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Senate | July 21, 2015 | Committee Room | Health Care Committee

Full MP3 Audio File

Ladies and gentlemen please take your seats and we will get our committee started, we have a quorum of members present and we have a loaded docket today. So we're going to go ahead and get started, I'd like to introduce our pages as I call your name if you'll please stand up and wave your hand so we may recognize you. Anna Dolchley[sp?] is page from Charlotte, her sponsor is Senator Rucho. Where is Anna? There is Anna back by the Coffee Mug, Anna, by the way served as a shadow for me a couple of months go, and she decided to come back and spend the four week with Senator Rucho so we're glad to have you back Sam Stein something tells me Sam is kin to a Senator who serves in this body we're glad to have you with us today Sam, Reiss, Mursell[sp?] I'm sure I've messed that up give us your correct last name. Masarelli. [xx] is also sponsored by Senator Taylor Dosier, Taylor is also sponsored by Senator Stan we're glad to have you folks with us. Christine [xx] from [xx] is sponsored by Senator Sanderson and myself. Chaired, is that Chaired or Chairs, cross we're glad to have you with us. You also are sponsored by Senator Sanderson and Senator Birngham, you're from Denton you knew that all along, didn't you? India, you guys need to go back and learn how to write [xx]. Would you give us your name please we're glad to have you with us India from durant[sp?] sponsored by Senator McKissick and errands from monoc[sp?] rapids, Evans the v's looks like the r's Amber Evans from Ronoughcaft sponsored by Senator Brians. The cardinal sin will be to spell Senator Brians name wrong. Senate sergeant at arms today is serving us a day and half Ted Burnhart and Marcus Kits. Glad to have the sergeants at arms to help us today. By the way if we need an overflow section, I'll ask the sergeant at arms to open up the back row of the members side so that people won't have to stand for a committee meeting today. we've a rather tight schedule, so we're going to get right on into it. Our first bill on the calender is House Bill 13 amend school health assessment requirements. there is a PCS, need a motion to adopt a PCS, senator Tucker moves that we adopt the PCS for our discussion, and whose presenting the bill, representative Torbitt you're recognized. Thank you Mr. Chairman members of the committee, thank you for taking the time out of your busy schedule to hear this House Bill. Ladies and gentlemen allow me to give you the genesis of this bill very briefly, baring some discussions on education issue we were looking at pretty much at all verses we [xx] about the children in the classroom and it came to my attention that although the state pretty much mandates a health assessment to be done, it only does that as the child enters kindergarten, so let me take you on that ride. If a child entered a kindergarten they must today have an health assessment, but if a child were to enter system for the first time in any grade other than kindergarten, there was no health assessment mandated, let's you don't come to North Carolina to enter the system in kindergarten but you do arrive in North Carolina your child is ready for school in the first grade they would go to school in the first grade but no health assessment at all so I guess there was this presumption perhaps that health assessment that every other state in the union and had one kindergarten and that child had come from previous state have a health assessment or other country and having a health assessment finding out that it wasn't set off on drafting this language pretty much just make sure that any time you are entering the North Carolina system for the first time at whatever grade level that you are to have a health assessment done and be honest with you when I

floated this back for some of my constituency here is the answer I got most commonly, "You mean we are not already doing that? " Excuse me for interrupting you. Senator Raven did you have a question or? I just wanted to move for favorable at the appropriate time. At the appropriate time That wraps up my comments unless there's any questions Mr. Chairman are there any questions for members of the committee? Senator Robinson yes thank you Mr Chair and what I first say that is certainly is important critical children have the health assessment but let me back you up a little bit to entrance into school kindergarten or first grade because we know immunization is critical as a matter of fact my agency is working to make sure parents get those immunizations in the cases where the health assessment is not done by the parents and this is 60 days in here. What do we have in process in the school systems to do some in some cases parents are illiterate and it may be and I would assume that where the child is on medicaid certainly the health assessment is in because that's probably done through the hearth department ET cetera but in cases where there is no health assessment what is in place in the school system to get out to that parent to make sure that if that information was taken home parent didn't read it, parent didn't understand and follow up, is there anything in place now?  Senator thank you for that question, I'll yield the staff after I make these comments, my understanding that the time period evolved around the health assessment mimics that currently in place for let's say in current law worth you have to have one goal there are window of times in that we mimic that current law but change it to any grade and not just  kindergarten and when it comes to immunization I looked at that but that actually is a separate and independent of a heath assessment, it might not need to be but it is currently and not opted at this time not to address immunization because of my understanding there are people looking at that issue follow up Mr. Chair, I'm not sure I clarify the question I'm sorry, I didn't mean what you just responded to in terms of what in place and their immunization are a part of that whole health assessment piece. I mean what is in place in school systems if this is not turned in to help that parent who maybe a little late to get it done. Do you understand what I'm saying?  I do understand Miss Chairman and that goes beyond my scope or field of research on this, that would be relevant to department of public instruction I don't have an answer. Staff Ms. Terissa would you care to respond. Certainly, Senator Robinson, the department of public instruction education stuff with an outline of responsibilities for various parties as it relates to and they refer to kindergarten helps us because that's the way it is right now, so if I may speak and say kindergarten helps us will because that's current long place, but under there Delineation of responsibilities of local school administrative unit, they are responsibilities but they essentially have to do with notifying the parents of the children entering kindergarten which now would be any grade that help assistance are required, informing the parents of the responsibility related to the health assessment, establish a procedure for receiving and rounding completed forms, maintaining the file so, the Local Health Department's do provide the health assessments at no cost to children meeting eligibility requirements, I don't know if that gives you any more reassurance about the process, but I do think that now at kindergarten and under these bill if it were enacted once any child enrolls in public schools there would be notification given. It appears that there is a number of opportunities for follow up with the parent to remind them they need to get the health assessment form and then if it's not submitted in a timely manner, under the bill and under the current law there are certain things that take place. Senator I apologize that was my initial meaning when I mimicked the law currently in place for Kindergartens. That's fine, I'll do some other

follow up school systems Further questions from members of the senate? Senator Davis. Thanks Mr Chair I just had a question for staff reading on page two if a child and now the 30 days is exceeded and they're allowed to make up the work is set in accordance with [xx] C 390.2 could you explain that to me, I just want to make sure I understand the process that the child would actually have to make up oak. Mrs [xx] Actually senator Davis we are fortunate today to have some [xx] education staff here and they're more of first in the process perhaps from making up the work, you'll notice that one of the things things that in the house that was amended it was the addiction of section 4.5 of bill that deep provide that, those absences don't count these suspensions and it also provides a number of support opportunities for the students when they're absent because they have some [xx] they have not submitted the health assessment form but I'm certain that perhaps our educations staff could elaborate on how is that clear that spot providen? Senator [xx] how I might aid the, from the knowledge the co-chairs this bill is supposed to go to the health policy after, I mean education policy after we move it here. so may be that would suffice for the time being senator Davis follow questions from members of the committee seeing none. Senator Ravi you're recognized. move for a favor. Sen. Raven you are moving for a favorable as to the PCS unfavorable as to the original bill with a referral to education policy, was that your motion? Whatever gets that done yes sir the motion is before us for a favorable to the PCS unfavorable to the original bill with a referral to education policy all those in favor of the motion please say aye all oppose may say no, the bill caries who is going to handle this on the floor for the senate I was hoping to find someone between now and education and the year 2017 that will Mr. Chairman more important thank you and members of the committee for hearing the bill today and thank you very much. Sen. Gram are you ready to go house bill 20 bring them through childhood diabetes education we have a PCS, in a motion to consider PCS, Senator Wade moves his discussion if not the PCS is before you all those in favor say Aye all oppose no. Go ahead. Thank you Mr. Chair and members of the committee let me pleasure to be with you this morning, I have house bill 20 you can tell by the designation house bill 20 this bill was introduced early in the session and it's a pleasure to be here talking about Reagan's rule it's a very simple piece of legislation easy to understand, can have some outstanding and far reaching applications for the health care of our babies in the state and basically all it does is during the well child visits from birth to age it encourages physicians, physician assistants, nurse practitioners, those healthcare profession who is doing that assessment during that time to have a discussion with the parent about the symptoms that they may be seeing  that might be related to type one diabetes, and of course at that point the healthcare profession can decide what steps to take at that time. This legislation came to me as a result of a death of a young child in my District who passed away from complications of undiagnosed diabetes, and this legislation is designed to prevent that tragedy from ever happening again or at least we're moving in the direction of having those situations never occurring in North Carolina. I would appreciate your

support and certainly if you would allow me Mr. Chair I have the mother [xx] the mother is she can make a comments. Certainly if you have to introduce here and sergeant at arms escort the lady to the to the microphone so she could speak for just a few minutes, Thank you. Good morning. as [xx] my name is [xx] and I was the mother Reagan [xx], Reagan was healthy, we took her for one-year old Jacob and she was diagnosed as healthy, two weeks later she started vomiting, not eating as much as [xx] the doctor that diagnosed her is a virus, three weeks later she was in the hospital and that's when we found out that she had elevated blood. [xx] talked to hundreds of across the country, across the globe which means the same thing. There are actually two children who passed away two weekends ago of the same exact thing diabetes was own diagnosed. One child lived through it and she passed away due to complications and another child well they diagnosed him as having And he passed away also. So I'm here to employ you to please pass this bill so we can save the lives of our children. Thank you so much. Thank you for your testimony, and we certainly share with you the loss that you incurred. Representative Brigham, there's a Section 2 in this PCS and I'm going to ask the staff if they'll briefly describe Section 2 so that the members of the committee will be familiar with that. Is that alright with you Senator Smith? That's no problem. Senator Smith that's okay. That's okay. Thank you Mr. Chair. in 2014 the general assembly passed some regulations pertaining to pharmacy benefits managers, and what Section 2 does is basically provides some enforcement authority to the commissioner of insurance to enforce those regulation that were passed, that statute that was passed in 2014, basically what it does is it requires a Pharmacy Benefits Manager to review the cost of the maximum allowable cost that it is reimbursing the pharmacies, and it must do that every seven days and then if necessary make an adjustment removal from that list within seven days, and what section 2 does it says that it just provides the authority for the commission of insurance to enforced that. It brings the PBM's Pharmacy Benefits Managers under the same authority of any other licensed person under chapter 58 and therefore the Commissioner of Insurance can impose between $100-1000 fine for any violation of a Pharmacy Benefits Manager failing to perform that review, there's an addition discretion that the commissioner would have to impose on additional penalty of up to $1000 for a prescription that is improperly reimbursed, because they didn't follow those regulation and adjust the prices, they should have within seven days. Now that was a part of the bill that I believe Senator Tillman was working on and he is then I'm able to hear you so far because he is tied up in other committee. Are there any questions from members of the committee concerning this Bill Central Law. My concern here, is on Section 2 childhood diabetes because of education because I think is really important. However, Section 2 what does this have to do with that I don't make the connection, I might be missing something. Thank you Sir. I will reffer to the expert committee senate for a second. [xx] I printed it all so about an hour ago. [xx] we can't it was a, It must be Tillman at that end, I just printed it off an hour ago and it wasn't just there so we didn't know anything about that provision.

It looks like Senator Tillman is going to be delayed a little bit but we'll go ahead with questions that need to be asked Senator Tucker. Yes Sir and these question maybe first of all do I see indicating the penalty, in here that applies to position needs the assistant and most practitioners do not provide or educate the warning signs of type I diabetes as we did it for pharmacy benefit management. My understanding is section one is almost like a policy statement encouraging physicians to do that sought of thing. Section two pertains to the requirements under chapter 58 of the insurance law requiring pharmacy benefits managers under that chapter to do certain things and providing penalties if they don't. Follow up Mr. Chair.  Go ahead. Tell me the difference between a pharmacist and a pharmacy benefit manager? So my understanding is that a pharmacy benefit manager is almost like a third party administrator that they entering the contracts the idea behind them is that they are able to use their economy of scales to negotiate certain prices for drugs amongst providers of medications your pharmacy is just what you of, is a Pharmacy like a CBS or something, business like that, follow up, follow up if I understood the constituent who lost a daughter it was a problem with diagnosis of the child with diabetes said a virus, it wasn't until the third trip that they realize she had she high blood sugar so I don't understand the correlation between the penality to the PDM and not the folks who are making the diagnosis. Would this monetary violation, it would almost come after the fact and how does DOI have a vehicle to enforce it? Can somebody share that with Senator want to hear from the department of Insurance. Senator come forward Okay. Thank you Mr. Chariman, members of the committee, it's my pleasure to be before you today day my name is Ben Popkin, I'm director of Govern Affairs for the department of Insurance. This is the first that we have seen or heard of this language in fact we had been in negotiations with the bill sponsor at his request with other stakeholders and that no point in that time was this language a part of that discussion. We had serious concerns about the resources that would be required to create and enforce this branch, in addition to the fact that we had shared with stakeholders during these earlier discussions that we have no regulatory authority over pharmacies, pharmacists or pharmacy benefit management companies. In fact as we pointed out repeatedly in the past, majority many of them are self-insured or often related to self-insured benefit policies which under Federal Arindhaal law are preempted from our state regulatory authority. So we would request kindly of the members of this committee that this issue be considered separately with the detail and consideration that it really wants and would be concerned that the very valid issues that were previously and remained in this bill be treated with the seriousness that they deserve, and this issue should be handled in a different fashion. Senator Haise? If the committee is OK with it, I think section two issue is something that the insurance is going to have to consider, and it seems to be more appropriate there than it does I'm not hearing any objections to the section one which prompt health policy, in the discussion, so what I would do is save at that time I'm making both favorable for both incharge referral to insurance and we can deal with those and get those moving forward, if there is questions about section two will let those be dealt with in the appropriate venue, and we can finish up the conversation here on the section one which is most directly related to health policy. So before we take that motion, let's see

if there are any questions concerning section one only if committee will indulge us, and will send the bill if it passes here over to insurance where section two will be receiving a thorough look at it. Is that agreeable with members of the committee? Sen. Tarte? Yeah, Mr. Chair. A couple of questions and with all due respect to Rep. Graham and Sen. Smith, my first question if I may is what is the primary attribute of type I diabetes? What is the primary attribute of type one diabetes? The answer is they are unable to produce insulin and they're required to be on insulin. Second question if I may follow up? Yes. Is this related to part one? only part one. Okay go answer. The second one do we know the frequency that Type 1 Diabetes occurs in the population? I don't have that. Less than 5%. Follow up? Follow up. Do we have an idea what the early warning signs are for Type 1? Well thank you for the question I'm not a doctor don't [xx], Neither am I But I do know that some of those early warning signs are virus like symptoms, If I may just  [xx] you may have proven your point. Yeah the thing that I want everybody in this room to understand with this and the concern I have, when you loose a child there's nothing worse on the planet. I can't even comprehend going through this, Type 1 Diabetes is typically caused by a virus. It's a virus of the pancreas because the pancreas is what produces it insulin. So what's going to be the early sign is your kid's going to get violently ill, and that's how you're going to know how to deal with it, but this is this classic example of government, bureaucrats, and politicians, and I introduced last time to do with something similar which probably shouldn't have done around DTap shots, But this is a classic example of us trying to practice medicine and go into doctor's office where we have no business. You've got doctors who have gone through four years of med school. My wife as most of you know is a more certified pediatrician, four years of med school, residency, they know what to ask and not ask, do they misdiagnose because it's an art as much as it's a science of course they do. But that's either a malpractice issue, misdiagnose it is a human error, but for us to dictate what we should do around this. Doctors already know, they are looking for these in the kids, and this is not something that just you test for and educate it's when they  get sick and have a virus, they're going to start looking for it. This is really dangerous when we start prescribing something, because they are already doing this, they're going to look for these things. They're not going to try to ignore these kids, and us dictating what you should ask, we start creating check-list in our medicine and this is why cost up, this is why doctors don't have time to spend on the reason the patient is in the room because they got all these other check-list of things we've told them they need to ask about it, when it may not be [xx] at all to the visit. And there's a whole list of reasons why if we're going to do it once a year, what happens if they haven't had an appointment or they didn't covered earlier. Are we going to require them to come in and spend money and take a visit just to educate them about type one when it occurs so infrequently. I mean there's just a lot of issues we need to think through before we move and how best to educate that population will be my concerns. Thank you Mr. Chair. Thank you Senator Trod[sp?]. Senator Mckissick, did you have a question as you meant to part one of the Bill? No mine was dealing with section two and it was the very issue that Ben Pumpkin spoke off in the [xx] Thank you, then we'll hold that question. Senator Davies, was your question [xx] to part one of the bill. Actually my original question was along the lines of to see the referrals so we appreciate that Mr Kochira[sp?]. Thank you. However I would like to make a brief comment. If you'll keep it very brief sir we still have three bills to go. If I understand correctly these are just words of encouragement, this would say it rises to some magnitude that is generated some level of concern but the language in this bill if I'm reading correctly it does nt mandate, it encourages and will therefore continue to ask for support for this bill. Further questions concerning part one of this Bill from members of this Committee, Senator Robinson. Yes Just real quick, I wanted to echo what Senator Davis said because it's appropriate for us to encourage education regarding health conditions so I support

that as well, thank you. Senator Smith. Thank you Mr. Chairman. I also wanted to just add a little bit of information. This happened in Robeson county, there is an extremely high incidence of diabetes in Robeson County, and we also have a lot of poverty level, people who are not aware of symptoms and that kind of thing one of the reasons that we where encouraging this, and it still does happen. Those symptoms often mimic the flu, so they get sort of misdiagnosed but may be if parents and doctors are encouraged to be on the lockout for it more, it will prevent that from happening. And as Ms [xx] Dunn mentioned just last week there were two more children, not in our area or even maybe in North Carolina but two more children died of undiagnosed diabetes. seeing no further questions, the Chair will entertain a motion for a favorable report to the PCS on favorable to the original bill with a serial referral to the department own insurance. Senator Davis, is that your motion? Sen. Davis moves, are there further questions? Volunteering carries committee, right? Yes sir. Okay, thank you. seeing no further questions, all those in favor of the motion will say aye, all oppose no, the motion carries the bill will be referred to committee on insurance. Thank you Mr. Chair. Senate bill 308 Correction, house bill 308, there's a PCS to it. We have a motion from senator Hise to adopt the PCS for discussion, representative Davis, you're recognized. Present the bill. Thank you Mr. Chairman, I appreciate the committee hearing this bill today, before I start Mr. Chairman if I may I previously lost my four year old glasses and while my new glasses are being ordered with a current prescription, I can't read unless with these magnifying glasses on and hold this very close, I just want to explain and ask you to bare with me please. You may lean over to the platform there if you want to get closer, [xx] you stand up straight when you get finished. Thank you Mr. Chair. House bill 308 has two sections to it. I'll address section number one first under the current law, G. S. 50-13.11 requires the court to order the parent of a minor child or other responsible party to maintain health insurance for the benefit of the child when the insurance is available at a reasonable cost, employer provide a group health insurances automatically consider reasonable. Under the PCS section one would provide that health coverage is available at a reasonable cost to the parent, if it does not exceed 5% of the parents [xx] income. The cost is defined as the cost of adding the child to the parents' existing coverage, child only coverage or if new coverage must be obtained the difference between the cost, the [xx], and family coverage. Section two of the PCS will and technical changes to the Long-term Care Ombudsman Program required by Federal Law. The Long-term Care Ombudsman program was designed to address the concerns of consumers in long term care facilities and their families. The program also provides education for consumers and the public about elder abuse awareness and prevention. The Administration of aging of The Administration for Community Living within the US Department of Health and Human Services issued a final rule to implement provisions of the older Americans Act regarding states long term care Ombudsman Programs, North Carolina must update its present statutes, regulation, policies, procedures and practices in order to operate the Ombudsman Program consistent with Federal Law and Federal Rule. The Long-term Care Ombudsman Program provides direct services to vulnerable older adults and disabled adults residing in licensed long-term care facilities, in an effort to protect their health welfare safety and ability to exercise their rights. The State is mandated once again, to be compliance by July 2016 or it could risk losing Federal Funds supporting the Ombudsman Program which is in the amount of approximately $2.75 million per year. The long term Representative Davids excuse me, we have a motion from someone behind you, Senator Hise recognize Senator [xx] at this time.

Mr. Chairman I move for a favorable report to the bill, unfavorable to the PCS, unfavorable to the original bill. Mr. Chair? if I may in the words of my fellow house member two I have no further comments. Thank you very much sir are there any questions from members of the committee? Senator Bingham please go ahead who did you say? I don't know. You answered so go ahead. Yes sir any objection to this bill I'm just curious, no objection. None that I'm aware of sir. Okay I'll send [xx] Thank you. Motion being made by senator Heisse for favorable report to the PCS unfavorable to the original bill. All those in favor please say aye, Aye. All opposed may say no, the bill carries Thank you Mr. Chairman and members of the committee. Is Senator Randleman still on tap to handle these representative Davis Yes. Senator Randleman is going to be the floor manager for end the senate. She's kind enough to say that you will thank you sir. House bill 724 amend the composition of North Carolina medical board, we have a Senator Heisse moves for consideration question of the PCS for purposes of consideration. At this time any discussion on that? All those in favor please say aye? All opposed no? Go ahead sir. Thank you Mr. Chairman. This is pretty straightforward, enhances support of the medical board and the medical society. It actually increases the number on the medical board from 12 to 13, and it changes one word in the appointment. One physician assistant or a nurse practitioner to one physician assistant and nurse practitioner, and. Representative Lambeth pardon me for interrupting you, but a see a couple of people acting like helicopters down there. I'm going to recognize Senator Lowe for his rendition. I'd like to move for a favorable report at the appropriate time. The time is now I believe unless Representative Lambeth has some more comments he would prefer to see if he can go downhill from here. Is there any further discussion on the motion. Hearing none, all those in favor of the motion to adopt the PCS unfavourable to the original bill will please say aye! Aye! All opposed may say no! Congratulations Representative Lambert. Carried on the floor. Senator Hise will carried on the floor Our final bill is house bill 809 Representative Barbara is going to brief us on this, I believe there's a PCS as well, there is a PCS so the PCS is before the motion so senator Robin moves as we hear the PCS and is there any discussion? Or if not all those in favor say aye. Aye The PCS before before you, Sen. Rabin. Let her say a word or two anyhow. Briefly two question. What is bill and why we need it? What the bill is for a number of years organizations in the state have been helping out patients when their illness has caused them to lose their jobs and they run the risk of losing the current coverage that they have. I need to clarify that because there does seem to be a misunderstanding that this is a mandate bill. When I refer to policies or premiums, those are referring to insurance policies and premiums that are in effect prior to any of this third party payment taking place. So there's no additional, no changes. The people have the insurance policy, particularly in the case of the American Kidney Fund. Those are patients in many cases who go into dialysis and at three days a week, four hours a day, it's difficult for many of them to keep their jobs and they run the risk of losing the insurance coverage. Why we need the bill is we currently have an insurance in the state that is now going to have a blanket policy of not accepting third party payments. Of the four entities that you

see listed, three of those are mandated federally. We're adding the Kidney Fund simply because of the health and convenience for our citizens so that they don't have to go on public assistance. I would ask for your support. Representative Avila, did I understand you have a guest who is here today? If you would like to introduce your guest for the benefit of the audience. Thank you, Mr. Chairman. I would like to introduce you to Ms. Levon Button[sp?] who is a CEO of the American Kidney Fund, so if you have any technical kind of questions about how their payments work and what types of situations they cover she'd be more than happy to answer those.   Thank you for being here Miss Button[sp?], would will go head we will proceed with business of our committee unless there is a technical question that we need to call upon you for your repley Senator Wade, you have a question? Thank you Mr. Chairman, just the appropriate time I move for a favorable report. We will hold on just a second to see if there is any other question senator Mickisy yes representative Robson landley[sp?] are you aware of any opposition to this particular provision and if so where is it coming from and what is the making out of that it is on I have heard there are some insurance company issues there have been in the past opposition decision from the chamber that this was not a men day that that was primarly their concerns we were adding another man day to our insurance laws they have removed their opposition and I will support it but I have not been directly approached and said I don't like your bill take it off the calendar and if there's anybody out there they'll have to volunteer the fact that they oppose it. Sure [xx] follow up? Destroy it. I didn't you if you could ask if there are any insurance companies that would like speak to this particular [xx] I know I had wanted to two people reach out to me but I'm not sure what the nature of their concerns were, unless someone ask that question, I mean I appreciate bill coming forward. Lets see if there are any other questions from the committee and then we'll see if time allows we'll I here from people in the gallery, Senator Robinson. Yes not a question just a comment Mr. Chair just to say that it's important that we have other forks organisations like the Kidney firm or even there are individuals who pay premiums so people can continue, I've done it for my mother who's 93 so is important that we have that support system so that the premium on the scan contain you, and insurance cover remain enforce for those individual so I certain support this. Further questions from members of committee seeing none, the are there anyone from the public who had like to speak to this issue? Please come up to the microphone state your name and who your represent. Thank you Mr Chairman, Mack Flaming Blue Cross Blue Shield North Carolina. We oppose to this legislation we do consider to be amended. We have 14 different mandate bills that have been introduced this year, at this time as health insurance rates are going up at a very unprecedented levels, we shouldn't be adding any mandates that will add one peny to the cost of insurance, Blue Cross Blue Shield has a third party premium payment policy, and we do allow for third party payments, but not for people who have health risk is for people that are having financial problems, so for example we have a relationship with the United Way and if a family is having financial problems because of bankruptcy and they're going to need help for three of four months we will allow the United Way to pay for that monthly premium to get them through that tough time, but we believe that this would set a bad precedent that once you start adding groups and adding unhealthy people to the risk pool, you're going to have a foundations coming in wanting to be added to this list, we have been approached by a hospital Foundation, wanting to

do something similar to this, and our policy doesn't allow it, because it will add additional risk to the individual health insurance pool, and will increase healthcare cost. Mr. Chairman if I may. Go ahead Amizabo.   I appreciate the response from the insurance companies, but I'd like to read you one sentence or two sentences really that I've re-emphasized for me why this is important. And it's to read from Blue Cross Blue Shield of North Carolina's third party premium payment policy. Blue Cross Blue Shield decision to accept payment through a premium system program is for one year only. Continued acceptance of payment from any or all third parties beyond 2015 isn't guaranteed and will be reviewed annualy he doesn't want to add expenses to insurance. These are people that for goodness knows how many years have been paying premiums. And they reach an expensive unfortunate health situation in their life, and the question is, do we want them to stay employed or not? And we're putting them out of their insurance at a time when they can't hold down a job to pay for their insurance.  And we have volunteers, we have contributors, we have individuals who contribute and government money to win some cases to these organizations that give people a crutch at a very bad time in their life. Would they like not to have to go on this? Of course they would. Nobody likes dialysis. We have people in the private community that want to help people in need. We have the opportunity now as the state of North Carolina, to help their contributions really help individuals. Please support the bill. Further discussion from members of the public were getting pretty close to the bleaching for a room, if anyone has any other comments, please come forward senator [xx] will recognize you for a question. I just have a question. and it may not apply but I'm just curious, but Medicaid cover these? you have to qualify for Medicaid first. Someone is out of general we're out of work, well have no resources or anything of that sort, so it seems to me am I missing something here? It's possible that your, I guess my though my thought on this is if people buy insurance with intent for it to cover their health regardless they're health maybe throughout their life we need to stand by the letter of the agreement I know we've changed the laws a lot, pre-existing conditions and such don't apply any more, but the issue of losing insurance and then getting it back is a very stressful incidence for anybody and medicaid somebody's going pay that bill too. That's frankly my point. If they lose their job and they don't have access to it, then the public as a whole in some form is likely to pick it up so it gets taken care of one way or another in one sense. The question is whether or not this is a better way to deal with it than essentially forcing someone to medicaid and I tend to agree that it is. Mr Chair, it looks like there's a serial referral to insurance. Is that correct? Yes. Yes, you're right there again I think maybe questions I'd hoped nature can be answered when it gets over to insurance Senator Raven. With send referral to insurance which I won't sit on I have o make a comment even though it extends the discussion a little bit. I took an insurance class way back in the dark ages, and I was told that insurance is your betting against the probability of occurrence if we want to take the risk out of the game what's the sense to have insurance at all? I think we should support the bill and move on thank you. Further question from members of the committee? Seeing none Senator Wade

you're recognized for your motion. Thank you Mr Chairman I move for a favorable report on the proposed committee substitute. Your motion I believe as I understand it is a favorable report to the PCS, unfavorable to the original bill with a serial referral to the insurance committee. Exactly. Further questions? All those in favor of the motion will please say aye. Aye. All opposed say no the bill carries. Thank you very much for your attendance today being no further business we are adjourned.