WELL GOOD AFTERNOON. WE'D LIKE
TO BETTER CALL THE SENATE RULES
COMMITTEE TO ORDER WE'RE
GRATEFUL THAT EACH OF YOU ARE
HERE TODAY WE'RE GOING TO
WELCOME ALL THOSE HERE IN THE
COMMITTEE ROOM. AND, OF COURSE,
THOSE WATCHING THROUGHOUT THE
CAPITOL BEFORE I GET STARTED. I
WANT TO SAY WHAT AN HONOR IT IS
TO BE ABLE TO WORK WITH THIS
GROUP OF SENATORS WHO ARE HERE
ON THE DAIS. I WANT TO SAY A FEW
THANK YOUS FIRST AND FOREMOST, I
WANT TO SAY THANK YOU TO THE
SENIOR MEMBER OF THE RULES
COMMITTEE, AND THAT'S SENATOR
LAIRD FOR HIS CONTINUED SERVICE.
WE ARE GRATEFUL FOR YOUR WORK
EACH AND EVERY DAY. THANK YOU SO
MUCH. SENATOR LAIRD. I SAY HOW
GRATEFUL I AM TO WORK WITH
SENATOR GROVE, WHO ONCE AGAIN IS
GOING TO BE STEPPING UP TO SERVE
AS VICE CHAIR, SENATOR GROVE?
THANK YOU SO MUCH FOR YOUR
CONTINUED SERVICE TO THE PEOPLE
OF CALIFORNIA AND THE RULES
COMMITTEE. I WANT TO SAY HOW
EXCITED WE ARE TO BE WORKING
WITH SENATOR AMAN, WHO WILL BE
SERVING ON THE RULES COMMITTEE,
BRINGING YEARS OF EXPERIENCE TO
THE ROLE. WE ARE VERY GRATEFUL,
DR EMAN FOR YOUR WORK EACH AND
EVERY DAY AND ALSO WANT TO
WELCOME THE REPUBLICAN LEADER,
REPUBLICAN LEADER JONES TO THE
COMMITTEE. UM, MR LEADER REALLY
GRATEFUL FOR OUR PARTNERSHIP ON
THIS. SO MANY OTHER ISSUES AND
LOOK FORWARD TO OUR WORK
TOGETHER AS WELL. FINALLY I WANT
TO SAY THANK YOU TO THE AMAZING
RULES TEAM. WHO'S HERE, OF
COURSE, LED BY OUR SECRETARY
CONTRERAS WITH CHINOOK WHO DO
SUCH AMAZING JOBS EACH AND EVERY
DAY. THANK YOU SO MUCH TO BOTH
YOU AND TO THE ENTIRE RULES
TEAM. WE HAVE A FULL DOCKET IN
FRONT OF US HERE THIS AFTERNOON,
AND WE WELCOME ALL OF THE
APPOINTMENT CANDIDATES WHO ARE
WITH US TODAY. THANK YOU SO MUCH
. WE LOOK FORWARD TO HEARING
YOUR TESTIMONY IN JUST A FEW
MOMENTS BEFORE WE GET INTO THE
TESTIMONY. WE ARE GOING TO BE
TAKING UP SOME ITEMS BEFORE US
PRIOR TO PRESENTATIONS AS WE
HAVE THAT FULL DOCKET. BUT
BEFORE WE DO ANYTHING ELSE, I
THINK WE NEED TO ESTABLISH A
ROLE. SO, MADAM SECRETARY, CAN
YOU PLEASE CALL THE ROLL?
MAGUIRE MAGUIRE HERE, GROVE.
GROVE HERE, MON MON HERE, JONES.
JONES. HERE AT LAIRD HERE, LAIRD
HERE. THANK YOU SO MUCH. MADAM
SECRETARY. QUORUM HAS BEEN
ESTABLISHED. WE ARE IN A GOOD
SPACE. SO HERE'S WHAT WE'D LIKE
TO BE ABLE TO DO. WE'RE GONNA
ROLL THROUGH SOME HOUSEKEEPING
ITEMS TO BE ABLE TO GET THOSE
ITEMS COMPLETED FIRST AND THEN
WE'LL GO TO THOSE WHO ARE HERE
WITH US. TODAY AND AGAIN. WE ARE
VERY GRATEFUL FOR YOUR PATIENCE
AND WE WILL GET THROUGH THIS AS
EFFICIENTLY AS POSSIBLE. SO,
LADIES AND GENTLEMEN, UH, WE ARE
GOING TO BE TAKING UP GOVERNOR
APPOINTMENTS NOT REQUIRED TO
APPEAR ITEMS TO F THROUGH N.
MEMBERS OF THE COMMITTEE WOULD
LIKE TO BE ABLE TO TAKE TWO
SEPARATE VOTES UNDER GOVERNORS,
APPOINTMENTS NOT REQUIRED TO
APPEAR. WE WOULD LIKE TO BE ABLE
TO SEE IF THERE IS A MOTION FOR
ITEM TWO F. IN THEN WE CAN ALSO
ALTERNATE MOTION IF THAT'S OK.
APPOINTMENTS NOT REQUIRED TO P
TWO FG HÌ. HØI THE OK? AND IN
WOULD BE ONE FULL MOTION.
EVERYTHING BUT M. GOT IT.
WONDERFUL THANK YOU SO MUCH,
MADAM VICE CHAIR. WE DO. WE DO
HAVE A MOTION ON THE FLOOR. BUT
VICE CHAIR DO YOU WANNA MENTION
THAT ONE MORE TIME, PLEASE?
MOTION TO TAKE UP ITEMS.
GOVERNOR'S APPOINTMENTS NOT
REQUIRED TO APPEAR ITEM TWO ITEM
FG HÌ IJ, Kò, L AND N AS IN
NANCY. WONDERFUL. THANK YOU SO
MUCH. I'D LIKE TO BE ABLE TO
TURN TO THE COMMITTEE. IF THAT
WORKS FOR THE COMMITTEE. WE HAVE
A MOTION ON THE FLOOR. MADAM
SECRETARY, CAN YOU PLEASE CALL
THE ROLL ON THE FOLLOWING ITEMS
ADVANCED BY THE VICE CHAIR?
MAGUIRE MAGUIRE. I GROVE I GROVE
. I EGM EG I JONES JONES. I
LAIRD I, LAD I 5 TO 0 THAT IS A
5 TO 0 VOTE. THOSE APPOINTMENTS
ARE NOW CONFIRMED. WE ARE NOW
GOING TO BE MOVING ON TO ITEM
TWO. M TWO M. SENATOR LAIRD.
WOULD YOU LIKE TO ADVANCE? YOU
KNOW I WOULD MOVE ITEM 21. THANK
YOU SO MUCH. WE HAVE A MOTION ON
THE FLOOR DISCUSSION. SEE NONE.
MADAM SECRETARY, CAN YOU PLEASE
CALL THE VOTE? MCGUIRE MCGUIRE I
GROVE NÓ GROVE NÓ EGMOND EGM I
JONES NÓ JONES NÓ LAIRD. AYE
LAIRD, I 3 TO 2. THAT'S A 3 TO 2
VOTE. THOSE APPOINTMENT. THAT
APPOINTMENT IS CONFIRMED. LADIES
AND GENTLEMEN OF COMMITTEE.
WE'RE NOW GOING TO BE MOVING
FORWARD ON OUR NEXT PORTION OF
TODAY'S AGENDA, AND THAT'S ON
BILL REFERRALS. THIS IS ITEM
NUMBER THREE ON OUR AGENDA
REFERENCE BILLS TO COMMITTEES.
I'LL ENTERTAIN A MOTION AT THIS
TIME. WE HAVE A MOTION BY THE
VICE CHAIR. THANK YOU SO MUCH,
SENATOR. ANY CONVERSATION ON
THIS HEARING? SEE NÓ. MADAM
SECRETARY, CAN YOU PLEASE CALL
THE ROLL ON ITEM THREE GROVE
HIGH GROWTH I MON MON, I JONES.
JONES I LEARNED I 5 TO 0. THAT'S
A 5 TO 0 VOTE IN THAT MOTION
PASSES. THANK YOU SO MUCH,
MEMBERS. LADIES AND GENTLEMEN,
WE'RE NOW GOING TO BE MOVING ON
TO OUR RULE WAIVER REQUEST. THIS
IS ITEM FOUR ITEM. FOUR RULE
WAIVER REQUEST BY CENTER PORTO.
THIS IS TO SUSPEND SENATE RULE
22.5. THIS IS IN REGARDS TO THE
BILL. BILL INTRODUCTION
LIMITATION, INTRODUCE ONE
ADDITIONAL MEASURE TO ACCOUNT
FOR A STATE CLAIMS BILL, WHICH
IS TRADITIONALLY AUTHORED BY THE
CHAIR OF APPROPRIATIONS. WE ARE
GOING TO ENTERTAIN A MOTION AT
THIS TIME. WE HAVE A MOTION BY
THE VICE CHAIR. ANY
CONVERSATION? HEARING SEE NÓ.
MADAM SECRETARY, CAN YOU PLEASE
CALL THE ROLL? MAGUIRE I GROW
GROW I GROW. I EG EG I JONES
JONES, I LAIRD LAIRD, I 5 TO 0.
LOOK AT THAT. 5 TO 0 BIPARTISAN
VOTE. THANK YOU SO MUCH TO THE
COMMITTEE MEMBERS. VERY EXCITING
. WE'RE READY TO GO TO COMMITTEE
APPOINTMENTS. THIS IS ITEM
NUMBER FIVE APPOINTED CHAIRS AND
MEMBERS OF COMMITTEES FOR THE
2024 LEGISLATIVE SESSION. WE
WILL ENTERTAIN A MOTION AT THIS
TIME. THANK YOU. SO MUCH FOR
MADAM VICE CHAIR. WE HAVE A
MOTION BY THE VICE CHAIR ON THE
FLOOR. ANY CONVERSATION ON THIS
ISSUE HEARING SEEN NONE FROM THE
COMMITTEE MEMBERS. MADAM
SECRETARY BACK TO YOU IF YOU
DON'T MIND CALLING THE ROLL,
MAGUIRE AGUIRE I GROVE I GROVE I
EGM EGM I, JONES JONES. I LAIRD
LAIRD, I 5 TO 0. THANK YOU SO
MUCH. IT'S A 50 VOTE THAT MOTION
PASSES. WE ARE NOW MOVING ON TO
OUR WEEKLY COMMITTEE SCHEDULE.
THIS IS ITEM SIX. ITEM SIX ON
THE CALENDAR. TODAY THIS WEEKLY
COMMITTEE SCHEDULE. THIS IS FOR
THE WEEKLY COMMITTEES COMMITTEE
SCHEDULE FOR THE 2024
LEGISLATIVE SESSION. IS THERE A
MOTION BE IF I CHAIR THANK YOU
SO MUCH. ANY CONVERSATION
HEARING? SEE? NONE MADAM
SECRETARY, CAN YOU PLEASE CALL
THE ROLL? MCGUIRE MCGUIRE I,
GROVE GROVE I EGMOND WHEN I
JONES JONES, I LAIRD HØI LAIRD,
I FIVE TO 05 TO ZERO THAT MOTION
PASSES. THANK YOU SO MUCH. MADAM
SECRETARY. WE ARE NOW GOING TO
BE MOVING ON TO ITEM NUMBER
SEVEN. ITEM SEVEN. THIS IS TO
APPROVE JOHN CASEY TO RETURN AS
RETIRED IN NEWTON IN THE OFFICE
OF PRO TÌM EMERITUS. ATKINS DO
WE HAVE A MOTION TO APPROVE THE
VICE CHAIR HAS ADVANCED A MOTION
TO APPROVE ANY CONVERSATION FROM
THE COMMITTEE. HEARING NÓ. MADAM
SECRETARY, CAN YOU PLEASE CALL
THE ROLL? MCGUIRE I MAGUIRE I
GROVE GROVE. I EGMOND EG I JONES
JONES. I LAIRD I LAIRD I 5 TO 0.
THANK YOU SO MUCH. THAT MOTION
PASSES 50. WE'RE NOW GOING TO BE
MOVING ON TO FLOOR
ACKNOWLEDGEMENTS. THIS IS
SOMETHING THAT THE VICE CHAIR IS
VERY EXCITED ABOUT AND HAS BEEN
WAITING FOR ALL DAY. THIS IS
ITEMS EIGHT AND NINE ITEMS EIGHT
AND NINE ON FLOOR
ACKNOWLEDGEMENT. IS THERE A
MOTION TO APPROVE? SO MOVE. ALL
RIGHT. THERE WE GO. THANK YOU SO
MUCH. YOU'VE BEEN A VICE CHAIR,
SEEN ANY CONVERSATION FROM THE
COMMITTEE HEARING? HEARING NONE.
MADAM SECRETARY, CAN YOU PLEASE
CALL THE ROLL? MÐI I, GROVE
GROVE. I EGM EGM. I JONES JONES.
I LAIRD I. I 5 TO 0. THAT IS A
50 VOTE. VERY GRATEFUL TO THE
COMMITTEE AND I AGAIN WANT TO
SAY THANK YOU TO EACH OF THOSE
APPOINTEES WHO ARE HERE TODAY.
THANK YOU FOR YOUR PATIENCE.
WE'RE NOW GOING TO BE GETTING
INTO THE DISCUSSION IN MEET OF
OUR HEARING. THIS IS GOVERNOR
APPOINTEES JUMPING BACK TO ITEM
ONE. FIRST AND FOREMOST, WE'RE
GOING TO BE ASKING DR RULLI TO
BE ABLE TO PLEASE STEP FORWARD
TO THE TABLE AT THIS TIME. WE
ARE GRATEFUL THAT YOU ARE HERE
TODAY, SIR. THANK YOU SO MUCH.
YOU'RE GONNA HAVE AN OPPORTUNITY
TO BE ABLE TO PROVIDE
APPROXIMATELY A MINUTE OF
OPENING TESTIMONY TO THE
COMMITTEE, DOCTOR, WE ASK THAT
YOU OPEN IT UP TO THE COMMITTEE
MEMBERS WITH ANY INTRODUCTIONS
THAT YOU MAY HAVE ONCE YOU HAVE
COMPLETED YOUR TESTIMONY WILL BE
TURNING OVER TO THE COMMITTEE TO
BE ABLE TO ASK QUESTIONS AND
USHER IN ANY COMMENTS AS WELL.
WE WILL BE KEEPING TIME OF
OPENING STATEMENT. I WILL GIVE
YOU A PROMPT WHEN WE GET CLOSE,
DR. BURLY GRATEFUL THAT YOU ARE
HERE TODAY. THANK YOU SO MUCH,
SIR. IT'S GOOD TO SEE YOU. THE
FLOOR IS YOURS. LIKEWISE THANK
YOU. GOOD AFTERNOON, AND THANK
YOU. MAGUIRE, VICE CHAIR, GROVE.
HONORABLE SENATORS. IT IS MY
PLEASURE AND PRIVILEGE TO APPEAR
BEFORE YOU TODAY, PUBLIC SERVICE
AND CIVIC DUTY ARE MORE
IMPORTANT NOW THAN THEY HAVE
EVER BEEN. AND IT IS IN THIS
REGARD THAT I WISH TO THANK
GOVERNOR NEWSOM AND THE
ADMINISTRATION FOR APPOINTING ME
TO THE CALIFORNIA LOTTERY
COMMISSION. I APPROACH THIS
APPOINTMENT WITH A GRAVITY AND
PRIDE AND WITH THE GOAL OF BEING
A STEWARD OF THE CALIFORNIA
STATE LOTTERY ACT, I GREW UP IN
THE GREATER LOS ANGELES AREA AS
AN IMMIGRANT IN THE 19 EIGHTIES.
I'M A PROUD PRODUCT OF THE
CALIFORNIA PUBLIC EDUCATION
SYSTEM. I WAS A THIRD GRADER
WHEN THE LOTTERY WAS
INAUGURATED. I AM A BENEFICIARY
OF THE LOTTERY'S MEANINGFUL
IMPACT ON PUBLIC EDUCATION. UM
OF THIS AMAZING STATE. I USE THE
RESOURCES AFFORDED BY THE
LOTTERY TO GO ON TO POST
SECONDARY EDUCATION TRAIN AT A
PUBLIC UNIVERSITY AND EVENTUALLY
ATTAIN MY DREAM TO PRACTICE THE
HEALING ARTS. I ACCEPTED THE
APPOINTMENT TO THE LOTTERY
COMMISSION TO GIVE BACK TO THE
SYSTEM THAT LIFTED ME TO HIGHER
GROUND. MY WORK AS A MEDICAL
PROFESSIONAL, HAVING WITNESSED
HUMANITY AT ITS BEST AND WORST
AND AT ITS MOST TRIUMPHANT AND
DESPONDENT HAS ALLOWED ME TO
DEVELOP A UNIQUE INSIGHT INTO
TÚI TWO KEY ORGANIZATIONAL
FUNCTIONS. ADMINISTRATIVE
OVERSIGHT AND ACCOUNTABILITY FOR
PEOPLE'S LIVES. I PLAN TO USE
THESE SKILLS TO HELP FULFILL THE
LOTTERY'S MANDATE OF PROVIDING
SUPPLEMENTAL FUNDING FOR THE
PUBLIC EDUCATION SYSTEM. WHOSE
MISSION HAS BECOME EXPONENTIALLY
MORE CRITICAL. I PLEDGED TO WORK
HARD TO ENSURE THAT THE
LOTTERY'S BUSINESS NEEDS ARE
CURATED IN SUCH A WAY AS TO
MAXIMIZE THE EFFICIENCY WITH
WHICH REVENUE ENDS UP IN THE
CLASSROOM. AND I AM FULLY AWARE
OF THE CHALLENGE, AS EACH DOLLAR
GENERATED HAS NEVER BEEN MORE
NECESSARY AND LESS SUFFICIENT IN
THIS COUNTRY'S MOST POPULATED
AND VIBRANT STATE. I AM HONORED
TO SERVE. THANK YOU FOR YOUR
TIME TODAY, DOCTOR. WE
APPRECIATE YOU APPEARING IN
FRONT OF THIS ESTEEM COMMITTEE.
THANK YOU SO MUCH AGAIN. THE
DOCTOR IS SEEKING AN APPOINTMENT
TO THE CALIFORNIA STATE LOTTERY
COMMISSION REFORMING TO THE CAY
COMMISSION. WE WOULD LIKE TO BE
ABLE TO OPEN IT UP TO ANY OF THE
COMMITTEE MEMBERS FOR QUESTIONS
AND COMMENTS AT THIS TIME,
PLEASE. UH, SENATOR THANK YOU.
AND THANK YOU FOR BEING HERE AND
YOUR YOUR WILLINGNESS TO SERVE.
UM I CHAIR THE EDUCATION BUDGET
SUBCOMITTEE, AND THERE'S A
COUPLE OF QUESTIONS. I WANTED TO
ASK ABOUT THE LOTTERY'S
RELATIONSHIP TO PUBLIC EDUCATION
. AND ONE IS THAT THE LOTTERY
AND I APOLOGIZE FOR NOT HAVING
HAD THE CHANCE TO MEET WITH YOU
BEFOREHAND. SO UH, THE LOTTERY
RECENTLY LAUNCHED A PUBLIC
EDUCATION CAMPAIGN TO INCREASE
PUBLIC. VISIBILITY ON HOW THE
LOTTERY FUNDS, UH HELP EDUCATION
AND ONE OF THE BANKS OF MY
EXISTENCE IS THAT AT LEAST A
COUPLE OF TIMES EVERY YEAR
SOMEBODY COMES UP AND SAYS, I
THOUGHT THE LOTTERY WAS GOING TO
TAKE CARE OF EDUCATION FUNDING.
THEY BELIEVED THE COMMERCIALS
WHEN IT WAS ON THE BALLOT, AND
THAT IS STILL A PUBLIC
PERCEPTION IN CERTAIN SECTORS.
BUT I KNOW THAT THIS IS NOT
DESIGNED TO DIRECTLY SPEAK TO
THAT. BUT HOW DO YOU ENVISION
THIS, UH, PROJECT AND HOW DO YOU
THINK IT WOULD HELP SERVE THAT
PURPOSE? THE CAMPAIGN IS
ORGANIZED AND ITS COMPREHENSIVE
ONE OF ITS PRONGS IS CHANGING
THE NARRATIVE QUOTE. UN QUOTE.
UM AND IT RELIES HEAVILY ON THE
MULTIPLE MODES OF MEDIA VIDEO
TESTIMONIALS. UM AND BASICALLY,
UH, FROM BEGINNING TO END ON HOW
EVERY DOLLAR IS DISTRIBUTED TO
HELP. UH, THE, UH, THIS MISSION
OF SUPPLEMENTAL EDUCATION
FUNDING. IT'S NOT AN EASY TASK
BECAUSE IT'S GOING AGAINST A
SIGNIFICANT INERTIA OF PUBLIC
PERCEPTION OF WHAT LOTTERY IS,
WHICH IS AND IN THE EYES OF MANY
AS GAMBLING, AND THAT'S IT'S NOT
QUITE WHAT IT IS. IT'S A GAME
AND IT RAISES MONEY. UM AND IT
DOES GOOD WORK, AND I AND I
THINK THE, UH, THE CAMPAIGN IS
VERY ORGANIZED, AND IT'S FAR
REACHING, AND IT HAS PRONGS THAT
ARE BOTH INTERNAL AND EXTERNAL.
UM SO I'M I'M HAPPY WITH WHAT
I'VE LEARNED SO FAR ABOUT THIS
CHANGING THE NARRATIVE CAMPAIGN.
WERE YOU ME IN ANY WAY? UH, THAT
YOU AFTERWARDS HAVE CHANGED. IN
A LITTLE OR IS THIS JUST
DESIGNED TO MAKE THE GO OF IT
AND JUST HOPE THAT IT DOESN'T?
UM UH, THE EFFORTS AND ITS
INCIPIENT ARE ARE OBVIOUSLY TO
MAKE A DENT AND THEN I'M I'M
SURE THE METRICS WILL BE
DESIGNED TO MEASURE THE
DIFFERENCE THAT IT'S MADE, AND
I'M SURE WE'LL LEARN MORE ABOUT
THAT. AS TIME GOES ON. GREAT AND
THEN JUST SORT OF A RELATED
QUESTION. IS UH, THE LOTTERY ON
TRACK THIS YEAR TO MEET THE LOSS
REQUIREMENTS FOR THE FUNDING
THAT'S ALLOCATED TO PUBLIC
EDUCATION. UH, II. I BELIEVE SO,
UM I THINK THE LOTTERY MAKES A
GOOD EFFORT. UH TO, UH, MAKE
SURE THAT IT'S ITS METRICS. ITS
NUMBERS ARE WITHIN SORT OF THE
FORMULAS ESTABLISHED IN 2020,
WHERE 65 TO 67% GOES TO, UH,
GAMING OR REVENUE EXPENSES AND
THE REST, WHICH IS ABOUT $2.1.
BILLION GOES TO EDUCATION. UM
AND I THINK THEY'RE DOING A GOOD
JOB WITH THAT. OK, I. I
APPRECIATE RESPONSE TO THE
QUESTIONS AND I WOULD JUST YOU
COULD INFER LOGICALLY THAT IF
THOSE ARE THE TWO THINGS I'M
ASKING ABOUT WE ARE CONCERNED
ABOUT THAT. SO I WOULD JUST HOPE
YOU WOULD, UH, TAKE THAT INTO
ACCOUNT AS YOU DISCHARGE YOUR
DUTIES AND THANK YOU FOR BEING
HERE IN ANSWERING THE QUESTION.
THANK YOU SO MUCH. SENATOR LAIRD
. WE'RE GONNA TURN IT OVER TO
THE VICE CHAIR, SENATOR GROUP.
UH, THANK YOU, UH, I WANT TO
FOLLOW UP ON MY COLLEAGUE'S
QUESTION REGARDING THE, UM THE
BUDGET QUESTION ON THE 2020
THREE 24 BUDGET, IT'S AND I
UNDERSTAND THAT YOU ARE NOT AT
THE MEETING ON JUNE 29TH 2023,
BUT THERE WERE CONCERNS THAT
WERE BROUGHT UP THAT, UM,
REVENUES ALLOCATED IN THE PUBLIC
EDUCATION SYSTEM RAISED. THEY
RAISED VERY AGGRESSIVELY FROM
WHAT I UNDERSTAND CONCERNS ABOUT
THE AVERAGE PROVISION
REQUIREMENT, UH THE AMOUNT
NEEDED TO BE ABLE TO SUPPLY TO
THE EDUCATION PORTION, SO I
GUESS A JUST A FOLLOW UP ON MY
COLLEAGUE'S QUESTION. HOW DOES
THE COMMISSION PLAN TO? I DON'T
KNOW. UM MEET THAT PROPORTIONAL
INCREASE OR THAT GAP IN THE
FUNDING. THAT'S ESTIMATED, UM
REGARDING THE, UM THE REVENUES
ALLOCATED FOR PUBLIC EDUCATION,
WHICH PEOPLE HAD QUESTIONS ON AT
THAT MEETING. MOST OF THE
NUMBERS I HAVE ARE FROM THE
PREVIOUS YEAR. UM AND I AND I
THINK THEY WERE ON TARGET FOR
THIS YEAR. I'D HAVE TO GO BACK
AND REVIEW THOSE NUMBERS AND GET
BACK TO YOU ABOUT THAT. UM BUT
I'M SURE EVERY EFFORT IS GOING
TO BE MADE TO MEET THE GOAL,
WHICH IS TO MAXIMIZE ABSOLUTE
DOLLARS IN TERMS OF FUNDING. DO
YOU THINK THAT'S GONNA REQUIRE
ADDITIONAL MARKETING AND MARKET
CAMPAIGN IN ORDER TO INCREASE
THE PUBLIC'S INTEREST IN
PARTICIPATING IN THE LOTTERY? I
DO AND I THINK THAT AND TO
BROADEN THE PLAYER I THINK WE
HAVE A REALLY DIVERSE STATE. AND
THEY, UM UH THERE'S THEY'RE ALL
CROSS SECTIONS OF THE STATE THAT
I DON'T THINK ARE AWARE OF THE
LOTTERY'S MISSION. AND I THINK
THAT IF WE TAP INTO THAT, AND
I'M SURE WE WILL, UM, THAT'LL
INCREASE SOME OF THE REVENUE AND
HELP MEET THE GAPS. THANK YOU.
THANK YOU, PRO TEM. AND MY
POLICE, SENATOR MON. UH, THANK
YOU. AND THANK YOU VERY MUCH FOR
BEING HERE TODAY. AND I THINK
YOU CAN TELL BY THE QUESTIONS
THAT WE ALL HAVE A LITTLE
CONCERN, UM, KIND OF ABOUT THE
PUBLIC IMPRESSION. AND WHAT KIND
OF METRICS YOU'RE USING TO
MEASURE IF YOU'RE SUCCESSFUL OR
NOT, AND I HEARD YOU REFER TO IT
NOT AS GAMBLING AS A AS A GAME.
I ALWAYS THINK GAME INVOLVES
SOME LEVEL OF SKILL, BUT MAYBE
THAT'S JUST ME. UM I AM NOT A
GAMBLER. UH BUT IF YOU'RE A
GAMER, I'M NOT A GAMER, EITHER.
I'M A SOURDOUGH BAKER. YOU'RE
VERY GOOD. THANK YOU VERY MUCH.
UM I LIKE I LIKE CONCRETE. I
LIKE SOMETHING I CAN TOUCH. UM
SO, SO WE ALL HAVE THIS CONCERN
AND WE CAN THINK THE PUBLIC HAS
THIS CONCERN TOO, RIGHT? I MEAN
THAT THERE'S BEEN SOME ISSUES
WITH THE LOTTERY OVER TIME. HOW
DO YOU GO ABOUT GETTING YOUR
BASELINE MEASURE TO ACTUALLY BE
ABLE TO TRACK DURING YOUR BEING
APPOINTED? HOW DO YOU BE OR HOW
ARE YOU GONNA BE ABLE TO TRACK
IF YOU'RE ACTUALLY MAKING ANY
ANY DIFFERENCE IN THAT KIND OF
PUBLIC PERCEPTION AND JUST
EXPANDING THE POOL? IF YOU WILL,
UH, I THINK THAT'S A GREAT
QUESTION. UM AND A PUBLIC
PERCEPTION IS OBVIOUSLY
SOMETHING THAT IS RESISTANT TO
CONCRETE NUMBERS. UM I KNOW THAT
FROM A HEALTH CARE PROVIDER
WE'RE MEASURED AS WELL. UH,
WE'RE EVALUATED OFTEN
SUBJECTIVELY. UM AND IT'S A
GREAT QUESTION. IT'S SOMETHING I
THINK WE ALL NEED TO THINK
ABOUT. I THINK THE INITIAL STEPS
INITIALLY, THERE WAS EXCITEMENT
OVER RAISING MONEY SUPPLEMENT
FOR EDUCATION. UM AND THEN THE
SECOND CONSIDERATION WAS YOU'RE
RAISING IT WITH, UM WITH THE
LOTTERY, WHICH IS A IS A GAMING
CONCERN. SO THAT COMES ALONG
WITH PUBLIC, UM SOME PUBLIC
STIGMA THAT HAS TO BE OVERCOME.
THAT'S THE FIRST EFFORT. UM THE
SECOND EFFORT IS TO MEASURE HOW
SUCCESSFUL YOU ARE IN THAT AND
II. I DON'T TAKE THE CONCERNS
LIGHTLY, AND I THINK I'M SURE
THERE ARE EFFORTS ONGOING WITHIN
THE LOTTERY DEPARTMENT ON HOW TO
MEASURE UH, PUBLIC PERCEPTION,
AND I'M SURE SOME OF THOSE
INCIPIENT EFFORTS UM UH, I, I
CAN I CAN DELINEATE FOR YOU AS
SOON AS I'M APPRISED OF THEM,
BUT, UM, UH, I THINK IT'S A VERY
VALID CONCERN. YEAH. THANK YOU.
SIR. DO YOU HAVE ANY FOLLOW UP
ON THAT? OK, THANK YOU SO MUCH
FOR HAVING ME LATER. JONES THANK
YOU, DOCTOR. THANKS FOR BEING
HERE. I COMMEND YOUR COMMITMENT
TO COMMUNITY SERVICE, AND THIS
IS MOSTLY AN UNPAID POSITION AND
YOU KNOW, THANKFULLY IN
CALIFORNIA, LOTS OF POSITIONS
BOTH AT THE LOCAL LEVEL, AND THE
STATE LEVEL ARE FILLED BY FOLKS
WITH THE SAME COMMITMENT AS YOU
JUST A QUICK QUESTION ON UH, YOU
KNOW, BEING ABLE TO FILL FULFILL
THE RESPONSIBILITIES OF THE
POSITION. I NOTICED THAT YOU
MISSED ONE OF THE MEETINGS
EARLIER IN THE YEAR, AND IT
HAPPENED TO BE THE BUDGET
MEETING. AND SO I JUST WANTED TO
SEE IF YOU COULD TALK TO THAT.
AND I. I GUESS THE BOTTOM LINE
OF THE QUESTION IS, DO YOU HAVE
TIME TO DO THIS AND STAY
COMMITTED TO THE COMMUNITY
SERVICE THAT WE'RE ASKING YOU TO
DO? I THINK I THINK THAT'S A
REALLY QUESTION TO SENATOR UM,
THERE'S ACTUALLY TWO. THE UH,
THE FIRST WAS A UH UH, UNPLANNED
SURGERY. UNFORTUNATELY IN IN OUR
LINE OF WORK, UM WHICH I'M
THANKFUL FOR BECAUSE I'VE HAD
SEVERAL ORTHOPEDIC SURGERIES,
RIGHT? UM I DON'T EXPECT THAT TO
HAPPEN AGAIN. IT WAS A PRETTY
EXCEPTIONAL CIRCUMSTANCE. THE
SECOND WAS I HAD COVID. UM SO,
UH AND WE DIDN'T EXPECT THAT
EITHER, BUT I THINK NOW THAT
I'VE HAD COVID FOUR TIMES, I, I
DON'T THINK I'M GONNA HAVE IT
AGAIN. OR MAYBE IF I DO, I WON'T
FEEL IT. AND, UM YES. THANK YOU.
THOSE ARE VERY GOOD ANSWERS. I
APPRECIATE IT. THANKS. THANK YOU
SO MUCH BEFORE WE GO TO PUBLIC
COMMENT, WANTED TO CHECK IN WITH
THE COMMITTEE TO SEE IF THERE'S
ANY ADDITIONAL QUESTIONS OR
COMMENTS FROM ANY OF THE
MEMBERS. HERE IN IN X. NINE.
DOCTOR THANK YOU SO MUCH FOR
YOUR PRESENTATION. WE'RE GOING
TO HAVE YOU HANG RIGHT THERE FOR
JUST A BIT. WE'RE NOW GONNA BE
TAKING PUBLIC COMMENTS ON THE
DOCTOR'S, UH, POTENTIAL
APPOINTMENT. FIRST AND FOREMOST,
WE'RE GONNA START WITH THOSE WHO
WOULD LIKE TO BE ABLE TO SPEAK
IN SUPPORT. IF YOU WOULD LIKE TO
BE ABLE TO SPEAK IN SUPPORT. IF
YOU CAN. PLEASE COME UP TO THE
PODIUM AT THIS TIME, YOU WILL
HAVE 60 SECONDS TO BE ABLE TO
PROVIDE AN OPPORTUNITY TO SPEAK
IN SUPPORT LOOKING FOR THOSE WHO
ARE IN SUPPORT. HEARING AND SEE
NÓ ONE RISE. WE ARE NOW GOING TO
GO TO THOSE WHO MAY BE IN
OPPOSITION HERE IN ROOM 2200 AND
WISHING TO TESTIFY IN
OPPOSITION. PLEASE COME FORWARD
AND SPEAK NOW. HEARING AND
SEEING NÓ ONE. WE ARE GOING TO
BRING IT BACK TO THE COMMITTEE
TO BE ABLE TO SEE IF THERE'S ANY
ADDITIONAL QUESTIONS OR COMMENTS
FROM THE RULES COMMITTEE AT THIS
TIME. PLEASE I WOULD MOVE THE
CONFIRMATION OF DRUM. WE HAVE A
MOTION FOR CONFIRMATION. THANK
YOU SO MUCH. SENATOR LAIRD.
MADAM SECRETARY. IF YOU CAN
PLEASE CALL THE ROLL, MCGUIRE I
GROVE NOT GROVE, NOT VOTING,
MON. EGGMAN I, JONES JONES, I
LAIRD LAIRD, I 4 TO 0 TETRA
BRAZIL. CONGRATULATIONS WE'RE
GRATEFUL THAT YOU'RE HERE. THANK
YOU. SO MANAGERS. I APPRECIATE
IT. THANK YOU SO MUCH. THANK YOU
FOR MAKING THE TREK TREK UP AS
WELL. ALL RIGHT. MR CHAIR. JUST
A POINT FOR DR RIZZOLI. WE'RE
ACTUALLY FORWARDING HIS
CONFIRMATION TO THE FLOOR, WHICH
IS THE NEXT STEP AND THEN THAT'S
WHAT HE SHOULD LOOK FOR NEXT.
CORRECT YOU'RE ABSOLUTELY
CORRECT. YEAH, OK, JUST
CHECKING. FINAL CONFIRMATION ON
THE FLOOR. THANK YOU SO MUCH.
ALL RIGHT. LADIES AND GENTLEMEN,
WE'RE GOING TO BE BRINGING UP
OUR NEXT GROUP POTENTIAL
APPOINTEES IF IT WORKS FOR THIS
COMMITTEE, WE ARE GOING TO
INVITE EACH OF OUR NEXT
POTENTIAL APPOINTEES UP AS A
GROUP. SO AS I CALL YOUR NAME,
IF YOU DON'T MIND COMING FORWARD
, WE WOULD BE GRATEFUL WE'RE
GOING TO HAVE DR DAVID CARLYLE
TO PLEASE COME FORWARD. DOCTOR
SANDRA HERNANDEZ, IF YOU COULD
PLEASE ADVANCE. WE HAVE DOCTOR
RICHARD KRONICK. IF YOU COULD
PLEASE AND THEN WE HAVE JAY
ELIZABETH MITCHELL. IF YOU COULD
PLEASE COME FORWARD. WE HAVE
MISS MITCHELL. DR KRONICK. MR
HERNANDEZ AND MR CARLO. WE'LL
GIVE IT A FEW MOMENTS TO BE ABLE
TO TAKE A SEAT. LADIES AND
GENTLEMEN COMMITTEE. THESE FOUR
INDIVIDUALS ARE GOING TO BE
SEEKING APPOINTMENT FOR THE
HEALTH CARE AFFORDABILITY BOARD.
WHAT WE WOULD LIKE TO BE ABLE TO
DO IS PROVIDE EACH OF THE
APPOINTEES AND OPPORTUNITY TO BE
ABLE TO HAVE SOME REMARKS IN
FRONT OF THE COMMITTEE. WE
RESPECTFULLY REQUEST THAT EACH
OF OUR POTENTIAL APPOINTEES.
KEEP THE REMARKS TO ABOUT A
MINUTE. OBVIOUSLY IF THERE IS
SOMETHING THAT YOU ARE BURNING,
TO BE ABLE TO SAY, WE WELCOME
THAT LAST THING I'LL SAY BEFORE
WE TURN IT OVER TO DR CARLYLE
FIRST, BECAUSE WE WANT TO SAY
THANK YOU SO MUCH FOR YOUR
SERVICE TO THE PEOPLE IN THE
STATE OF CALIFORNIA. WE'RE
GRATEFUL THAT YOU'RE HERE. DR
KYLE. GOOD AFTERNOON. WE'RE
GRATEFUL FOR YOUR SERVICE. THE
FLOOR IS YOURS FOR ONE MINUTE.
THANK YOU, PRO CHAIRMAN AND
COMMITTEE MEMBERS JUST TO
INTRODUCE MYSELF. I'M DAVID
CARLISLE. I'M THE PRESIDENT AND
èC E Ó OF CHARLES R DREW
UNIVERSITY OF MEDICINE AND
SCIENCE IN LOS IT'S A PLEASURE
TO BE HERE ON BEHALF OF THE
COMMITTEE AND CALIFORNIA. THANK
YOU SO MUCH, DOCTOR. I REALLY
APPRECIATE YOU BEING HERE. WE
ARE NOW GOING TO BE TURNING THE
FLOOR OVER TO DR HERNANDEZ. GOOD
AFTERNOON, DR HERNANDEZ. THANK
YOU SO MUCH FOR TAKING TIME AT
YOUR BUSY SCHEDULE. THE FLOOR IS
YOURS. THANK YOU, SENATOR. AND
NICE TO BE WITH ALL OF YOU
TODAY. I'M DOCTOR CEDAR
HERNANDEZ AND I'M CURRENTLY
SERVING AS THE PRESIDENT èC E
Ó OF THE CALIFORNIA HEALTH CARE
FOUNDATION, WHERE A PRIVATE
INDEPENDENT FOUNDATION THAT
SERVES THE PEOPLE OF CALIFORNIA.
UM I CAME TO CALIFORNIA ABOUT 40
YEARS AGO TO DO MY MEDICAL
TRAINING AT UCSF AND SUBSEQUENT
TO THAT HAVE HAD REALLY AN
INCREDIBLE OPPORTUNITY TO SERVE
IN A NUMBER OF DIFFERENT
CAPACITIES, BOTH AS A PRIMARY
CARE PHYSICIAN. UM BUT ALSO IN
PUBLIC HEALTH AND WORKING IN
HEALTH POLICY, AND IT'S A REAL
HONOR TO BE WITH ALL OF YOU
TODAY. ATTORNEY IN THANK YOU SO
MUCH FOR YOUR SERVICE. IT'S GOOD
TO SEE YOU. WE NOW WOULD LIKE TO
BE ABLE TO TURN THE FLOOR OF THE
COMMITTEE OVER TO DR CRONICK.
DOCTOR KRONICK. GOOD AFTERNOON.
THE FLOOR IS YOURS. THANK YOU SO
MUCH FOR THE OPPORTUNITY TO BE
HERE TODAY. UM I AM QUITE
EXCITED, UH, TO BE CONSIDERED
FOR CONFIRMATION AS A MEMBER OF
THE BOARD OF THE OFFICE OF
HEALTH CARE AFFORDABILITY AND
LOOK FORWARD TO THE DISCUSSION
THAT WE WILL HAVE. UM UH UH,
LIKE TO THANK VIRTUALLY IN
ATTENDANCE. MY AND PARTNER OF 45
YEARS, AMY BRIDGES CHRONIC, UM,
AS WELL AS MY SPECTACULAR
DAUGHTERS, EMMA AND DOROTHY, AND
FOUR VERY DELICIOUS
GRANDCHILDREN. I LOVE IT. MY
GOODNESS. THANK YOU SO MUCH 45
YEARS. CONGRATULATIONS MY
GOODNESS. RAMOS AT ABOUT 20 IN
OUR HOUSE, SO THERE WE GO. UM,
BUT CONGRATULATIONS, SIR. THANK
YOU SO MUCH. AND WE ARE GRATEFUL
, MISS MITCHELL THAT YOU ARE
HERE TODAY. THANK YOU SO MUCH
FOR TAKING TIME OUT OF YOUR BUSY
SCHEDULE. THE FLOOR IS YOURS AND
THANK YOU FOR YOUR SERVICE.
THANK YOU FOR HAVING ME. I AM
HONORED TO BE HERE. MY NAME IS
ELIZABETH MITCHELL. I'M THE
PRESIDENT AND èC E Ó OF THE
PURCHASER BUSINESS GROUP ON
HEALTH. WE ARE A 501 èC THREE
NONPROFIT, AND FOR 35 YEARS WE
HAVE BEEN WORKING ON MAKING
HEALTH CARE, HIGHER QUALITY,
MORE EQUITABLE AND MORE
AFFORDABLE SO THIS COULD NOT BE
MORE IN LINE WITH MY INTERESTS
AND COMMITMENT OVER THE LAST 25
YEARS. I DO, HOWEVER, WANT TO
ALSO RECOGNIZE MY FAMILY WHO
GRACIOUSLY JOINED IN MY MOM WHO
WAS THE SENATE PRESIDENT OF
MAINE IS WATCHING. OH, MY GOD
AND MY SISTER. AND HER FAMILY.
MY DAUGHTER, ABBY, IN L, A MY
DAUGHTER, HANNAH, AND, UH,
SEATTLE AND THEN MY TEENAGE SON,
WHO WAS STUDYING IN ITALY IS
ALSO WATCHING, BUT I HOPE HE
GOES TO BED SOON. SO UM, THANK
YOU SO MUCH. THIS IS SUCH
IMPORTANT WORK AND I'M HONORED
TO BE CONSIDERED. HOW MANY YEARS
DID YOUR MOM SERVE? MAYBE 30.
THAT'S AMAZING. YEAH, A WHILE. I
GREW UP IN THE STATE HOUSE. OH,
MY GOSH. LOVE IT. LOVE THAT
CONNECTION. THANK YOU SO MUCH,
SIR. SIR UH, JUST A POINT OF
CLARIFICATION. YES, PLEASE.
THANK YOU. WE HAVE A COURT
REPORTER RULE IS DIFFERENTLY
THAN ANY OTHER COMMITTEES, AND
SHE TAKES NOTES. AND UM, OVER
THE YEARS BEING ON RULES. I HAVE
LEARNED TO READ HER, UM, LOW
FACE, LITTLE EXPRESSION,
EXPRESSIONS. AND IF I COULD ASK
YOU GUYS JUST TO SLOW DOWN
BECAUSE SHE DOES TAKE DOWN EVERY
WORD YOU SAY SO. THANK YOU.
THANK YOU. THANK YOU SO MUCH.
MADAM VICE CHAIR WAS THAT TO THE
TO THE GUEST OR TO THE CHAIR?
BOTH ABSOLUTELY BOTH. I'VE
ALREADY RECEIVED A NOTE FROM
SENATOR GROVES. SLOW IT DOWN. SO
UH, YES. THANK YOU SO MUCH. NÓ
IT'S FINE. IT'S FINE. THANK YOU
SO MUCH. UH, I'VE ALREADY HAD
THE SAME GUY AS WELL. FROM THERE
WE GO. BUT UH, VERY GRATEFUL.
ALL RIGHT AGAIN. WE ARE SO
APPRECIATIVE THAT EACH OF YOU
ARE HERE. WHAT WE WOULD LIKE TO
BE ABLE TO DO NOW IS OPEN IT UP
FOR QUESTIONS IN ANY COMMENTS
FROM THE COMMITTEE WHO WOULD
LIKE TO BE ABLE TO KICK US OFF
ON QUESTIONS, COMMENTS AND
CONVERSATIONS, PLEASE. DR EGM.
THANK YOU AND I'LL START
DISCUSSING MY FIRST COMMITTEE
MEETING. SO I MIGHT AS WELL JUST
JUMP IN. UH AND I DIDN'T GET TO
MEET WITH ALL OF YOU. I GOT TO
MEET WITH DR HERNANDEZ AND THANK
YOU VERY MUCH FOR, UH, USHERING
ME NICELY INTO THE THIS THIS NEW
ROLE THAT I HAVE, UM èC MA HAS
BEEN TALKING ABOUT, UM, ABOUT
THE METRICS. YOU SET THREE THREE
VERSUS THREE 0.5. CAN YOU TALK A
LITTLE BIT JUST ABOUT THAT ABOUT
THE PROCESS AND WHY WE LANDED
THERE. WHY? WE THINK IT'S
IMPORTANT. WOULD GO TO ANYBODY
WHO WANTS TO START. THAT IN,
PLEASE. THANK YOU, SENATOR
EDMUND FOR THAT QUESTION. UM
WHAT I WOULD SAY IS THAT THE
LEGISLATION ALLOWS FOR THIS
BOARD AND THE OCA STAFF TO
DEVELOP A METHODOLOGY, WHICH.
THE OFFICE HAS DONE WITH A GREAT
DEAL OF INPUT FROM ADVISORY
BOARD MEMBERS FROM THE GENERAL
PUBLIC FROM CONSUMERS, AND THAT
METHODOLOGY REALLY RESTS LARGELY
ON THE NOTION OF AFFORDABILITY
FOR CONSUMERS. AND SO AS WE
CONSIDERED THOSE IN THIS BOARD
HAS NOT YET TAKEN ACTION ON THAT
THE OCA OFFICE HAS MADE A
RECOMMENDATION AND I THINK A
NUMBER OF ISSUES AND CONCERNS
WENT INTO THAT. UM, WE DON'T ALL
SHARE THE SAME OPINION ABOUT
THAT. MY OWN PERSONAL VIEW IS
THAT WE SHOULD SET A VERY
AGGRESSIVE TARGET FOR SPENDING
IN THE STATE. IN ORDER FOR
CONSUMERS TO BE ABLE TO CATCH
UP. WE WILL NEVER BE ABLE TO
REDUCE WHERE OUR COSTS ARE TODAY
WILL REALLY SLOWING. THE GROWTH
IS WHAT OUR CHARGE IS. AND SO,
UM, I THINK THE METHODOLOGY HAS
BEEN SOUND. THE INPUT HAS BEEN
RIGOROUS AND WILL CONTINUE TO
DEBATE THAT AS WE GO FORWARD.
THANK YOU VERY MUCH, UM. AND AS
WE TALK ABOUT THAT, II I WAS
JUST REALLY STRUCK BY SOMETHING,
DR HERNANDEZ SAID IN OUR OUR
INTERVIEW YESTERDAY ABOUT THE
IDEA THAT WE PROBABLY NEED I
MEAN, WE GET WE GET HEALTH CARE
MORE AFFORDABLE WHEN WE HAVE
LESS HOSPITAL BEDS. NOT MORE
RIGHT. WE DO MORE PREVENTATIVE
CARE. WE DO MORE PUBLIC
HEALTHCARE, AND WE ARE NOT
HAVING PEOPLE IN THE ER OR
COMING IN FOR THINGS THAT THAT
THAT AREN'T AREN'T ACUTE. UM SO
I GUESS I WONDER IF I COULD HEAR
FROM THE REST OF YOU ABOUT YOUR
THOUGHTS ABOUT THAT ABOUT THAT
CONCEPT OF BUT WE JUST WE NEED
TO SHIFT WHERE WE'RE THE HIGHEST
COSTS ARE, UM INTO IN INTO A
DIFFERENT KIND OF MODEL AND YOUR
VISION OF BEING ABLE TO ATTAIN
THAT. WHY DON'T WE START WITH
MISS MITCHELL AND WE'LL WORK OUR
WAY DOWN? AS SENATOR AMAN HAS
ASKED EACH TO ADDRESS MS
MITCHELL. I SEE YOU WENT TO READ
AND I DID MY GRADUATE SCHOOL IN
PORTLAND. SO WELCOME A READ
HERE. THANK YOU. UM YES, AND ONE
OF THE I THINK STRENGTHS OF THE
LEGISLATION IS THAT IT IS
COMPREHENSIVE BECAUSE THIS WILL
BE A SYSTEMIC SHIFT. IT'S NOT
JUST ABOUT LIMITS. IT'S ABOUT
ACTUALLY INVESTING WHERE WE HAVE
UNVESTED LIKE PRIMARY CARE
COMMUNITY-BASED CARE, AND THERE
IS SOME REALLY GOOD EVIDENCE OUT
THERE THAT SHOWS THAT INVESTMENT
IN PRIMARY AND COMMUNITY BASED
CARE REDUCES SPENDING BY KEEPING
PEOPLE HEALTHIER. BETTER CARE
CAN COST LESS, AND WE KNOW THAT
EVEN IN SMALL AND RURAL
COMMUNITIES THAT BY UM ENABLING
PEOPLE TO GET THE CARE THEY NEED
WHEN THEY NEED IT. THEY DO AVOID
HOSPITALIZATIONS, AND IT
ACTUALLY REDUCES THE TOTAL SPEND
WHILE IMPROVING OUTCOMES. SO THE
GOOD NEWS ABOUT THE LEGISLATION
IS THAT WE CAN LOOK AT PRIMARY
CARE INVESTMENT. WE CAN LOOK AT
WHAT WHAT REGIONAL DIFFERENCES
MIGHT NEED TO BE ACKNOWLEDGED.
BUT ACCESS IS CRITICAL, AND
EVERYONE ON THE BOARD IS
COMMITTED TO PRESERVING ACCESS
BECAUSE THAT IS PART OF
AFFORDABILITY. SO WE ARE LOOKING
AT THIS, UM SYSTEMATICALLY, AND
I THINK WE CAN MAKE REALLY
IMPORTANT IMPROVEMENTS. THANK
YOU, MS MITCHELL. DR. KNOCK THE
FLOOR IS YOURS. PLEASE ADDRESS,
SENATOR. THANK YOU, YOU KNOW,
REALLY IMPORTANT AND EXCELLENT
QUESTION. ONE OF THE CENTRAL
CHALLENGES FOR THE OFFICE, AND
THE BOARD IS CHANGING THE
DECISION. CALCULUS FOR HOSPITAL
ADMINISTRATORS, HEALTH SYSTEM
MANAGERS, UM IN THE STATUS QUO.
THE. SUCCESS IS BASED ON
INCREASING REVENUE. AND THE
PREMISE OF THE LEGISLATION. BUT
THE CHALLENGE FOR THE OFFICE AND
THE BOARD TO ACTUALLY IMPLEMENT
THIS IS I. I THINK CHANGING THAT
CALCULUS. TO SUCCESS BEING
FIGURING OUT HOW TO IMPROVE
ACCESS AND QUALITY IN THE
CONTEXT OF A CONSTRAINED BUDGET.
AND THAT'S A VERY BIG CHANGE
FROM WHAT? HOW SUCCESS IS
DETERMINED TODAY AND WILL BE A
HARD CHANGE TO ACCOMPLISH. I
MEAN, AS YOU KNOW, THERE IS AN
ENORMOUS INDUSTRY OR REALLY
COLLECTION OF INDUSTRIES AND
CHANGING HOW SUCCESS IS MEASURED
FOR THAT FOR THE SEVEN OF US ON
THE BOARD AND THE STAFF OF THE
OFFICE, UM YOU KNOW, THERE THERE
ARE VERY STRONG LEVERS PROVIDED
IN THE LEGISLATION TO DO THAT,
BUT WE WILL BE AN ONGOING
CHALLENGE OVER TIME. THANK YOU.
THANK YOU SO MUCH. IF IT'S ALL
RIGHT. DOCTORS WILL GO TO DR
CARLYLE AND, UH, HAVE YOU CLEAN
UP. IS THAT ALL RIGHT? THANK YOU
SO MUCH. DOCTOR. KYLO. THANK YOU
FOR COMING. AND THANK YOU,
SENATOR FOR THAT QUESTION. YOU
KNOW, AND IN CALIFORNIA, WE HAVE
A REALLY GREAT HEALTH CARE
SYSTEM MAY BE THE BEST IN THE
UNITED STATES. WE HAVE GREAT
HOSPITALS. WE HAVE GREAT DOCTORS
. THE TRAGEDY OF THE SYSTEM IS
THAT NOT EVERYBODY CAN AFFORD TO
ACCESS THE WONDERFUL SYSTEM THAT
WE HAVE IF WE CAN DO ANYTHING TO
KIND OF MOVE THE EQUILIBRIUM IN
FAVOR OF IMPROVED ACCESS TO THE
WONDERFUL SYSTEM WE HAVE. WE
SHOULD DO IT BECAUSE MORE PEOPLE
WILL GET HEALTH CARE THEY NEED
AND HEALTH CARE OUTCOMES WILL
IMPROVE. SO I THINK THAT'S ONE
OF THE GOALS OF, UH THE STATUTE
AND I THINK ONE OF THE IMPORTANT
TARGETS FOR THE STATE OF
CALIFORNIA. UM I'VE NEVER HEARD
ANYBODY COME UP TO ME AND SAY,
UH, DAVE, THE HEALTHCARE SYSTEM
IS SO CHEAP. I CAN'T BELIEVE IT.
USUALLY THEY SAY, I CAN'T
BELIEVE IT'S SO EXPENSIVE
$25,000 FOR THREE HOURS IN THE
EMERGENCY ROOM. UM IT'S AMAZING.
IT'S PARADOXICAL, ACTUALLY.
THANK YOU, SENATOR. THANK YOU SO
MUCH, PLEASE SET HERNANDEZ.
THANK YOU AGAIN, SENATOR FOR THE
TIME WE HAD TO VISIT. I WOULD
AGREE WITH EVERYTHING MY
COLLEAGUES HAVE SAID, AND I
WOULD ADD TWO ADDITIONAL DATA
POINTS. ONE IS THAT, UH, AS DR
CARLO MENTIONED, IT'S REALLY NOT
AFFORDABLE FOR ANYBODY. UM SMALL
BUSINESSES STRUGGLE WITH
PROVIDING PREMIUMS FOR THEIR
WORKFORCE. SO THE PROBLEM THAT
WE HAVE WITH AFFORDABILITY IS A
PROBLEM THAT REALLY EXISTS IN
RURAL COMMUNITIES. IN OUR
BUSINESS COMMUNITY HAS SEEN
ITSELF IN LIMITING WHAT WE'RE
ABLE TO DO IN WAGES. AND SO I
WANT TO MAKE THAT POINT AND THE
CALIFORNIA HEALTH CARE
FOUNDATION DOES A POLL EVERY
YEAR AND ASK FOLKS ACROSS THE
STATE ALL WALKS OF LIFE. WHAT IS
THE BIGGEST CHALLENGE IN HEALTH
CARE AND AFFORDABILITY? IS THAT
ISSUE AND SO I THINK, IF YOU
HEAR FROM CONSUMERS OR FROM THE
SMALL BUSINESS COMMUNITY, AS OUR
COLLEAGUES HAVE SAID, WE HAVE AN
OPPORTUNITY THROUGH THIS. TO
REALLY SHIFT THE INCENTIVES TO
TRY TO KEEP PEOPLE WELL AND TO
TRY TO TAKE CARE OF THEM IN A
WAY THAT IS BOTH BENEFICIAL FOR
THEIR OUTCOMES AND FOR THEIR
LIVELIHOOD, AND THAT REALLY
REDIRECT SOME OF THE INCENTIVES
THAT WE HAVE RIGHT NOW IN OUR
SYSTEM THAT REALLY DRIVES UP
COSTS. OK, THANK YOU. IF I JUST
HAVE A FOLLOW UP. I'M SORRY.
THIS I LIKE THIS AREA. UM AND I
AND I AGREE, AND DOCTOR CARLA,
IT KIND OF SURPRISED ME WHEN WE
SAY WE HAVE THE BEST SYSTEM IN
THE COUNTRY, RIGHT? BECAUSE WE
HEAR COMPLAINTS FROM SO MANY,
AND WE KNOW THAT OUR HEALTH CARE
OUTCOMES AREN'T GREAT, RIGHT?
OUR HEALTH CARE OUTCOMES ARE NOT
REFLECTIVE OF THE BEST SYSTEM IN
THE IN THE COUNTRY. UM AND SO
WHEN WE'RE TALKING ABOUT ACCESS,
I KNOW ACCESS IS CLOSELY
CORRELATED WITH WORKFORCE. AND
THAT IS PART OF YOUR ROLE AS
WELL RIGHT BECAUSE WE'RE NEVER
GOING TO PROVIDE BETTER ACCESS
AND REDUCE COSTS UNTIL UNLESS WE
HAVE THE WORKFORCE, ESPECIALLY
OUT THE COMMUNITY TO BE ABLE TO
PROVIDE SOME OF THAT. SO I'M
JUST WONDERING LIKE, HOW DO YOU
SEE THOSE TWO THOSE TWO THINGS
GOING TOGETHER AND THE
COMMISSION BEING ABLE TO MAKE
PROGRESS ON THAT. OH, YES, AGAIN
. I DO THINK WE HAVE SOME OF THE
COUNTRY'S BEST HOSPITALS. UM,
BEST PHYSICIANS IN THE STATE OF
CALIFORNIA, BUT WE DO HAVE MAJOR
ACCESS TO CARE ISSUES IN THE
STATE OF CALIFORNIA. SO THANK
YOU, SENATOR FOR YOUR QUESTION.
UM, I WOULD SAY THAT WE CAN
ACTUALLY HAVE AN EVEN BETTER
SYSTEM IF OUR SYSTEM CAN BE MORE
EFFICIENT, AND THAT MEANS THAT
THE SYSTEM IS ABLE TO GIVE
PEOPLE WHAT THEY NEED WHEN THEY
NEED IT MORE EFFECTIVELY, AND
THAT'S REALLY ONE OF THE GOALS
OF THE OF THE BOARD. THAT'S ONE
OF THE GOALS OF THE ACT AND THE
OFFICE AS WELL. I THINK THAT'S A
VERY IMPORTANT GOAL FOR THE
STATE OF CALIFORNIA. UH, WE HAVE
GREAT. SOURCES BUT NOT EVERYBODY
CAN ACCESS THEM AND I WOULD LIKE
TO SEE THAT IMPROVE. THANK YOU.
THANK YOU SO MUCH. ANYONE ELSE
ON THIS? UH QUESTION FROM THE
SENATOR BEFORE WE TURN BACK OVER
TO SENATOR FOR ANY CLOSING ON
THIS, BUT ANYONE ELSE ON THIS
ISSUE? SENATOR EGMOND, PLEASE
TAKE IT AWAY. OTHER ITEMS THAT
YOU HAVE NÓ. AND JUST IF WE
COULD JUST TALK ABOUT THE ISSUE
ABOUT MENTAL HEALTH RIGHT, AND
WE ALSO KNOW THAT'S A HUGE
DRIVER OF OUR HEALTH CARE COST
OF OUR WORKFORCE AND EVERYTHING.
I JUST HAD OCCASION TO BE IN OUR
NURSE'S OFFICE, GETTING A
DRESSING ON A ON A ON A WOUND,
BUT I SAID TO HIM, WHAT'S THE
BIGGEST? YOU KNOW, WE'RE BIG
CAPITAL. WHAT'S THE BIGGEST
THING THAT PEOPLE COME IN FOR? I
GUESS ALLERGIES RIGHT, HE SAID,
UH, HEADACHES WHICH COME FROM
ALL DIFFERENT KINDS OF MEANINGS,
BUT ALSO SOME MENTAL HEALTH
ISSUES, RIGHT THAT WE KNOW CAUSE
A LOT OF PHYSICAL MANIFESTATION
IF WE DON'T KNOW WHAT'S GOING
ON, SO HOW DO WE GO? MORE
HOLISTICALLY. BEING ABLE TO DEAL
WITH OUR OUR MENTAL HEALTH
ISSUES WORKFORCE AND JUST
INTEGRATING US ALL OVER INTO THE
COMMUNITY. HERNANDEZ. THANK YOU
FOR THAT, UH, REALLY IMPORTANT
QUESTION, SENATOR. I'LL JUST SAY
THAT, UM THEY CAME FROM A FAMILY
WHERE MENTAL ILLNESS EXISTED. UH
AND I'VE WATCHED, UM, A VERY
DEBILITATING PSYCHIATRIC
CONDITIONS AND SEEING THE WAY
OUR SYSTEM TRIES TO DEAL WITH
ONE SET OF A PROBLEM, UH, WITH
AN INDIVIDUAL AT THE EXPENSE OF
ANOTHER, AND ONE OF THE
OPPORTUNITIES THAT WE HAVE IN
THIS STATE IS REALLY TO BEGIN TO
LOOK AT HOW WE DELIVER
MEANINGFUL WHOLE PERSON CARE FOR
AN INDIVIDUAL WHETHER THEY
HAPPEN TO HAVE A PRE EXISTING
CONDITION OR AN EPISODIC MENTAL
HEALTH CONDITION AND INTEGRATE
THAT FULLY INTO A PRIMARY CARE
MODEL. WE HAVE MANY EXAMPLES OF
WHERE THAT WORKS. WE HAVE A
SIGNIFICANT WORKFORCE SHORTAGE
BACK TO YOUR PRIOR QUESTION,
PARTICULARLY IN MENTAL HEALTH
AND BEHAVIORAL HEALTH. BUT WE
ALSO HAVE EVIDENCE ABOUT HOW WE
CAN ACTUALLY LEAVE THESE
PROGRAMS IN A MEANINGFUL WAY IN
COMMUNITIES. MY COUSIN SUFFERED.
SCHIZOPHRENIA AND A VERY SMALL
RURAL COMMUNITY AND YOU CAN SEE
THE WAY A COMMUNITY CAN COME
AROUND THEM. BUT WHEN WE DON'T
HAVE ACCESS TO PSYCHIATRIC
MEDICATIONS, AND YOU DON'T HAVE
ACCESS TO GOOD PRIMARY CARE, YOU
MAY TREAT THE PSYCHIATRIC
CONDITION QUITE WELL AND
SUCCUMBED TO THE PHYSICAL. AND
SO I THINK THE GOAL HERE IS
REALLY TO INTEGRATE THOSE INTO
REALLY BUILD A WORKFORCE THAT
CAN BE A WIDE CONTINUUM OF
MENTAL HEALTH. UH UH, CONDITIONS
THAT WE HAVE IN THE STATE. THANK
YOU. THANK YOU. LET'S GO TO MISS
MITCHELL. AND WE'RE GOING TO GO
TO DR KNICK. MS. MITCHELL, THE
FLOOR IS YOURS. THANK YOU FOR
THIS QUESTION. IT COULD NOT BE
MORE IMPORTANT. MY DAUGHTER IS A
CLINICAL SOCIAL WORKER WORKING
WITH YEAH, WITH, UH ADOLESCENTS
AND KIDS IN EMERGENCY ROOMS AND
TRYING TO FIND MENTAL HEALTH
SERVICES IS ALMOST IMPOSSIBLE.
IT IS AN ABSOLUTE CRISIS AND ONE
OF THE CONTRIBUTING FACTORS.
THERE ARE MANY IS OBVIOUSLY
WORKFORCE BUT ALSO THE FEE FOR
SERVICE SYSTEM WHERE YOU CANNOT
EVEN GET IN FOR AN ADEQUATE
AMOUNT OF TIME TO HAVE CONDITION
TREATED TO DR HERNANDEZ'S POINT.
WE ARE WORKING VERY HARD WITH MY
MEMBERS MY JUMBO EMPLOYER
MEMBERS TO ACTUALLY PAY
DIFFERENTLY SO YOU CAN SPEND THE
TIME NEEDED AND COVER SOCIAL
NEEDS AND ALSO INTEGRATE
BEHAVIORAL HEALTH INTO PRIMARY
CARE, BECAUSE HONESTLY, MENTAL
HEALTH CARE IS PRIMARY CARE. IT
NEEDS TO BE INTEGRATED, SO THE
WHOLE PERSON IS TREATED. BUT
RIGHT NOW, THE PAYMENT SYSTEM
MAKES THAT HARD. UM A LOT OF
INSURANCE PLANS LIKE THAT HARD
SO ONE OF THE OPPORTUNITIES WITH
OCA IS TO REALLY THINK ABOUT NEW
DELIVERY SYSTEMS PAID FOR
DIFFERENTLY SO WE CAN TREAT THE
WHOLE PERSON AND WE NEED SAME
DAY BILLING WITH ME TOO. I THANK
YOU SO MUCH, DOCTOR CRONICK,
PLEASE. OK THANK YOU. FOR THE
QUESTION, I, I WOULD ADD TO, UM
UH, SANDRA AND ELIZABETH'S
COMMENTS THAT IN THINKING ABOUT
THE LEVERS THAT, UM THE OFFICE
AND THE BOARD HAVE YOU KNOW, ONE
OF THE PROVISIONS OF THE
LEGISLATION IS THE ESTABLISHMENT
OF BENCHMARK SPENDING TARGETS
FOR BOTH PRIMARY CARE AND
BEHAVIORAL HEALTH. WE HAVEN'T
DISCUSSED WHAT THOSE TARGETS
MIGHT BE. BUT I THINK ALL OF OUR
PRESUMPTIONS IS THAT THE TARGETS
WOULD BE HIGHER THAN THE STATUS
QUO LEVEL OF SPENDING. UM PART
OF WHAT THE OFFICE CAN DO IS TO
INCREASE TRANSPARENCY AND
INFORMATION. WE DON'T EVEN KNOW
WHAT THE STATUS QUO LEVEL OF
SPENDING IS, WHICH WILL MAKE IT
HARD TO ESTABLISH A BENCHMARK
THAT IS ABOVE THAT, BUT I AM
CONFIDENT THAT THE OFFICE, UH
WILL WILL BE ABLE TO MAKE
PROGRESS IN THAT. THANK YOU,
DOCTOR. THE COMMENTS FROM
SENATOR I BEING PLEASED DR
CARLYLE IN THE TO ADVANCE IN
THIS THE OTHER COMMENT THAT I
WAS GONNA MAKE. UH, SENATOR IS,
UM I. I UH, LEAD AN INSTITUTION
IN SOUTH LOS ANGELES, ONE OF THE
GREATEST LARGEST UNDERSERVED
REGIONS IN THE UNITED STATES AND
IN THIS REGION WHEN YOU'RE WHEN
YOU'RE FACING A MENTAL HEALTH
CRISIS, PEOPLE ARE RETICENT TO
CALL 911. UH, BECAUSE WHEN THEY
CALL 911 FOR SOMEBODY THAT'S
HAVING A ATTACK OF SCHIZOPHRENIA
OR SOME OTHER, UM UH UH, OUT OF
CONTROL SITUATION, ALL TOO OFTEN
BAD OUTCOMES CAN OCCUR
IMMEDIATELY. AND SO THIS IS JUST
A FUNCTION OF THE ABSENCE OF
WORKFORCE IN HEALTH CARE AND
WORKFORCE IN HEALTH SERVICES. SO
I, I ABSOLUTELY RESONATE WITH
YOUR CONCERN ABOUT THIS AS A AS
AN IMPORTANT AREA THAT CAN
IMPROVE, UH, WITH THE
APPROPRIATE ADMINISTRATION OF
THE ACT HERE. THANK YOU. JUST
ONE FINAL SAY YES OR NÓ WE'VE
INSTITUTED OVER THE LAST COUPLE
OF YEARS WITH THE ADMINISTRATION
THAT THE UM BEHAVIORAL AND CHILD
AND ADOLESCENT INFRASTRUCTURE. I
CAN'T REMEMBER THE NAME BUT IT'S
LIKE YOU KNOW, ONLINE ON TIME,
PEOPLE CAN GET ACCESS. HOW DO
YOU SEE THAT BEING A TOOL OR OR
IS IT JUST THE PROGRAM WE HAVE
STARTED? WELL SENATOR. THANK YOU
FOR THAT QUESTION. I HAVE A 23
YEAR OLD DAUGHTER AND I WILL
TELL YOU THAT, UH, ALL OF HER
PEERS USE TOOLS THAT COME IN THE
FORM OF A PHONE FOR MOST ALL
THINGS, AND SO I THINK WE NEED
TO USE ALL THE TOOLS THAT ARE AT
OUR DISPOSAL, AND THERE ARE MANY
THAT ARE FOCUSED ON SCHOOL AGE,
FOLKS. UM, THERE ARE COMPANIES
THAT ARE TRYING TO EXPAND.
ACCESS TO CARE IN LOS ANGELES
SCHOOL DISTRICT AS AN EXAMPLE.
UM, SO WE'VE GOT ENTREPRENEURS
THAT ARE THINKING ABOUT THIS. WE
HAVE TECHNOLOGY TO BE ABLE TO DO
THAT, AND I. I THINK THAT GIVEN
THE CRISIS AND GIVEN THAT WE'RE
NOT GOING TO UH, THERE ARE A LOT
OF INPUTS. UM, BUT BUT I WHAT I
WHAT I WOULD SAY IS THAT, UM WE
SHOULD USE ALL THE TOOLS THAT WE
HAVE IN MENTAL HEALTH AND
BEHAVIORAL HEALTH AS WE BUILD
OUT THIS NECESSARY WORKFORCE. WE
HAVE YOUNG PEOPLE WHO ARE COMING
OUT OF A CRISIS WHERE COVID
REALLY DISRUPTED THEIR LIVES
QUITE DRAMATICALLY, AND THEY ARE
JUST BEGINNING TO ADDRESS SOME
OF THOSE FEARS. SOCIETY IS
ASSOCIATED WITH THAT, AND I
THINK WE HAVE MANY TOOLS. WE
SHOULD LOOK AT WHICH ONES WORK
AND TRY TO MAKE SURE WE RESOURCE
THOSE THANK YOU SO MUCH. WHY
DON'T WE SENATOR EDMUND HAS
ASKED TO BE ABLE TO PROVIDE A
BRIEF ANSWER. IF THAT WORKS. SO
WHY DON'T WE START WITH MS
MITCHELL? WE'LL WORK OUR WAY
DOWN ON IS OK, NÓ. THAT'S GREAT.
ANYONE ELSE WANNA COMMENT ON
THIS AS WELL? I'M TRYING TO JUST
THANK YOU, UH, ANY OTHER
COMMENTS? DR EMAN? THANK YOU ALL
VERY MUCH FOR BEING WILLING TO
TAKE ON THIS HUGE TASK. I
APPRECIATE IT. IT'S IMPORTANT.
THANK YOU, DR EKMAN FOR HIS
LEADERSHIP AND PASSION ON THIS
ISSUE, WE WILL TURN OVER TO
MADAM VICE CHAIR. THANK YOU. MR
PRO TEM? UH, A HUGE TASK AT
HAND. AND, UM I WORKED ON THE
FINANCIALLY DISTRESSED HOSPITAL
BILL LAST YEAR, THE M èC Ó TAX
THINGS. I HAVE FINANCIALLY
DISTRESSED HOSPITALS IN MY
DISTRICT. UM I FIRMLY BELIEVE
THAT IT'S BECAUSE OF POLICIES
THAT COME OUT OF THIS, UM,
BUILDING THAT CREATE, UM, A LOT
OF THE CATASTROPHIC ISSUES THAT
WE FACE, INCLUDING MEDICARE
REIMBURSEMENTS AND, UM SEISMIC
AND SOME OTHER THINGS. UH OVER
HALF OF CALIFORNIA'S HOSPITALS
ARE OPERATING AT A FINANCIAL
LOSS. UM, IN ALMOST ALL OF OUR
DISTRICTS, INCLUDING THE PRO TEM
UM, DOCTOR EGGMAN, SENATOR
LAIRDS, UM ALL OF US. AND
SPECIFICALLY, MAYBE NOT ON THIS
DAAS COMPLETELY. BUT UM, A LOT
OF US IN THE SENATE ARE
EXPERIENCING THIS AND WORKED
REALLY HARD TO TRY TO REPAIR
SOME OF THAT, UM I GUESS MY
CONCERN THAT I HAVE WITH THE WAY
THE BOARD IS APPROACHING THINGS
WITH ONE OUT OF HALF. FIVE.
HOSPITALS REMAIN AT RISK FOR
CLOSURE. UM AS AN Ó èC HÌ A,
UH. BOARD MEMBER. HOW DO YOU
VIEW THE CHALLENGES OF TRYING TO
BALANCE FINANCIAL CHALLENGES ON
THE HOSPITALS, DOCTORS AND
PROVIDERS AND PATIENT ACCESS TO
CARE AND ACCOUNTABILITY? AND THE
REASON WHY I ASKED THAT QUESTION
IS THAT, UM YOU HAVE A DOCUMENT
OR SOMETHING THAT YOU'RE WORKING
ON IS LIKE A THREE PERCENT. UH
DOLLAR AMOUNT 3% OF SPENDING
WHEN YOU KNOW, UH THE G Dð P
GROWTH IN CALIFORNIA IS THREE
THREE 0.5. SO YOU'RE OPERATING.
YOU'RE ASKING YOUR HOSPITALS TO
OPERATE LESS THAN THE G Dð P
GROWTH WHEN THEY'RE ALREADY
LOSING MONEY, AND YOU'RE NOT
ACCOUNTING FOR THERE'S NÓ
EXEMPTIONS FOR SEISMIC FOR
MEDICAL SUPPLIES,
PHARMACEUTICALS, MEDICAL
TECHNOLOGIES, UM, AND ALL THESE
THINGS THAT ARE COSTING MORE,
INCLUDING LABOR COST THAT JUST
WENT UP TO. I BELIEVE A MINIMUM
OF $25 AN HOUR HERE OR THERE
ABOUT A NUMBER. UH WHERE DID YOU
COME UP WITH 3% AND WHY IS IT
NOT EVEN SUBJECT TO THE THREE
0.5% TIED TO G Dð P IN
CALIFORNIA OR DO YOU HAVE
ANOTHER SOLUTION? WE CAN START
WITH MS MITCHELL. IF THAT WORKS
FOR YOU. SORRY MR CHAIR. SORRY I
APOLOGIZE. MR MITCHELL. OK?
YEAH. THANK YOU FOR THAT
QUESTION. IT'S OBVIOUSLY
CRITICALLY IMPORTANT. UM, I
ACTUALLY USED TO WORK FOR A
HOSPITAL BASED HEALTH CARE
SYSTEM, AND WE HAD RURAL
HOSPITALS THAT FACED VERY
DIFFERENT CHALLENGES THAN SOME
OF THE LARGE ACADEMIC MEDICAL
CENTERS. UM ONE OF THE I THINK
THE STRENGTHS OF THE LAW IS THAT
IT ALLOWS US TO LOOK AT
REGIONALITY NOT TO HAVE A ONE
SIZE FITS ALL RESPONSE, AND WE
WILL ALSO HAVE DATA TO
UNDERSTAND HOW DIFFERENT REGIONS
AND DIFFERENT FACILITIES ARE
BEING IMPACTED. UM THE 3% THAT
YOU REFERRED TO AS A STAFF
RECOMMENDATION. OCA HAS NOT
ACTUALLY TAKEN ACTION YET.
OBVIOUSLY THAT IS SOMETHING THAT
WE ARE CONSIDERING, BUT IT IS
ABOUT SORT OF BALANCING
OBVIOUSLY, THE CRITICAL NEEDS OF
THE INDUSTRY WITH THE, UM
INABILITY TO AFFORD SOME OF THE
SERVICES THAT PEOPLE NEED. AND
SO WE'VE HAD. VERY UM, I THINK
IMPORTANT CONVERSATIONS ABOUT
HOW DO WE DO THAT MOST
EFFECTIVELY AND FAIRLY, BUT
CLEARLY UNDERSTANDING THE
SPECIFIC NEEDS OF RURAL AREAS IS
FIRST AND FOREMOST ON MANY OF
OUR MINDS, AND WE WANT TO
PRESERVE ACCESS TO NEEDED CARE,
BECAUSE IF WE DON'T HEALTH CARE
WILL ONLY BECOME MORE EXPENSIVE.
YOU, MISS FITCH. WOULD IT BE? IS
IT TO GO DOWN THE LINE AND THEN
WE'LL TURN IT RIGHT BACK OVER TO
YOU, MADAM. VICE CHAIR, IS IT?
ABSOLUTELY, SIR. THANK YOU, SIR.
DR KICK. THANK YOU, UM, I. I
WOULD ADD TO ELIZABETH'S, UH,
COMMENTS. UH, FOR FIRST IT'S
LIKE CLARIFICATION. THE 3% IS 3%
PER PERSON. IT IS STILL AN
AGGRESSIVE TARGET. EXCUSE ME, E.
EVEN SO, UM YOU KNOW, 35 YEARS
AGO, I. I WAS CO AUTHOR ON AN
ARTICLE THAT DESCRIBED HEALTH
CARE IN THE U S¼ AS A PARADOX OF
EXCESS AND DEPRIVATION. AND AND,
SADLY, I THINK THAT THAT
DESCRIPTION IS STILL APT. 35
YEARS LATER, AND SO, AS YOU
POINT OUT, WE HAVE MANY, UH
HOSPITALS AND OTHER HEALTHCARE
PROVIDERS STRUGGLING TO STAY
AFLOAT AT THE SAME TIME THAT WE
SPENT TWICE AS MUCH MONEY PER
PERSON AS ANY OTHER DEVELOPED
NATION AND HEALTH CARE IS
UNAFFORDABLE FOR SO MANY IN
CALIFORNIA AND THE CHALLENGE.
THAT WE ALL FACE IS TRYING TO
RECONCILE THESE TWO KIND OF
POLAR EXTREMES. UM I, I DO THINK
THAT IT IS POSSIBLE TO DO SO.
IF, UM WE WORK CAREFULLY AND
SENSITIVELY, UH AND AS AS
ELIZABETH POINTED OUT, UM THE
LEGISLATION PROVIDES THE
OPPORTUNITY TO CONSIDER TARGETS
DIFFERENTLY FOR, UH BY REGIONS
BY SECTORS. WE HAVEN'T YET HAD
THE CONVERSATIONS OF HOW THAT
MIGHT LOOK, WE, YOU KNOW IT IS
STILL IN IN FORMATIVE PHASE, SO
THERE IS WORK TO BE DONE. AND UM
, NÓ, I CAN'T KIND OF MAKE YOUR
SILVER BULLET. MAGIC PROMISE
EXCEPT TO SAY THAT WE ARE AWARE
OF THESE CHALLENGES, AND I THINK
THAT THE LEGISLATION PROVIDES
THE TOOLS AND OPPORTUNITIES TO
MAKE PROGRESS. THANK YOU. THANK
YOU, DOCTOR HERNANDEZ. I GO TO
DR CARLISLE, AND WE'RE GOING TO
BRING HIM BACK TO THE VICE CHAIR
FOR FOLLOW. SENATOR GROVE
IDENTIFIED A REALLY FUNDAMENTAL
CHALLENGE THAT THE BOARD HAS. I
WILL TELL YOU THAT WHEN I WAS
DIRECTOR OF HEALTH IN SAN
FRANCISCO, I OVERSAW SAN
FRANCISCO GENERAL HOSPITAL,
LAGUNA HONDA HOSPITAL. AND UM,
EVERY YEAR, YOU'RE CHALLENGE IS
TO MATCH REVENUES WITH EXPENSES
BECAUSE THE PUBLIC HOSPITAL
YOU'RE NOT GOING TO GO IN DEBT.
YOU DON'T HAVE THE ABILITY TO
BORROW. AND YOU MAKE DECISIONS
BASED ON WHAT IS REIMBURSED AND
WHAT VOLUME AND NOT NECESSARILY
AROUND WHAT YOUR COMMUNITY NEEDS
YOU TO BE ABLE TO PROVIDE. A
GOOD EXAMPLE WOULD BE WHEN YOU
DON'T HAVE AN Ó BGY N OF RUN
AN Ó BGY N UNIT. YOU CAN'T RUN
IT AN Ó BGY N UNIT THAT'S A
WORKFORCE ISSUE THAT'S
FUNDAMENTAL TO A SERVICE THAT'S
CRITICAL IN A COMMUNITY. SO WHAT
WE'RE TRYING TO DO HERE IS USE
THIS LEGISLATION TO THE BEST OF
OUR ABILITY. AS WE'VE SAID IN
OTHER RESPONSES TO MOVE THE
REIMBURSEMENT TO THE SERVICES
THAT ARE MOST NEEDED IN THOSE
COMMUNITIES, AND I PERSONALLY
THINK ONE OF THE MOST IMPORTANT
PARTS OF THE LEGISLATION IS THE
TRANSPARENCY THAT WE WILL GET
THAT CONSUMERS WILL GET THAT
LEGISLATORS WILL GET THAT
POLICYMAKERS WILL GET TO
UNDERSTAND AT A REGIONAL LEVEL
WHERE THERE HAVE BEEN MARKET
FAILURES, AND THERE ARE CLEARLY
MANY FAILURES AND MANY THRIVING
MARKETS ACROSS THE STATE OF
CALIFORNIA. SO THE TOOLS THAT WE
HAVE IN THE TOOLBOX AT OA FOR
TRANSPARENCY ALONE, I THINK WILL
BE INCREDIBLY HELPFUL FOR US TO
BE ABLE TO LEARN ABOUT WHAT THE
ETIOLOGY IS OF REGIONAL ISSUES
THAT EMERGE. THANK YOU. OH,
SORRY. I WAS JUST GONNA GO, DR
CARLA AND TURN RIGHT BACK OVER
TO YOU. IS THAT ALL RIGHT?
ADVICE HERE. ABSOLUTELY I
APOLOGIZE. PLEASE DOCTOR
CARLYSLE. THEN WE'RE GONNA BRING
IT BACK TO THE VICE CHAIR FOR
COMMENTS. WELL THANK YOU, PRO
TEM. AND THANK YOU, SENATOR
GROVE FOR, UH, FOR THE QUESTION.
UM YOU KNOW, THIS IS THIS IS
REALLY A, UH, A VERY IMPORTANT
CONSIDERATION. UM IF WE HAVE A
HEALTH CARE PROVIDER, A
HOSPITAL, UM, DISAPPEAR BECAUSE
OF, UM UH, ANY ANYTHING THAT
THAT WE MIGHT, UM, MIGHT APPROVE
AS PART OF THIS PROCESS THAT
DOESN'T IMPROVE ACCESS TO CARE
IN THE STATE OF CALIFORNIA AND
I'VE BEEN TO VIRTUALLY EVERY
COUNTY EVERY COUNTY IN
CALIFORNIA HAS SEEN MANY RURAL
CRITICAL ACCESS HOSPITALS. AND I
KNOW HOW THIN THEIR MARGINS ARE
OR HOW NEGATIVE THE MARGINS ARE.
AND I KNOW HOW IMPORTANT THEIR
CONTRIBUTIONS ARE. UM IF YOU
HAVE A HOSPITAL WITH A LABOR AND
DELIVERY UNIT THAT ALL OF A
SUDDEN CLOSES AND YOU HAVE TO
TRAVEL FOUR OR FIVE HOURS
THROUGH SNOW COVERED HIGHWAYS TO
HAVE A BABY OR MORE, UM,
CALIFORNIA SUFFERS, SO I WOULD
SAY, UM, I'M ASSURED MYSELF THAT
ON OUR BOARD, WE HAVE A
COLLECTION OF COLLEAGUES WHO ARE
VERY AWARE OF THE IMPORTANCE OF
THESE ISSUES AND ARE GOING TO
TAKE THIS INTO CONSIDER. AS WE
MOVE FORWARD WITH THIS PROCESS,
RECOGNIZING THAT THE PROPOSED 3%
TARGET IS A TARGET RIGHT NOW, UM
, SOMETHING THAT HASN'T BEEN
APPROVED YET, AND WE ARE ENGAGED
IN A VERY PUBLIC PROCESS WITH A
LOT OF TRANSPARENCY TO GUIDE US
THROUGH THIS PROCESS. AND IF WE
FIND THAT THERE ARE ISSUES WITH
IT, I KNOW THAT WE WILL REVISIT
THE PROCESS AND IF WE HAVE TO
RECALIBRATE THE TARGET, I KNOW
THAT WE WILL THANK YOU SO MUCH,
DOCTOR. THANK YOU. THANK YOU,
UH, FULL DISCLOSURE. THIS IS OUR
BRAND NEW SENATE PRO TEM THAT WE
JUST SELECTED AND, UM, WE'RE
GETTING I'M GET I'M GETTING USED
TO HIS STYLE. UM SO I APOLOGIZE
THAT I KEEP STEPPING ON YOU,
SIR. I'M SO SORRY. I AGREE TO I
DIDN'T MEAN TO DO THAT. UM BUT I
WILL LEARN YOUR STYLE BECAUSE I
THINK IT'S EXTRAORDINARILY
EFFECTIVE. IT'S GOOD. UM THE
ONLY REASON I'M KIND OF A HARSH
AND KIND OF DIRECT ON THIS
SUBJECT IS I HAVE RIDGECREST
COMMUNITY HOSPITAL, AND IT IS
CLOSING DOWN ITS LABOR AND
DELIVERY SERVICES. AND YOU'LL GO
88 MILES AND 88 MILES. DON'T
THINK IT'S 88 MINUTES. IT'S 60
MILES AN HOUR. YOU'RE GOING DOWN
A CANYON WHERE YOU CAN ONLY GO
10 MILES AN HOUR AROUND SOME OF
THESE CURVES WITH A DROP OF
ABOUT 100 AND 20 FT. NEXT TO YOU
ON A TWO LANE ROAD AND A
MOUNTAIN WITH ROCKS THAT
OVERHANG ON THE OTHER SIDE. SO
UM, I'M NOT TALKING SAN
FRANCISCO LOS ANGELES ARE GOING
DOWN THE I FIVE UM, IF SOMETHING
DOESN'T CHANGE BETWEEN NOW AND
APRIL, 1ST, THEY'RE GOING TO GO
TO STAND BY EM EMERGENCY. THIS
IS ALSO THE HOSPITAL THAT TAKES
CARE OF ONE OF THE LARGEST
RESEARCH, THE LARGEST RESEARCH
AND DEVELOPMENT BASES THAT DOES
OUR PROTECTION FROM CALIFORNIA
AND THE SOUTH CHINA SEA, AND
IT'S THE CHINA LAKE NAS NAVAL
AIR WARFARE CENTER. THEY MAKE
STUFF UP JUST BRILLIANTLY TO,
UM, CREATE SAFETY IN OUR, UM,
CYBER SECURITY. I MEAN, THEY
JUST BRILLIANT PEOPLE OUT THERE.
THINK OUTSIDE THE BOX, AND THEY
JUST THINK OF STUFF THAT WORKS.
YOU'RE NOT GOING TO RECRUIT
THOSE PEOPLE. IF THEY CAN'T HAVE
A BABY, YOU'RE NOT GONNA RECRUIT
THOSE PEOPLE IF THERE'S AN
URGENCY WITH THEIR SON OR
DAUGHTER, AND THEY DON'T HAVE AN
EMERGENCY ROOM TO GO TO. I'M IN
CONSTANT COMMUNICATION WITH THIS
PARTICULAR HOSPITAL ALMOST ON A
DAILY BASIS, AND THOSE ARE MY
FEARS. AND THE FEAR I HAVE IS
THAT IF THAT HOSPITAL CLOSES
DOWN ITS EMERGENCY ROOM, IT
AFFECTS THE TOWN. THE CITY. THE
BASE OUR SECURITY. AND I'M VERY
CONCERNED THAT THE FOCUS THAT
YOU HAVE IS YOU'RE GONNA CUT
SPENDING 23% INSTEAD OF REALLY
ADDRESSING THE PROBLEMS THAT WE
HAVE WITH REIMBURSEMENT RATES
WITH ACCESS TO CARE. I'M A
BUSINESS OWNER IN THE REAL
WORLD. UM I SEE THE REAL WORLD.
I MEAN, OTHER THAN THIS JOB. UM,
I'M A BUSINESS OWNER. AND, UM IF
I HAD AN EMERGENCY ROOM AS I WAS
HAVING TO STAFF FOR THE Ó, BGY
N AND A COMPLETE STAFF AND
STAFFING RATIOS, AND I HAD THREE
BABIES A MONTH. THAT'D BE PRETTY
DARN DIFFICULT TO DO. THOSE
BABIES STILL HAVE TO HAVE A
PLACE TO BE BORN. UM I'M VERY
CONCERNED ABOUT THE
CARDIOPULMONARY UNIT. YOU'RE
HAVING A HEART ATTACK OR A
STROKE. YOU WANNA GO 88 MILES
AND DOWN A CANYON? I KNOW THAT.
UM AND I'M NOT SPEAKING FOR HER
AS A NEW MEMBER ON THE
COMMITTEE. BUT I KNOW THAT DR
EDMAN HAS ONE OF THE SAME
CONCERNS THAT I HAVE ABOUT RURAL
HEALTHCARE AND, UM I APPRECIATE
THE FACT THAT YOU GUYS ARE
ADDRESSING REAL HEALTH CARE THAT
YOU HAVE BEEN TO EVERY COUNTY.
I'M ASSUMING YOU'VE BEEN TO KERN
COUNTY AS WELL. UH, DOCTOR, UH,
I JUST I, UM. I HAVE HUGE
CONCERNS ABOUT ELIMINATING RURAL
HEALTHCARE TO PEOPLE WHO DESERVE
IT. MY OTHER HOSPITAL AND I KNOW
I'M ON A RANT RIGHT NOW. IS
KOREA. 90% OF THE PEOPLE THAT GO
THROUGH THAT HOSPITAL ARE LOW
SOCIO-ECONOMIC DISADVANTAGED
COMMUNITIES ON ME, RIGHT? ME
REIMBURSEMENT RATES. THERE'S NOT
ENOUGH OFFSET FOR, UM THE PLANS.
THERE'S NOT ENOUGH OFFSET AND
YOU, MA'AM, MISS HERNANDEZ SAID.
YOU'RE IN SAN FRANCISCO. WHEN A
CONVERSATION WITH THE SAN
FRANCISCO LEGISLATOR, HE GOES,
JUST GET A DONOR TO GIVE YOU A
COUPLE OF BILLION. DOLLARS I
DON'T HAVE A DONOR THAT'S GONNA
GIVE ME A COUPLE OF BILLION
DOLLARS FOR A FOUNDATION. THIS
1700 BEDS. UM AND, UH, IF, IF Kò
COLLAPSES, IT WILL AFFECT FRESNO
BECAUSE WE'VE ALREADY LOST
MERCED, WHICH IS HOPEFULLY
COMING BACK ONLINE A LITTLE BIT
WITH ADVENTIST HEALTH. UM AND
IT'LL AFFECT BAKERSFIELD SO THE
CENTRAL VALLEY WILL BE ALMOST
WITHOUT HEALTH CARE, AND IT
SERVES THE HIGHEST UM MOST
MEDICAL POPULATION IN THE STATE.
I BELIEVE. AND THOSE ARE MY
CONCERNS. I THINK THAT WE ALL
WANT THE SAME SOLUTION. ACCESS
TO HEALTH CARE, ADEQUATE HEALTH
CARE, UH, EXCELLENT HEALTH CARE
THAT IS AFFORDABLE. I HAVE A
PROBLEM ABOUT HOW YOU GUYS ARE
GETTING THERE FROM A BUSINESS
PERSPECTIVE. AND UM I'M VERY
CONCERNED ABOUT THAT. AND I JUST
WANT TO SHARE THAT WITH YOU.
THANK YOU, SIR. THANK YOU SO
MUCH, MADAM VICE CHAIR FOR YOUR
FOCUS AND PASSION, ESPECIALLY IN
RURAL CALIFORNIA. VERY GRATEFUL
FOR THAT. I THINK IT'S SOMETHING
THAT, UH, YOURSELF, DR EGM
MYSELF. WE ALL FACE EACH AND
EVERY DAY. THANK YOU SO MUCH.
PLEASE. I. I WOULD ADD MYSELF TO
THAT LIST OF HAVING A LOT OF
RURAL CALIFORNIA DISTRICT. UM. I
WANNA FOLLOW UP ON, UH WHAT
SENATOR GROVE ASKED AND I FIRST
THANK YOU ALL FOR MEETING WITH
ME ON ALMOST NÓ NOTICE TODAY. I
REALLY APPRECIATE THAT. AND. AND
I HAVE TO CONFESS THAT WHEN I
STUDIED UP FOR THIS LAST NIGHT,
I REALIZED I'M THE ONLY MEMBER
OF THE COMMITTEE THAT WAS NOT IN
THE LEGISLATURE WHEN THIS BILL
WAS ADOPTED, SO THE DEBATE WAS
NEW TO ME IN IN IN A NUMBER OF
WAYS AND I GET WHAT THE GOAL IS.
SENATOR GROVE JUST TALKED ABOUT
IT. AND WHEN I WAS IN THE
ASSEMBLY, WE HAD RETREATS WERE
THE NUMBER ONE PRIORITY FROM A
LOT OF THE PROVIDERS WAS
LOWERING THE COST BECAUSE IT
WOULD LEAD TO MORE ACCESS OUR
TOTALLY SUBSCRIBE TO THE NEED
FOR THIS. THE THING I WANT TO
FOLLOW UP FIRST WAS ON ON. WHAT
SENATOR GROVE ASKED IS I WAS
SORT OF SURPRISED WHEN I TALKED
TO YOU BECAUSE I WAS A LITTLE
TAKEN ABACK BY THE 3% POSSIBIL.
OF THAT BEING THE NUMBER THAT
WAS PICKED. THAT'S NOT EVEN UH,
AT WHAT THE GROWTH IS IN THE
GROWTH, NATIONAL PRODUCT, AND SO
AND I DON'T WANT EVERY ONE OF
YOU THAT FEELS BEST EQUIPPED TO
ANSWER. I LEARNED FROM EACH OF
YOU THAT THERE WAS A LOT OF
FLEXIBILITY THAT THIS OR THERE
WAS FLEXIBILITY THAT THIS
PROCESS WILL GO ON FOR TWO OR
THREE YEARS BEFORE THERE IS ANY
KIND OF REMOTE ENFORCEMENT, AND
IT IS REALLY TEASING OUT WHETHER
THAT NUMBER WORKS. AND SO WHO
COULD SPEAK TO THAT? THAT WOULD
SORT OF GIVE SOME COMFORT. TO
THOSE THAT ARE CONCERNED ABOUT
ABOUT THE POSSIBILITY OF THIS
NUMBER BEING PICKED BECAUSE I
KNOW YOU HAVEN'T PICKED IT YET.
WHO WOULD LIKE TO BE ABLE TO
COMMENT ON THAT IN ADDRESS.
SENATOR LAIRD, PLEASE, DOCTOR
HERNANDEZ, THE FLOOR IS YOURS.
THANK YOU, SENATOR FOR THAT
QUESTION, AS WE TALKED ABOUT
BRIEFLY EARLIER TODAY. THIS BODY
DOES INTO THE OFFICE HAVE THE
ABILITY ULTIMATELY TO DO SOME
KIND OF ENFORCEMENT. BUT REALLY,
THE GOAL HERE IS NOT IN MY MIND
ABOUT ENFORCEMENT. IT'S REALLY
ABOUT UNDERSTANDING. UH, WHAT
THE COST AND CONDITIONS ARE
REGIONALLY THROUGHOUT THE STATE
OF CALIFORNIA AND A TRADE OF
PUSH THIS SYSTEM AS WE'VE TALKED
ABOUT TO BEING MUCH MORE OF A
PREVENTION, PRIMARY CARE,
BEHAVIORAL ORIENTED DELIVERY
SYSTEM, UM THERE WILL CLEARLY BE
SYSTEMS THAT ARE NOT ABLE TO
COMPLY WITH ANY TARGET THAT WE
SET AND WHAT WE WILL WANT TO
KNOW IS TO TRY TO UNDERSTAND WHY
THAT IS. AND WE WILL, FOR THE
FIRST TIME REALLY HAVE PUBLIC
DATA THAT WILL ALLOW US TO TRY
TO UNDERSTAND THAT AND THEN TO
WORK WITH THOSE SYSTEMS TO TRY
TO ADDRESS WHAT THOSE CONCERNS
ARE. THERE MAY BE VERY
LEGITIMATE REASONS WHY THEY
CAN'T MAKE THE TARGET AND THERE
MAY BE NOT. BUT I THINK THE
FIRST POINT IS TO NUDGE THE
SYSTEM TO MOVE IN THE RIGHT
DIRECTION AND THE SECOND THEN IS
TO REALLY UNDERSTAND WHAT WHERE
IT'S WORKING AND WHERE IT ISN'T
AND WHERE IT ISN'T REALLY
UNDERSTAND WHY THAT IS AND WHERE
WE NEED TO MAKE EXCEPTIONS TO DO
SO. I THINK WE HAVE THE BENEFIT
OF GETTING A LOT MORE
TRANSPARENCY AND KNOWLEDGE AND
INFORMATION AT A VERY REGIONAL
LEVEL ACROSS THE STATE. AND ONCE
THE TARGET IS SET, WHATEVER IT
IS SET AT, WE WILL WORK WITH
THOSE SYSTEMS TO UNDERSTAND
THEIR ABILITY TO MEET THAT
TARGET AND WHERE APPROPRIATE
WORK ON PLANS TO ADDRESS THAT,
MAYBE LEARN FROM OTHER SYSTEMS
AND WHAT THEY'VE DONE TO BE ABLE
TO DO SO. SO I THINK THIS IS A
LOT OF A LEARNING JOURNEY. THERE
IS FLEXIBILITY, AND I DO THINK
WE NEED TO PUSH OUR SYSTEM TO
MOVE TOWARDS SOMETHING THAT IS
SIGNIFICANTLY MORE AFFORDABLE. I
SHOULD NOTE. WE HAVE SPENT A LOT
OF TIME YOU DID AS A LEGISLATURE
WITH A LOT OF INPUT AROUND THESE
TOOLS, AND I THINK THE
LEGISLATION IS BUILT IN SUCH A
WAY THAT WE HAVE A NUMBER OF
TOOLS TO BE ABLE TO LEARN AND TO
APPLY THE TARGETS APPROPRIATELY.
AND MR CHAIR. I SEE MS MITCHELL
LEANING TOWARD HER MICROPHONE.
LET ME ASK IF SHE HAS ANYTHING
YOU WOULD LIKE TO ADD. POLICE
THE FLOOR YOURS, MITCHELL. I
LIKE COMPLETELY CONCUR WITH, UM
SANDERS' COMMENTS AND HAVING THE
VISIBILITY THROUGH THE DATA WILL
ACTUALLY ENABLE US TO MAKE SURE
WE'RE MAKING SMART DECISIONS
FROM A COMPREHENSIVE VIEWPOINT.
BUT I ALSO WANT TO SAY THERE,
THERE ARE EXAMPLES AND THERE'S A
GROWING EVIDENCE BASE THAT WE
CAN PROVIDE BETTER CARE FOR
SIGNIFICANTLY, UM, LOWER COST,
AND I THINK THAT WE HAVE SUCH
SORT OF INNOVATIVE LEADERS IN
CALIFORNIA IN THE HEALTH CARE
INDUSTRY THAT BELIEVE THAT THEY
CAN FIND WAYS TO NOT JUST
CONTINUE TO MEET ACCESS AND
QUALITY NEEDS, BUT ALSO DO IT IN
A WAY THAT BALANCES THAT WITH
AFFORDABILITY, SO I I'M VERY
ENCOURAGED BY THE LEADERSHIP IN
THE INDUSTRY AND ALSO THE
EVIDENCE THAT IS REALLY BECOMING
AVAILABLE THAT THIS CAN BE DONE,
UM, FOR LOWER COST. AND THEN LET
ME ASK A FOLLOW UP QUESTION, AND
IT ALSO RELATES. TO WHAT SENATOR
GROVE ASKED. AND IT'S MY
PERSONAL EXPERIENCE. BECAUSE I
HAVE A SPRAWLING DISTRICT THAT
TAKES FIVE HOURS TO GET FROM ONE
END TO ANOTHER BEFORE THERE'S A
LIMIT OR PUT ON ON CARS DUE TO
SPEED LIMIT. UH UM AND IT IS
REALLY DIFFERENT IN THE HEALTH
FACILITIES AND THE PRIME
EXAMPLES. I WORKED HARD TO SAVE
WATSONVILLE HOSPITAL TWO YEARS
AGO IT WAS GOING UNDER IT HAS A
BAD MIX OF. UH, UH, PUBLIC. UH,
UH, PRIVATE. AND NOT MORE THAN
20. MILES AWAY IS THE HOSPITAL
AND THE MONTEREY PENINSULA,
WHICH THIS GOT TO BE DOING
ALMOST AS WELL AS ANY HOSPITAL
IN THE UNIVERSE, AND THEY ARE
RIGHT THERE AND IN THE
WATSONVILLE HOSPITAL WHEN WE
WORK TO SAVE IT, THEY'RE NOW
GOING TO THE VOTERS AND THEY'RE
GONNA BUY THE BUILDING. THEY'RE
GONNA EXPAND THE ER SO THAT IT'S
UH UM URGENT CARE. THEY'RE GONNA
ADD BACK A COUPLE OF FACILITIES
THAT WILL ALLOW THEM TO EXPAND
CARE. HOW DO YOU MAKE SURE THAT
A THAT'S THAT DISPARATE FROM THE
OTHERS AND IS TRYING TO ADD
THINGS THAT COST MORE MONEY IS
NOT CAUGHT HERE SOMEHOW, IN A
WEB THAT SAYS THERE SOMEHOW, NOT
IN A PER CAPITA SPENDING IN THE
RIGHT WAY. HOW DOES YOUR SYSTEM?
UH, ALLOW FOR THAT TO WORK?
KRONICK, PLEASE. UH, THANK YOU,
UH, SENATOR LAIRD FOR THAT, YOU
KNOW. REALLY EXCELLENT QUESTION
AND THE LEGISLATION DOES PROVIDE
THE OFFICE AND THE BOARD THE
FLEXIBILITY TO CONSIDER THE
CIRCUMSTANCES OF INDIVIDUAL. UH
PROVIDERS. UM WE WE'RE ASKED TO
LOOK AT, UM, HIGH COST, UH,
PROVIDERS SEPARATELY OR
DIFFERENTLY FROM LOW COST
PROVIDERS. AND YOU KNOW, I
MENTIONED EARLIER, THE SORT OF
PARADOX OF EXCESS AND
DEPRIVATION, WHICH OF, YOU KNOW
ILLUSTRATED. WELL UH, WITH WITH
WITH WITH YOUR EX EXAMPLE HERE,
UM AND THERE'S NÓ, UH,
REQUIREMENT AS AS ELIZABETH SAID
EARLIER AT NÓ EXPECTATION OF
KIND OF ONE SIZE FITS ALL HERE
AND, UM, IN FACT, IT CAN BRIEFLY
RESPOND TO YOUR EARLIER QUESTION
ABOUT 3% AND HOW DOES THAT
COMPARE TO THE G? Dð P PROJECTED
GROWTH? I MEAN, IT IS 3% PER
PERSON. IF WE CLOSE TO THE
PROJECTED RATE OF GROWTH OF G Dð
P PER PERSON. AS AS YOU KNOW, WE
SPEND MUCH HIGHER FRACTION 18%
OF G Dð P ON HEALTH CARE IN THIS
COUNTRY THAN IN WESTERN EUROPE,
WHICH AVERAGES IN THE 10 TO 12%
RANGE, AND THERE IS NOTHING IT
IS SCARY TO THINK OF. OH, MY
GOODNESS. HOW SPENDING MIGHT GO
FROM 18% OF G Dð P TO 17% AND
WHAT WOULD THAT MEAN FOR ACCESS
AND QUALITY BUT ACCESSING
QUALITY OR JUST FINE AND IN MANY
PLACES BETTER IN IN MANY WESTERN
EUROPEAN COUNTRIES THAN HERE,
AND SO THE QUESTION IS, HOW DO
THESE CHANGE CHANGES GET MADE?
AND AGAIN. I RETURN TO THE
COMMENT I MADE EARLIER THAT YOU
KNOW A FUNDAMENTAL PART. IN
ADDITION TO AS DOCTOR, HERNANDEZ
SAID. INCREASING TRANSPARENCY
AND INFORMATION OF FUNDAMENTAL
DRIVER OR OF THE STATUTE, AND
THE WORK IS CHANGING THE
INCENTIVES THAT PROVIDERS FACE.
AND THE HOSPITAL. UM THAT YOU
MENTIONED, UH, IN IN MONTEREY,
THAT, UH THEY HAVE INCENTIVES TO
MAXIMIZE REVENUE. AND THAT WOULD
CHANGE UNDER THE STRUCTURE OF
THE STATUTE OF THE OFFICE AND
THE BOARD. IN JUST MAYBE. AN
ITERATIVE FOLLOW-UP, AND THAT IS
THAT. WHEN YOU LOOK AT THE
SPECIFICS OF HOSPITALS, I MEAN,
SOMETIMES WHEN THERE CAN'T BE
ENOUGH FULL TIME NURSES.
TRAVELING NURSES ARE HIRED THAT
COST MUCH MORE AND BELIEVE ME.
THE CALIFORNIA NURSES
ASSOCIATION ME. LOTS OF OTHER
PEOPLE WANT THE PERMANENT NURSES
THERE, BUT IF THEY COST MORE,
AND THAT'S THE ONLY WAY TO FILL
A NURSING POSITION IN A CRISIS
FOR A WEEK OR SOMETHING, THEN
THAT'S GONNA DRIVE THE COST UP.
AND WHAT I'M HEARING IS, IS THAT
YOU BOTH WANT TO INCENT. THAT
DOES NOT HAPPEN, BUT AT THE SAME
TIME YOU WANT TO BE FLEXIBLE
ENOUGH TO ALLOW THAT. IF THAT
TURNS OUT, THAT'S THE ONLY WAY
TO CONTINUE DELIVERING MEDICAL
CARE FOR A PERIOD OF TIME. IS
THAT AN ACCURATE THAT IS EXACTLY
CORRECT. THANK YOU. THANK YOU,
DR CARLISLE ON THE ISSUE OF
SENATOR LAIR, PLEASE. FOR
RESOURCE? YES. THANK YOU FOR TAD
FOR THE QUESTION AND I. I WOULD,
I WOULD SAY II, I THINK YOU SORT
OF HIT THE NAIL ON THE HEAD WITH
THAT. THAT LAST, UH, CONCLUDING
COMMENT, UM, I, I WOULD VIEW
THINGS. UM MAYBE FROM MY
PERSPECTIVE AS WHAT IF THE GLASS
IS HALF FULL INSTEAD OF HALF
EMPTY, UM, WHAT IF WE CAN CAN
GET TO OUR 3% TARGET OR OR CLOSE
TO IT UPON SOME REVISION, IF
NECESSARY WITHOUT DEC. SEEN
ACCESS TO CARE WITHOUT LOSING A
HOSPITAL WITHOUT LOSING A LABOR
AND DELIVERY UNIT WOULDN'T
HEALTH CARE IN CALIFORNIA BEING
IN A MUCH BETTER POSITION? THAT
IS THE GOAL HERE IN MY MIND, AND
I THINK WE CAN GET THERE AND I
THINK, YOU KNOW, I DON'T WANT TO
SPEAK FOR MY COLLEAGUES ON THE
BOARD, BUT, UH, I THINK WE ALL
PROBABLY SHARE THAT PERSPECTIVE.
SO MUCH ANYONE ELSE ON THIS
ISSUE, PLEASE THROUGH SENATOR
LAIRD. THANK YOU. THAT'S RETURN
BACK TO SARAH. JUST LET ME SAY
THANK YOU. I APPRECIATE THE
EXCHANGE AND I DID HAVE A
CONVERSATION WITH MY SPOUSE. WHO
HAS HAD INTERACTIONS WITH THE
SYSTEM, AND IT SEEMS LIKE THERE
HAS NEVER BEEN A TEST ON
ORDERED. EVEN IF IT WAS GIVEN A
MOMENTS BEFORE IT SEEMS LIKE AND
SO, UH UM HE HAD THE OPINION
THAT THIS WAS HEADED DOWN THE
RIGHT DIRECTION IF IT FORCED THE
ISSUE OF NOT INCENTING, THE
REVENUE AND THE OTHER THINGS
THAT COME FROM THAT, BUT JUST
WHAT IS THE MOST EFFICIENT CARE,
SO I REALLY APPRECIATE THIS
EXCHANGE AND I THINK IT HELPED
HIGHLIGHT WHAT THE ISSUES ARE IN
FRONT OF YOU AND US AND YOUR
CONFIRMATION. THANK YOU, MR
CHAIR. THANK YOU SO MUCH.
SENATOR VERY GRATEFUL BEFORE WE
GO TO PUBLIC COMMENT. WE'D LIKE
TO BE ABLE TO SEE IF THERE IS
ANYONE ELSE WHO WOULD LIKE TO BE
ABLE TO SPEAK. HEARING AND
SEEING NÓ ONE ELSE ON THE
COMMITTEE WISHING TO SPEAK AT
THIS TIME. WHAT WE WOULD LIKE TO
BE ABLE TO DO IS TO LOOK TO
THOSE WHO WOULD LIKE TO BE ABLE
TO SPEAK IN SUPPORT. WE ARE
ASKING INDIVIDUALS WHO WOULD
LIKE TO GO TO SPEAK IN SUPPORT
OF THIS PANEL. WE WELCOME HIM UP
TO THE PODIUM TO MY RIGHT. WE'RE
GONNA REQUEST RESPECTFULLY THAT
EACH MEMBER KEEP THEIR COMMENTS
TO ONE MINUTE KEEP THEIR
COMMENTS TO ONE MINUTE I'LL GIVE
YOU A PROMPT AS YOU GET CLOSE.
PLEASE DON'T TAKE THAT AS ME
BEING RUDE. JUST MAKING SURE YOU
KNOW WHAT THE TIME WE WELCOME
YOU IF YOU CAN PLEASE YOUR FIRST
AND LAST NAME. AND IF YOU'RE
WITH AN ORGANIZATION IF YOU
COULD PROVIDE THAT AS WELL, GOOD
AFTERNOON, THANKS FOR HANGING
WITH US. GOOD AFTERNOON, MR
CHAIR AND MEMBERS OF THE
COMMITTEE. I'M KATIE VAN DYNES
WITH HEALTH ACCESS CALIFORNIA,
THE STATEWIDE HEALTH CARE
CONSUMER ADVOCACY COALITION, AND
WE ARE HERE IN STRONG SUPPORT OF
THE GOVERNOR'S APPOINTEES TO THE
HEALTH CARE AFFORDABILITY BOARD
THE DECISION MAKING BODY OF THE
OFFICE OF HEALTH CARE
AFFORDABILITY. WE ARE ADVOCATING
FOR THE CREATION OF THE OFFICE
OF HEALTH CARE AFFORDABILITY TO
ADDRESS THE ESCALATING COST OF
HEALTH CARE AND THE
AFFORDABILITY CHALLENGES THAT
CALIFORNIANS ARE FACING. MORE
THAN HALF OF CALIFORNIANS ARE
BILLING OR SKIPPING HEALTH CARE,
UH, DUE TO THE COST AND ALMOST A
QUARTER ARE IN MEDICAL DEBT.
WE'VE WORKED WITH EACH OF THE
GOVERNORS APPOINTEES, AND THEY
ARE EACH, UM, DISTINGUISHED
LEADERS IN THEIR FIELD. UM AND,
UH, UH, EACH OF THESE
APPOINTEES, AS YOU'VE HEARD
TODAY HAVE A DEEP KNOWLEDGE OF
THE CHALLENGES THAT CALIFORNIANS
ARE FACING IN THEIR HEALTH CARE
AND WILL BRING EXPERTISE TO THE
BOARD TO GUIDE US TOWARDS, UM,
ADDRESSING THESE ESCALATING
COSTS, AS WELL AS TRANSFORMING
THE SYSTEM TO BE MORE EFFICIENT,
IMPROVE QUALITY AND IMPROVE
EQUITY. UM WE RESPECTFULLY ASK
FOR YOUR I VOTE. THANK YOU.
THANK YOU SO MUCH FOR BEING HERE
TODAY. WE'RE REALLY GRATEFUL.
GOOD AFTERNOON, SIR. IF YOU
COULD PLEASE PROVIDE YOUR FIRST
AND LAST AND ANY ORGANIZATION
YOU'RE AFFILIATED WITH. WE'RE
GRATEFUL THAT YOU'RE HERE. THANK
YOU, UH, GOOD AFTERNOON CHAIR.
MEMBERS OF THE COMMITTEE JOHAN
CARDENAS WITH THE CALIFORNIA PAN
ETHNIC HEALTH NETWORK. èC P IS
PROUD TO SUPPORT THE
CONFIRMATION OF THE GOVERNOR'S
APPOINTEES TO THE HEALTH CARE
FOR THE BAILOUT REPORT. WE
BELIEVE THAT EACH APPOINTEE WILL
BRING RELEVANT AND IMPORTANT
BACKGROUND EXPERIENCE AND,
PERHAPS, MOST IMPORTANTLY, A
COMMITMENT TO OUR COMMUNITIES.
COMMUNITIES OF COLOR CONTINUE TO
FACE A FINANCIAL STRAIN. WHEN IT
COMES TO THEIR HEALTH CARE, MANY
OPT OUT TO FORGO THEIR
MEDICATIONS OR EVEN SKIP
PREVENTATIVE TREATMENT BECAUSE
THEY ARE FORCED TO CHOOSE
BETWEEN LIVING EXPENSES AND
THEIR HEALTH CARE. UM HEALTH
CARE FOR THE ABILITY SHOULD NOT
BE A BARRIER FOR ALL
CALIFORNIANS, AND WE MUST
CONTINUE TO TRANSFORM OUR HEALTH
CARE SYSTEM UNDER OCA, UH, SEE
LOOKS FORWARD TO WORKING WITH
THE BOARD AND WE URGE THE
CONFIRMATION OF THESE APPOINTEES
BEFORE US. THANK YOU. THANK YOU.
SO MUCH FOR YOUR COMMENTS. GOOD
AFTERNOON. NICE TO SEE YOU. IF
YOU COULD PLEASE PROVIDE YOUR
FIRST AND LAST IN ANY AFFILIATED
ORGANIZATION. THANK YOU FOR
BEING WITH US. GOOD AFTERNOON,
MATT LE ON BEHALF OF S¼, èC IU,
CALIFORNIA. UH WE WERE, UH,
PROUD, UH, PART OF THE COALITION
THAT HELPED BRING THE OFFICE OF
HEALTH CARE AFFORDABILITY
FORWARD BECAUSE WORKERS CONTINUE
TO SHARE MORE AND MORE OF THEIR
INCOME, NOT WITH THEIR HOUSEHOLD
, BUT SEND IT TO THE HEALTH CARE
INDUSTRY SO REALLY SUPPORTIVE OF
ALL OF THE AMAZING, UM,
CANDIDATES THAT WE HAVE HERE
TODAY, UM AND UH OR THE
APPOINTEES. AND UM, BELIEVE THAT
THEIR EXPERTISE THEIR EXPERIENCE
, AND THEN I THINK, AS YOU HEARD
THE ANSWERS TODAY, THEY'RE GONNA
BE RIGHT THERE TO MAKE SURE THAT
WE CAN REALIZE THIS PURPOSE OF
THE BOARD TO MAKE SURE THAT
CONSUMERS IN CALIFORNIA CAN
AFFORD HEALTH CARE. SO THANK YOU
VERY MUCH. AND I RESPECTFULLY
ASK FOR I VOTE. IT'S GOOD TO SEE
YOU. THANK YOU SO MUCH FOR YOUR
TIME. GOOD AFTERNOON. GOOD TO
SEE YOU. IF YOU COULD PLEASE
PROVIDE YOUR FIRST AND LAST AND
ANY AFFILIATED ORGANIZATION. UH,
GOOD AFTERNOON, CHRISTOPHER
RUGGLES WITH ASK ME, UM, WE
SUPPORT THE GOVERNOR'S
APPOINTEES FOR THE Ó A BOARD
AND WE JUST WANT TO GO THE
HEALTH ACCESS COMMENTS. THANK
YOU FOR YOUR TIME. THANK YOU SO
MUCH FOR BEING HERE. LADIES AND
GENTLEMEN WHO ARE IN COMMITTEE.
THIS IS GOING TO BE OUR LAST
CALL FOR ANYONE WHO WOULD LIKE
TO BE ABLE TO SPEAK IN SUPPORT.
LAST CALL FOR THOSE WHO WOULD
LIKE TO BE ABLE TO SPEAK IN
SUPPORT. IF YOU COULD PLEASE
COME FORWARD AT THIS TIME.
SEEING NÓ ONE ELSE RISE. LADIES
AND GENTLEMEN, WE'RE IN THE
COMMITTEE. WE'D LIKE TO BE ABLE
TO SEE IF THERE'S ANYONE WHO
WOULD LIKE TO BE ABLE TO RISE IN
OPPOSITION. WE ARE LOOKING FOR
THOSE WHO MAY BE IN OPPOSITION
IF HE COULD COME FORWARD TO THE
PODIUM. LAST CALL. ALL RIGHT.
WE'RE GOING TO BRING BACK TO
COMMITTEE TO BE ABLE TO SEE IF
THERE ARE ANY ADDITIONAL
COMMENTS. QUESTIONS FROM THE
COMMITTEE MEMBERS. PLEASE.
SENATOR LAIRD, I WOULD JUST SAY
THIS HAS BEEN A GOOD DISCUSSION
IT IT'S A GOAL WE HAVE TO MEET
AND THIS IS GOING TO BE AN
ARDUOUS PROCESS. AND I THINK
THAT FROM THE DIVERSITY OF
EXPERIENCE HERE. IT IS GOING TO
REALLY HELP NAVIGATE THROUGH IT,
AND IN PARTICULAR. THE
UNDERSTANDING THAT WILL ALLOW IN
WHAT ONE SAID WAS WORKING. NOT
HAVE A TOTAL ONE SIZE FITS ALL
TO HAVE THE GOAL AND TO TRY TO
USE DIFFERENT WAYS TO GET THERE.
I'M JUST GLAD THAT THAT THAT
OPINION HAS BEEN ARRIVED AT BY
PEOPLE THAT WILL BE MAKING THE
DECISION. SO MR CHAIR UNLESS
THERE'S A REQUEST TO DIVIDE
THIS, I WOULD MOVE ALL FOUR
TOGETHER FOR CONFIRMATION. WE
HAVE A REQUEST THAT WE'RE GOING
TO NEED TO BE ABLE TO DIVIDE
EACH OF THESE IF THAT WORKS OUT
FOR THE GROUP, AND WE WILL TAKE
THESE INDIVIDUALLY, CORRECT. OH,
YOU WANT TO TAKE THEM ALL? GOT
IT. OH, AND I WOULD REPEAT MY
MOTION. ALL RIGHT. THANK YOU SO
MUCH. UH, SO WE CURRENTLY HAVE A
MOTION ON THE FLOOR TO BE ABLE
TO TAKE UP ONE BE DOCTOR KYLA
CARLYLE ONE èC DOCTOR HERNANDEZ
, ONE Dð DOCTOR KRONIG IN ONE EM
MITCHELL DO WANT TO SAY BEFORE
WE GO TO THE VOTE, HOW GRATEFUL
WE ARE CANDIDLY FOR YOUR WORK.
THIS IS ONE OF THE MOST
CHALLENGING TASKS THAT'S IN
FRONT OF THE STATE AND WHAT WE
ARE INCREDIBLY GRATEFUL FOR IS
ONE LOOKING AT MAKING A MORE
EFFECTIVE AND RESPONSIVE HEALTH
CARE SYSTEM. HOW WE CAN MAKE IT
MORE EFFICIENT. WE ARE ALSO
APPRECIATIVE ARE HIS COMMENTS ON
LOOKING AT A GLOBAL VIEW WHETHER
IT IS URBAN OR RURAL. HOW CAN WE
DELIVER THE BEST HEALTH CARE
POSSIBLE? THE RESIDENTS OF
CALIFORNIA ARE GRATEFUL FOR YOUR
WORK. WE HAVE A MOTION TO
APPROVE BY SENATOR LAIRD,
SECRETARY. IF YOU CAN PLEASE
CALL THE ROLL. I GROVE GROVE,
NOT VOTING, EGLIN. I JONES
JONES, NOT VOTING GLARED, AYE
GLARED A THREE TO ZERO. THAT IS
A THREE ZERO VOTE.
CONGRATULATIONS THE FINAL
CONFIRMATION WILL BE ON THE
FLOOR. WE ARE GRATEFUL FOR YOUR
WORK. THANK YOU SO MUCH FOR
ATTENDING TODAY AND THANK YOU TO
THE MEMBERS FOR SUCH A ROBUST
CONVERSATION. THANK YOU SO MUCH.
THANK YOU. GIVE OUR BEST TO YOUR
MOM. MY GOODNESS. UM LADIES AND
GENTLEMEN, THIS CONCLUDES
TODAY'S AGENDA. I'M GOING TO
START IT. I WANNA END IT AS I
STARTED. I WANT TO SAY THANK YOU
SO MUCH TO MADAM SECRETARY
CONTRERAS FOR ALL OF HER WORK. I
WANT TO SAY THANK YOU TO MADAM
SECRETARY FOR ADVANCING, OF
COURSE TO MS CHIN FOR EVERYTHING
SHE DOES EACH AND EVERY TIME AND
THEN TO OUR ATTORNEY, MS
GRIFFITHS FOR HER WORK IN PREP
AS WE MOVED INTO THIS FIRST
COMMITTEE, I WANT TO SAY THANK
YOU SO MUCH TO THE SENATORS FOR
THEIR PATIENCE AS WELL AS THIS
IS THE FIRST COMMITTEE OF THE
SEASON FOR SENATE RULES IN
EXCITING AND GRATEFUL TO BE
WORKING WITH EACH AND EVERY ONE
OF YOU. WE'LL SEE YOU NEXT WEEK.
THIS COMMITTEE IS NOW ADJOURNED.
THANK YOU SO MUCH.