Insurance & Commerce- House
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Bills discussed (29)
| Bill | Title | Sponsor | Status |
|---|---|---|---|
|
HB1930
· 6 mentions in agenda, chapter, transcript
Matched: “…RY PRACTICES; AND TO PROVIDE FOR ENFORCEMENT OF VIOLATIONS. HB1930 Wardlaw TO MANDATE MINIMUM REIMBURSEMENT LEVELS FOR HEALTHC…”
|
TO MANDATE MINIMUM REIMBURSEMENT LEVELS FOR HEALTHCARE SERVICES. | Wardlaw | Died on House Calendar at Sine Die adjournment. |
|
HB1009
· 2 mentions in chapter, agenda
Matched: “HB1009 A. Collins TO ALLOW PREGNANCY TO BE A QUALIFYING EVENT FOR…”
|
TO ALLOW PREGNANCY TO BE A QUALIFYING EVENT FOR ENROLLMENT IN CERTAIN HEALTH BENEFIT PLANS. | A. Collins | Died in House Committee at Sine Die adjournment. |
|
HB1014
· 2 mentions in chapter, agenda
Matched: “HB1014 A. Collins TO REQUIRE COVERAGE OF IN VITRO FERTILIZATION UN…”
|
TO REQUIRE COVERAGE OF IN VITRO FERTILIZATION UNDER THE STATE AND PUBLIC SCHOOL LIFE AND … | A. Collins | Died in House Committee at Sine Die adjournment. |
|
HB1295
· 2 mentions in chapter, agenda
Matched: “HB1295 L. Johnson TO CREATE THE HEALTHCARE COST-SHARING COLLECTION…”
|
TO CREATE THE HEALTHCARE COST-SHARING COLLECTIONS TRANSPARENCY ACT. | L. Johnson | Died in House at Sine Die adjournment. |
|
HB1354
· 2 mentions in agenda, chapter
Matched: “…TO REGULATE SECURITY MEASURES AT RETAIL CONVENIENCE STORES. HB1354 Lundstrum TO REGULATE PHARMACY BENEFITS MANAGERS; TO AMEND…”
|
TO REGULATE PHARMACY BENEFITS MANAGERS; TO AMEND THE LAW CONCERNING THE STATE AND PUBLIC SCHOOL … | Lundstrum | Recommended for study in the Interim by the … |
|
HB1409
· 2 mentions in chapter, agenda
Matched: “HB1409 Long TO AMEND THE LAW REGARDING ENERGY; AND TO CREATE THE E…”
|
TO AMEND THE LAW REGARDING ENERGY; AND TO CREATE THE ELECTRIC RELIABILITY ACT. | Long | Died in House Committee at Sine Die adjournment. |
|
HB1443
· 2 mentions in agenda, chapter
Matched: “…EPARTMENT FOR FIREFIGHTING SERVICES BASED ON TIME ON SCENE. HB1443 Pilkington TO CREATE THE SECOND AMENDMENT FINANCIAL PRIVACY…”
|
TO CREATE THE SECOND AMENDMENT FINANCIAL PRIVACY ACT; TO PROHIBIT FINANCIAL INSTITUTIONS AND PAYMENT NETWORKS … | Pilkington | Died in House Committee at Sine Die adjournment. |
|
HB1533
· 2 mentions in agenda, chapter
Matched: “…D TO AMEND THE LAW CONCERNING CERTAIN HEALTH BENEFIT PLANS. HB1533 Gramlich TO CREATE THE DECENTRALIZED UNINCORPORATED NONPROF…”
|
TO CREATE THE DECENTRALIZED UNINCORPORATED NONPROFIT ASSOCIATION ACT. | Gramlich | Recommended for study in the Interim by the … |
|
HB1625
Act 974
· 2 mentions in chapter, agenda
Matched: “HB1625 Barnett TO AMEND THE LAW CONCERNING INSURANCE REQUIREMENTS…”
|
TO AMEND THE LAW CONCERNING INSURANCE REQUIREMENTS FOR LICENSED HOME INSPECTORS. | Barnett | Notification that HB1625 is now Act 974 |
|
HB1659
· 2 mentions in chapter, agenda
Matched: “HB1659 S. Meeks TO AMEND THE UNIFORM COMMERCIAL CODE; AND TO CLARI…”
|
TO AMEND THE UNIFORM COMMERCIAL CODE; AND TO CLARIFY THE PRIORITY AMONG SECURITY INTERESTS AND … | S. Meeks | Died in House Committee at Sine Die adjournment. |
|
HB1813
· 2 mentions in agenda, chapter
Matched: “…P RECOVERABLE DEPRECIATION UNDER PROPERTY AND CASUALTY LAW. HB1813 Gramlich TO ADOPT THE FAIR AND EFFICIENT TRANSMISSION COMPA…”
|
TO ADOPT THE FAIR AND EFFICIENT TRANSMISSION COMPACT. | Gramlich | Recommended for study in the Interim by the … |
|
HB1868
· 2 mentions in agenda, chapter
Matched: “…HE USES OF THE CONSTRUCTION ASSISTANCE REVOLVING LOAN FUND. HB1868 L. Johnson TO REQUIRE AN INSURER TO PAY A FAIR AND REASONAB…”
|
TO REQUIRE AN INSURER TO PAY A FAIR AND REASONABLE SERVICE FEE DIRECTLY TO A … | L. Johnson | Died in House Committee at Sine Die adjournment. |
|
HB1905
· 2 mentions in chapter, agenda
Matched: “HB1905 Lundstrum TO CREATE THE BUYER BEWARE ACT; AND TO REQUIRE A…”
|
TO CREATE THE BUYER BEWARE ACT; AND TO REQUIRE A REAL ESTATE LICENSEE REPRESENTING A … | Lundstrum | Died in House Committee at Sine Die adjournment. |
|
HB1949
· 2 mentions in chapter, agenda
Matched: “HB1949 Schulz TO ADD MEDICAL, EMERGENCY MEDICAL, AND AMBULANCE SER…”
|
TO ADD MEDICAL, EMERGENCY MEDICAL, AND AMBULANCE SERVICES TO THE LIST OF PROFESSIONAL SERVICES FOR … | Schulz | Died in Senate Committee at Sine Die adjournment. |
|
HB1955
· 2 mentions in agenda, chapter
Matched: “…estrictions designating areas as 'Members and Staff Only'. HB1955 S. Meeks TO REPEAL THE SHIELDED OUTDOOR LIGHTING ACT. HB195…”
|
TO REPEAL THE SHIELDED OUTDOOR LIGHTING ACT. | S. Meeks | Died in Senate Committee at Sine Die adjournment. |
|
SB331
· 2 mentions in agenda, chapter
Matched: “…TO AMEND THE LAW CONCERNING THE INVESTMENT OF STATE FUNDS. SB331 G. Leding CONCERNING COVERAGE FOR GENETIC TESTING FOR INHER…”
|
CONCERNING COVERAGE FOR GENETIC TESTING FOR INHERITED CANCER MUTATIONS; AND TO CREATE THE GENETIC TESTING … | G. Leding | Died in House Committee at Sine Die adjournment. |
|
SB480
Act 739
· 2 mentions in chapter, agenda
Matched: “SB480 K. Hammer TO AMEND THE LAW CONCERNING THE INVESTMENT OF STA…”
|
TO AMEND THE LAW CONCERNING THE INVESTMENT OF STATE FUNDS. | K. Hammer | Notification that SB480 is now Act 739 |
|
SB519
Act 958
· 2 mentions in agenda, chapter
Matched: “…ION, AND STATE-OWNED PROPERTY; AND TO DECLARE AN EMERGENCY. SB519 J. Boyd TO AMEND THE STANDARD NONFORFEITURE LAW FOR LIFE IN…”
|
TO AMEND THE STANDARD NONFORFEITURE LAW FOR LIFE INSURANCE; AND TO REGULATE THE PAYMENT OF … | J. Boyd | Notification that SB519 is now Act 958 |
|
SB544
Act 775
· 2 mentions in chapter, agenda
Matched: “SB544 M. Johnson TO AMEND THE ARKANSAS PHARMACY BENEFITS MANAGER…”
|
TO AMEND THE ARKANSAS PHARMACY BENEFITS MANAGER LICENSURE ACT. | M. Johnson | Notification that SB544 is now Act 775 |
|
HB1159
· 1 mention in chapter
Matched: “HB1159 J. Richardson TO CREATE THE RETAIL CONVENIENCE STORE SECURI…”
|
TO CREATE THE RETAIL CONVENIENCE STORE SECURITY ACT; AND TO REGULATE SECURITY MEASURES AT RETAIL … | J. Richardson | Died in House Committee at Sine Die adjournment. |
|
HB1177
· 1 mention in chapter
Matched: “HB1177 M. Brown TO AMEND THE ARKANSAS FRANCHISE PRACTICES ACT; AND…”
|
TO AMEND THE ARKANSAS FRANCHISE PRACTICES ACT; AND TO CLARIFY THE APPLICABILITY OF THE ARKANSAS … | M. Brown | Died in House Committee at Sine Die adjournment. |
|
HB1308
· 1 mention in chapter
Matched: “HB1308 Steimel CONCERNING UNFAIR PRACTICES RELATED TO RESIDENTIAL…”
|
CONCERNING UNFAIR PRACTICES RELATED TO RESIDENTIAL REAL ESTATE REPAIR CONTRACTS; AND TO REGULATE SOLICITING RESIDENTIAL … | Steimel | Recommended for study in the Interim by the … |
|
HB1408
· 1 mention in chapter
Matched: “HB1408 Pilkington TO ALLOW QUALIFYING PATIENTS OR DESIGNATED CAREG…”
|
TO ALLOW QUALIFYING PATIENTS OR DESIGNATED CAREGIVERS TO PURCHASE MEDICAL MARIJUANA USING A FLEXIBLE SPENDING … | Pilkington | Died in House Committee at Sine Die adjournment. |
|
HB1811
· 1 mention in chapter
Matched: “HB1811 Steimel TO AMEND PROPERTY AND CASUALTY LAW; AND TO REQUIRE…”
|
TO AMEND PROPERTY AND CASUALTY LAW; AND TO REQUIRE REASONABLE PROOF OF PAYMENT OF A … | Steimel | Recommended for study in the Interim by the … |
|
HB1950
· 1 mention in chapter
Matched: “HB1950 Torres TO PROTECT LICENSED FAMILY CHILDCARE HOMES FROM TERM…”
|
TO PROTECT LICENSED FAMILY CHILDCARE HOMES FROM TERMINATION OF HOMEOWNERS INSURANCE COVERAGE; AND TO PROHIBIT … | Torres | Recommended for study in the Interim by the … |
|
HB1956
· 1 mention in chapter
Matched: “HB1956 S. Meeks TO CREATE THE ARKANSAS NIGHTTIME ENVIRONMENT PROTE…”
|
TO CREATE THE ARKANSAS NIGHTTIME ENVIRONMENT PROTECTION ACT. | S. Meeks | Died in Senate Committee at Sine Die adjournment. |
|
SB420
Act 736
· 1 mention in chapter
Matched: “SB420 Hester TO EXPAND ELIGIBILITY FOR WATER DEVELOPMENT STATE PR…”
|
TO EXPAND ELIGIBILITY FOR WATER DEVELOPMENT STATE PROGRAMS; TO AMEND THE WATER AUTHORITY ACT; AND … | Hester | Notification that SB420 is now Act 736 |
|
SB481
Act 779
· 1 mention in chapter
Matched: “SB481 Gilmore TO CREATE A MORE SUSTAINABLE SYSTEM OF PROPERTY INS…”
|
TO CREATE A MORE SUSTAINABLE SYSTEM OF PROPERTY INSURANCE FOR PUBLIC SCHOOLS, STATE-SUPPORTED INSTITUTIONS OF … | Gilmore | Notification that SB481 is now Act 779 |
|
SB483
Act 957
· 1 mention in chapter
Matched: “SB483 Irvin TO REPEAL CERTAIN REPORTING REQUIREMENTS FOR THE STAT…”
|
TO REPEAL CERTAIN REPORTING REQUIREMENTS FOR THE STATE INSURANCE DEPARTMENT AND THE STATE SECURITIES DEPARTMENT; … | Irvin | Notification that SB483 is now Act 957 |
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Speaker 1
0:00
Yes, sir. Thank you, Mr. Chairman. Just go ahead and introduce yourself for the record and proceed with your bill, please. Representative Bart
Representative Bart Schulz
Unverified
0:12
Schultz, District 28, Sharpstone, Lawrence, and Independence Counties. Committee, I ran a bill very similar to this two years ago that we passed unanimously out of the House, but our friends in the Senate decided not to let it out. We made a few changes, but basically what this is, to
Speaker 5
0:28
give you a little back story, I spent 12 years on a quorum court, previous to being here.
And I also am in the ambulance business. Well, they always had a quandary. If a
Representative Bart Schulz
Unverified
0:41
county has a contract with an ambulance service, if they put out bids for this ambulance service, it is strictly lowest bidder. That's all they can look at, whoever's the cheapest. Well, if you want somebody taking care of your family, do you want the cheapest or do you want the best? that was the way i always looked at it so when i got down here some folks brought this idea to me currently if a county submits for contracts for financial services architectural services
engineering construction management land surveying or professional consultant services they go through an rfq process all i'm proposing with this bill is we change ambulance services over to this same RFQ process as all these professional entities. And with that, I would answer any questions. We
Representative Sonia Eubanks Barker
Unverified
1:44
Thank you. Thank you, Representative Schultz, for bringing this to us. How does this kind of relate to our current procurement process? Because I've kind of run into my own troubles and understanding how we procure or review procurement for contracts with EBD. So what's kind of how this would change, or is the current procurement process still operation? Well, thank you for that question. How
Representative Bart Schulz
Unverified
2:06
it currently works is with all these other entities that I named, you rank the top three, one, two, three,
and you go to number one and you negotiate a contract. If you can come up with a fair negotiation, that's the end of it. Number one gets it. If that doesn't work, you go to number two, repeat the process, then to number three. So we would just be adding ambulance services to that same process. Thank
Speaker 13
2:37
you. Any further questions from the committee? Okay, seeing none, is there anyone in the audience who would like to speak against this bill?
Representative John Maddox
Unverified
2:45
Anyone who would like to speak for this bill? Seeing no one, you're recognized to close for your bill,
Speaker 15
2:50
Representative. I'm close for my bill, and I would appreciate a good
Speaker 1
2:53
vote. We have a motion due passed by Representative Ladyman. All in favor say aye. Aye. All opposed say no. Congratulations, you have passed your bill. Thank you, committee. Representative Wardlaw, thank you for your patience. I have no patience.
Representative Jeff Wardlaw
Unverified
3:17
When it comes to you, Representative Maddox, I just see hearts and flowers. I'll be following me.
Representative John Maddox
Unverified
3:53
Okay, thank you, members. So my remembrance of this matter is that we were, you had presented, and we were now in the for and the against. So I believe we are now in the, the next is a for, is my recollection. So the next one, I think, would be Stephen Webb, for. And if there's certainly you don't
Speaker 1
4:21
have to, if there's anyone who wants to join him, that's fine.
Representative Jeff Wardlaw
Unverified
4:26
So, Mr. Chair, I think what we'll do is, if you
don't mind, let's hear all the against first, and then I'll calculate how many of the four we need to hear from because there's no reason to hear from all the hospital administrators that are here. I just would put on the record that we have a number of them here to speak in favor of the bill. I don't want to belabor the time of the committee by possibly hearing some of the same things over and over, if that's amenable to you.
Representative John Maddox
Unverified
4:56
I do appreciate that. So what I'll do, I don't know if we'll do it exactly that way, but we'll go to the against now. Thank you. So the next
Speaker 24
5:07
one on the against, I think they've decided to pull. Why don't
Representative John Maddox
Unverified
5:19
we just go back to Blue Cross? Blue Cross, why don't you go back to the end of the table? Thank you.
Speaker 1
5:31
Thank you. Thank you. And go ahead and just briefly introduce yourselves
Speaker 26
5:44
again, please. David Manns, Arkansas Blue Cross. Alicia Berkmeyer, Arkansas Blue
Representative John Maddox
Unverified
5:49
Cross. Thank you. So, members, most of you were here, but some of you had left, and they were in the midst of taking questions. I want to make certain that any member
has a question for Blue Cross has the ability to ask that question. So if you have any, now would be the time to ask it.
Representative Sonia Eubanks Barker
Unverified
6:06
President Baker. Thank you, Mr. Chair. Thank you both for being here. Just for clarification, who are you representing today with your testimony? Arkansas Blue Cross. Okay. So I guess my first question is if this is something where you guys are helpful in giving us data on how this will impact, you're helpful in articulating how those cost impacts will happen.
So I guess if your position is that these will just pass through to your end user, I
Speaker 29
6:57
guess why do you have a position on this? That's actually a very
Speaker 31
7:03
good question. So, last year, we had 125 small businesses drop coverage,
and those small businesses did not pick up coverage anyplace else. For Blue Cross, you know, we're here to, we were established by the Arkansas Hospital Association, by the Arkansas Medical Society, and by Farm Bureau. And our mission is to serve all three of those.
And so in order to have a working health care system, we need a payer. The only other payer beyond commercial is government. And so what we see happening in the market is a move toward a single-funded health care payer system where government is the only payer. Our job is to figure out how to balance those three, try and have affordable health insurance
rates, but also have a system that works for people. So we have 3,200 employees that rely on the health care system. I lost a little brother to cancer, and Arkansas Children's Hospital did their best. My dad, about four weeks ago, had quintuple bypass surgery.
And fortunately, he's recovering well. But we would not, I mean, every one of our employees have stories like I do. It's our employees, it's their immediate family members, it's their parents, their aunts and their uncles and cousins if they love them. If you add all that up, it's about 50,000 people that's affected. And so our mission is to serve everyone. And so that's why we're testifying.
Representative Sonia Eubanks Barker
Unverified
9:23
Thank you. That's very helpful. That helps clarify a lot of the motives and how, because again, when I see that, you know, the playing field is leveled and you guys serve as the in-between, it kind of begs the question like, you know, where is your position in this? You know, I heard you say that for a functional health care system, it has to have a functioning payer, but also we would agree that it also has to have functioning providers. I mean, it doesn't matter how cheap it is if there's nowhere to go, right?
And so I'm sympathetic, and I appreciate you sharing that, and thank you for your
Representative Robin Lundstrum
Unverified
10:05
answer. Thank you, Representative Baker. Any further questions? Representative Lundstrom, you're recognized. Thank you. You mentioned that Blue Cross is helping our hospitals and doctors with
increased payments. Can you elaborate how you are helping them with that? i'd be happy to talk a little
Speaker 39
10:20
bit where we've discussed arkansas blue cross and blue shield along with other payers partnering with medicare we have been really invested in increasing the value
based reimbursement and trying to bring additional payments outside of just fee for service so looking at both quality cost utilization and partnering with the hospitals i briefly mentioned earlier that many of the hospitals in the state we work collaboratively with those hospitals, meeting on a regular basis on a population to truly look at the quality metrics. What we see is working in that collaborations with our clinical teams, with executive teams, actuarial teams, really seeing some good outcomes through those.
There's been many incentives have been received through those hospitals, through some of those collaboratives and the risk arrangements we've had, both upside and upside and downside shared risk opportunities. I actually got a text just recently from one of the doctors, a primary care doctor, that talked about since we've been invested in these value-based programs back to 2012, that the incentives and the bonuses they're receiving had quite grown, and he was very pleased
Representative Robin Lundstrum
Unverified
11:24
with the program. One question. I understand hospitals negotiate for these
fee services or for the payments. Are y'all helpful in those negotiations? Do you participate in the negotiations? Absolutely, absolutely. All right, thank
Representative John Maddox
Unverified
11:38
you. Thank you. I do have a question. I have some clarification just for
me. So before we broke, you were talking about the increase in premiums that could occur if this passes. I just want to make certain that we're, had you seen the amendment where it only has to be at the 45% for January of 2026,
I want to make sure you'd seen that and that was still accurate
Speaker 31
12:05
and correct. If you could just talk about that for a
Speaker 29
12:09
moment. Yeah, so I actually spoke with Representative Johnson after
Speaker 31
12:15
our meeting, after the first part of the meeting. The way we read the language, it seems to us that the language says that if whatever the reimbursement rate is for the average state,
that we would pay 45% of that in year one and then pay that out separately. If I understand correctly, the way maybe it's intended from Representative Johnson is that instead of that, it would be whatever the average rate is from the surrounding states. If you are 45% of that and above, then you wouldn't pay it. So I think that I'm not, you know, I think, you know, I'm not sure if that's the way it, you know, if that's what it's intended to be.
Representative Lee Johnson
Unverified
13:10
Representative Johnson. I would say I'm not the bill's sponsor. I would have to defer to the bill's sponsor for intent. The way I read the bill is 45% of the minimum reimbursement level of the first year, which would be the minimum reimbursement levels defined in the bill, if I understand correctly. and that's created through this process that the commissioner sets through RAND. So the way I read that bill is, yes, it would be 45%, which I think is what is related to the testimony that was given that said, hey, at this particular point, only a small percentage of carriers are paying less than that amount.
Speaker 31
13:46
I think that's the intent. Wouldn't you agree? I don't know what the intent is. When I read it, we read it differently. If that's the intent, it doesn't look like it would provide any meaningful reimbursement. Go ahead. If I
Representative Lee Johnson
Unverified
14:05
could have a follow-up question. Were you here when I asked
Mr. Ryle that question, if that would help hospitals? And he said, indeed,
Speaker 31
14:18
I had the conversation afterward, I think, you know, so we're the largest payer, right, in the state.
And so if it's at 45%, that wouldn't affect us as a payer. So I
Representative Lee Johnson
Unverified
14:32
guess I have a question. Do you know what the average
Speaker 31
14:39
commercial rate is? So I think in order to find the commercial, the average commercial rate, the way that we read the bill, it's looking at each of the codes. So there are thousands of codes. And so, you know, it's an average rate for each code.
So you're asking, it sounds like what you're asking is, do
Speaker 49
14:59
I know the average rate for each of those codes? I guess my
Representative Lee Johnson
Unverified
15:04
question is if you're going to make a reasonable expectation of what premium increases would be, the only way I
think you could make that is if you at some point through your actuaries made an accurate assessment of what the average rate was and then applied that across the board based on the original draft of the bill, which was 85%, 95%, 100%. I don't see how you can make that calculation if you don't know what the average commercial rate is.
I don't know it. I just,
do you know, do your actuarials know that? Did they calculate that when they were looking
Speaker 47
15:37
at the... They went through the bucket of codes and then made an
Speaker 31
15:42
estimate from there, and that's what they provided me with. And then their interpretation was how I explained it earlier, which is that you take the average rate and, you know, to get us up to that point, we would only pay 85% of that the first year, which was that big number.
But if it's calculated separately, we'd have to go back and really dig into the numbers a lot further
Speaker 29
16:07
to do that whole calculation differently. Okay, so that was kind of
Representative John Maddox
Unverified
16:15
my question. I'm going to ask you is if the premium increases you were discussing were reflective of the amendment at 45%. I guess it's going to take you some more time. You've got some more time
to go back and look at it again because I guess you've learned now the intent is different.
Speaker 31
16:31
Is that accurate? It seems to be. And, again, I didn't have an in-depth conversation with our actuaries when we went back. But it sounded as if if it's at 45% and then it was at 55 and then 65 and 75, that it might not have any meaningful revenue impact from the payers that we, from our folks, until maybe year four.
Representative Lee Johnson
Unverified
17:03
That makes sense to me, Representative Johnson. Does that mean it would also not have any impact on premiums? That's correct. So your testimony at the moment
Speaker 49
17:12
is, based on the bill's current draft, it wouldn't have any effect on premiums? Correct, which means there would be no revenue to all of our real hospitals that
Representative Lee Johnson
Unverified
17:21
we're trying to help. I don't know that that was the testimony from the hospital association. But if we don't know what the average, if we don't currently know what the average reimbursement rate is, I think it's hard to say whether it's going to be revenue net positive or not.
It wouldn't be revenue net positive maybe for Blue Cross Blue Shield, but for some carriers, it sounds like it might be. You don't know the rates for
Speaker 31
17:42
United or other carriers, correct? So we're by far the largest carrier in the state other than Medicare and Medicaid. And so our premiums are based on what we're going to be paying out. And so if we're not going to be paying out, then we wouldn't increase the premiums. Thank you. That was kind of the issue I was trying to get to. I appreciate
Representative John Maddox
Unverified
18:00
that. It sounds like you're going to have to go do some more work, and I apologize for that.
But any further questions from
Representative Jim Wooten
Unverified
18:10
the committee? Representative Whitton. Mr. Mann, you gave me a number of $3,011 that the premium would increase. In other words, it would be upwards of $20,000. Is that correct? That's correct. Now, if I calculated it correctly, it would be $1,345 if it's 45%.
Speaker 31
18:36
so so that number that i gave you was based on how we calculated at 45 percent based on the previous understanding of what that 45 percent meant
Representative Jim Wooten
Unverified
18:49
so the three thousand eleven is based on the 45 percent it was yes all right thank you mr thank you any any other questions okay thank
Representative John Maddox
Unverified
18:59
you committee and thank you for your testimony The next person
to sign up to speak against is Randy Zook with the State Chamber.
Sir, we all know you, but if you don't mind, just introduce yourself and who you're
Speaker 64
19:33
with for the record and proceed with your testimony. thank you mr chairman randy zook with the arkansas state chamber of commerce once again in this committee and others i find myself on both sides of the issue because i've got members on both sides at least two sides of the issue providers as well as insurers but also especially employers and employees who pay the bills um somebody earlier said i might be
called mr doomsday or referred to people that talk about doomsday effects of these bills i guess i'll have to wear that title let me make a couple of comments and then be happy to take any questions, if there are any. In our view, and this was heavily debated at length by our executive committee Friday morning, so some of the numbers and everything may be a little bit different, but I think we can at least talk about worst case or try to mitigate the impact of some of it.
HB 1930, in our view, proposes mandating minimum reimbursement levels for health care providers in Arkansas. Although the bill intends to address low reimbursement rates, the language in the bill would cause a significant increase in health care costs for employers, employees, and self-funded health plans, including those operated by private businesses and nonprofit organizations. It's a cost shift of unreimbursed or unaccounted for revenue loss due to Medicaid and Medicaid reimbursement rates that are out of whack.
But it's a cost shift of those avoided revenues to employers and employees. If enacted, HB 1930 would have broad and costly consequences across the state. Private employers and employees, and this, again, I don't know how, this number may be a little bit fuzzy at this point, but we were told that private employers and employees could see a 30% increase in insurance premiums.
Now, with the amendment to 45% on the reimbursement, let's just say it's a 20% increase in insurance premiums, and this was provided by, I don't want to put words in their mouth, but I've large insurer, probably
Speaker 66
22:11
the largest insurer in Arkansas. That's now getting to about
Speaker 64
22:16
$1,000 per year for every employee and every employee's dependents who are on their health insurance
plans. $1,000. Call it $100 a month, just for round numbers, per life. Applying $1,000 dollars to various employee groups, the size groups, the total increase for a company that has 10,000 covered lives, that's employees and dependents, this would be a 10 million dollar cost to them. If they have 100 lives, that would be 100,000 lives, I mean $100,000 per year.
For our little group at the state chamber office, we've got about 25 covered lives, and our costs would go up by about $25,000. That's a couple of thousand dollars a month to a group of 10 or 12 employees and their dependents. This is real money. This is not just a marginal amount. Now, with the changes and the phase-in and all of that, maybe it mitigates the impact and maybe it softens the blow for a while, but every one of your companies and your districts
and every insured individual, whether they're an employee or a dependent of an employee, is going to feel this in their pocketbook. A family of four would see an annual premium increase, we've heard already, of about somewhere around $3,000. I think that's kind of low based on what we were told earlier. These increases could, and I would say will, result in the abandonment of some self-funded health plans or benefit cuts at the least.
Private businesses and non-profits will be forced to absorb higher costs, making it harder to provide affordable coverage to their employees. Some smaller firms, we've already heard a number last year, without this cost pressure, 120-something small businesses threw in the towel and quit providing group insurance for themselves and their employees. Smaller firms will stop providing health care coverage.
This will be a cost shift. This is a thinly disguised tax increase at best, by any other name. You might call it the Medicaid tax. Rather than strengthening the health care system, HB 1930 risks undermining it by making Arkansas less competitive for business investment, job creation, and talent retention. And while the state chamber and AIA support improving access to health care,
obviously and totally, a state-level cost shift is not the right approach. We are trying to solve a national, federal problem with state policy. It's just a bridge too far. And so with that, I'd be happy to take any questions. I just want to stress the point that we are all for more money for the hospitals. We're all for everybody getting paid, but it can't just be covered by private group insurance
and private health insurance payers with half or more of the population. And now with the EBD carve-out and the higher ed carve-out, even fewer people are left to pay this tax, this bill. With that, I'd happy to take any questions. Thank you, Mr. Zook, for your
Representative John Maddox
Unverified
25:57
testimony. There are a few questions
if you'd like to take some. I'll try. Representative Johnson, you're first in the queue.
Representative Lee Johnson
Unverified
26:07
I'm just trying to understand the math again. And, I mean, those are big statements, big numbers. I don't know that anybody's told me what the average commercial rate is. I don't see how you make these calculations without understanding what those are. I mean, I think it's pretty bold to come to the table and spout large numbers without, like, somebody show me the math, how it works. I'd like to understand better. Currently, based on this legislation with this amendment, it's hard for me to see those big price increases. And do you have evidence to say that it's going to be the ballpark numbers that you're shooting,
or is this just numbers you were given by somebody else? Numbers I was given by somebody else. And do you know how they came to those numbers? I have no
Speaker 32
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clue. So you don't know if they're accurate, not accurate? You don't know what they based
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it on? It was our insurance cover, our provider, and they gave us the number. Representative
Representative Jon S. Eubanks
Unverified
27:05
Eubanks, question? Thank you, Mr. Chair. Mr. Zook, in council last year, we sent out tens of millions of dollars to hospitals to help them survive.
And I don't know that your employers are going to have much success if we don't have hospitals in the state. I don't know what the correct answer is, but I know it's imperative that we have that health care available in the various communities around the state. and I think you know that, too. Somebody's going to have to pay for it. Now, we're going to have to do it one or two ways. Either we're going to have to, you know, maybe reach into GR and do it,
or we're going to try to have to spread it around. And you do understand the need for the hospitals in our
Speaker 64
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communities around the state. without question, and we recognize that availability of health care is one of the most critical problems facing communities across the state, especially the eastern third, the delta region. I grew up in southeast Arkansas. In fact, a couple of the hospitals that are probably here to support it are in my home county of Deshay County. My dad's name is on the wing
of one of those hospitals, so I get it about the need for hospitals in small communities. But we can't just put all of the cost on just the private employers and the private employees of those companies in those areas. So it's got to be a broader spreading of this cost in our view. Representative Wooten,
Representative Jim Wooten
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28:50
Mr. Tuck, you've come to the same conclusion,
Your group has come to the same conclusion regarding the federal level and the involvement there, which has to be dealt with, which they will not deal with. So do you all have a suggestion relative to how we deal with this
Speaker 64
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mess? At this point, no. I wish we did. I wish we had. I guess our suggestion would be spread the costs
Representative Jim Wooten
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29:25
over a greater portion of the population. Paula, you're the second person that has used the 20%, 25% increase this year, which would be $1,000.
And if I understood Mr. Mann correctly, that would mean that it would be about $18,000 a year for a family of four. So what does that equate to in your group, in the commercial end, relative to the group
Speaker 64
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policies? Our little group, we've got about 25, maybe 26 or 7 lives for a dozen employees who are covered.
A couple of us are not. We're on Medicare as primary provider. But our monthly bill is just shy of $14,000 a month. And if that goes up, I don't know, 15%, 20%, 25%, that's a couple of thousand dollars a month at least. And I don't see it. Our group is at ages, as most groups do. The older your employees become, the more the premium goes up.
Representative Jim Wooten
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30:38
So your membership understands the problem that we face. We do. No questions about it. Thank you. Representative Eves,
Representative John Maddox
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30:45
you are right now asking for a question. Thank you, Mr. Chairman. Brandy, when you
Representative Les D. Eaves
Unverified
30:53
read the bill, do you see that, at least the way I read it, it seems like we're excluding any insurer that provides services to the state, so that's going to be a whole bunch of people.
We're excluding any plans purchased on the marketplace, and we're excluding plans provided by a trust. So I'm kind of agreeing with you, I guess. It seems like we've shifted the entire burden of solving this problem onto the backs of mostly private industry. Is that how you read it, or am I
Speaker 64
31:27
missing something? That's exactly how we read it. And it's, I mean, you've carved out EBD, the Employee Benefits Division, so all the state employees have carved out. The federal employees, the second largest employee group in the state, they're not covered by this.
And then I understand higher ed has been carved out, so there's another probably 100,000 lives. So you're getting it down to a pretty small pool of payers. Thank you, Representative Veves. Any other questions for Mr. Dutt? Thank you
Representative John Maddox
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31:57
for your testimony, sir. Thank you very much, and you really have my deepest
Speaker 64
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sympathy in trying to figure this out. And if we can be helpful, we'll certainly try. Thank you for your testimony. We appreciate you.
Representative John Maddox
Unverified
32:11
Uh, Jack Hopkins, would you like to come to the table and introduce yourself and who you're with and you can proceed with your testimony on this
Speaker 84
32:23
bill. Thank you, Mr. Chair. Jack Hopkins with Qual Choice Health Insurance. Um, uh, I'll keep my comments brief, but I wanted to touch on a couple of the questions the committee had for the two previous witnesses. Uh, first, Representative Baker, of course, um, uh, insurance doesn't exist without a provider network, right? and I think that some of the conversation that was left out is that we need our providers to form a network,
and that's how the market works, and that's how we negotiate raise. To that end and the questions around whether that system is working, I think that it's important for me to testify to that end. In the last 15 months of the seven major health systems in the state that represents over 33 hospitals, We've renegotiated with all seven, or all six of the seven. We're in the process of the seventh right now. So to the question of Representative Lundstrom and somewhat to Representative Eubanks' question
of whether the system's working, we feel it's moving in the right direction. Has it solved all of the issues of all of our hospitals? No. But I wanted to dissuade the idea that payers, or specifically us, are remaining stagnant and not addressing the needs of hospitals. We're moving in the right direction even up to the last 15 months of increasing reimbursement on average to our hospitals. Additionally you'll notice in SB 527 in our home program we're also increasing the medical loss ratio from 80 to 85 percent so even on that program which we are a part and so is Blue Cross we're increasing the mark to reimburse our providers on that. One further
question I think was what what the impact is and how we arrived at our numbers. So for us we took the RAND report. We took the average of all the seven states that are listed, both inpatient, outpatient, and physician rates, and we took the RAND report averages and ran them against our own encounter data. Not premium increase, not margin for the health insurer, just pure medical unit cost increase for our plan, which is much smaller than Blue Cross and United,
but just for our plan, we see 30% cost increase just based on this language. I also want to point out that to the point of the bill, yes, Arkansas on some of those services are lower than our surrounding states. However, it doesn't take into the full consideration of the market conditions for each state and how Arkansas stands out, how our market is different than Oklahoma, Texas, Mississippi, Missouri, and Tennessee. Additionally, what that RAND report and what our own numbers show is that our primary care physician rates are actually higher than most
all those states except for Tennessee and Texas. So when you're looking at this,
Chair
Unverified
34:55
it's not just about one service versus the other. It's the whole gamut. With that, I would take any questions. Thank you, Mr. Hopkins. Any questions? Representative Ecker, you're recognized.
Representative Sonia Eubanks Barker
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35:08
Thank you, Mr. Chair. Thank you, Mr. Hopkins. I appreciate the perspective. I know that you're offering a perspective kind of statewide because QualiChoice represents a statewide program. I think the concern comes in where you have smaller hospitals, where you have smaller provider groups and networks
that don't have the ability to leverage, and they get left out. So, again, if you're a good actor, which we have all the evidence you provide here that you are, we thank you for that service. When we hear stories of UnitedHealthcare kicking out Baptist or Calway Regional or Carti, those are large groups, right, that even when they struggle with the capacity to serve patients who have paid into a program and can't find a place to go, that's where this problem comes here for us to solve. So it's not a reflection of the efforts that you guys have made.
It's a reflection of you have a disproportionate amount of leverage across the state with an equal level of necessity for care. Wouldn't you agree?
Speaker 84
36:02
I could be sympathetic, Tud, and I can't answer for each contract negotiation of all hospitals in the state of Arkansas. I think the main point was that the notion that nothing is being done or that we're not moving in the correct direction is different than what we see in the field. Thank you.
Speaker 1
36:25
Any other questions from the committee? Thank you, Mr.
Representative John Maddox
Unverified
36:30
Hopkins. Thank you, Mr. Chair. Is there anyone else? There's no one else signed up. Is there anyone else who would like to speak against this bill? Okay. My understanding is numerous CEOs are going to come up at the same time to try to keep this moving as opposed to calling them one by one. So it's just unfortunate at the end of the session We are in the time constraint, and I apologize for that, but that's how we're going to handle it.
So whoever is going to speak, once you get seated, introduce yourself and who you're with, and you can proceed with
Representative Jeff Wardlaw
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37:06
your testimony. Mr. Chair? Yes, sir. I'd like to introduce all the CEOs present before we do that, if that's possible. Sure. So members, we have with us today Brian Thomas from Jefferson Regional in Palm Bluff. if you would stand or wave every time. We have Chad Abdul and Angie Longing from CHI St. Vincent.
We have Matt Troop from Conway Regional. Along with Matt, we have Rebecca Fincher. She's over there. We also have Ron Peterson from Baxter Regional. We have Stephen Webb from White River. We have Terry Schultz from McGee. He's mine, by the way, and he's Randy Zooks, just for the record. You know, it's all fun and fairing games. We have Jeremy Capps from Delta Regional, from Dumas.
Thank you. Also one of mine. We have Jay Quebec from Baptist Regional, who represents all small hospitals around. And we have John Hurd, who I almost forgot, from Lake Village, and I'm sorry. He's also one close to me. With that, you can see that we brought and asked for a whole wide range of CEOs from across the state. So with that, Mr. Chair, I yield to the members that are going to speak. Okay,
Representative John Maddox
Unverified
38:22
thank you. But before we do, one correction. It's Jay Quibido. He used to be mine, so I just wanted to clarify his last night.
So you gentlemen can introduce yourselves and proceed with your testimony. Good evening. My
Matt Troop
Unverified
38:38
name is Matt Troop, and I serve as CEO of Conway Regional Health System. It has been a long day, but I think it's
Speaker 88
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important to go back to eight hours ago when we first gathered in this room and we heard a discussion about athletics and the desire to have a level playing field, an opportunity for athletics to be able to compete at a level with states in the area and at the competitive level to be able to have NIL funds.
Really what this is about is about fairness. It's about a fair and equitable rate here in the state of Arkansas, and the data is the data. The data quite clearly shows that we are the most poorly paid state in the country. Let that sink in. We are the most poorly paid state in the country. We have the highest incidence of hospitals at or near closure because of the financial performance of their health care systems. So we can debate the impact on premiums. I think it's rather a fascinating discussion, the way math works.
If 162% is the average commercial rate, then well over half, potentially half, at least if it's an even distribution, half of all employers will have absolutely no effect by this bill, by the decision you make here tonight and the decision subsequent when it gets voted on. The other half will be impacted. Those hospitals will become stronger. One of the many hats that I get to wear in my community is I'm chair of our chamber of commerce.
Every time we bring a new business into Conway, every time we try to recruit someone into our community, health care is typically top one or two items that we talk to them about. And more and more, it's becoming difficult to provide for our patients, for our growing community, not just here in Conway, but for others as well. This notion that the market has moved is a fallacy. We don't see the increases in premiums that are talked about across the state.
We don't see those premiums commensurate. And this notion that the market can kind of take care of itself in Arkansas is also a rather fascinating discussion. At Conway Regional in 2023, we terminated United. We went out of network for about seven weeks. That decision cost us millions of dollars, millions of dollars in uncovered care, hours and hours and hours. I can't explain to you how many hours, not just of my time and my team's time, but our hospital team trying to find care for patients, patients that were left in a lurch.
Nobody wants to go to a termination with a payer. The thought of terminating a payer that has 70 plus percent market share in the commercial world would be catastrophic to the hospitals that certainly that I represent and the hospitals behind me. So this notion that we can just negotiated out, it isn't based upon fact. The fact of the matter is we're in a situation where the rates are unequal. We're the worst paid state in the country. We have more hospitals at financial
distress than any other hospital or any other state in the country. And this notion that it's going to impact premiums is just, I mean, we can speculate all day long. Look at the data. There's a 10% delta from high to low on premiums between Arkansas and the surrounding states. 10% high to low on average premiums. The average reimbursement to hospitals goes anywhere between 35% to over 50%. Somehow Mississippi can figure this out. Somehow Mississippi can have rates premiums that are actually lower than Arkansas
and yet pay their hospitals 50% more. I think we're smart enough to figure
Matt Troop
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42:17
that out, And I think our employer community, working with hospitals, can figure out how we can decrease utilization to protect costs.
Brian Thomas
Unverified
42:28
Thank you, sir. You can proceed. Good
evening, everyone. My name is Brian Thomas. I'm president and CEO at Jefferson Regional in Pine Bluff. And Matt did a great job
Speaker 93
42:38
explaining kind of the dynamics of where I think all of our CEOs are coming from. but I thought I'd give a personal testimony of what's going on in the Delta area with Jefferson Regional and Southeast Arkansas.
Brian Thomas
Unverified
42:51
First of all, I've been there for close to 20 years. I've been in health care for close to 30. And, you know, right now there are challenges in Arkansas, and
Speaker 93
43:00
I would say that health care has certainly escalated to the top of that list in most of our markets. We currently have close to 30. It's debatable, but at least 30 of our facilities are on the verge of closing. We've heard some of that testimony earlier. Financial losses have become the norm, and our balance sheets have been decimated. As an example of our facility, just since COVID-19 in the last five years, we have lost
money on operations consecutively every year. Last year, we posted a negative 10% operating margin. No representative Ferguson's heard my spiel at our hospital directly a couple of times, but that equates to about a $20 million operating loss. We've improved that significantly through a lot of advancements with our cost-cutting and other advancements, but we're still finding ourselves upside down. Our cash reserves have gone from a strong 300-plus days cash on hand. With the intent of investing in our infrastructure for the future, we've got a building that needs a lot of work.
But, however, we've had to dip into those investments and draw out to be able to fund our operational losses. We're currently, we've gone from 300 days cash on hand now to 160 days cash on hand, which I know a lot of hospitals would love to have, but we're needing that money to fund a lot of our investments for our future for our campus. We find ourselves now relying on subsidies such as the provider assessment taxes and things like 340B just to make ourselves survive, and I think every CEO would agree with that.
These circumstances were certainly not created by Arkansas. We all talked about Medicare and things like that, But there are some things that we can address, and I think this is the first time. And I commend Representative Wardlow for actually bringing something that's actually useful and can make a difference for our hospital. I appreciate that very much. You know, I've heard about our commercial payments. I won't spend a lot more time on that, but the facts are the facts. And I think Matt did a great job explaining that. But post-COVID, our facilities, all of our hospitals across the state,
have seen a skyrocketing cost increase of probably in the neighborhood of 25-plus percent. We're not able to go recoup that from anywhere else. So unlike the coffee shops and the restaurants and the retail, we can't simply pass that cost on because negotiating with our payers and our friends at the payer side, if you want to call that negotiation, is very, very difficult and it's been very, very challenging. But as you've heard countless times, our neighboring states are certainly paid at a much higher level of services for the exact same rates, in many cases right across that state line.
Some of our states across the country are reaping as much as three times what we're paid from the commercial level. Three times what we're getting paid. And the bill you're addressing this evening is simply taking those average rates of our neighboring states and getting us close to half of that, half of that average. So it seems like a very mild way to kind of get into that neighborhood of increasing our ability for getting better payments here. We recently as a hospital engaged a national firm called Kauffman Hall.
They are nationally known for coming in and helping hospitals look the way to improve operations and performance. I want to bring a couple of quotes that we're going to report that we got from them. One was that Jefferson Regional is operating its facility at the top of the game with regard to its staffing levels. and negotiating supply chain management services. This hospital cannot cut its way to prosperity. We found this very interesting, and so did our board of directors. Long-term survival will only come by way of significant improvements with reimbursement and commercial payments.
The bottom line is that hospitals can no longer lose money for health care. In fact, we're not just losing money. We're subsidizing health care in our markets. So let that sink in. Our health care systems are subsidizing services, not only for the government payers, but also now for the commercial payers. And I think that's a big deal. We certainly, as a hospital, support this bill. We appreciate the leadership of Representative Wardlaw and other officials that brought this forward. And I would leave you with this.
Just five years ago, I know everyone quickly forgets what COVID was like, but when COVID-19 hit, we were really faced with something we'd never seen before in our lifetimes. I'm not sure our health systems would be able to sustain that if we had another pandemic next week, next year, if we couldn't get better support with our reimbursement plan. So I appreciate the opportunity to be here tonight and speak, and thank you for your consideration. Thank you for your testimony. before we
Representative John Maddox
Unverified
47:42
oh I'm sorry did you know if you if you want to go ahead go ahead and introduce yourself
Speaker 96
47:49
and I'm sorry no you're fine I'm Angie Longing and I started my nursing career at as a labor and delivery nurse over 30 years ago in Moralton and today I serve as their president so I took the president role um this past fall and um you know since that time you know I've come to understand that that hospital means everything to the community. We're one of the largest employers. We provide high-quality care, great patient experience,
incredible employee engagement. Last year, we were named one of the top 100 critical access hospitals in the nation. We achieved Pathway to Excellence, which is a national nursing excellence designation, the first and only in the state of Arkansas. So, even though all of these achievements, we're at risk as our financial performance has declined over the past several years, and our future is not sustainable. Over the past five years, salaries and benefits alone are up 36%, as a result of the nursing and staffing shortages locally and across the nation.
So even though St. Vincent Moralton experienced these large increases in the cost of providing care, our revenue from government and commercial payers has not even approached the cost of inflation. In fact, it is down 5% for the same period with the same volumes. So we went from having a slight income that we could reinvest in our facility to losing $2 million two years ago and over $4 million last year.
So now we're looking at services that we have to cut or close, and we're questioning, can we remain a hospital? The cost of health care is going up, and we've absorbed those increases. but we must have relief with increased reimbursement to remain viable. Thank you for your consideration. Thank you. Thank all of you for your testimony. We do have
Representative John Maddox
Unverified
49:57
a couple questions. I have one for Mr. Troop, just to make sure that I understood you. And I may not have.
Speaker 1
50:03
Did you say Mississippi's premiums are less, or did I misunderstand that?
Speaker 88
50:07
Yes, they're about $100 less, according to a Northwest Arkansas study. It's in my notes. So
Speaker 1
50:13
obviously we know about the reimbursement issue, but your testimony is their premiums are also less. That's, yes, based
Representative John Maddox
Unverified
50:19
upon that study. Thank you. Thank you. There are a couple questions. Representative Richardson, you are next. Thank you, Mr. Chair,
Representative R. Scott Richardson
Unverified
50:29
and thank you guys for being here. So I just want to follow up. I asked a question earlier today about hospitals not paying or not charging the full amount that they're supposed to.
Can any of you give me examples of when any of you have done that? Is that happening in
Matt Troop
Unverified
50:53
your hospitals, and what's the cause for that? Makes me giggle. No, not that I
Speaker 88
50:57
know of. Now, there are occasions where there may be an error in a charge. Maybe we didn't charge for something that might result in a bill going out that was the lesser of, right, the lesser of charge versus the contracted rate that a payer may pay. What I would submit, what's illogical to me, is if they wanted to pay the hire of the allowable charge
versus the actual hospital charge, we'd be okay with that. It's kind of illogical to say that the solution to this is to charge more. Let's all go back to our communities and talk about hospital charges and that we need to charge more. That doesn't make any sense to me. It does happen. It does happen in error sometimes. But that's a contractual term that we'd love to see change if this body wanted to take action on that and say that they must pay the higher of. But that's not what we're here to talk about. And it's a very minor issue in the grand scheme of things, I would say, as well.
Speaker 1
51:52
Okay. Thank you. Representative McGrew, do you have a question? Yes,
Representative Richard McGrew
Unverified
51:59
thank you, Chairman. And thank each one of y'all for the services y'all provide. It's very important to our communities. and I can sympathize and understand the fact that there's not enough money there. The question I have is what was brought up with Randy and Les Eves, that we're not spreading this to state employees, to higher ed, and all that.
It seems, and we talk about fair and level, that doesn't seem fair and level to me. So what is your statement on that as far as it not being spread to all the other people? It seems like to me the weight on small business and private people is tremendous. My daughter came to me. Her and her husband have two kids. They're paying a tremendous amount for health insurance. She's got a tumor on her hip, and it's financially killing them.
So a 5% increase is terrible on her. But my question to you is, what do you feel about it not being spread equally across all our Kansas instead of targeting private business? And maybe that's something that you can get on closing, Jeff, that they don't. But that's a concern. I wasn't here earlier. I was in another committee.
Speaker 13
53:30
Thank you. Representative Wooten. You are next with
Representative Jim Wooten
Unverified
53:35
a question. Thank you. First of all, I want to recognize Ms. Longing. Everybody else was recognized. She is a Badger, former student in BB, so we're proud of her. My
question is of either one of the three of you or whoever, we're faced with a real problem, which you know better than most.
You hear Mr. Zook's comments, Randy's comments relative to what it will do to industry and commercial rates and all that. And we've got to come to grips with it. And the one way to come to grips from your standpoint is to raise the reimbursement that you're receiving at the hospital level, which we recognize and see. But the downside of that is we're faced with the dilemma of what it does to the taxpayers
and to the policyholders of the state of Arkansas. What has Mississippi done that's so different from what we have done or we could do? Representative Wooten, I would suggest that we
Brian Thomas
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54:52
really don't know all those facts, and we certainly are going on some assumptions based on the payers
Speaker 93
54:58
that premiums would have to increase. That is an assumption. Other states have clearly figured this out, and I'll echo what Mr. Troop said earlier.
Surely we can figure this out in the state of Arkansas because our rates are right there in line with the other adjacent states near us, but we've got to figure out how we can get our hospitals and our
Speaker 107
55:20
health systems better reimbursed or we're not going to have a health system in the state of Arkansas
Representative Jim Wooten
Unverified
55:26
for very long. Well, you want to be a part of the solution. Correct. We want to be a part of the solution. And so I'm asking you, and you're telling me that you don't know what the other states have done?
With regards to how they're passing those days on? With regards to the dilemma that we're in. If Mississippi has a better program than us or Tennessee, what have they done that we're not doing? Or what have we overlooked or what have we missed?
Matt Troop
Unverified
56:00
I'll give you my best answer to that, and I think it's multifactorial. One of the reasons
Speaker 88
56:04
our rates are so low is because we're largely a rural state, and that's something we share in common with other states.
What I think is unique, and I come from a perspective of having worked at four other states in this country. I've worked in Texas, Oklahoma, Florida, and now Arkansas. No other state has a market concentration on the payer side like we have here in Arkansas. Also, no other state has as many independents, community-based, hospital-based systems like we do. So I think it creates a market environment where it's hard to negotiate rates.
Rates tend to stay low, and as providers, we want rates to stay low. We want care to be available and accessible to our patients and our community. I don't know. I can't get into the ins and outs of Mississippi health care, but my speculation is it's an economic issue between how their payers are structured and their market dynamics of how many providers there are in the market.
Representative Jim Wooten
Unverified
57:08
So you're saying that it's like we have 3 million people in the whole state
and Houston has 11 million, 10 million. So this inequity as it relates to the spread of the wealth is what could be contributing to
our situation. Could be. They have, as providers, more
Speaker 88
57:35
occasion to negotiate rates at higher rates than we do here in this state. As I said before, the thought of taking on a payer over rates
and taking that to contract term is a reality that as hospitals, we can't afford to take. I think, as Mr. Thomas said, with COVID, I think we would be challenged to take on another pandemic. We'd also be challenged to take on another payer and go to term where we couldn't take care of patients. And so I don't know that those other providers, those other states,
Representative Jim Wooten
Unverified
58:15
have that same truth. Well, I agree with Representative Eubanks. We poured millions and millions of dollars from the federal government that came into Arkansas.
I was in one meeting of the ALC where we spent $40 million in one swath to help the hospitals. $10 million went to White County, and the rest of it came down here to a Baptist, I think. But we're trying to find a solution. And this apparently, with Representative Wardlaw's assistance, this has been what we've come up with.
Is the problem that we've exempt so many from being involved, is that affecting us? And I'll probably pay for asking that question. But, I mean, you talk about the number of people, and then we talk about exempting X numbers. So somewhere in there, there's got to be a balance.
Thank you, Mr. Chairman. I would answer your
Brian Thomas
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59:27
question maybe a little differently than maybe how you're framing it.
I think if we were going to solve the entire complexity problems of health care, we would be here for a long, long
Speaker 93
59:39
time. I'm not sure we can do that, but this is the first step in the right direction of something that's really substantive that can actually take a step. And again, an average of all the neighboring states' reimbursement at a lesser rate than even 100% of that is a very small step in the right direction. And it is the very first step that anybody has made to help the hospital systems in Arkansas.
So, again, I commend the efforts of all the people that have put this forward, but this is the first step in the right direction that's giving any of our CEOs for your health systems a glimmer of hope that we've got some prosperity out there to at least improve the situation and the pathway that we're on. Nothing else brought forward before has even suggested, and even Representative Wardlow mentioned earlier in his testimony that really we're not able to throw money at hospitals and solve anything for a long-term perspective.
That's the worst, probably the worst investment, although our hospital would have loved to have gotten that money ourselves. That's probably the worst investment for the state of Arkansas to continue to throw money at hospitals. This is the first step towards a solution and being mindful of what we can do to put things in place that, in our opinion, are reasonable for the state of Arkansas and for the payers as well as the employers that are paying the
Representative Jim Wooten
Unverified
1:01:03
bill. Well, I'm the first to say that it's not a Democratic problem or a Republican problem.
It's a Washington, D.C. problem that should have been dealt with by the federal government years ago. And that's all
Representative John Maddox
Unverified
1:01:17
I've got to say. Thank you, Representative Wooden. Thank you. Any further questions from the committee? Okay. Representative Baker, you're
Representative Sonia Eubanks Barker
Unverified
1:01:26
next. Thank you, Mr. Chairman. I really appreciate you guys being here. And, you know, I've heard some discussion about how we've limited the pool, but I think it's important to show that you guys each have your own employee health benefits, right?
And I don't imagine that any of you, I mean, we've heard underutilization or drop of coverage. I can't imagine you guys wanting to drop coverage for your own employees. No. And I can't imagine you wanting to limit that employee's use of that plan in any way, right? Correct. And so I think it's very telling that you're saying we don't see we're an employer, too. Like we're not just pulling from the system, we're participating in it as well. So I appreciate you guys being transparent with that, and I really appreciate what you do for your communities as well.
Representative Lee Johnson
Unverified
1:02:12
Regent Johnson, question? Yeah, I appreciate that. Yeah, so I have a lot of questions, I guess. I'm going to try to limit just because of time. I want to understand some of the things that were said better. One of the questions I have is around rates. So I assume that you all go through negotiations on rates with payers, correct? How often and to what percent are you getting increases in rates over the last, say, five years or ten
years? Is that something that happens every year that you get a rate increase? How often is that happening?
Matt Troop
Unverified
1:02:44
It varies by payer. Traditionally, we meet with each payer, go over market conditions,
Speaker 88
1:02:49
things going on in our hospitals, salary rate increases, supply chain drugs, that kind of stuff. With some payers, it's a polite listening, and then, you know, frankly, we get told what's going to happen. And sometimes that's a mix of a little bit on outpatient services, for example, and a little bit on inpatient, and they take away in other areas. So it varies by payer. It's really not until you get to a point of, like we did in August of 2023,
Where we terminate a payer, can we really get anything substantive? Medicare is going to do anything between 1% and 2%, 3%, maybe tops. It does get to be kind of complicated because those aren't just, you know, across-the-board increases. They're selective, and sometimes they give and take away. So it varies. But I can say this without doubt. We don't see rate increases at the hospital being commensurate to what we hear premium increases being.
That is definitive. And so it varies year by year and by payer. But clearly, on average, it's nowhere near what we see in premium increases. Mr. Thomas, I appreciate you laying your cards on
Representative Lee Johnson
Unverified
1:04:04
the table regarding cash in hand. I would think that if I'm looking at all the men behind you and women here at the table, You're in a unique position compared to a lot of the hospitals in the state. Does anyone here at the table, anyone in front of us, do you have an idea of cash in hand for
payers? Do we have an idea of what their surplus is, their risk-based capital, from the standpoint of cost?
Do we know? I'm not aware of that. Okay. And then you mentioned, it was mentioned that you might be charging less. How much of your time is spent, and again, anyone can answer, working through downcoding, working through denial of charges, working through prior authorization processes, things that, you know, how much effort are you spending, how much time and money are you spending just trying to get
the payers to pay what you feel like is an appropriately contracted rate?
Brian Thomas
Unverified
1:04:58
Fortunes. We're spending fortunes. We've hired probably
Speaker 93
1:05:02
in excess of 12 individuals just at our hospital to take on mainly Medicare Advantage plans. that are denying payments but these are efforts that your hospitals are having to go through and this is not just arkansas this is nationwide but that that whole experience is its own set of issues it's it's a completely different situation but we're having to expend more resources to defend service is already rendered so keep in mind when people hit our doors they're getting care the law
says that we have to do it but we want to do it out of the nature of our missions but we're having having to then go fight for those dollars that have already, for services that have already been rendered. So a significant amount, I bet if we were to add up the FTEs, just in the hospitals behind us right here, we're probably in close to proximity of 50 people just in these facilities that are being added, that have been added, just to go defend ourselves, to get paid for services that have
Representative Lee Johnson
Unverified
1:06:01
already been rendered. And you mentioned subsidizing. One of the thoughts that I've had,
and I don't know if this is a thought others have had, but if you have national payers who are paying claims in all the surrounding states and paying claims in Arkansas, is it possible that we are subsidizing some of these lower premium rates by allowing our rates to be so low? Does that make sense to you at all, or is that a wrong way to think about it? I mean, if they're paying certain claim rates in Mississippi, Oklahoma, across state lines, and they're also paying rates here, let's say like a United, a large national company.
In my mind, if those premiums are being kept low in the other states, while their rates are
high, the money has to come from somewhere. Is it possible that we're subsidizing those low premiums in the
Speaker 107
1:06:49
surrounding states? That's exactly what we're saying, especially in the neighboring communities just beyond
Chair
Unverified
1:06:58
our borders. All right. Any other questions from the
Representative Jack Ladyman
Unverified
1:07:03
committee? Yes. Representative Leitman, you recognize? Thank you, Mr. Chairman. Well, I'm totally confused. I mean, we're hearing a lot of numbers, and I don't know exactly where we're at on cost.
But, you know, we talk about the payers. The true payers are the people out there paying the premium, okay? They pay the insurance companies, and then they pay you guys. And I understand we've got a problem, and I understand where you guys are coming from. But someone was talking, and I had a lot of thoughts here. I won't cover them all because we're short on time, but talked about a level playing field. The problem I see with this is that we're requiring a small population to pay for the problem here.
And if we've got a level playing field, you know, I've not worked in state government until I got elected to an office. I worked in private industry. And when I look around this table, about 50% of the people sitting here are private workers. They work for private industry. So if we implement this thing, and I worked at factories, okay, so if I had an electrician working at a factory, he's going to pay more in premium. If premiums go up, and I can't tell whether they're going to go up or not, but if they do, let's assume they do, that electrician in that factory is going to pay more.
An electrician working out at Arkansas State is not going to pay more. Is that right? That's the way I read it, because this is only for commercial people, not for government employees. Well, let me go on. It looks like you can't. Maybe Jeff can address this. But in order to decrease the impact on an individual, we need to broaden the base.
As Chamber of Commerce said a while ago, that's one way to do it. So I just don't think it's fair. We took out higher ed because it was too expensive for them. And when I worked in private industry and we would see rates increase and taxes increase and all that, we thought, well, why is government paying less than us working for private business? Primarily it's because I don't know how many private, you know, plant managers or people that own their own businesses are here to talk about their side of this.
But I can't support a program when we reduce it to only private individuals and we take out all of government employees. That's not fair. We've got a problem that we've got to fix. One other thing, then I'll quit, but, you know, somebody said, well, Oklahoma, we're a rural state. Well, let me tell you, Oklahoma's rule. They've got Oklahoma City and Tulsa and everybody else's rule. And I drove through Mississippi last week, and I've got relatives that live down there. It's as rule as we are. So if they're doing it right, we're doing something wrong.
And I don't understand why we can't figure out what they're doing. Look at all the data and everything that's going on there and figure out what we need to do to match them. I understand it's a national problem, but we ought to be able to get closer to what Mississippi and Oklahoma is doing. All right. Thank
you, Representative. Any other questions from the committee? Seeing none, thank you all for your testimony. Is there anyone else here to speak against this bill?
Anyone here to speak for this bill? Seeing none, Representative Eubanks, you're recognized for a motion. Thank
Representative Jon S. Eubanks
Unverified
1:10:48
you, Mr. Chair. I have a motion to expunge the vote by which the amendment was passed. That is a proper motion. All those in favor say aye. Aye. All those opposed? Seeing none, congratulations.
Representative Jeff Wardlaw
Unverified
1:11:04
The vote has been expunged. We have a new amendment with a grammatical fix. I shouldn't have mentioned that earlier in the committee, but we did find one,
and we wanted to make it very clear of higher ed's exemption, So the amendment fixes the grammatical fix and makes higher ed a very clear and less broad. All right, I'll give everyone a chance to take a look at that, and then
Representative Jon S. Eubanks
Unverified
1:11:26
I'll take a motion on that. Motion to adopt. That is a proper motion. All those in favor, say aye. Aye. All opposed, say no.
Congratulations. Your amendment is passed. You may present the bill as amended. Close for my bill as amended, please.
Speaker 126
1:11:40
That's the wheel of the committee. So, Mr. Chair, if
Representative Jeff Wardlaw
Unverified
1:11:50
it pleases you, I can take questions before I close. I realize the rules don't allow questions after I close, but I'm ready to close if the committee is ready for that. You recognize the close for your bill?
Thank you, Mr. Chair. So sitting and listening to the testimony today, there's been a lot of argument about who we included, why we included, or why we have the ramp-up that we have. So let me walk you through it. We're not putting the whole problem in this bill. We're not fixing the whole problem with this bill. Nowhere in this bill are we going to get here in five years when the whole bill is in effect and go, whoo, we've got a bunch of money in hospitals. That's not true. What we're trying to do here is start a conversation
that fixes hospitals on a long-term basis through funding them on an everyday basis instead of sending one-time dollars, which is what we've been doing the last five years to keep our rural hospitals open. It's not sustainable, folks. You want to talk about sending it through this group of people or that group of people? If you keep it the way we got it, we're taking it straight out of the income tax dollars and sales tax dollars of the state, and we're going to be sending them a check because there's no more federal reserves coming here like CARES Act and ARPA.
So we have to address this problem one way or the other. Does it cost money? I started my bill presentation off earlier today with the answer, absolutely yes, it costs money. It has to cost money or they can't pay the doctors, they can't buy the blood, they can't buy the supplies that it costs to keep the hospital open. Yes, it costs money. Will it cost as much as the insurance company said here and told you? The answer is absolutely no. We know that from last session when we got the impacts from all the bills that were passed last
session. They told us when we passed the bill that Representative Johnson brought, they'd done away with prior authorizations, and I believe it was a gold card that we called it, was going to cost this many millions of dollars. We never seen a single dollar of that cost, because they do it to scare you guys. And they do it to scare you because most of you guys are not in health care. Most of you guys have no idea how health care works. If I went and sat here and started talking to you about billing practice in health care, you'd all blow your minds because you wouldn't even understand why we bill at X
and we collect Y, which is less than 20% of X, for the record. It's very confusing. I've been in the health care business for 25 years. I sit here and quote it all off to you. But we have to address this issue. We have to address it in a very educational way. The question keeps coming up, why did you exclude EBD? Why did you exclude higher ed? I'll tell you right off why EBD was excluded, because I did it before we ever got here. I did it when I drafted a bill.
We've already initiated millions of dollars of costs this session alone in EBD. I was scared to death to do that again, because our reserves was already getting very, very low. So the reason we went to the five-year ramp-up today is because if you come back in two years from now and include EBD, you will not affect the bill at all because the bill will have almost zero impact by that point. That's the reason we started off at 45% of the average. It was spoke a while ago, can we protect the 45% average so we don't have insurance companies drop their
reimbursements to the 45% average? Well, I think the protections that's done through the negotiation of the contracts through the hospitals. And if any hospital signs a contract for less than that, I don't know if we don't need to hire a new administrator and probably the whole administrative staff. So the colleges, the same reason. They can be included next session very easy. This bill, we worked on it for six months to get to this point or I'd have filed a thing at the beginning of the session.
It's just been a very tough bill to work on. It's been a very tough process. There's no easy way to come to you and tell you people have to spend money. Absolutely no easy way. But these businesses in the room that testified wouldn't be in the communities they're in if they don't have a hospital. Because I promise you, in that grain bin in McGee, if that man loses his leg in the bottom of it tomorrow, and he has to go all the way to Pine Bluff or all the way to Little Rock, he's either not going to be alive and he's sure not going to be able to get his leg sewed back on. So we need those hospitals in McGee to stabilize them before they transport.
We need that hospital in Dumas. We need those hospitals in Camden in case there's, God forbid, some accident out at the government facilities. These things have to be there. The choice is now on the table. Do we walk away from the issue for another session, or do we start the conversation to get it addressed? Mr. Chair, I'd appreciate a good vote from the committee. Thank you for hearing it. What's the will
Representative Jon S. Eubanks
Unverified
1:16:51
of the committee? Motion do pass as amended.
Representative Eubanks. proper motion. Any discussion on the motion? Seeing none. All those in favor say aye. Aye.
All opposed say no. No. Yeah, ayes
Speaker 129
1:17:23
your bill. Thank you, Mr. Chair and committee.
Representative Jon S. Eubanks
Unverified
1:17:27
All right, I think we're going to adjourn here.
We do have further business here, but I believe I'm
Speaker 130
1:17:36
just going off of Representative Maddox's call earlier, so we are adjourned.
Agenda
REGULAR AGENDA
Number Sponsor Subtitle
HB1295 L. Johnson TO CREATE THE HEALTHCARE COST-SHARING COLLECTIONS ACT.
HB1308 Steimel CONCERNING UNFAIR PRACTICES RELATED TO RESIDENTIAL REAL ESTATE REPAIR CONTRACTS; AND TO REGULATE SOLICITING RESIDENTIAL CONTRACTORS AND TREE CONTRACTORS.
HB1811 Steimel TO AMEND PROPERTY AND CASUALTY LAW; AND TO REQUIRE REASONABLE PROOF OF PAYMENT OF A DEDUCTIBLE TO RECOUP RECOVERABLE DEPRECIATION UNDER PROPERTY AND CASUALTY LAW.
HB1813 Gramlich TO ADOPT THE FAIR AND EFFICIENT TRANSMISSION COMPACT.
SB420 Hester TO EXPAND ELIGIBILITY FOR WATER DEVELOPMENT STATE PROGRAMS; TO AMEND THE WATER AUTHORITY ACT; AND TO AMEND THE USES OF THE CONSTRUCTION ASSISTANCE REVOLVING LOAN FUND.
HB1868 L. Johnson TO REQUIRE AN INSURER TO PAY A FAIR AND REASONABLE SERVICE FEE
DIRECTLY TO A FIRE DEPARTMENT FOR FIREFIGHTING SERVICES BASED ON TIME ON SCENE.
HB1443 Pilkington TO CREATE THE SECOND AMENDMENT FINANCIAL PRIVACY ACT; TO PROHIBIT FINANCIAL INSTITUTIONS AND PAYMENT NETWORKS FROM USING CERTAIN DISCRIMINATORY PRACTICES; AND TO PROVIDE FOR ENFORCEMENT OF VIOLATIONS.
HB1930 Wardlaw TO MANDATE MINIMUM REIMBURSEMENT LEVELS FOR HEALTHCARE SERVICES.
SB480 K. Hammer TO AMEND THE LAW CONCERNING THE INVESTMENT OF STATE FUNDS.
SB331 G. Leding CONCERNING COVERAGE FOR GENETIC TESTING FOR INHERITED CANCER MUTATIONS; AND TO CREATE THE GENETIC TESTING ACT.
SB483 Irvin TO REPEAL CERTAIN REPORTING REQUIREMENTS FOR THE STATE INSURANCE DEPARTMENT AND THE STATE SECURITIES DEPARTMENT; AND TO REVISE CERTAIN REPORTING REQUIREMENTS FOR THE STATE INSURANCE DEPARTMENT.
HB1949 Schulz TO ADD MEDICAL, EMERGENCY MEDICAL, AND AMBULANCE SERVICES TO THE LIST OF PROFESSIONAL SERVICES FOR PURPOSES OF PROCUREMENT.
HB1955 S. Meeks TO REPEAL THE SHIELDED OUTDOOR LIGHTING ACT.
HB1956 S. Meeks TO CREATE THE ARKANSAS NIGHTTIME ENVIRONMENT PROTECTION ACT.
SB481 Gilmore TO CREATE A MORE SUSTAINABLE SYSTEM OF PROPERTY INSURANCE FOR PUBLIC SCHOOLS, STATE-SUPPORTED INSTITUTIONS OF HIGHER EDUCATION, AND STATE-OWNED PROPERTY; AND TO DECLARE AN EMERGENCY.
SB519 J. Boyd TO AMEND THE STANDARD NONFORFEITURE LAW FOR LIFE INSURANCE; AND TO REGULATE THE PAYMENT OF INTEREST ON DEFERRED PAYMENT OF ANY CASH SURRENDER VALUE ACCORDING TO THE TERMS OF THE POLICY.
SB544 M. Johnson TO AMEND THE ARKANSAS PHARMACY BENEFITS MANAGER LICENSURE ACT.
HB1177 M. Brown TO AMEND THE ARKANSAS FRANCHISE PRACTICES ACT; AND TO CLARIFY THE APPLICABILITY OF THE ARKANSAS FRANCHISE PRACTICES ACT.
HB1408 Pilkington TO ALLOW QUALIFYING PATIENTS OR DESIGNATED CAREGIVERS TO PURCHASE MEDICAL MARIJUANA USING A FLEXIBLE SPENDING ACCOUNT OR A HEALTH SAVINGS ACCOUNT.
HB1625 Barnett TO AMEND THE LAW CONCERNING INSURANCE REQUIREMENTS FOR LICENSED HOME INSPECTORS.
RE-REFERRED TO COMMITTEE
Number Sponsor Subtitle
HB1905 Lundstrum TO CREATE THE BUYER BEWARE ACT; AND TO REQUIRE A REAL ESTATE LICENSEE REPRESENTING A SELLER TO DIRECT THE SELLER TO THE OFFICE OF THE COUNTY ASSESSOR FOR THE CURRENT ASSESSED VALUE OF A RESIDENTIAL REAL ESTATE PROPERTY.
DEFERRED BILLS
Number Sponsor Subtitle
HB1659 S. Meeks TO AMEND THE UNIFORM COMMERCIAL CODE; AND TO CLARIFY THE PRIORITY AMONG SECURITY INTERESTS AND ENTITLEMENT HOLDERS UNDER THE UNIFORM COMMERCIAL CODE.
HB1009 A. Collins TO ALLOW PREGNANCY TO BE A QUALIFYING EVENT FOR ENROLLMENT IN CERTAIN HEALTH BENEFIT PLANS.
HB1014 A. Collins TO REQUIRE COVERAGE OF IN VITRO FERTILIZATION UNDER THE STATE AND PUBLIC SCHOOL LIFE AND HEALTH INSURANCE PROGRAM.
HB1409 Long TO AMEND THE LAW REGARDING ENERGY; AND TO CREATE THE ELECTRIC RELIABILITY ACT.
HB1159 J. Richardson TO CREATE THE RETAIL CONVENIENCE STORE SECURITY ACT; AND TO REGULATE SECURITY MEASURES AT RETAIL CONVENIENCE STORES.
HB1354 Lundstrum TO REGULATE PHARMACY BENEFITS MANAGERS; TO AMEND THE LAW CONCERNING THE STATE AND PUBLIC SCHOOL LIFE AND HEALTH INSURANCE PROGRAM; AND TO AMEND THE LAW CONCERNING CERTAIN HEALTH BENEFIT PLANS.
HB1533 Gramlich TO CREATE THE DECENTRALIZED UNINCORPORATED NONPROFIT ASSOCIATION ACT.
HB1950 Torres TO PROTECT LICENSED FAMILY CHILDCARE HOMES FROM TERMINATION OF HOMEOWNERS INSURANCE COVERAGE; AND TO PROHIBIT DISCRIMINATION AGAINST LICENSED FAMILY CHILDCARE HOMES BY HOMEOWNERS INSURANCE PROVIDERS.
Documents
| Title | Type | Pages | Source |
|---|---|---|---|
| Agenda — INSURANCE & COMMERCE- HOUSE, Apr 7, 2025 | Agenda | 3 | Official source ↗ |
Speakers
Speaker 1
Representative Bart Schulz
Unverified
Speaker 5
Speaker 8
Representative Sonia Eubanks Barker
Unverified
Speaker 13
Representative John Maddox
Unverified
Speaker 15
Representative Jeff Wardlaw
Unverified
Speaker 24
Speaker 26
Speaker 29
Speaker 31
Representative Robin Lundstrum
Unverified
Speaker 39
Representative Lee Johnson
Unverified
Speaker 50
Speaker 49
Speaker 47
Representative Jim Wooten
Unverified
Speaker 64
Speaker 66
Speaker 32
Speaker 72
Representative Jon S. Eubanks
Unverified
Representative Les D. Eaves
Unverified
Speaker 84
Chair
Unverified
Matt Troop
Unverified
Speaker 88
Brian Thomas
Unverified
Speaker 93
Speaker 96
Representative R. Scott Richardson
Unverified
Representative Richard McGrew
Unverified
Speaker 107
Representative Jack Ladyman
Unverified
Representative Trey Steimel Chair
Unverified
Speaker 126
Speaker 85
Speaker 129
Speaker 130