Vermont Legislature SmartTranscripts:

[Rep. Alyssa Black (Chair)]: Hi, welcome back everybody. So we have a few amendments we need to hear on for bills that are on the floor today. And before third reading, representative Chittenden is presenting amendments on 08/14. Jen, if you just want to walk us through the very, very, very short amendment, and then Brian, if you want to speak to it.

[Rep. Brian Cina (Member)]: I'll make it as quick as I can.

[Wendy Critchlow (Office of Legislative Counsel)]: All right. So good morning again. Wendy Critchlow from the Office of Legislative Council. Let me just share. I'm just going to share from my calendar.

[Rep. Alyssa Black (Chair)]: So this is a proposal. It is

[Wendy Critchlow (Office of Legislative Counsel)]: on page eleven forty two of today's house calendar. It was a proposal sponsored by representative Cina on page eight fourteen, responsible and ethical use of artificial intelligence in health care, human services, education. Oh, and this section four, which is that report back from the AI Advisory Council. Adding some language in one of the pieces and the lead in language, I just want to remind us, The lead in language for this particular piece has the honor before January 15, the AIA Advisory Council in coordination with the Director of Division of Artificial Intelligence will submit a written report to the General Assembly. And then one is recommending any additional statutory changes necessary to further the purposes of this Act, including and in the bill as you passed it out, it says including protections for neurological rights in relation to neurotechnologies. This would change that to say protections for neurological rights, protections related to neurotechnologies, and proposed definitions for relevant terminology. So again, this is recommending additional statutory changes needed to address protections for neurological rights, protections related to neurotechnologies and proposed definitions for relevant terminology. So this is to well, I will let the sponsor tell you what this is addressing.

[Rep. Brian Cina (Member)]: So as you may recall, and for those watching online, you can go back and watch the YouTube of the floor yesterday. A representative had questions about the definitions of AI and the definitions of neurotechnology, and we had the floor debate and discussion about those issues, the definition of artificial intelligence, the committee has already discussed that, and in H816, that was addressed, and ledge councils working across committees to coordinate the definition of AI, but for neurotechnology, there is no definition yet. There wasn't a definition in the underlying bill, but because we don't have extensive amounts of time to sit here discussing a definition and taking testimony on it for an amendment. I talked with the chair and we thought that incorporating it into the study made sense, that they could come back and say, in our investigation, we determined that here's the best way you can define neurotechnology, but in the meantime, we can still have the rights so that anything that might be neurotechnology is covered. So that's kind of like our solution. And I talked with other members and they seem satisfied and heard, but I will let them speak for themselves if they so choose, like on the floor if they so choose. This was our compromise.

[Rep. Alyssa Black (Chair)]: Thank you, Brian, and thanks for bringing this forward. Really appreciate it. Wasn't expecting those questions on the floor yesterday, but you know, they have a little prompt. Karen, did you have a question for Oh, no, not at all. Very welcome. Any questions for Jen or Brian on this language? Okay. And we will do a straw poll for all in

[Unidentified Committee Member]: favor of finding this amendment favorable.

[Rep. Alyssa Black (Chair)]: I never quite know the language. Is your hand up, Val? Yes. Or just your pen? Okay. So eleven-zero-zero. So this will be fun, Brian. You get to present the amendment on the floor. Debate myself. Debate yourself. And then indicate what the straw poll of the committee is.

[Rep. Brian Cina (Member)]: Yes, and usually when this if there had been time, I would have asked you all if you wanted to sponsor it, but there was we wanted to get it in the calendar. So often when a committee does this, it does go quickly. When a committee member or the committee amends it, and this is part of the process for those who are newer. This happens all the time where a committee will fix something instead of having it. If another member has a concern, the committee just says, Okay, we'll do it, so that it's less of a confrontation. So there won't be somebody Oh, you will do your part. Yeah, exactly. In other words, I'll say, I amend this and here's why. And then the other member may get up and say, Thank you, committee, for hearing me, or they may say nothing. So I don't know how that's going to go.

[Rep. Alyssa Black (Chair)]: That's fine. Okay. So we have two other amendments, and we've invited both the Aren't you authors of the amendments? Sponsors. Sponsors. That's right, you're technically the author. The sponsors of the amendments, and they don't appear to be here.

[Unidentified Committee Member]: Oh,

[Rep. Alyssa Black (Chair)]: is one outside? Jen, if you just wanna present we'll see who's first.

[Unidentified Committee Member]: Well,

[Rep. Alyssa Black (Chair)]: if you just wanna show us

[Wendy Critchlow (Office of Legislative Counsel)]: Representative yeah.

[Rep. Alyssa Black (Chair)]: Do you want

[Wendy Critchlow (Office of Legislative Counsel)]: me to show you both, or do you wanna do representative North specifically because he's here?

[Rep. Alyssa Black (Chair)]: Let's do why don't you show us both? Okay. Great. So

[Wendy Critchlow (Office of Legislative Counsel)]: I'm looking at again, we're on

[Rep. Alyssa Black (Chair)]: the house

[Wendy Critchlow (Office of Legislative Counsel)]: calendar, bottom of page eleven seventy eight. So after the committee report on H five eighty five, this is the insurance bill that you've worked on. The first the first amendment offered is by representative Logan, and she is proposing striking out sections one and two of the bill. So these are the pieces around governance and executive compensation of nonprofit hospital service corporations, the statute language for Blue Cross Blue Shield for those those whole sections around Section one is really the is really the governance and executive compensation language in the statute. And then Section two says non profit hospital corporations must update their bylaws to comply with the provisions of the act. That that's a related piece that would come out with the deletion of section one. The second amendment offered is from representative North. And, again, pretty straightforward. It would strike out section 10, which is the chapter on health care sharing plans and reader assistance in both cases worth striking that up and just deleting. So in both cases, it's striking language out of the bill. Both sponsors are proposing to take language out of the bill and not replace with anything you just deleted. That's terrific.

[Rep. Alyssa Black (Chair)]: We might have questions about the language pretty gents. We've heard we've heard every straightforward amendment. Absolutely.

[Rep. Brian Cina (Member)]: I guess it's one of the clarification of what these amendments do, because they are so simple. Essentially give the body the power to weigh in on the straw poll we did in the committee, but only on certain sentence. Like we're saying to the whole body, how do you feel about these two? And then everyone gets the vote.

[Wendy Critchlow (Office of Legislative Counsel)]: Yes, I think the result is similar. Or if somebody were to literally, you could divide the question this way, but it would be sort of

[Rep. Alyssa Black (Chair)]: dividing. And

[Rep. Brian Cina (Member)]: then at the end, we just decide how we feel about the bill based on the outcome of these amendments. Exactly. So it's a similar process for the whole body that we went through.

[Wendy Critchlow (Office of Legislative Counsel)]: Okay. Let's turn that away for a minute.

[Rep. Alyssa Black (Chair)]: Got a straw pulled the whole body.

[Wendy Critchlow (Office of Legislative Counsel)]: I can prepare more amendments if you want to.

[Rep. Francis “Topper” McFaun (Vice Chair)]: Do you have

[Rep. Rob North]: a question?

[Rep. Alyssa Black (Chair)]: Alright, thank you. So let's start with representative Logan.

[Rep. Kate Logan]: Thank you to the committee for, having me in to talk about the, amendment that I drafted. I actually I have a few questions for the committee, if that's okay. Okay. I can speak briefly to my rationale, behind, proposing the amendment, but Let's start with that. Okay. My concern with section one and and the related section two for h five forty five is that it blurs fiduciary duties for a private nonprofit and produces inherent conflict. And I think that that is kind of the intention, actually, of that section, is to shift the fiduciary duty of the board so that it takes on a public interest, rather than putting it in statute that the board of directors must include those things in its fiduciary duty. It appoints it it appoints, allows the governor to appoint two members of the board of directors, who would defend that public interest. I, am not comfortable with I I do think that this politicizes governance in a way that could be destabilizing for operations and creates a precedent for state encroachment into independent nonprofit boards. I recognize that that this type of nonprofit is defined very specifically in statute, but it still concerns me. And I and I believe that there are a number of other options, policy options that we could take to achieve similar goals because I think we all agree on the goal, which is accountable, affordable health care. And, you know, so I think other policy mechanisms would be things like more clearly defining the makeup of the board and asking DFR to enforce establishing well, that's a more drastic recommendation. You know, making regulatory requirements, for the fiduciary framing of nonprofit health insurance providers, to include broader societal requirements, advisory seats on the board, additional reporting requirements, or even expanding Green Mountain Care Board's authority to have them co regulate with DFR. I think those are all options for us that don't require us to have political appointments on private nonprofit boards.

[Rep. Alyssa Black (Chair)]: Any questions for Kate? Go ahead, Tucker.

[Rep. Francis “Topper” McFaun (Vice Chair)]: Could you define, far right, what you mean by political appointments?

[Rep. Kate Logan]: Well, the governor is elected, as a politician, and so any appointments he makes are are political appointments to a board of directors. And then that who is appointed could change based on the governor. And so short term goals of the governor could influence the way that he, she, or they appoint members to the board of directors.

[Unidentified Committee Member]: Just

[Rep. Francis “Topper” McFaun (Vice Chair)]: those people who have appointed for x amount of years. Just because the governor changes, it's not gonna.

[Rep. Alyssa Black (Chair)]: Sure. The governor is elected by Vermonters. In

[Rep. Kate Logan]: a partisan election, still political. There's nothing neutral about who our governor is, even if it expresses the public will, but that doesn't express a 100% of the public will. So it's inherently political.

[Rep. Alyssa Black (Chair)]: So if if the governor is elected by Vermonters, then the governor's duty is to represent Vermonters. And so any appointments he would make specifically to a board to two members whose charge is to represent the healthcare system as a whole in the state of Vermont, then regardless of political or not, those members would be bound by representing Vermont.

[Rep. Kate Logan]: Sure. But I will I'll I'll add that they would not be doing so with under the, oversight of the legislature. So that's, fairly typical. It's typical for the governor to appoint members to, certain bodies, quasi public entities or, you know, public, commissions or what have you. But in general, there's a shared, oversight with the legislature.

[Rep. Alyssa Black (Chair)]: Daisy? And then I'm Brian.

[Unidentified Committee Member]: Do you I hope it's okay

[Rep. Daisy Berbeco (Ranking Member)]: to ask. Do you support universal health care?

[Rep. Kate Logan]: I do. In fact, that was the stronger recommendation that I would have is if we want to treat health insurance like a public utility, then we should. So

[Rep. Daisy Berbeco (Ranking Member)]: if we want to eventually see universal health care in this world, how are we going to do that if we don't eventually begin to trust elected people, elected by the general public, to help us manage our investments in health care? I just wouldn't give that authority to the governor directly without legislative oversight.

[Rep. Kate Logan]: I think we would have a far more rigorous and shared, oversight authority on a single payer publicly funded and publicly operated system. And I don't see this as an incremental step towards that kind of system either. You don't see this potentially being a shift towards that at all? Unless we intend to take over the operations of Blue Cross Blue Shield Vermont.

[Rep. Alyssa Black (Chair)]: I hear your question, but are you aware that less than a year ago, we almost had to take over the operations of Blue Cross Blue Shield of Vermont? I am. And the amount of money that Blue Cross Blue Shield asked the state to supply to them so that our entire system of health care in the state did not collapse.

[Rep. Kate Logan]: I am aware, and I think we take a great risk in allowing the private sector to provide health insurance for us.

[Wendy Critchlow (Office of Legislative Counsel)]: Brian?

[Rep. Brian Cina (Member)]: Yeah, just back to the issue of the political dynamics involved with this policy change, what I'm hearing is your concern is that the way that this is structured doesn't respect the checks and balances that the constitution establishes of the different separation of powers, and how What I just heard you say is that if we wanted universal healthcare, the way to do it would be to have a public financing mechanism that had checks and balances and separation of powers. Here, I think the issue is that we're letting one power have the sole authority to influence the private the private sector essentially in an unprecedented way. And even and I I guess what I would just say is I do see it as political because regardless of who's elected as governor, they are supposed to represent the interests of the people as a whole, but all of us have biases. No one is ever truly neutral. Even judges have biases, social workers have biases. We get training in how to sort through that when we make our decisions and to own our biases if indeed that's influencing our decision. But to say we're unbiased is is is often delusional. I don't mean that in an offensive way. So so I just I because I'm talking about myself too. So I think regardless of who's governor, they're gonna have biases, they're gonna have political allegiances, they're gonna have donors who they owe something to. And it would be unfortunate if if suddenly we have governor's campaigns being funded by interest groups that are like, oh, this governor's gonna a seat on that insurance company's board, or maybe we can get more seats on other boards and influence these private sector people through this position of the governor. So this is not about who is the governor, it's about the position and how the position, the power that that position has. And I think I mean, I it's it's not a surprise. I originally didn't want this in the bill, and this is precisely the reason I I landed on two is that it's it feels like a bit of overreach. But I just wanted to say that piece around the political aspect, because I could see how it isn't necessarily going to be a bad thing, but it might not be a good idea to just let one branch of government have this power on something so sensitive as the healthcare system, like what you said. I guess my question would be, you think it's good enough just to remove this for now and there's not a replacement, there's not another step we could take to She mentioned some. For this bill, do you feel like this bill is not the vehicle, that there's another way we'd have to do it?

[Rep. Kate Logan]: I mean, if I had more than a day, I would likely propose an amendment. But I'm not prepared to make a recommendation now. I mean, are a number of aspects. I didn't bring a printed out copy of the bill with me, but the section that strikes out the regulations on the composition the board, for example. Part of the reason why I strongly support removing this section from the bills, because I think that that would be a bad amendment, just on merit. But yeah, I do think that this is an expansion of the executive into health care regulation that I'm not comfortable with. So that framing problematic for me just on principle. And I do think that we could, yeah, we could do a lot of other things to, achieve similar goals. There there have been bills, for example, to regulate hospital executive compensation. I see I share I share the concern about, executive compensation in the health care sector despite all the arguments from the other side. And and and we could do similar things under the auspices of the DFR, I would imagine. I don't know the limits to what what we're able to do this.

[Rep. Alyssa Black (Chair)]: I think we're gonna hear from DFR, and maybe they can explain the limits. I have Leslie and Topper, and then I think we're going to move to DFR. Thank

[Rep. Leslie Goldman]: you. You said you had some questions for us, but one thing I just wanted to say, I don't know if you want to do those first, but initially I was with you. And then the more I heard about the composition of the Blue Cross board, I got a list of everyone who's

[Rep. Alyssa Black (Chair)]: on it and I felt

[Rep. Leslie Goldman]: it was really narrow and did not necessarily represent the wider range of Vermonters that I would like to see. There are positions on the board dedicated to Blue Cross of Michigan, and that represents a business model and not Vermonters. And the other thing I've learned in my time here is everything can be changed in the field. So I thought it was important to at least start representing Vermonters, and as the Commissioner used the word nudge in the direction of moving Blue Cross forward to a more holistic view of Vermont. So I get what you're saying, and I think there's a

[Rep. Alyssa Black (Chair)]: lot of validity to it.

[Rep. Leslie Goldman]: But I think in the short term, I'd like to see where Vermont is being protected. And that was why I shifted from piece to the other.

[Rep. Kate Logan]: Well, I think that was one of my questions, which is why don't you make the section on the composition of the board more specific and then ask DFR to enforce that? It does sound to me, based on the current statute, that the composition of the board might not, really, meet statutory requirements, at least for the intention, which certainly, intends for three quarters of the board to be made up of what sounds to me like Vermonters who are subscribers or private citizens. So that to me sound that was a question. So DFR might be the right, group to, answer that question. But we could, we it seems like we could move that direction through more regulatory measures rather than an expansion of the executive.

[Rep. Alyssa Black (Chair)]: Talker. And then we're going to move on

[Rep. Francis “Topper” McFaun (Vice Chair)]: I'll to try to make this quick. Leslie just said, I want to read one. In addition to being maintained and operated solely what benefit its subscribers, a non profit hospital service corporation must ensure that the benefits are balanced.

[Rep. Kate Logan]: I liked that part, yeah.

[Rep. Francis “Topper” McFaun (Vice Chair)]: This is an attempt. I understand.

[Rep. Kate Logan]: Just don't agree with you. Yeah,

[Unidentified Committee Member]: I agree. I don't know if

[Rep. Francis “Topper” McFaun (Vice Chair)]: you know this or not, but I think it's five members, Michigan of Blue Cross Blue Shield are automatically on that.

[Rep. Kate Logan]: I'm not under I based on statute that was struck struck through, in section one of this legislation, I don't understand how that board composition is in compliance with our state statute. Thank

[Rep. Alyssa Black (Chair)]: you. I do wanna just say, you know, we took extensive testimony on this these particular sections, and we had vigorous, long debate over whether to include them or not. Committee landed where it did. Thank you. You for

[Unidentified Committee Member]: She had questions. Just don't know if

[Rep. Alyssa Black (Chair)]: you have questions. I think that maybe we should hear from DFR first. And then if she has questions for DFR or has any other questions for us, then she can And

[Rep. Kate Logan]: I just turn my questions into statements. Thanks.

[Rep. Alyssa Black (Chair)]: Thank you, Consentative Logan. Commissioner Simpson, just wanted to see if you wanted to pass weigh in on striping these two sections.

[Commissioner Sampson (Department of Financial Regulation)]: Yeah. Samson, commissioner of DFR. We continue to support the language that we put forward In terms of some of the comments around concerns for legislative oversight, we are open, and we discussed different options around that, remain open to different different ways to have legislative input into the appointments. So but, of course, what this amendment would do would throw the whole thing out as opposed to work work to change it. So, yeah, to be clear, we are open to following the Green Mountain Care Board's appointment process, which is lengthy, well thought out in statute already. And, you know, there's there's there's a lot I like about that process, but it does and it does bring in a lot of legislative input into that. So we would be open to that as as well. So I think, you know, I hope that addresses the concern. So there's there's no attempt to avoid legislative input. Think I'll let the chair speak to the deliberations on, you know, you know, how we how we got to to not amend that, you know, the the clean, simple, you know, two governor appointees. All of the care board has is is governor appointees, I believe, through that different process. But in terms of slippery slope, this is and as I said before, this is entirely focused on nonprofit hospital medical service providers. The idea that this is an overreach given the nature that the the enabling statute and the nature of this entity and the some of the history of understanding and being near the brink in understanding the criticality of this entity to the health and well-being and and safe operation of a very complex health system is, you know, very important to understand. Any attempt to put governor or legislative appointees on any other type of entity or nonprofit would require the action of of the legislature. So there's there's and there's there's no other scope creep that I can see here in terms of this proposed appointment.

[Rep. Alyssa Black (Chair)]: Can you remind us and maybe explain again the current makeup of Oh, okay. Remind us of the current makeup of Blue Cross Blue Shield's board and how it's configured. I think we've had confusion over sort of like Mito power or

[Rep. Rob North]: Yeah.

[Rep. Alyssa Black (Chair)]: And and their relationship, their affiliation, relationship with Blue Cross Blue Shield of Michigan.

[Commissioner Sampson (Department of Financial Regulation)]: Yeah. Unfortunately, I, and I don't have Hillary available, our attorney, who, did all the deeply legal work and and testified to some of that earlier. My under so we have a a board of 12, and seven of those are, Vermonters. Five are, or seven are kind of, put it the other way, five are appointed by or the the the purview of Blue Cross Blue Shield of Michigan. Those they can and I think have appointed Vermonters as part of their five, not exclusively, but I believe that's how they're in compliance to the representatives. Question is that just because five are within the power of Michigan to appoint to the blue to the Vermont board, doesn't mean they're all Michiganders. But I'm not certain of that. I'm not certain of of whether that's how they hit the three the current statutory requirement on being made up of Vermonters. But she isn't

[Rep. Alyssa Black (Chair)]: the other seven.

[Commissioner Sampson (Department of Financial Regulation)]: It's there's an you had testimony on that from from Blue Cross, I believe. But, essentially, there's a I believe there's a nominating committee, and it it is what I consider a self perpetuating board. The members of the board and probably senior management, speculating here. I know there is a a nominating process. They choose, many candidates, vet them, and then advance those candidates, for, through a process of board approval to to be a new member of the of the board of directors. I I believe that that anyone on that is selected does have to be approved by the Michigan Blue Cross. That's kind of

[Rep. Alyssa Black (Chair)]: the final approval necessary. So five members are essentially appointed by Blue Cross Blue Shield of Michigan. They don't need to be Michiganders. The other seven are through a nominating process. And Blue Cross Blue Shield of Michigan has to approve the final people put forward for the remaining seven positions?

[Commissioner Sampson (Department of Financial Regulation)]: That's my understanding. Yes.

[Rep. Alyssa Black (Chair)]: So is that what we mean by they have veto power over Yes. Okay. Any questions? All right.

[Rep. Brian Cina (Member)]: I feel like we're beating a dead horse because we've talked about this. We've talked about this. I'm

[Rep. Rob North]: sorry you used that word

[Rep. Alyssa Black (Chair)]: for us.

[Rep. Leslie Goldman]: I was gonna send out four horse, come on.

[Rep. Brian Cina (Member)]: Insurance company knows

[Rep. Alyssa Black (Chair)]: it. Unless there's any other questions, I'm going to ask Let's do a straw poll on whether this amendment we find favorable. So all those We'll review what a yes and no vote is just for a second. So a yes vote would mean that you are in favor of this amendment. A no vote would mean that you are not in favor of this amendment. So all those in favor of this amendment. Three. All those opposed to this amendment? Can't count.

[Rep. Brian Cina (Member)]: That's eight. So I'm gonna go

[Rep. Alyssa Black (Chair)]: with eight, because I can do subtraction. So the vote was eight-three-zero unfavorable. All right. Thank you. Representative North? Thank you. Thank you, Kate, for coming in. Thank

[Rep. Rob North]: Thank you. You, colleagues, having me back again on this same topic. I appreciate your willingness to hear me one more time. Yeah, so back to talking about this section 10 of the bill, which proposes to apply some regulations and data collection on health share organizations. And you heard from me last time, so I'm not going to repeat all of the testimony that I offered about my personal experience with the health share and how well it works, extremely well it works. So this time I'm going to step back a little bit, kind of take the bigger picture view with this amendment. That is that these health care plans and arrangements are not unique. The specific category of organizations and plans that are called out in section 10 are not unique. In fact, there are very big, very broad set of very similar organizations that are member based, that are not insurance, and that are mutual aid business models. And they all operate do the health share plans operate without insurance style reporting. So that's the broad picture. There are already many forms of this across multiple business sectors, not just within the health care sector, but multiple business sectors have membership based, non insurance mutual aid type business models that are out there that are not regulated the way we're proposing to regulate this one narrow category called health share plans and arrangements.

[Rep. Alyssa Black (Chair)]: I'm sorry, can I interrupt you? Can you give us an example of what you mean by that?

[Rep. Rob North]: Absolutely, I'm going to go through several of them. Healthcare cooperatives, member owned organizations that pool resources to purchase and organize healthcare. They operate under cooperative or nonprofit law, and they don't operate under insurance law, unless they underwrite risk, which most of them don't. And their reporting is typically just limited to corporate tax and nonprofit disclosures, not solvency or actuarial violence. There are organizations, again, within that specific within the healthcare arrangement or sector, there are direct primary care, DPC practices. Again, pay monthly membership fees directly to providers. There's explicitly defined in many statutes and many states that these are not insurance. And maybe that's ultimately a path that this group might want to consider in this type of legislation is just simply declare all of these membership based non insurance support organizations are not insurance. Just make sure I make that clear. Maybe that would satisfy what you all are looking for. But direct primary care practices require no special reporting beyond ordinary business and consumer disclosure. There's concierge medical practices, also called membership medical practices, where members pay an annual and monthly membership providing enhanced access to the doctors. They're voluntary. There are contractual arrangements outside of an insurance system. They're not subject to insurance down regulation. There's also self funded employer health plans, where the employers pay the claims directly rather than buying insurance. They involve large scale risk pooling, and they're largely exempt from state insurance regulation under federal law. So that's just within the healthcare realm. If you go beyond the healthcare realm, step back even bigger, there are non healthcare analogs to the same kind of thing, farm and agricultural cooperatives, membership pools, financial risk pooling. They're governed by cooperative law. No special financing reporting, of course, they operate as a banker insurer, which most of them don't. There's electric and utility cooperatives. Again, member owned cost sharing entities regulated for service quality and governance, but not as financial institutions. There are housing cooperatives and community land trusts where you share financial responsibility, collective ownership, regulated under housing and corporate law, not insurance law. There's mutual aid and benevolent associations. We have one written right into our Fairfax town charter called Rogers and Hazard. It's exactly one of these. It's a long standing voluntary membership funded support system operating outside of insurance style regulation, And even crowdfunding platforms, many of which do medical fundraising, raise funds for medical expenses with no guarantees of payment, and these have no insurance oversight and far less transparency even than health sharing ones. So there's just a couple. Just want more. Those are ones that I listed out here. So, this is not unique. We're carving out one very small slice and saying, this particular slice is going to be regulated, like insurance. And so, in addition to the fact that we're unfairly therefore selecting this one particular group, a couple other things came to mind that are the broader scale level. We talked about one of these before, and that is that Colorado is the only other state that's done this, and they're stepping into some legal challenges on that. I don't know that we want to step into that at this point. Secondly, some of the data that's being requested, on how you interpret some of the words there, could be stepping on some data privacy issues. I know most of us are pretty concerned about data privacy. Talking about asking for members and how much medical care they've received and how much money that they've spent, what kind of claims they took and rejected, and all those kinds of details, I don't know that I want that data shared about me personally. So in conclusion, I'm proposing we delete section 10 really for regulatory consistency. Vermont has never required insurance style reporting for voluntary member organizations or cooperative risk sharing models for non guaranteed aid arrangements, of which there are many, nor have we ever required Vermont ever required this kind of reporting for religious organizations, such as churches, which many of these health care organizations happen to be faith based. Therefore, I would say health sharing plans and arrangements, specifically, which is what's called out here, health care sharing plans and arrangements, in quotes, Meet all of those. They're voluntary member organizations. They're cooperative risk sharing models. They're non guaranteed aid arrangements, they're religious organizations. Many of them are at least. So I I don't think we should be imposing this kind of this kind of regulation. We've never done that before. This would be really stepping into a new territory.

[Rep. Alyssa Black (Chair)]: Two questions for you really quickly. And then I see Leslie has a question. You just mentioned data privacy.

[Rep. Rob North]: Yeah.

[Rep. Alyssa Black (Chair)]: So there is nothing in this reporting that has protected health information at all. It's de identified, it is numbers. It is not your sharing plan reporting to the Department of Financial Regulation that Rob North has this, and here's how much Rob North's things were. But my other

[Rep. Rob North]: opinion Are is

[Rep. Alyssa Black (Chair)]: sharing plans a HIPAA covered entity under HIPAA? And maybe legislative counsel would

[Rep. Rob North]: They are an entity specifically identified in the Affordable Care Act as meeting the requirement for minimum essential coverage.

[Rep. Alyssa Black (Chair)]: Is that

[Rep. Rob North]: what you mean?

[Rep. Alyssa Black (Chair)]: Or No. Are they a HIPAA covered entity?

[Rep. Brian Cina (Member)]: Need to find out. We don't even know what that You'd have to look at the law. It

[Rep. Alyssa Black (Chair)]: concerns patient privacy, and it concerns protected health information, which

[Rep. Brian Cina (Member)]: I'll ask AI in the meantime.

[Rep. Alyssa Black (Chair)]: Which a sharing plan a plan would actually have all that data. And we did take testimony, I believe it was MediShare who indicated that they actually not only require a claim, but they also ask for a patient's medical record. And I'm wondering if that's protected. And if they I mean, you raise a good point about data privacy.

[Rep. Rob North]: Can step away just for a second? In my briefcase, was one particular segment of the bill as it's written, that's a list of data that's required to be collected. It sounded to me kind of like we're asking for specific patient information. Just can't remember it off the top of my head, but I have to refind it.

[Rep. Leslie Goldman]: Don't know the definition of person.

[Rep. Rob North]: This is from the calendar where the bill is printed. It's item I, item I under, this is right in the first section. In the following information that's to be collected, item I, total dollar amount of reimbursements made to a plan or arrangement participants. That sounds like you're going to find out the dollar amount that was paid for me in the state in the immediately preceding calendar year for health care services provided to or received by a plan or arrangement participant. That sounds like you're going to identify me. Maybe I'm reading that wrong, maybe that's not what you intended.

[Rep. Alyssa Black (Chair)]: Think that's you read wrong. It's how many participants do you have and how much you can be paid on behalf of participants essentially.

[Rep. Rob North]: In the whole, not like In aggregate. Yeah, that was the other word that was tripping me up.

[Rep. Alyssa Black (Chair)]: Identifying who the participant is. It

[Rep. Rob North]: without would be an all the names associated with it. Okay, great. I take that argument off of it. Okay, thank you. Because I read that, I'm like, what?

[Rep. Alyssa Black (Chair)]: Regulate.

[Rep. Rob North]: Good, good, good. Thank you.

[Rep. Alyssa Black (Chair)]: I have

[Mike Fisher (Health Care Advocate)]: Leslie,

[Rep. Alyssa Black (Chair)]: I have Daisy, and did I see a hand over here somewhere? Okay, Leslie?

[Commissioner Sampson (Department of Financial Regulation)]: So I just wanted

[Rep. Leslie Goldman]: to clarify, you talk about this being regulation, and I'm not seeing it that way, I'm seeing it only as data collection. There's no regulation involved in this section at all. I just want to make sure that that makes sense to you.

[Rep. Rob North]: Well, when I asked the question why we're doing this last time I was here, it was because this sector is unregulated and we had to provide some regulation. That was the answer that I got.

[Rep. Leslie Goldman]: Okay, so maybe miscommunication or misunderstanding, but this is only about data collection and understanding the sector. Just wanting then

[Rep. Rob North]: we get

[Rep. Leslie Goldman]: that information, who knows what, like I said earlier, we can change anything and we do.

[Rep. Rob North]: Can we do that same level of data collection for all those other sectors that I left in?

[Rep. Alyssa Black (Chair)]: Probably more. More. Much more. Because we regulate those. Are reason for this section is so that we can have information about our health care marketplace in the entire state of Vermont. That's

[Rep. Rob North]: Regulate healthcare cooperatives. You regulate direct primary care practices.

[Rep. Alyssa Black (Chair)]: Direct primary care is a contract between an individual and one provider. It is not paying dues or membership fees that then are transferred to other providers and other people.

[Rep. Rob North]: I agree it's not exactly the same, but it's analogous.

[Rep. Alyssa Black (Chair)]: A contract. Just right. If you contracted with somebody to mow your lawn, you would have a contract with that person, and that would be between yourself. Will tell you one of the things that I'm concerned about most is not necessarily the concept behind a sharing plan. I think that it works for many people in a lot of ways and that it benefits a lot of people. I think the problem that concerns me, which is why it's important to know how much of this we have in this space, is that it's not necessarily about a contract between an individual and their sharing plans. It then adds into it a layer of our providers in our state having to become a party and a negotiator with this private contract between an individual and their sharing plan. That's sort of the space that I inhabit in this because we do an awful lot in this committee around our providers, our provider administrative burdens. We hear about that endlessly. And just concerns around how it brings another party, an unwilling or non contractual participant into a financial transaction between two parties. I have did I I see. Okay, go ahead.

[Rep. Daisy Berbeco (Ranking Member)]: So you're no longer concerned about data privacy. Is that correct? Correct.

[Rep. Rob North]: Yeah. I think you clarified that for me.

[Rep. Daisy Berbeco (Ranking Member)]: Okay. But you weren't aware of what HIPAA is?

[Rep. Rob North]: No. I am aware of what HIPAA is. I just don't know of all the specifics of HIPAA related to the health plan I participated And I would imagine that they

[Rep. Daisy Berbeco (Ranking Member)]: Did you watch the testimony when the folks representing these share plans were in our committee?

[Commissioner Sampson (Department of Financial Regulation)]: I did

[Rep. Rob North]: not watch the whole thing. Mean, I was here for quite a bit

[Commissioner Sampson (Department of Financial Regulation)]: of it, but I didn't watch thing.

[Rep. Daisy Berbeco (Ranking Member)]: Because there were several excellent points made by those individuals about how Vermont residents can really vet the plans. I mean, there's information out there. We can check that they've filed their LLC, that they're accredited. There was a long list that the gentleman sitting here gave to us on how people can be sure to check that they are actually joining a shared plan that is legit, because there is. A simple Google search will show you the fraud that Vermonters are at risk of. If they don't know, to check whether something is accredited, filed with our Secretary of State's office and legitimate. I don't understand if that data is out there and we understand there is a demonstrated risk to our constituents. There is a demonstrated risk because of tremendous cases of fraud with these plans, maybe not in Vermont, but they are certainly at risk. We can't ignore the risk. If there are ways to demonstrate that something the risk is reduced, and we can do that for our constituents, why wouldn't we?

[Rep. Rob North]: If it adds significant cost to the participants, then I'm not a 100% sure that and we don't know of any particular fraud occurring here. It seems like we're shooting in

[Rep. Daisy Berbeco (Ranking Member)]: the wind. Should we wait for a case of fraud?

[Rep. Rob North]: I think we already have the ability to battle fraud, through through any number of already existing statutes that prevent or that make fraud illegal. I mean, you're not allowed to falsely advertise something. And I think that's primarily the thing you're concerned about is falsely advertising their insurance when they're not. Least that's what I heard last time I was in here, already sue for that. You can already sue somebody for false advertising if they're claiming their insurance when they're not.

[Rep. Daisy Berbeco (Ranking Member)]: No, that would be through the Office of Consumer Protection, and this is not an act of, consumer fraud because of where these folks sit. It's not an act of What do you say? They don't fall under that statute. And I don't know where else they fall that

[Commissioner Sampson (Department of Financial Regulation)]: So if

[Rep. Rob North]: we're just doing data

[Rep. Daisy Berbeco (Ranking Member)]: would fall into protection for participating with

[Rep. Brian Cina (Member)]: them.

[Rep. Rob North]: If we're just doing data collection, then how how how would we're not adding any new laws that somebody could sue them under.

[Rep. Daisy Berbeco (Ranking Member)]: No. My question is just if we have the capacity to check whether these entities are accredited, if they are filed as an LLC and they're legit, why would we not do that to protect our constituents? Why

[Commissioner Sampson (Department of Financial Regulation)]: would we not do that to protect our constituents? There's there

[Rep. Rob North]: I'm not I'm I'm still not clear as to how that how data collection protects our constituents. We already have the legal protections that we need.

[Commissioner Sampson (Department of Financial Regulation)]: They're already available to us.

[Rep. Rob North]: I I feel like we're talking about apples and oranges.

[Commissioner Sampson (Department of Financial Regulation)]: We're talking about two different things here.

[Rep. Alyssa Black (Chair)]: Can I ask you a question based on an answer that you gave? You mentioned administrative cost and the high administrative cost. Colorado has been doing this for four years now, and most of these sharing ministries have been compliant. How much has it cost them in aggregate each year?

[Commissioner Sampson (Department of Financial Regulation)]: Well, that's a good question. Good question.

[Rep. Rob North]: Yeah, it's a good question. Yeah, so really the bottom line is then how many other organizations are we going start doing this with that are volunteer membership organization, cooperative risk sharing, and non guaranteed arrangements, really disorganizations? Who else are we going to start who's next on the list to start dredging them for data?

[Rep. Alyssa Black (Chair)]: I'm sorry, I interrupted you. Did you put more questions? No, I'm done. Any other questions? Yes, go ahead. I think

[Unidentified Committee Member]: that what bothers us about this is just to have it on file. So if somebody did go on a website and wanted to look at one of these plans, there's no information. And it would just be nice to say, Oh, look, it is legitimate. They're not going to get any other information that it's an entity that serves Vermonters. I don't think there's anything wrong with that. And I also have to say, one of the things I looked at the websites, one of the things that really bothered me is the whole bronze, silver, gold plants, which is very misleading, I think. It looks like an insurance plan to me. And so I just think if it was on I don't think you're asking for anything more than a Vermonter looking at one of these plants could just go on to the website and say, It's legit. I don't think that's a lot to ask.

[Rep. Alyssa Black (Chair)]: Other recipes, of course we

[Unidentified Committee Member]: should do it for them too, aren't we? And like the concierge, I know they're very regulated. I don't have one, which I did, but would

[Rep. Alyssa Black (Chair)]: encourage anybody if they have questions to go, have you seen Colorado's yearly reports on healthcare sharing plans and arrangements? I have not. It's a fantastic report. Look forward to seeing Vermont's. And to your question, they do point out, because part of this is advertising and you know, some but when you're using terms like gold, silver, bronze, when you're talking about things like open enrollment, These are when you talk about things like deductibles and cost shares, this is language that is used in regulated health insurance and can oftentimes be confusing to people. So thank you for coming in. Thank you for your amendment. Thank you for the discussion. We're going to have DFR come up. Do you want to ask Representative North a question or? No, just the committee. Okay. Let's have have Thank you. Yes. Thank you. Thank you

[Rep. Francis “Topper” McFaun (Vice Chair)]: very much.

[Rep. Alyssa Black (Chair)]: I thought it would be good to sort of re ground. It's been a couple of weeks, I feel like, since we had Mary Bock in here. And I know she's not available today, but thank you for coming and hosting. Sure. Wanted your sort of opinion on the removal of section 10.

[Commissioner Sampson (Department of Financial Regulation)]: So so this was not part of our original proposal, but we have no objection to it, And there are some upsides to it, which have been mentioned. Certainly, knowing the information, we struggle to understand the full marketplace, and it's important as health care and health insurance regulators to understand the full marketplace. So this would absolutely be a reporting tool, not a regular so I echo that. This is not I don't see this if this was if you were asking DFR to regulate these, we'd be here till June, you know, just talking about this, about what makes sense, constitutionality, for sure. But as a data reporting requirement, I see a lot of benefit, which which you alluded to in seeing this data, mostly to understand the market. But I also, as this conversation evolved just now, thought in terms and and committee members touched on this as well, that if you are and I wanna say that I am probably in terms of my fellow regulators, not only in Vermont but across the country, more open to these than one might expect in terms of the arrangements themselves done properly, communicated properly, advertised or marketed properly. And part of where I stand on that is because of the extreme cost of care in this state that, and you've heard me talk about it on other proposals, that having an alternative that does meet needs, you know, you know, it's not to say that I endorse them by any means because, absolutely, there is a history of fraud, misleading, consumer abuse, as there is in just about any industry. But with that said, so if if there was a discussion of disallowing them, you know, if there weren't constitutional issues, which there certainly are, you know, I I think that would be a different discussion. But this is purely reporting, and I do put myself in the shoes of someone who would be looking to alternatives. I would think that being able to go to the state website, to DFR website, know that they've registered, knowing what kind of volume they do in the state, knowing what type of inflow and outflow in terms of sharing dollars, that would be of comfort to me. So I I think, you know, although we're, you know it's not our proposal, we we do not have any concerns about it, and that includes we don't we have no significant legal concerns about the constitutionality issue, you know, that does come up with reporting requirements on entities like this because of their religious affiliation with many of them.

[Rep. Alyssa Black (Chair)]: Do you have a a you response? And I know it's not your job to respond to representative North, but do you have an argument that we have had not heard before regarding all these other things that we don't require. Do you

[Commissioner Sampson (Department of Financial Regulation)]: have some of them

[Rep. Alyssa Black (Chair)]: insurance regulator, would you be able to speak to?

[Commissioner Sampson (Department of Financial Regulation)]: Sure. When we look at ERISA plans, they are regulated. They're regulated just by a different regulator, the federal government, the DOL. And then we do have several touch points of regulation in there around insurance come and reporting requirements around insurance companies that also administer ERISA plans. So there is there is ample regulation, not as much as full insurance, but there's there's there's a lot of regulation around ERISA. It's just a different avenue. In terms of concierge medicine and cooperatives and other I forgot the term, but there are several permutations of insurance company entities like interstate sharing or inter inter I forgot. Inter insurance exchange. There are fraternal benefit societies that are regulated like insurance, not quite insurance. So there there are many examples. But I think some of those examples to me didn't weren't good analogies to what a a health care sharing arrangement does, which make no mistake that the the number one concern is when they look like, feel like insurance and people believe that they are in terms of guarantees, coverages, guarantee fund, the ability to come to our department for assistance in a claim dispute. None of that exists here unless they start behaving like insurance, then we can go after an entity for conducting insurance without a license. But in terms of consumer protections beyond that that you'd expect in an insurance contract, they aren't there.

[Rep. Alyssa Black (Chair)]: I forget Mary's testimony, but did she indicate that the Department of Financial Regulation has received inquiries from Vermonters for claim disputes?

[Commissioner Sampson (Department of Financial Regulation)]: I I don't recall. And, in my latest term, you know, in this position, I I'm not aware of of any, but and I forget, you know, she's got a longer more more recent tenure than I do in the department.

[Rep. Alyssa Black (Chair)]: So She did address it. But Any questions for Commissioner Chittenden?

[Unidentified Committee Member]: Yes, I do have a These health care plans have been around for a while. Was there anything flagged to your department about some of the data not collected? Or why did the department wait till now to even think about any data collections? Has there been issues with it?

[Commissioner Sampson (Department of Financial Regulation)]: Multistate, absolutely. Right? So we but in terms of I think it's a similar question to chair of Black's, and maybe, Mary or someone or perhaps, the health care advocate, might have, some perspective. I I rejoined the department in April. Since then, nothing has come to my attention in terms of a complaint or an issue. But keep in mind that they might also go to the AGs. But, like, we don't have jurisdiction as the issue. So to look at DFR as a measure of whether there are problems in this industry when we explicitly can't regulate them or don't can't or don't, might not be the best metric of of whether there are issues. Again, unless they're crossing that line and the complaint is around unlicensed insurance activity.

[Rep. Alyssa Black (Chair)]: Do you have a question? You keep saying that we're not regulating them, but yet you keep using the word.

[Commissioner Sampson (Department of Financial Regulation)]: How am I using the words?

[Rep. Alyssa Black (Chair)]: You keep using the word regulation.

[Commissioner Sampson (Department of Financial Regulation)]: I'm a regulator, and I'm and I'm I'm talking about I'm talking about ERISA plans. I'm talking about fraternal benefit societies insurance.

[Rep. Alyssa Black (Chair)]: And So eventually, it is gonna be regulation.

[Commissioner Sampson (Department of Financial Regulation)]: Not unless this body acts to give us the authority to regulate them. That you know, I think there's certainly some semantics there. This is a reporting requirement. This the only regulatory power within this one can argue over the strict definition of what's regulation. But if they don't report and we know they should report, I believe there's a fine involved. But in terms of could this go further, that's up to the legislature.

[Rep. Alyssa Black (Chair)]: Go ahead.

[Unidentified Committee Member]: There's questions for anybody, really. So we don't really know what's out there. We don't know how many of these shared plans. So how do we get them to report when we don't know? I mean, are we going after the ones who have not done anything incorrectly? Or are we just how are we going how are we going to go about that? Like, was this 01/2002? Was it originally 01/2002? And it

[Commissioner Sampson (Department of Financial Regulation)]: was

[Unidentified Committee Member]: added to 05/08. So was this brought up last year?

[Rep. Alyssa Black (Chair)]: I believe, yes, it was. And where did it go? I think at that time, we didn't opt to take it up last year. Why? I'm just saying, it seems pretty important.

[Rep. Daisy Berbeco (Ranking Member)]: Right? And I would just say so do a lot

[Unidentified Committee Member]: of the bills on the wall. Like, sometimes we just run out of time.

[Commissioner Sampson (Department of Financial Regulation)]: I mean, I can answer why we didn't bring it up, That, you know, when you get into this is a reporting requirement. We we haven't advanced it. Maybe similar to yeah. There are important things, but there are a lot of important things. And in terms of prioritization, when we have a insured regulated market cost care crisis, our eyes are on different priorities in terms of thinking through and advancing something that has been controversial in some areas because of a lot of the testimony you hear from members or the sharing plans themselves. In terms of the question of it's a good question. Like, how do I know what I don't know? If I get a report with 15 I just

[Rep. Alyssa Black (Chair)]: don't have to.

[Commissioner Sampson (Department of Financial Regulation)]: Yeah. That's probably in the design of the reporting, which would say if you're ABC health care sharing, tell me what other states you do business in. And then if we were to try to do some work to ensure compliance, we would look at who's on Colorado's list that says they're doing business in Vermont that's not on our list. And then we would and I think there's I know there's language in there that says, you know, we we can give them thirty days to say, hey. You reported to Colorado. You're doing business in Vermont. You need to report in Vermont now. We passed the law. But I I do not anticipate with our resources that we would, in the near term, do anything or prioritize any regulatory work, for compliance or whatever beyond this being a consumer transparency issue. Here's here who has reported to us under this law that's doing business in the state. Here's the volume of, of activity sharing that happens, everything that's in that bill, and and we'll report it as required by this piece of the statute. And, you know, I do see this as an ability for a consumer to understand that those arrangements a little bit more and see who's complying with Vermont law in terms of the reporting.

[Unidentified Committee Member]: I The the those persons are all already in place that we have to do all of that paperwork for?

[Commissioner Sampson (Department of Financial Regulation)]: It's it's info in, info out. Essentially, what we would generate from a report is just consolidating. So that that's maybe I'm naive. I need a couple hours work annually.

[Mike Fisher (Health Care Advocate)]: Thank you.

[Unidentified Committee Member]: I think for me, this language is very important because we had, one, to your point of how will people know, right? Obviously, they know because we had members of these organizations or their lobbyists in this room for testimony. So people do pay attention. But I think for me, what was most telling was during that testimony, when they kept referring to the language, information is already available on our websites. And when you go on their website, their websites, I've gone through all of them, there's no information there. And what I thought was even more telling was, one, was completely offline until we all mentioned it was offline. And then within a second, it was back online. So to be able to go to an entity like Department of Financial Regulation and have the information there for someone to see what's really going on, I think, is really valuable when, based on what we see on the websites, there's nothing there. And they label things, I think, as Daisy said, bronze, silver, gold makes it look just like our qualified health plans.

[Unidentified Committee Member]: And that's confusing to consumers.

[Rep. Alyssa Black (Chair)]: Any other questions for Commissioner Sampson? Thank you. Thanks so much for coming in short noted. I do want to say that we're going to struggle with this, but I also ask the Office of the Attorney General to comment on this. I believe they're going to send some written testimony. Unfortunately, there was a big meeting where almost everybody from the AG's office was in that meeting and they weren't able to get here in the time constraint that we have. But look for written testimony from that and we'll have that posted as well. Our healthcare advocate actually wanted to and we kind of had you on the schedule on this and ran out of time. And then so yeah, I wanted to give you as a

[Mike Fisher (Health Care Advocate)]: think can speak. Very brief given the time. Mike Fisher, health care advocate. Yes. I was on the schedule to talk about this a while ago, it just didn't work out, which is totally fine. I I think there's two things that very narrow things I wanna address. One of them is just to recognize that health care sharing ministries are written into the Affordable Care Act, with regard to the individual mandate. That's the place where it was written in. And so just to recognize that there was a time in state policy where we entertained a state individual mandate and got wrapped up in health care sharing industries at that time. But that's that's the place where it is recognized. We support this section. We're opposed to this amendment. When so I did spend a little time looking at cases that have come through the health care advocate's office. And I always need to mention, of the universe of people who have problems, who may have had problems with this, how many of them knew to call the health care advocate's office? I have no idea. We represent a canary in the coal mine life. We don't represent any data about the occurrence. But, yes, we have had a few cases over the years, a handful of cases over the years, and they and and we have had cases where people said, I thought I bought insurance, and it turns out it doesn't meet my needs. And interestingly, we have had cases where people were aggrieved, were frustrated that when they discovered that their their their health sharing mechanism didn't met their needs, that they didn't get a special enrollment period, so they were then not able to buy real insurance. So those are the two types of dynamics that I've seen in our data. I wanted to see So

[Unidentified Committee Member]: it wasn't fraud. It was just a miscommunication that they had perceived that they were getting something that they weren't. It wasn't that like, they gave money somewhere and then that, whatever, ran away with their money. It wasn't anything like that. It was just they were confused.

[Mike Fisher (Health Care Advocate)]: They they thought they were buying something that would meet their needs, and it turned out that it didn't.

[Unidentified Committee Member]: Did they buy something, or did they sign up for something?

[Mike Fisher (Health Care Advocate)]: I think they participated in this thing. Yeah.

[Unidentified Committee Member]: Thank you.

[Mike Fisher (Health Care Advocate)]: People are often confused about health insurance and related things. It's a very confusing world.

[Rep. Alyssa Black (Chair)]: Trying to find my chart, my menu. Health insurance is complicated. Go ahead. Yeah.

[Rep. Brian Cina (Member)]: I'm hearing you say that there's been people who purchased or who participated, that's the word, in health sharing plans, and it didn't deliver the results they expected. Would you say that that's also the case for people who purchase health insurance plans?

[Unidentified Committee Member]: For sure. For I

[Unidentified Committee Member]: think I I think I

[Mike Fisher (Health Care Advocate)]: I go a little bit to representative Berbeco's or other people have said it. I think that there are times when these entities have report themselves with language that sounds like insurance. You know, the metal levels is the main example that I've heard discussed. But but for sure, if if you don't need care, all you care about is how big the premium or contribution is. That's all you care about. And then when you need care, you start to worry about all of the components of what you think you've purchased for participating in. And and, yes, for sure, people are agreed all the time in that.

[Rep. Brian Cina (Member)]: Because I know, sometimes think of a similar example in private insurance. They tell you that you get these benefits, like, I'm trying to think of an example, like gym membership or reimbursement for going to the gym. And so then I contacted the insurance company and they're like, Well, you don't. It's not your plan. And I'm like, Then why did it say it on the thing? But then I looked and there was this little one, and then at the bottom of the page, there was this little one that said, excluding bronze, this, that, and the other. So it sounds like the concern that that issue in the insurance plans, that that's happening, but at least it's regulated, And in the health sharing plans, it's happening, but there's no oversight of that. There's no way to hold people accountable.

[Mike Fisher (Health Care Advocate)]: Thank you. That was exactly what I was gonna And say in to remind us, this is just reporting.

[Rep. Brian Cina (Member)]: Just what? Reporting. Thank

[Rep. Rob North]: you. Thank

[Rep. Alyssa Black (Chair)]: you. I'm going to ask for a straw poll on or a a yes will mean that you find the amendment favorable and that you would like to see the amendment, and a no would mean that you find it unfavorable. So I'm gonna ask for a show of data. So a yes means that you are approving of the amendment.

[Rep. Leslie Goldman]: To repeal of this section.

[Rep. Alyssa Black (Chair)]: To repeal this section. No means that you do not approve the amendment and you keep the section as is. All those in favor of the amendment, please raise your hand. One, two, three. And all those opposed to the amendment? Eight again. So, eight to zero. Alright, thank you and thank you, Representative North. The vote

[Rep. Kate Logan]: on that

[Rep. Alyssa Black (Chair)]: bill was Yes. Eight

[Unidentified Committee Member]: It could be much more effective in its own.

[Rep. Daisy Berbeco (Ranking Member)]: Maybe that'll be your opinion. I

[Rep. Alyssa Black (Chair)]: will say, as the one that presented it to the Department of Financial Regulation on whether or not we include it in this bill, The thought was because this bill was sort of an omnibus insurance Department of Financial Regulation bill that dealt with lots of things. And we had conversations around association health plans and Blue Cross Blue Shield's governance, and that it fit nicely into that because we're dealing with multiple issues through this bill that target various things in our regulated and non regulated insurance. So that's why it fits nicely.

[Unidentified Committee Member]: Yeah, no, I understand where the connection came from.

[Rep. Alyssa Black (Chair)]: Okay, thank you everybody. We will see you on the floor at 01:00. We have, let's see, we have third reading plus the amendment on 08/14. We have third reading on eightsixteen. And then we have five eighty five second reading and then these amendments additionally on May. So see you all out there. Lots of health care today. Lots of health care today. Thanks. We