all of us anyway apparently, and stating and it sort of goes along with the case said this morning that we shouldn't treat them, all the same, the black community, the Hispanic community, the indigenous community, etc. So I just thought it was interesting than anybody else get that letter or see it. There are a lot of nods, you're getting a lot of nods so some of us are more up to date with our emails than others. So, Carl are. So, Carl is what you are suggesting that we take a look at the where as is and make sure that we and add some or differentiate between populations is that what you're suggesting. I just thought it was interesting how this person is substantiating or not necessarily substantiating but agreeing with something in case brought up this morning that we can't look at it as one group of people called BIPOC. Okay, not that the resolution necessarily says it, but it's implied because it's it's grouping them all together. So, and obviously I mean you know how I feel on this that we shouldn't use it. It's not a resolution as a resolution on racism but as you know, joint resolution relating to racial, ethnic, cultural, and I would say circumstantial disparities that need to be addressed. Thank you. Thank you Carl. Mary Beth. Thank you madam chair. I similarly to representative small feel. I'm really protective of this resolution because it was composed by people of color. People from the black community and you know, it's important to me that that you know myself as a white person I don't want to swoop in and kind of start messing with things that I, you know, I really that don't directly affect me and that I don't really understand all the reasoning for it being there so I feel similarly like I really trust that the people who came together felt these were important data points that they wanted to emphasize and, and I'm, I'm good with that. I did appreciate cases perspective I really did it was really an important perspective and I appreciate what he said about not pulling out one group, you know a data point from one group and really, you know, providing data for all of the groups, I would say in Vermont one of our challenges is we don't have the data we haven't captured a lot of this data. So that's, it's a great aspiration but it's a problematic reality because we don't have the data captured in many cases. You know, I appreciate his perspective. I also, you know, have heard from many of my black and brown brothers and sisters that they are very, you know, they feel there are systemic structural issues and I, I have had to really be humble and hear that and really learn from that and I guess I don't feel comfortable starting to kind of toy with something that, you know, is just really. I just want to trust the people that put it together and, and really take their word that these are the important points to emphasize. Thanks Mary Beth Jessica, go ahead. So just sorry, I didn't know I was unmuted. I I wanted to just agree with Mary Beth and Taylor I I thought a lot about to today what what we heard on on with two very different perspectives and it was helpful to me to think about that because what I heard is very similar to what I hear when I go home to Rhode Island to my brother and we have similar discussions and one thing that struck me at the end was when I remember when Mary Beth said is coming from the black I don't need after reading the all the letters today now I'm not sure should I say by park or should I say but it's coming from the community that's the most impacted and that to me. The whole idea of it not being a statute is because we need to allow more collection of data, there just isn't the data and that's one of the things that I'm always sort of talking about is do we have the data. And we don't have the data for a statute so we need this resolution in order to move in the right direction and fill in those holes and understand them better. The other thing for me is I think a lot about what this committee did and I wasn't that here when you did this but the work on the trauma. And how we talked a bit this morning about whether or not the racism itself is a why are why is there more illness or more in more illness around the black community what's the difference between putting economically disadvantaged or whatever and I think that the big difference is that that 400 year history of trauma that gets into your genetics I mean one of the things I think it was Mark Levine who talked to us about is that it's cumulative it it's inside of you your babies and their baby and then the next set of babies that it becomes part that trauma is inside and so there really is a difference in the black community that they've been dealing with all kinds of trauma that has damaging long term effects and it's not just physical health but mental health as well that we all know and I hardly ever refer to my significant other in this environment but but we've talked a lot about this and as well and the unbelievable importance of that your mental well being on your physical health and there just isn't a community that has been more impacted both physically and mentally I believe through by the trauma from their past and so I'm very supportive of moving forward on this and being able to collect the data and really look and also bring attention to the importance of this work for all of us like in the hospitals and in state government making sure that we're remembering and putting this forward as an important thing so anyhow. Thanks Jessica. I wish I could pull out, which I can't right now, a film that I have shown in my class that if you, and now I'm going to forget what the word is, if you, regardless of economic situation. In particular this was about women. Women's health outcomes are worse. So, if your income if you if your income is the same. The, as it relates to women. Your your health is worse, your health outcomes are less healthy if you are a woman of color. So it's not. It's not solely where you, you know it's not solely if you are living in a more impoverished situation. Topper I wish I could remember a the name of the film and be the data, but if you control for economics. Race seems to be the factor, Dane. Why don't you refer to me on that. Because you because you asked the other because you asked about you asked earlier about data and where it was from. And so I was being I was trying to. I know that that's important. So I was just, yeah, my question was why are people of color, more susceptible to disease. Can answer that. Dane. Thank you, Madam Chair. Just giving my two cents on this really enjoyed our conversation this morning and the different perspectives and ways of looking at this. I think I am at a place where I support the bill. It's a resolution as as written based on a lot of feedback that we've gotten as far as it's it's a resolution it's not statute. It's really about sending a message and that there are a lot of people that are involved in it and feel that that are stakeholders that are supportive of it. I love to edit things and all of that. I this is a point where I feel like yes it's time to sort of step back and other people have put a lot of thought into this. I think that also just going to the word racism as kind of the subject. I think it's that focusing on racism necessarily ignores other issues or or, you know, minimizes other issues there are so many other disadvantages that we need to consider, but we also I think need to name racism and I think it is notable. What you said about there's something about naming racism that divides us. It creates division and tension. And I think one of the potentials of a resolution like this is that it could sort of get us closer to where talking about racism isn't something that divides us as much it's something that we accept we're able to talk about we're able to work on. It's a part of our sort of, you know, vocabulary. And, yeah, I also just think, you know, looking at making an economic inequalities or something else as the, I think that there are just so many overlapping factors. So within health outcomes, you know, and it isn't just racism but I think we do see across the board, a lot of points it does point back to race. And I think that we need to look at that and address it. And, again, I don't think it's minimizing economic opportunity or anything like that. So that's my two cents. Carl. Thank you. Just another anecdotal comment. I, I gave this resolution to my son of law and asked him to read through it also. And he had almost the exact same reaction as, as case did, and especially on sort of the, the name of the thing which is what we call joint resolution. Saying racism is essentially a public health crisis. He couldn't understand why we were using that term. I think he thought more like I did why don't we attack the issues that are pointed out in the resolution that there are communities and work on those instead of going ahead and working on using a term that I know, regardless of what Dan says, but I mean I appreciate what he said. It's a more divisive word and keeps us from really dwelling on the issues that are important to this, these different groups of people, whether they be great people of color, indigenous, Hispanic, etc. So anyway, I just thought it was interesting that my son of law and as you know he's a man of color also so he had the exact same reaction. Thank you. Thanks Carl. Teresa. I didn't even get a chance to get my hand all the way up man chair. Was that leaning forward. I know that leaning forward. So, I think the use of the word racism is important, important. I think it's important because it calls attention to the disparities that are there, and my hope is that the use of such a word doesn't close people's, you know, eyes, ears, minds to the underlying issues that people of color face in Vermont and like a one or the other kind of kind of choice for people and I really, really appreciated the conversation this morning with both of the witnesses and I really feel like both of them gave us things to think about and if, if I were sitting down and writing the resolution, I would, I would look, you know, seriously to some of those questions that I'm trying to pronounce his name correctly. Oh yeah. Thank you Carl. I thought I didn't agree with them all but I thought that some of them, you know, had had some validity to think you know to further thought, but I, for me, the thing that I think that sits with me at this point in time is the statement and Dr. Levine statement, similar statement that until we name something until we call attention to it, we won't devote the resources to it and we won't collect the data and, you know, and we won't be informing ourselves and without that information you can't improve things and so that's, that's where I lean on the people who spent many hours coming up with this language and feeling like I'm, I don't feel like since it's not along, it's the intention of it is to call attention to the issue and to for us to start to collect more data on it and to help to improve systems that it's, I don't feel like it's necessary to change it and I, I feel like, you know, I've reviewed the data that backs it up and I feel like, you know, the statements that are made or backed up by data, most of which is Vermont data. And so I'm, I'm comfortable with it the way it is, although, like I said, I really did appreciate the conversation this morning of multiple viewpoints on it. Thank you. Carl. Sorry for it, but we're talking about data and I think Camelia made a good point that data by itself doesn't indicate causation. Okay, there's a piece of data that has a greater preponderance of sickle cell anemia amongst black people. And then that definitely that's that's a racial issue because it's something having to do with race itself, not having anything to do with racism, but that's a piece of evidence that is collected. And doesn't necessarily mean that the cause of that is racism. Okay. And that's what I was getting at and many of these disparities that are mentioned. I call them disparities. Okay, anyway, that they are. But probably, I mean, you know, I don't think so. But I mean, there may be some of them are the so many of them are not. I mean, the, the multi generational family living conditions and the greater exposure because of that to people with COVID and all that. It really in many ways have nothing to do with race. It's a cultural, plus what I would call a circumstantial issue with many of them are are people coming into this country. And that is the most efficient way to live is in a more communal setting. And has nothing to do with race that has to do with the circumstance of coming to this country and trying to live economically like I mentioned about my family when they came to the United States from Sweden. Anyway, I just wanted to point that out that data by itself doesn't mean causation. It, it, it's important, but we have to be careful. We don't just say what has to be this way, because, you know, more people that are black have this particular situation. It does. It's not the causation connection. Thank you. Thank you, Carl. Kelly. Well, that just has kind of made me think about what bore said the end that you know this resolution is not saying what should be done with the data that's collected and it is not saying what the solutions are and it is not saying what the path is forward it's, it's a beginning statement and I think keeping the term racism in there is important as you know, looking at systems and underlying issues, it is a factor and not acknowledging it, I think does more detriment than it would be helpful. Thanks Kelly, Mary Beth. Thanks, Madam Chair. I just think it's, it's super important for us to not like not decide that anything is not caused or cause like we're not we're not medical people we don't know all the underlying factors there are a lot of underlying factors for that relate to race, you know, some of the generational trauma that Jessica referred to earlier. You know, I think it's just important that we really are open to, you know, everyone some people come, you know, as refugees other people have lived here longer than my family has. I just think there is no one way or another I just think we have to maintain an open mind that there are many ways that these health disparities are result and I believe that race is one of them races one of the contributing factors. So I just want to be careful of us making these blanket statements that you know I just think we have to be really mindful of people's experience of people's, you know, you know, the social determinants of health back generations which lead to these outcomes and are definitely based in race. I want to leave an open space for all of the possibilities relative to people's physical and mental emotional challenges that they deal with. I encourage us. The resolution talks about racism and system systemic racism. It doesn't talk about race. It talks about racism and systemic racism and I think that we, we need to sort of keep that in mind. Jessica then Kelly. Well, this is just a little add on to what Mary Beth was saying and what I said earlier about why some of the issues around health care are more difficult maybe than other other of us. And that is the other one that I remember and I can't even remember who said this, but was around the learning in medical school and nursing school about people of color and what their, how high their pain is and how they handle certain medications and all these things that impact when you are treating a person in that way, it impacts their health long term and so there's another issue and the other piece is just the piece of how they're treated inside of the system. Is it always and that's the work I think that hospitals are doing right now but that's an important thing. And then there's the piece of, if you're a black physician, and you walk into a room and so and you hear regularly, are you here with the lunch, my lunch stuff from our room and what that how that impacts that physician or a nurse and the long term impacts of that as well I mean there. There's so many keep raising our hand and keep telling more stories I'm sure that we, we all know of but there are it's sad that there are as many as there are. So thank you thank you for centering and giving examples in terms of health care. This is not a resolution about race, and this is not a resolution about health care. This is a resolution about racism and public health and public health is is wider than health care. It is those. It includes those elements of our daily lives that impact our health outcomes. Talks about where we live, where we get our food, what the quality of our housing is what the quality of our food is, as well as how the mental health and medical so it's both end, and I just want to keep reminding us that that really is this. If this was a resolution solely about physical health care, we wouldn't have it. This is a resolution about racism and public health, which we're wrestling with Teresa. Well, I guess I just feel like I need to sort of put out on the table that if we were sitting around the table. That this resolution is not calling anyone a racist. And I, I just, I guess I felt the need to say that because I think sometimes when we talk about systemic racism. Sometimes people internalize that and believe that we are calling people racists and there's a distinct difference between those those two things and so I just felt like I need to put that out on the table that that is not what this resolution is doing. Teresa, thank you. Thank you very much. I appreciate I personally appreciate you're saying that I'm not quite sure where I mean we could have these we could have a conversation all afternoon. I would like to wait before we make any final action on the resolution until we hear from rights in democracy and there. You know, people had been and Carl I really appreciate your bringing someone today. And I guess my question to two folks is, are there other people who you would like to hear from and Julie, have we identified we asked other people already. I've invited other people a couple of times and have not gotten a response or responses they couldn't testify. Okay, thank you. So I guess I would just ask you all if there are other individuals or that you would like to, to, to hear from that will be important for you before you decide how you're going to act on this. I think I'm not overnight. Okay, absolutely. Absolutely. Okay, thank you. Switching subjects tomorrow. Julie, would you tell us who we're hearing from tomorrow at nine o'clock. Yes, we're going to hear from Dale from Champlain services and I'm looking for my list here. When the developmental disabilities council after Katie doesn't walk through of age 243. Okay, so with age 243 we are sort of chipping away at all those pieces of legislation that we had initially identified at the beginning of this session. Now I'm going to stand corrected if someone corrects me. Clearly since that time we have gotten other other bills that. And so we'll need to figure out either do we. What bills do we go back to what do we want to have. And how many of the bills that have been introduced do we have the time and does it make sense to get an introduction to so that we know what was there. But in the time, you know, right now people are still talking about 22nd as the last day. If things go as they have gone in the past. Soon the floor schedule may change. And we may start being on the floor earlier than one earlier than one o'clock. And that we have as the child care bill or other bills that are in the Senate that hopefully we'll see will. What we you know whether we agree with if they've thought of making any changes in our wonderful work, but if they have, do we accept them. And then we have also what's in the budget. And there are a couple of big issues that I think are, to be honest, I'm not sure if it's in the budget or if it's in a separate piece of the budget. But housing. And we need to get together, we need to get together a small group to to work inter intercommittee appropriations, health care, human services and House General, in terms of looking at what happens over from the administration and the Senate. And so I guess I'm saying all of that in terms of I'm a little unclear right now, as to what happens after next week, in terms of what we are looking at. And before we left for lunch. Dan if he is on and not frozen. Okay. It's been very frustrating day with the internet keep dropping my zoom so hopefully I, I hang on here for a little bit. So what's happening with your bill in the Senate, what's happening with the, the child youth and family advocate in the Senate. Well, thanks for asking. Um, the, the bill has still not been entered into the committee, the morning committee in the Senate stops at the end of this week. So they will not be taking action on the bill. At this point is what we heard from the chair. In the Senate morning committee stop on May 4. So gives them time to to act on committee of conferences and more floor time in the Senate. So, unfortunately, looks like we're going to have to make sure we're on our game. When the session starts back up in January. Thank you. Disappointing but very disappointing. We'll keep moving forward. We can get here in one day so looking forward to seeing that taking some testimony in the Senate in January. The same is true for 153 as well. And I, I am going to assume that the same is true for therapeutic dosage of buprenorphine. Although, both, they're having a hearing tomorrow morning Wednesday Thursday Thursday morning, both a joint hearing between Senate judiciary and Senate health and welfare. And it is, it is disappointing on all accounts. That said, people are, you know, people need to move in the at the timing and the way that they are most comfortable and I, on some level, I guess I am seeing the glass half full in terms of the child youth and family advocate. It took about 10 years to get it past the house. So, the fact that we've gotten that far, I think it is on some level, huge and we just need to really keep the pressure on and talk with not not only the members of the Senate health and welfare, but people in the community who think that this is an important bill to move forward, and the same with the other two. I think that the Teresa I think you're the bill around Medicare is is less may still be hard to do but it's less controversial, if I want to say, some of the other things that we have now. We and the house thought that they were not controversial at all. I was going to say, which senator you asked. Yeah, right. But, you know, so we will try to go. Kelly were you going to say something. No, you were just moving. Okay. Is there if I just say something little absolutely on this same topic I so last night I I tried to look at the budget areas that we worked so hard on. And I was curious, I can talk about that another day but I was curious if Teresa, the budget piece we have put money in on the bill that you passed, but we had also put it in into the budget do you know if it made it through the budget process. The cost of living increases in the budget. Yes. Okay, just not the added jump, right. Yeah, there was there wasn't, there was, it was a flat 2% cost of living increase in them in the budget. So, because in the areas that I know more about they pretty much went with us on everything. I don't see any cuts I mean the building break futures still got their 261,000 the CIS the 1.5 million. They really pushed on the reach up stuff that we had just written about but not actually put numbers to and they put numbers to it. And they added in parent child care centers with a big bump not to the base but to to them and there's some other things too. So at some point we could talk about that if you want and absolutely. I mean those are things those are things and go ahead Teresa oh and but Carl, can you wait Carl has his hand up. I just thought maybe we should do some more straight in like we will hold a chemical bill hostage until they can give us some of our bills back. How would that sound. I love you. You are you are just so. Just what's happening right now. What. I'm sorry Topper what'd you say. You're holding the light up until we get this chemical bill back to them. I'm Teresa. Well I was just going to mention the adult day programs. There was a big chunk of money. In addition to the 2% there's $5 million in one time money for assistance with reopening and additional costs and so that stayed in the budget. But there's a like the whole language section we should take a look at next week. I don't think people have a problem with the language but that's just my two eyes on it and would appreciate. You know when we have a chance to look at that as a committee it's essentially giving some additional flexibility and assurances that that $5 million will stay in adult days, even if it's spread out over a period of time. I don't think there's anything wrong with that. I don't think there's anything wrong with that. There's obviously housing and nutrition that I didn't know as much about, but I'll say that there are some changes there. It's a little messy. So we probably won't have housing is. Really complicated. And it's not just in the budget. There's. There's a whole housing plan in terms of them. I'm sorry. They're all unhoused and who are currently in motels. The plan is the plan from the administration right now is that they will leave their hotels by July 1. Not quite sure where they're going to go. I believe there's a there's a tent camp off the off of Pine Street in South Burlington. Don't know if that's going to enlarge anyway. There's a plan. There's a plan that we have to think that this is what I was taught that I was alluding to, which is not just us and so it's really important that we don't go off on our own, rather that we work collaboratively get the same information as much of at the same time with House general appropriations and healthcare because some of the issue around people who have been identified as homeless who are now in hotels has to do with healthcare and mental health and stuff like that. Topper then Dan. Thanks Jessica. Thanks madam chair. Wouldn't it be nice. If we looked at the reasons why people were in trouble in terms of housing, instead of moving them to a tent in the summer and moving them to a motel in the winter. Topper, I think some of the legislation is talking about rehabbing housing and putting it up, but that's not going to solve the problem. Topper, that great minds think alike and that is why we are involved and not just House general, which is more focused on the aspects of housing, but what are those things what are the social supports or what are the other things. And then we share with, I mean, we probably could have all 11 or 12 committees focus on housing, but that's why there's so many that's a great, a good point Topper. Dan. Just to add quickly, there was a group that met with the Lamoille County delegation on on Monday that was from the FQHC Lamoille housing just kind of big picture looking at access to housing in Lamoille County as a health, you know, making sure people don't have that that that support to to not keep going from hotel to being homeless back to hotel and and how that impacts their health and wellness so just thought I'd pass that it was it was a good good informational meeting and they're really trying to plan how they can move forward here in Lamoille County with access to housing. Great. So really sort of this is also the time of year where all sorts of things are going to start happening and it's like, oh my God, how did that happen and they'll happen it really quick times and I'll get grumpy because I'll go. How did that happen and how come no one told me and shouldn't we know. And so let's just make sure that we all keep each other on this, you know, informed about what's going on because we're not in this, we're not in the same building. We're not going to see each other in the cafeteria or run into each other. Let's begin to think about not being in the legislature for 11 months of the year, and in fact getting out in at the end of May. So, I'll see you all tomorrow. And when and Topper gets mad at me when I call it toppers bill, but when we take up when we take up the bill around the study or the evaluation or the around autism. And so thank you all very much. And please come. Please, if you please come to committee tomorrow with the expectation that the committee is going to take action on s 20. And so if you have thoughts. That Katie needs to be involved in, please let Katie know. And otherwise I will see you. I'll see you all at nine for something else instead. This ends our afternoon.