Senate Standing Committee on Rules

Well, good afternoon. We'd like to be able to call the Senate Rules Committee to order. We're grateful that each of you are here today. We're going to welcome all those here in the Committee room. And, of course, those watching throughout the Capitol. Before I get started, I want to say what an honor it is. To be able to work with this group of Senators. Who are here on the dais. I want to say a few thank yous.

First and foremost, I want to say thank you to the senior Member of the Rules Committee. And that's Senator Laird for his continued service. We are grateful for your work each and every day. Thank you so much, Senator Laird. I want to say how grateful I am to work with Senator Grove. Who once again is going to be stepping up to serve as Vice Chair. Senator Grove, thank you so much. For your continued service. To the people of California. Here on the Rules Committee.

Want to say how excited we are to be working with Senator Eggman. Who will be serving on the Rules Committee? Bringing years of experience to the role. We're very grateful, Dr. Eggman, for your work each and every day. And also want to welcome the Republican leader, Republican leader Jones, to the Committee. Mr. Leader, really grateful for our partnership on this and so many other issues. And look forward to our work together as well. Finally, I just want to say thank you to the amazing rules team.

Who's here, of course, led by our secretary Contreras and Chinook. Who do such amazing jobs each and every day. Thank you so much to both you and to the entire rules team. We have a full docket in front of us here this afternoon. And we're going to welcome all the appointment candidates who are with us today. Thank you so much. We look forward to hearing your testimony in just a few moments.

Before we get into your testimony, we are going to be taking up some items before us. Prior to presentations. As we have that full docket. But before we do anything else, I think we need to establish a role. So, Madam Secretary, can you please call the roll?

[Roll Call]

Thank you so much. Madam Secretary, a quorum has been established. We are in a good space. So here's what we'd like to be able to do. We're going to roll through some housekeeping items. To be able to get those items completed first. And then we'll go to those who are here with us today. And again, we are very grateful for your patience. And we're going to get through this as efficiently as possible.

So, ladies and gentlemen, we are going to be taking up Governor appointments not required to appear. Items two, f through n. Members of the Committee, we'd like to be able to take two separate votes under governor's appointments not required to appear. We'd like to be able to see if there is a motion for item two, F, L, and N.

Can I make an alternate motion, if that's okay?

Sure. Go right ahead.

Appointment is not required to cure two, F, G, H, I, J, K, L, N would be one full motion. Everything but M. Got it.

Wonderful. Thank you so much, Madam Vice Chair. We do have a motion on the floor, Madam Vice Chair, do you want to mention that one more time, please?

Motion to take up items. Governor's appointments not required to appear. Item two, item F, G, H, I, J, K, L. and N, as in Nancy.

Wonderful. Thank you so much. I'd like to be able to turn to the Committee, if that works for the Committee. We have a motion on the floor. Madam Secretary, can you please call the roll on the following items advanced by the Vice Chair?

[Roll Call]

That is a five-zero vote. Those appointments are now confirmed. We are now going to be moving on to item two. M. Two M. Senator Laird, would you like to advance?

Yeah, I would. Move item two, M. Thank you so much.

We have a motion on the floor. Any discussion? Seeing none, Madam Secretary, can you please call the vote?

[Roll Call]

That's a three-two vote. Those appointment. That appointment is confirmed. Ladies and gentlemen of Committee, we're now going to be moving forward on our next portion of today's agenda, and that's on Bill referrals. This is item number three on our agenda. Reference bills to committees. I'll entertain a motion at this time. We have a motion by the Vice Chair. Thank you so much. Senator, any conversation on this hearing? Seeing none, Madam Secretary, can you please call the roll on item three?

[Roll Call]

That's a five-zero vote in that motion passes. Thank you so much, Members. Ladies and gentlemen, we're now going to be moving on to our rule waiver request. This is item four. Item four, rule waiver request by Senator Portantino. This is to suspend Senate rule 22.5. This is in regards to the Bill introduction limitation to introduce one additional measure to account for a state claims Bill which is traditionally authored by the chair of appropriations. We're going to entertain a motion at this time.

We have a motion by the Vice Chair. Any conversation hearing seeing none. Madam Secretary, can you please call the roll?

[Roll Call]

Look at that five-zero bipartisan vote. Thank you so much. To the Committee Members. Very exciting. We're ready to go to Committee appointments. This is item number five. Appoint the chairs and Members of committees for the 2024 legislative session. We're going to entertain a motion at this time. Thank you so much, Madam Vice Chair. We have a motion by the Vice Chair on the floor. Any conversation on this issue hearing seeing none from the Committee Members. Madam Secretary, back to you, if you don't mind calling the roll?

[Roll Call] Five-zero.

Thank you so much. At the five-zero vote, that motion passes. We are now moving on to our weekly Committee schedule. This is item six. Item six on the calendar here today. This is for the weekly Committee Committee schedule for the 2024 legislative session. Is there a motion? Madam Vice Chair? Thank you so much. Any conversation, hearing seeing none. Madam Secretary, can you please call the roll?

[Roll Call] Five to zero.

Five-zero, that motion passes. Thank you so much, Madam Secretary, we're now going to be moving on to item number seven. Item seven. This is to approve John Casey to return as a retired annuitant in the office of ProTem Emeritus Atkins, do we have a motion to approve? The Vice Chair has advanced a motion to approve any conversation from the Committee hearing scene none. Madam Secretary, can you please call the roll?

[Roll Call] Five to zero.

Thank you so much. That motion passes, five-zero. We're now going to be moving on to floor. Acknowledgments. This is something that the Vice Chair is very excited about and has been waiting for all day. This is items 8 and 9. Items 8 and 9 on floor. Acknowledgments. Is there a motion to approve? All right, there we go. Thank you so much, Madam Vice Chair. Seeing any conversation from the Committee hearing? Seeing none. Madam Secretary, can you please call the roll?

[Roll Call] Five-zero.

That is a five-zero vote. Very grateful to the Committee. And I again want to say thank you to each of those appointees who are here today. Thank you for your patience. We're now going to be getting into the discussion and meat of our hearing. This is Governor appointees, jumping back to item one. First and foremost, we're going to be asking Dr. Rasouli to be able to please step forward to the table at this time. We are grateful that you are here today, sir.

Thank you so much. You're going to have an opportunity to be able to provide approximately a minute of opening testimony to the Committee. Doctor, we ask that you open it up to the Committee Members with any introductions that you may have. Once you have completed your testimony, we'll be turning it over to the Committee to be able to ask questions and usher in any comments as well. We'll be keeping time of your opening statement, and I'll give you a prompt when you get close. Doctor, we're really grateful that you are here today. Thank you so much, sir. It's good to see you. The floor is yours.

Likewise. Thank you. Good afternoon and thank you. ProTem Mcguire, Vice Chair, Grove, and honorable Senators, it is my pleasure and privilege to appear before you today. Public service and civic duty are more important now than they have ever been. And it is in this regard that I wish to thank Governor Newsom and the Administration for appointing me to the California Lottery Commission. I approach this appointment with gravity and pride and with the goal of being a steward of the California State Lottery Act.

I grew up in the greater Los Angeles area as an immigrant in the 1980s. I'm a proud product of the California public education system. I was a third grader when the lottery was inaugurated. I am a beneficiary of the lottery's meaningful impact on public education of this amazing state. I used the resources afforded by the lottery to go on to post-secondary education, train at a public university, and eventually attain my dream of practicing the healing arts.

I accepted the appointment to the Lottery Commission to give back to the system that lifted me to higher ground. My work as a medical professional, having witnessed humanity at its best and worst, and at its most triumphant and despondent, has allowed me to develop a unique insight into two key organizational functions, administrative oversight and accountability for people's lives. I plan to use these skills to help fulfill the lottery's mandate of providing supplemental funding for the public education system, whose mission has become exponentially more critical.

I pledge to work hard to ensure that the lottery's business needs are curated in such a way as to maximize the efficiency with which revenue ends up in the classroom. And I am fully aware of the challenge, as each dollar generated has never been more necessary and less sufficient in this, the country's most populated and vibrant state. I'm honored to serve. Thank you for your time today.

Doctor, we appreciate you appearing in front of this esteemed Committee. Thank you so much. Again, the Doctor is seeking appointment to the California State Lottery Commission. Reappointment to the California State Lottery Commission. We'd like to be able to open it up to any of the Committee Members for questions and comments at this time, please. Senator Laird, thank you.

And thank you for being here and your willingness to serve. I Chair the Education Budget Subcommittee, and there's a couple of questions I wanted to ask about the lottery's relationship to public education. And one is that the lottery and I apologize for not having had the chance to meet with you beforehand. So the lottery recently launched a public education campaign to increase public visibility on how the lottery funds help education.

And one of the banes of my existence is at least a couple of times every year, somebody comes up and says, I thought the lottery was going to take care of education funding. They believed the commercials when it was on the ballot, and that is still a public perception in certain sectors. But I know that this is not designed to directly speak to that. But how do you envision this project, and how do you think it would help serve that purpose?

The campaign is organized and it's comprehensive. One of its prongs is changing the narrative, quote, unquote, and it relies heavily on the multiple modes of media, video testimonials, and basically from beginning to end on how every dollar is distributed to help this mission of supplemental education funding. It's not an easy task because it's going against a significant inertia of public perception of what lottery is, which is, in the eyes of many, as gambling. And that's not quite what it is.

It's a game, and it raises money and it does good work. And I think the campaign is very organized, and it's far reaching, and it has prongs that are both internal and external. So I'm happy with what I've learned so far about this. Changing the narrative campaign.

Will you measure in any way that you afterwards have changed it a little, or is this just designed to make the go of it and just hope that it does it?

The efforts and its incipients are obviously to make a dent. And then I'm sure the metrics will be designed to measure the difference that it's made, and I'm sure we'll learn more about that as time goes on.

Great. And then just sort of a related question. Is the lottery on track this year to meet the law's requirements for the funding that's allocated to public education?

I believe so. I think the lottery makes a good effort to make sure that its metrics, its numbers are within sort of the formulas established in 2020, where 65% to 67% goes to gaming or revenue expenses, and the rest, which is about $2.1 million, goes to education, and I think they're doing a good job with that.

Okay. I appreciate the response to the questions, and you could infer logically that if those are the two things I'm asking about, we are concerned about that. So I would just hope you would take that into account as you discharge your duties. And thank you for being here and answering the question.

Thank you so much, Senator Laird. We're going to turn it over to the Vice Chair, Senator Grove.

Thank you. Pro Tem. I do want to follow up on my colleague's question regarding the budget question on the 2023-24 budget. And I understand that you were not at the meeting on June 29, 2023 but there were concerns that were brought up that revenues allocated in the public education system raised. They raised very aggressively, from what I understand, concerns about the average provision requirement being under the amount needed to be able to supply to the education portion.

So I guess, just to follow up on my colleague's question, how does the Commission plan to, I don't know, meet that proportional increase or that gap in the funding that's estimated regarding the revenues allocated for public education, which people had questions on at that meeting?

Yeah, most of the numbers I have are from the previous year, and I think they were on target for this year. I'd have to go back and review those numbers and get back to you about that. But I'm sure every effort is going to be made to meet the goal, which is to maximize absolute dollars in terms of funding.

Do you think that's going to require additional marketing and market campaign in order to increase the public's interest in participating in the lottery?

I do, and I think that. And to broaden the playership, I think we have a really diverse state, and there are whole cross sections of the state that I don't think are aware of the lottery's mission. And I think that if we tap into that, and I'm sure we will, that'll increase some of the revenue and help meet the you.

Thank you. Pro Tem.

Please, Senator Eggman, thank you.

And thank you very much for being here today. And I think you can tell by the questions that we all have a little concern, kind of, about the public impression and what kind of metrics you're using to measure if you're successful or not. And I heard you refer to it not as gambling, as a game. I always think game involves some level of skill, but maybe that's just me. I'm not a gambler.

You're a gamer?

I'm not a gamer either. I'm a sourdough baker.

You're very good.

Thank you very much. I like concrete. I like something I can touch. We all have this concern, and we can think the public has this concern too, right? I mean, that there's been some issues with the lottery over time. How do you go about getting your baseline measure to actually be able to track during your being appointed? How are you going to be able to track if you're actually making any difference in that kind of public perception and just expanding the pool, if you will?

I think that's a great question. And a public perception is obviously something that is resistant to concrete numbers. I know that from a healthcare provider, we're measured as well. We're evaluated often subjectively, and it's a great question. It's something I think we all need to think about. I think the initial steps, initially, there was excitement over raising money supplementally for education. And then the second consideration was you're raising it with the lottery, which is a gaming concern.

So that comes along with some public stigma that has to be overcome. That's the first effort. The second effort is to measure how successful you are in that. And I don't take the concerns lightly. And I think, I'm sure there are efforts ongoing within the Lottery Department on how to measure public perception. And I'm sure some of those incipient efforts I can delineate for you as soon as I'm apprised of them, but I think it's a very valid concern.

Thank you, Senator Eggman, do you have any follow up on that? Thank you so much, Senator Eggman. Leader Jones.

Thank you, Doctor. Thanks for being here. I commend your commitment to community service. And this is mostly an unpaid position. And thankfully, in California, lots of positions, both at the local level and the state level, are filled by folks with the same commitment as you. Just a quick question on being able to fulfill the responsibilities of the position.

I noticed that you missed one of the meetings earlier in the year, and it happened to be the budget meeting and so just wanted to see if you could talk to that. I guess the bottom line of the question is, do you have time to do this and stay committed to the community service that we're asking you to do?

I think that's a really good question, too, Senator. There's actually two. The first was an unplanned surgery, unfortunately, in our line of work, which I'm.

Thankful for because I've had several orthopedic surgeries.

Right. I don't expect that to happen again. It was a pretty exceptional circumstance. The second was I had Covid. We didn't expect that either. But I think now that I've had Covid four times, I don't think I'm going to have it again. Or maybe if I do, I won't feel it. Thank you.

Those are very good answers. I appreciate it.

Thanks. Thank you so much. Before we go to public comment, wanted to check in with the Committee to see if there's any additional questions or comments from any of the Members here. Doctor, thank you so much for your presentation. We're going to have you hang right there for just a bit. We're now going to be taking public comments on the Doctor's potential appointment. First and foremost, we're going to start with those who would like to be able to speak in support.

If you'd like to be able to speak in support, if you can please come up to the podium at this time, you will have 60 seconds to be able to provide an opportunity community to speak in support. We're looking for those who are in support. Hearing and seeing no one rise, we're now going to go to those who may be in opposition here in room 2200. Anyone wishing to testify in opposition, if you could please come forward and speak now.

Hearing and seeing no one, we're going to bring it back to the Committee to be able to see if there's any additional questions or comments from the Rules Committee at this time, please.

I would move the confirmation of Dr. Rasouli.

We have a motion for confirmation. Thank you so much, Senator Laird. Madam Secretary, if you can please call the roll.

[Roll Call] Four to zero.

Dr. Rasouli congratulations. We're grateful that you're here. Thank you so much.

I appreciate it.

Thank you so much. Thank you for making the trek up. Good trek up as well. All right.

Mr. Chair, just a point for Dr. Rizuli. We're actually forwarding his confirmation to the floor, which is the next step. And then that's what he should look for next, correct?

You're absolutely correct. Yep. Okay.

Just checking.

Final confirmation on the floor. Thank you so much. All right, ladies and gentlemen, we're going to be bringing up our next group, potential appointees. If it works for this committee, we are going to invite each of our next potential appointees up as a group. So as I call your name, if you don't mind coming forward, we would be grateful. We're going to have Dr. David Carlisle to please come forward. Dr. Sandra Hernandez, if you could please advance.

We have Dr. Richard Kronick, if you could please advance. And then we have J. Elizabeth Mitchell, if you could please come forward. We have Ms. Mitchell, Dr. Kronick, Mr. Hernandez and Mr. Carlisle. We'll give it a few moments to be able to take a seat. Ladies and gentlemen of committee, these four individuals are going to be seeking appointment for the Healthcare Affordability Board.

What we'd like to be able to do is provide each of the appointees an opportunity to be able to have some remarks in front of the committee. We respectfully request that each of our potential appointees keep the remarks to about a minute. Obviously, if there is something that you are burning to be able to say, we welcome that.

Last thing I'll say before we turn it over to Dr. Carlisle first is we want to say thank you so much for your service to the people in the State of California. We're grateful that you're here. Dr. Carlisle. Good afternoon. We're grateful for your service. The floor is yours for 1 minute.

Thank you. Pro Tem and committee cembers, just to introduce myself, I'm David Carlisle. I'm the President and CEO of Charles Drew University of Medicine and Science in Los Angeles. And it's a pleasure to be here on behalf of the committee in California.

Thank you so much, Doctor. Really appreciate you being here. We're now going to be turning the floor over to Dr. Hernandez. Good afternoon, Dr. Hernandez. Thank you so much for taking time out of your busy schedule. The floor is yours.

Thank you, Senator. And nice to be with all of you today. I'm Dr. Sandra Hernandez and I'm currently serving as the President CEO of the California Healthcare Foundation. We're a private, independent foundation that serves the people of California. I came to California about 40 years ago to do my medical training at UCSF. And subsequent to that, I've had really an incredible opportunity to serve in a number of different capacities, both as a primary care physician, but also in public health and working in health policy.

And it's a real honor to be with all of you today.

Dr. Hernandez, thank you so much for your service. It's good to see you. We now would like to better turn the floor of the committee over to Dr. Kronick. Dr. Kronick, good afternoon. The floor is yours.

Thank you so much for the opportunity to be here today. I am quite excited to be considered for confirmation as a member of the board of the Office of Healthcare Affordability and look forward to the discussion that we will have. Like to thank, virtually in attendance, my wife and partner of 45 years, Amy Bridges chronic, as well as my spectacular daughters, Emma and Dorothy, and four very delicious grandchildren.

I love it. My goodness. Thank you so much. 45 years. Congratulations. My goodness. We're almost at about 20 in our house, so there we go. But congratulations, sir. Thank you so much. And we are grateful, Ms. Mitchell, that you are here today. Thank you so much for taking time out of your busy schedule. The floor is yours, and thank you for your service.

Thank you for having me. I am honored to be here. My name is Elizabeth Mitchell. I'm the President and CEO of the Purchaser Business Group on Health. We are a 501 nonprofit, and for 35 years, we've been working on making healthcare higher quality, more equitable and more affordable. So this couldn't be more in line with my interests and my commitment over the last 25 years. I do, however, want to also recognize my family, who graciously joined in, my mom, who was the Senate President of Maine, is watching.

Oh my gosh.

And my sister Emily and her family, my daughter Abby in LA, my daughter Hannah in Seattle, and then my teenage son, who is studying in Italy, is also watching, but I hope he goes to bed soon. So thank you so much. This is such important work, and I'm honored to be considered.

How many years did your mom serve?

Maybe 30.

That's amazing.

Yeah, a while. I grew up in the state house.

Zero, my gosh. Love it. Love that connection. Thank you so much.

Sir. Just a point of clarification.

Yes, please. Thank you.

We have a court reporter. Rules is done differently than any other committees, and she takes notes. And over the years, being on rules, I have learned to read her little facial expressions. And if I could ask you guys just to slow down, because she does take down every word you say. So thank you. Thank you.

Thank you so much, madam Vice Chair.

Both. Absolutely both. I've already received a note from Senator Groves. Slow it down. Yes. Thank you so much. No, it's fine. It's fine. Thank you so much. I've already had the stink eye as well. There we go. But very grateful. All right, again, we are so appreciative that each of you are here.

Was that to the guests or to the chair?

What we'd like to be able to do now is open it up for questions and any comments from the committee who would like to be able to kick us off on questions, comments, and conversations, please. Dr. Eggman, the floor is yours.

Thank you. And I'll start just because of my first committee meeting, so I might as well just jump in and I didn't get to meet with all of you. I got to meet with Dr. Hernandez, and thank you very much for ushering me nicely into this new role that I have. CMA has been talking about the metrics you set, 3 versus 3.5. Can you talk a little bit just about that, about the process and why we landed there and why we think it's important?

I would go to anybody. I don't know if we want to start.

Dr. Hernandez, please.

Sure. Thank you, Senator Eggman, for that question. What I would say is that the legislation allows for this board and the OKA staff to develop a methodology, which the office has done with a great deal of input from advisory board members, from the general public, from consumers. And that methodology really rests largely on the notion of affordability for consumers.

And so, as we considered those, and this board has not yet taken action on that, the OKA office has made a recommendation, and I think a number of issues and concerns went into that. We don't all share the same opinion about that. My own personal view is that we should set a very aggressive target for spending in the state in order for consumers to be able to catch up. We will never be able to reduce where our costs are today.

We're really slowing the growth is what our charge is. And so I think the methodology has been sound, the input has been rigorous, and we'll continue to debate that as we go forward.

Thank you very much. And as we talk about that, I was just really struck by something Dr. Hernandez said in our interview yesterday about the idea that we probably need. I mean, we get health care more affordable when we have less hospital beds, not more. Right.

We do more preventative care, we do more public health care, and we're not having people in the ER or coming in for things that aren't acute. So I guess I wonder if I could hear from the rest of you about your thoughts about that? About that concept of we need to shift where the highest costs are into a different kind of model, and your vision of being able to attain that.

Why don't we start with Ms. Mitchell and we'll work our way down, as Senator Eggman has asked each to address.

And also say, ms. Mitchell, I see you went to read, and I did my graduate school in Portland. So welcome.

Thank you. Yes, and one of the, I think, strengths of the legislation is that it is comprehensive, because this will be a systemic shift. It's not just about limits. It's about actually investing where we have actually underinvested, like primary care, like community based care. And there is some really good evidence out there that shows that investment in primary and community based care actually reduces spending by keeping people healthier, so better care can cost less.

And we know that even in small and rural communities, that by enabling people to get the care they need when they need it, they do avoid hospitalizations, and it actually reduces the total spend while improving outcomes. So the good news about the legislation is that we can look at primary care investment, we can look at what regional differences might need to be acknowledged, but access is critical, and everyone on the board is committed to preserving access because that is part of affordability.

So we are looking at this systematically, and I think we can make really important improvements.

Thank you, Ms. Mitchell. Dr. Kronick, the floor is yours. Please address Senator Eggman.

Thank you. Really important and excellent question. One of the central challenges for the office and the board is changing the decision calculus for hospital administrators, health system managers in the status quo. Success is based on increasing revenue and the premise of the legislation, the challenge for the office and the board to actually implement this is, I think, changing that calculus to success being figuring out how to improve access and quality in the context of a constrained budget.

And that's a very big change from how success is determined today and will be a hard change to accomplish. I mean, as you know, there's an enormous industry, or really collection of industries, and changing how success is measured for that. For the seven of us on the board and the staff of the office, there are very strong levers provided in the legislation to do that, but will be an ongoing challenge over time.

Thank you. Thank you so much. If it's all right, Dr. Hernandez, we'll go to Dr. Carlisle and have you clean up. Is that all right? Thank you so much, Dr. Carlisle.

Thank you for time. And thank you, Senator, for that. Know, in California, we have a really great healthcare system, maybe the best in the United States. We have great hospitals. We have great doctors. The tragedy of the system is that not everybody can afford to access the wonderful system that we have.

If we can do anything to kind of move the equilibrium in favor of improved access to the wonderful system we have, we should do it because more people will get health care they need and healthcare outcomes will improve. So I think that's one of the goals of the statute, and I think one of the important targets for the State of California. I've never heard anybody come up to me and say, "Dave, the healthcare system is so cheap. I can't believe it."

Usually they say, "I can't believe it's so expensive. $25,000 for 3 hours in the emergency room." It's amazing. It's paradoxical, actually. Thank you, Senator.

Thank you so much. Please. Dr. Hernandez.

Thank you again, Senator, for the time we had to visit. I would agree with everything my colleagues have said. I would add two additional data points. One is that, as Dr. Carlisle mentioned, it's really not affordable for anybody. Small businesses struggle with providing premiums for their workforce. So the problem that we have with affordability is a problem that really exists in rural communities. We feel it in our business community. It's seen itself in limiting what we're able to do in wages.

And so I want to make that point. And the California Healthcare Foundation does a poll every year and asks folks across the state all walks of life, what is the biggest challenge in healthcare and affordability is that issue.

And so I think if you hear from consumers or from the small business community, as our colleagues have said, we have an opportunity through this legislation to really shift the incentives to try to keep people well and to try to take care of them in a way that is both beneficial for their outcomes and for their livelihood. And that really redirects some of the incentives that we have right now in our system that really drives up cost.

Okay, thank you. If I just have a follow up. I'm sorry. I like this area, please. And I agree. And, Dr. Carlisle, it kind of surprised me when we say we have the best system in the country, right, because we hear complaints from so many, and we know that our health care outcomes aren't great. Our health care outcomes are not reflective of the best system in the country.

And so when we're talking about access, I know access is closely correlated with workforce, and that is part of your role as well, right? Because we're never going to provide better access and reduce costs unless we have the workforce, especially out in the community, to be able to provide some of that. So I'm just wondering, how do you see those two things going together and the commission being able to make progress on.

Well, yes, and again, I do think we have some of the country's best hospitals, best physicians in the State of California, but we do have major access to care issues in the State of California. So thank you, Senator, for your question. I would say that we can actually have an even better system if our system can be more efficient. And that means that the system is able to give people what they need when they need it more effectively.

And that's really one of the goals of the board. That's one of the goals of the act. And the office as well. I think that's a very important goal for the State of California. We have great resources, but not everybody can access them, and I would like to see that improve.

Thank you.

Thank you so much. Anyone else on this question from the Senator before? We will turn it back over to Senator for any closing on this, but anyone else on this issue, Senator Eggman, please take it away. Other items that you have.

No. And if we could just talk about the issue about mental health, right. And we also know that's a huge driver of our health care, cost of our workforce and everything. I just had occasion to be in our nurse's office getting a dressing on a wound. But I said to him, what's the know? We're big capital. What's the biggest thing that people come in for? I guess allergies, right. He said headaches, which come from all different kinds of meanings, but also some mental health issues.

Right. That we know cause a lot of physical manifestations if we don't know what's going on. So how do we go about more holistically being able to deal with our mental health issues workforce and just integrating us all over into the community, please.

Dr. Hernandez.

Thank you for that really important question. Senator, I'll just say that I came from a family where mental illness existed, and I've watched very debilitating psychiatric, their conditions and seeing the way our system tries to deal with one set of a problem with an individual at the expense of another.

And one of the opportunities that we have in this state is really to begin to look at how we deliver meaningful whole person care for an individual, whether they happen to have a preexisting psychiatric condition or an episodic mental health condition, and integrate that fully into a primary care model. We have many examples of where that works. We have a significant workforce shortage. Back to your prior question, particularly in mental health and in behavioral health.

But we also have evidence about how we can actually link these programs in a meaningful way in communities. My cousin suffered paranoid schizophrenia in a very small rural community, and you can see the way a community can come around them. But when you don't have access to psychiatric medications and you don't have access to good primary care, you may treat the psychiatric condition quite well and succumb to the physical.

And so I think the goal here is really to integrate those and to really build a workforce that can meet a wide continuum of mental health conditions that we have in the state.

Thank you. Thank you. Let's go to Ms. Mitchell. Then we're going to go to Dr. Kornick. Ms. Mitchell, the floor is yours.

Thank you for this question. It could not be more important. My daughter's actually a clinical social worker. Working with adolescents and kids in emergency rooms and trying to find mental health services is almost impossible. It is an absolute crisis. And one of the contributing factors there are many is obviously workforce, but also the fee for service systems where you can't even get in for an adequate amount of time to have your condition treated.

To Dr. Hernandez's point, we are working very hard with my Members, my jumbo employer members, to actually pay differently so you can spend the time needed and cover social needs and also integrate behavioral health into primary care, because honestly, mental health care is primary care. It needs to be integrated so the whole person is treated. But right now, the payment system makes that hard. A lot of insurance plans make that hard.

So one of the opportunities with OKA is to really think about new delivery systems paid for differently so we can treat the whole person.

And we need same day billing with MediCal, too.

Thank you so much, Dr. Kronick, please.

Thank you for the question. I would add to Sandra and Elizabeth's comments that in thinking about the levers that the office and the board have, one of the provisions of the legislation is the establishment of benchmark spending targets for both primary care and behavioral health. We haven't discussed what those targets might be, but I think all of our presumptions is that the targets would be higher than the status quo level of spending. Part of what the office can do is to increase transparency and information.

We don't actually even know what the status quo level of spending is, which will make it hard to establish a benchmark that is above that. But I am confident that the office will be able to make progress in that.

Thank you, Doctor. On the comments from Senator Eggman, please. Dr. Carlisle, any items that you'd like to advance in this.

The other comment that I was going to make, Senator, is I lead an institution in South Los Angeles, one of the greatest, largest underserved regions in the United States. And in this region, when you're facing a mental health crisis, people are reticent to call 911, because when they call 911 for somebody that's having an attack of schizophrenia or some other out of control situation, all too often bad outcomes can occur immediately.

And so this is just a function of the absence of workforce in healthcare and workforce in mental health services. So I absolutely resonate with your concern about this as an important area that can improve with the appropriate Administration of the act here. Thank you.

And just one final, and you can just say yes or no. We've instituted, over the last couple of years with the Administration, the behavioral, child and adolescent infrastructure. I can't remember the name, but it's like online on time. People can get access. How do you see that being a tool? Or is it just another program we've started?

Well, Senator, thank you for that question. I have a 23 year old daughter, and I will tell you that all of her peers use tools that come in the form of a phone for most all things. And so I think we need to use all the tools that are at our disposal. And there are many that are focused on school age folks. There are companies that are trying to expand access to care in Los Angeles school district, as an example.

So we've got entrepreneurs that are thinking about this. We have technology to be able to do that. And I think that given the crisis and given that we're not going to.use.

There are a lot of inputs. But what I would say is that we should use all the tools that we have in mental health and in behavioral health as we build out this necessary workforce. We have young people who are coming out of a crisis where COVID really disrupted their lives quite dramatically. And they are just beginning to address some of those fears and anxieties associated with that. And I think we have many tools.

We should look at which ones work and try to make sure we resource those.

Thank you. So why, Senator Eggman has asked each to be able to provide a brief answer if that works. So why don't we start with Ms. Mitchell? We'll work our way down on you. Sure. Okay. No, that's great. Anyone else want to comment on this as well? Dr. Hernandez, thank you. Any other comments? Dr. Eggman.

Just thank you all very much for being willing to take on this huge task. I appreciate it. It's important.

Thank you, Dr. Eggman, and for your leadership and passion on this issue, we're going to turn it over to Madam Vice Chair.

Thank you. Thank you, Mr. Pro Tem. A huge task at hand. And I worked on the financially distressed hospital bill last year, the MCO tax things. I have financially distressed hospitals in my district. I firmly believe that it's because of policies that come out of this building that create a lot of the catastrophic issues that we face, including medical reimbursements and seismic and some other things.

Over half of California's hospitals are operating at a financial loss in almost all of our districts, including the Pro Tem, Dr. Eggman, Senator Lairds, all of us specifically. Maybe not on this dais completely, but a lot of us in the Senate are experiencing this and worked really hard to try to repair some of that. I guess my concern that I have with the way the board is approaching things, that with one out of five hospitals remain at risk for closure.

As an OCHA board member, how do you view the challenges of trying to balance financial challenges on the hospitals, doctors and providers, and patient access to care and accountability? And the reason why I asked that question is that you have a document or something that you're working on is like a 3% dollar amount, 3% of spending when the GDP growth in California is 3.5. So you're asking your hospitals to operate less than the GDP growth when they're already losing money. And you're not accounting for,

there's no exemptions for seismic, for medical supplies, pharmaceuticals, medical technologies, and all these things that are costing more, including labor cost. That just went up to, I believe, a minimum of $25 an hour here or there? About a number. Where'd you come up with 3%? And why is it not even subject to the 3.5% tied to GDP in California? Or do you have another solution? And we can start with Ms. Mitchell, if that works for you. Sorry, Mr. Chair. Sorry. I apologize,

No, Good. Ms. Mitchell. Okay.

Yeah. Thank you for that question. It's obviously critically important. I actually used to work for a hospital based healthcare system, and we had rural hospitals that faced very different challenges than some of the large academic medical centers. One of the. I think the strengths of the law is that it allows us to look at regionality, not to have a one size fits all response. And we will also have data to understand how different regions and different facilities are being impacted.

The 3% that you referred to is a staff recommendation. OKA has not actually taken action yet. Obviously, that is something that we are considering. But it's about sort of balancing, obviously, the critical needs of the industry with the inability to afford some of the services that people need. And so we've had very, I think, important conversations about how do we do that most effectively and fairly. But clearly, understanding the specific needs of rural areas is first and foremost on many of our minds.

And we want to preserve access to needed care because if we don't, healthcare will only become more expensive.

Okay. Mr. Mitchell, would it be.

Sure.

All right. Is it all right if we go down the line and then we'll turn it right back over to you, madam Vice Chair?

Absolutely, sir. Thank you, sir.

Dr. Kornick.

Thank you. I would add to Elizabeth's comments for first a slight clarification. The 3% is 3% per person. It is still an aggressive target. Even so, 35 years ago, I was co author on an article that described healthcare in the US as a paradox of excess and deprivation. And sadly, I think that that description is still apt 35 years later.

And so, as you point out, we have many hospitals and other healthcare providers struggling to stay afloat at the same time that we spend twice as much money per person as any other developed nation. And healthcare is unaffordable for so many in California. And the challenge that we all face is trying to reconcile these two kind of polar extremes. I do think that it is possible to do so if we work carefully and sensitively.

And as Elizabeth pointed out, the legislation provides the opportunity to consider targets differently, by regions, by sectors. We haven't yet had the conversations of how that might look. It's still in formative phase, so there's work to be done. And no, I can't kind of make you a silver bullet magic promise, except to say that we are aware of these challenges. And I think that the legislation provides the tools and opportunities to make progress.

Thank you.

Thank you, Dr. Hernandez. I'm going to go to Dr. Carlisle and we're going to bring it back to the Vice Chair for policy.

Senator Grove, you identify a really fundamental challenge that the board has. I will tell you that when I was Director of health in San Francisco, I oversaw San Francisco General Hospital, Laguna Honda Hospital. And every year your challenge is to match revenues with expenses. Because it's a public hospital, you're not going to go in debt, you don't have the ability to borrow.

And you make decisions based on what's reimbursed and at what volume and not necessarily around what your community needs you to be able to provide. A good example would be when you don't have an OBGYN to run an OBGYN unit. You can't run an OBGYN unit. That's a workforce issue. That's fundamental to a service that's critical in a community.

So what we're trying to do here is use this legislation to the best of our ability, as we've said in other responses, to move the reimbursement to the service.

That are most needed in those communities. And I personally think one of the most important parts of the legislation is the transparency that we will get, that consumers will get, that legislators will get, that policymakers will get to understand at a regional level where there have been market failures, and there are clearly many market failures and many thriving markets across the State of California.

So the tools that we have in the toolbox at Oka for transparency alone, I think, will be incredibly helpful for us to be able to learn about what the etiology is of regional issues that emerge.

Thank you. Dr. Haynes. Sorry, I was just going to go to Dr. Carlyle and turn right back over to you. Is that all right, Madam Vice Chair?

Absolutely.

I apologize. Please, Dr. Carlisle. And then we're going to bring it back to the Vice Chair for comments.

Well, thank you, pro Tem. And thank you, Senator Grove, for the know, this is really a very important consideration. If we have a healthcare provider, a hospital disappear because of anything that we might approve as part of this process that doesn't improve access to care in the State of California. And I've been to virtually every county, every county in California has seen many rural critical access hospitals.

And I know how thin their margins are or how negative their margins are, and I know how important their contributions are. If you have a hospital with a labor and delivery unit that all of a sudden closes and you have to travel four or 5 hours through snow covered highways to have a baby or more, California suffers.

So I would say I'm assured myself that on our board, we have a collection of colleagues who are very aware of the importance of these issues and are going to take this into consideration as we move forward with this process, recognizing that the proposed 3% target is a target right now, something that hasn't been approved yet. And we're engaged in a very public process with a lot of transparency to guide us through this process.

And if we find that there are issues with it, I know that we will revisit the process. And if we have to recalibrate the target, I know that we will.

Thank you so much, Doctor.

Thank you.

Thank you. Full disclosure, this is our brand new Senate pro tem that we just elected. And I'm getting used to his style. So I apologize that I keep stepping on you, sir. I'm so sorry. I didn't mean to do that. But I will learn your style because I think it's extraordinarily effective. It's good. The only reason I'm kind of harsh and kind of direct on this subject is I have Ridgecrest community hospital, and it is closing down its labor and delivery services.

And you'll go 88 miles and 88 miles. Don't think it's 88 minutes at 60 miles an hour. You're going down a canyon where you can only go 10 miles an hour around some of these curves with a drop of about 120ft next to you on a two lane road and a mountain with rocks that overhang on the other side. So I'm not talking San Francisco, Los Angeles, or going down the I five.

If something doesn't change between now and April 1, they're going to go to standby emergency. This is also the hospital that takes care of one of the largest research, the largest research and development bases that does our protection from California on the South China Sea, and it's the China Lake Nas Naval Air Warfare center. They make stuff up just brilliantly to create safety in our cybersecurity. These brilliant people out there think outside the box and they just think of stuff that works.

You're not going to recruit those people if they can't have a baby. You're not going to recruit those people if there's an urgency with their son or daughter and they don't have an emergency room to go to. I'm in constant communication with this particular hospital almost on a daily basis, and those are my fears. And the fear I have is that if that hospital closes down its emergency room, it affects the town, the city, the base, our security.

And I'm very concerned that the focus that you have is you're going to cut spending to 3% instead of really addressing the problems that we have with reimbursement rates, with access to care. I'm a business owner. In the real world, I say the real world. I mean, other than this job, I'm a business owner.

And if I had an emergency room, as I was having to staff with an OBGYN and a complete staff and staffing ratios, and I had three babies a month, that'd be pretty darn difficult to do, but those babies still have to have a place to be born. I'm very concerned about the cardiopulmonary unit. If you're having a heart attack or a stroke, you don't want to go 88 miles down a canyon.

And I'm not speaking for her as a new Member on the Committee, but I know that Dr. Eggman has one of the same concerns that I have about rural health care. And I appreciate the fact that you guys are addressing rural health care, that you have been to every county I'm assuming you've been to Kern county as well. Doctor, I have huge concerns about eliminating rural health care to people who deserve it. My other hospital, and I know I'm on a rant right now, is Kuea.

90% of the people that go through that hospital are Low socioeconomic disadvantaged communities on medical. Right. Medical reimbursement rates. There's not enough offset for the plans. There's not enough offset. And, ma'am, Ms. Hernandez said you're in San Francisco. When a conversation with the San Francisco Legislator, he goes, just get a donor to give you a couple of $1.0 billion. I don't have a donor that's going to give me a couple of $1.0 billion for a foundation. It's 1700 beds.

And if Kawea collapses, it will affect Fresno because we've already lost Merced, which is hopefully coming back online a little bit with adventist health, and it'll affect Bakersfield. So the Central Valley will be almost without healthcare, and it serves the highest, most medical population in the state. I believe those are my concerns. I think that we all want the same solution. Access to health care, adequate health care, excellent health care that is affordable.

I have a problem about how you guys are getting there from a business perspective, and I'm very concerned about that. And I just wanted to share that with you. Thank you, sir.

No, thank you so much. And madam Vice Chair, for your focus and passion, especially in rural California. Very grateful for that. I think it's something that yourself, Dr. Eggman, myself, we all face each and every day. Thank you so much, Senator Laird, please.

I would add myself to that list of having a lot of rural California.

You're absolutely right.

My district. I want to follow up on what Senator Grove asked. And first, thank you all for meeting with me on almost no notice today. I really appreciate that. And I have to confess that when I studied up for this last night, I realized I'm the only Member of the Committee that was not in the Legislature when this Bill was adopted. So the debate was new to me in a number of ways, and I get what the goal is.

Senator Grove just talked about it, and when I was in the Assembly, we had retreats where the number one priority from a lot of the providers was lowering the costs because it would lead to more access. So I totally subscribe to the need for this. The thing I want to follow up first on what Senator Grovest is. I was sort of surprised when I talked to you because I was a little taken aback by the 3% possibility of that being the number that was picked.

That's not even at what the growth is in the growth national product. And I don't want every one of you that feels best equipped to answer. I learned from each of you that there was a lot of flexibility, or there was flexibility that this process will go on for two or three years before there's any kind of remote enforcement. And it is really teasing out whether that number works. And so who could speak to that?

That would sort of give some comfort to those that are concerned about the possibility of this number being picked, because I know you haven't picked it yet.

Who would like to be able to comment on that and address Senator Laird, please? Dr. Hernandez, the floor is yours.

Thank you, Senator, for that question. As we talked about briefly earlier today, this body does, and through the office have the ability ultimately to do some kind of enforcement. But really, the goal here is not in my mind about enforcement. It's really about understanding what the cost and conditions are regionally throughout the State of California. And to try to push this system, as we've talked about, to being much more of a prevention, primary care, behavioral oriented delivery system.

There will clearly be systems that are not able to comply with any target that we set. And what we'll want to know is to try to understand why that is. And we will, for the first time, really have public data that will allow us to try to understand that and then to work with those systems to try to address what those concerns are. There may be very legitimate reasons why they can't make the target, and there may be not.

But I think the first point is to nudge the system to move in the right direction. And the second then is to really understand where it's working and where it isn't and where it isn't, really understand why that is and where we need to make exceptions to do so. So I think we have the benefit of getting a lot more transparency and knowledge and information at a very regional level across the state.

And once the target is set, whatever it is set at, we will work with those systems to understand their ability to meet that target and where appropriate, work on plans to address that, maybe learn from other systems and what they've done to be able to do so. So I think this is a lot of a learning journey. There is flexibility, and I do think we need to push our system to move towards something that is significantly more affordable.

I should note we spent a lot of time you did as a Legislature with a lot of input around these tools. And I think the legislation is built in such a way that we have a number of tools to be able to learn and to apply the targets appropriately.

And, Mr. Chair, I see Ms. Mitchell leaning toward her microphone. Let me ask if she has anything you would like to add, please. The floor is yours.

Ms. Mitchell, I completely concur with Sandra's comments, and having the visibility through the data will actually enable us to make sure we're making smart decisions from a comprehensive viewpoint. But I also want to just say there are examples, and there's a growing evidence base that we can provide better care for significantly lower cost.

And I think that we have such sort of innovative leaders in California, in the healthcare industry, that I believe that they can find ways to not just continue to meet access and quality needs, but also do it in a way that balances that with affordability. So I'm very encouraged by the leadership in the industry and also the evidence that is really becoming available that this can be done for lower cost.

And then let me ask a follow up question. And it also relates to what Senator Grove asked. And it's my personal experience, because I have a sprawling district that takes 5 hours to get from one end to another before there's a limiter put on cars due to speed limit. And it is really different in the health facilities and the prime examples. I worked hard to save Watsonville Hospital two years ago, it was going under.

It has a bad mix of payees, public, private, and not more than 20 miles away is the hospital in the Monterey Peninsula, which has got to be doing almost as well as any hospital in the universe. And they are right there. And in the Watsonville hospital, when we work to save it, they're now going to the voters and they're going to buy the building. They're going to expand the ER so that it's urgent care.

They're going to add back a couple of facilities that will allow them to expand care. How do you make sure that a hospital that's that disparate from the others and is actually trying to add things that cost more money is not caught here somehow in a web that says they're somehow not in a per capita spending in the right way? How does your system allow for that to work?

Dr. Kernick, please.

Thank you, Senator Leard, for that really excellent question. And the legislation does provide the office and the board the flexibility to consider the circumstances of individual providers. We're asked to look at high cost providers separately or differently from Low cost providers. And I mentioned earlier the sort of paradox of excess and deprivation, which you have illustrated well with your example here, and there's no requirement, as Elizabeth said earlier, and no expectation of kind of one size fits all here.

If I can briefly respond to your earlier question, about 3%, and how does that compare to GDP projected growth? It is 3% per person, relatively close to the projected rate of growth of GDP per person. As you know, we spend much higher fraction, 18% of GDP on health care in this country than in western Europe, which averages in the 10 to 12% range. And there is nothing, it is, I think, scary to think of. zero, my goodness.

Health spending might go from 18% of GDP to 17 and a half percent. And what would that mean for access and quality? But access and quality are just fine and in many places, better in many western European countries than here. And so the question is, how do these changes get made?

And again, I returned to the comment I made earlier that a fundamental part, in addition to, as Dr. Hernandez said, increasing transparency and information, a fundamental driver of the statute and the work is changing the incentives that providers face. And the hospital that you mentioned in Monterey, that they have incentives to maximize revenue. And that would change under the structure of the statute of the office and.

The board, just maybe an iterative follow up. And that is that when you look at the specifics of hospitals, I mean, sometimes when there can't be enough full time nurses, traveling nurses are hired that cost much more. And believe me, the California Nurses Association, me, lots of other people want the permanent nurses there. But if they cost more, and that's the only way to fill a nursing position in a crisis for a week or something, then that's going to drive the cost up.

What I'm hearing is that you both want to incent that that doesn't happen, but at the same time, you want to be flexible enough to allow that. If that turns out that's the only way to continue delivering medical care for a period of time, is that an accurate.

That is exactly correct.

Thank you.

Thank you. Dr. Carlisle, on the issue of Senator Laird, please. Floor is yours.

Yes, thank you pro tem. And thank you, Senator Laird, for the question. And I would say, I think you sort of hit the nail on the head with that last concluding comment. I would view things maybe from my perspective as, what if the glass is half full instead of half empty?

What if we can get to our 3% target, or close to it upon some revision if necessary, without decreasing access to care, without losing a hospital, without losing a labor and delivery unit, wouldn't healthcare in California be in a much better position? That is the goal here in my mind, and I think we can get think, you know, I don't want to speak for my colleagues on the board, but I think we all probably share that perspective.

Thank you so much. Anyone else on this issue, please, through Senator Laird. Thank you. That's returned back to Senator Laird.

Just let me say thank you. I appreciate the exchange. And I did have conversation with my spouse who has had interactions with the system, and it seems like there has never been a test unordered, even if it was given moments before, it seems like, and so he had the opinion that this was headed down the right direction if it forced the issue of not incenting the revenue and the other things that come from that, but just what is the most efficient care?

So I really appreciate this exchange, and I think it helped highlight what the issues are in front of you and us and your confirmation. Thank you, Mr. Chair.

Thank you so much, Mr. Senator. Very grateful. Before we go to public comment, we'd like to be able to see if there's anyone else who would like to be able to speak, hearing and seeing no one else on the Committee wishing to speak at this time. What we'd like to be able to do is to look to those who would like to be able to speak in support. We're asking individuals who would like to be able to speak in support of this panel.

We welcome you up to the podium to my right. We're going to request, respectfully that each Member keep their comments to 1 minute. Keep their comments to 1 minute. I'll give you a prompt as you get close. Please don't take that as me being rude, just making sure you know all the time. We welcome you. If you can, please provide your first and last name, and if you're with an organization, if you could provide that as well. Good afternoon. Thanks for hanging with us.

Good afternoon, Mr. Chair and Members of the Committee. I'm Katie Van Dynes with Health Access California, the statewide Healthcare consumer advocacy coalition. And we are here in strong support of the governor's appointees to the Healthcare Affordability Board, the decision making body of the Office of Healthcare Affordability. We advocated for the creation of the Office of Healthcare Affordability to address the escalating costs of health care and the affordability challenges that Californians are facing.

More than half of Californians are delaying or skipping health care due to the cost, and almost a quarter are in medical debt. We've worked with each of the governor's appointees, and they are each distinguished leaders in their field.

And each of these appointees as you've heard today, have a deep knowledge of the challenges that Californians are facing in their health care, and will bring expertise to the board to guide us towards addressing these escalating costs, as well as transforming the system to be more efficient, improve quality, and improve equity. We respectfully ask for your. I vote. Thank you.

Thank you so much for being here today. We're really grateful. Good afternoon, sir. If you could please provide your first and last and any organization you're affiliated with. We're grateful that you're here.

Yeah, thank you. Good afternoon. Chair and Members of the Committee, Johann Cardenas with the California Pan Ethnic Health Network. CPEN is proud to support the confirmation of the governor's appointees to the healthcare Affordability Board. We believe that each appointee will bring relevant and important background, experience, and perhaps most importantly, a commitment to our communities. Communities of color continue to face a financial strain when it comes to their health care.

Many opt out to forego their medications or even skip preventative treatment because they are forced to choose between living expenses and their healthcare. Healthcare affordability should not be a barrier for all Californians, and we must continue to transform our healthcare system under OkA. CPEN looks forward to working with the board and we urge the confirmation of these appointments before us. Thank you.

Thank you so much for your comments. Good afternoon. Nice to see you. If you could please provide your first and last in any affiliate organization. Thank you for being with us. Good afternoon.

Matt Lege on behalf of SCIU California, we were proud part of the coalition that helped bring the Office of Healthcare Affordability Forward because workers continue to share more and more of their income, not with their household, but send it to the healthcare industry, and so really supportive of all of the amazing candidates that we have here today, or the appointees, and believe that their expertise, their experience.

And then I think, as you heard the answers today, they're going to be right there to make sure that we can realize this purpose of the board, to make sure that consumers in California can afford healthcare. So thank you very much, and I respectfully ask for your. I vote. It's good to see you. Thank you so much for your time. Good afternoon. It's good to see you. If you could please provide your first and last and any affiliate organization. Good afternoon. Christopher Ruggles with AFSME.

We support the governor's appointees for the OKA board, and we just want to go with the health access comments. Thank you for your time. Thank you so much for being here. Ladies and gentlemen who are in Committee, this is going to be our last call for anyone who would like to be able to speak in support. Last call for those who would like to be able to speak in support.

If you could please come forward at this time, seeing no one else rise, ladies and gentlemen, who are in the Committee, we'd like to be able to see if there's anyone who would like to be able to rise in opposition. We're looking for those who may be in opposition. If you could please come forward to the podium. Last call. All right, we're going to bring back the Committee to be able to see if there are any additional comments, questions from the Committee Members, please.

Senator Laird, I would just say this has been a good discussion. It's a goal we have to meet. And this is going to be an arduous process. And I think that from the diversity of experience here, it is going to really help navigate through it, and in particular, the understanding that will allow what one said was working to not have a total one size fits all, to have the goal, and to try to use different ways to get there.

I'm just glad that that opinion has been arrived at by people that will be making the decision. So, Mr. Chair, unless there's a request to divide this, I would move all four together for confirmation.

We have a request that we're going to need to be able to divide each of these, if that works for the group, and we'll take these up individually. Kurt? zero, you want to take them all up? Got it.

Then I would repeat my motion.

All right. Thank you so much. So, we currently have a motion on the floor to be able to take up one B, Dr. Carlisle. One C, Dr. Hernandez. 1D, Dr. Kronik. And one E, Ms. Mitchell. I do want to say before we go to the vote how grateful we are candidly, for your work. This is one of the most challenging tasks that's in front of this state. And what we are incredibly grateful for is, one, looking at making a more effective and responsive healthcare system.

Two, how we can make it more efficient. What we're also appreciative are your comments on looking at a global view. Whether it is urban or it is rural, how can we deliver the best health care possible to the residents of California? We're grateful for your work. We do have a motion to approve by Senator Laird. Madam Secretary, if you can please call the roll.

[Roll Cal] Three to zero.

That is a 3-0 vote. Congratulations. The final confirmation will be on the floor. We're grateful for your work. Thank you so much for attending today, and thank you to the Members for such a robust conversation. Thank you so much. Thank you. Give our best. Your mom. My goodness. Ladies and gentlemen, this concludes today's agenda. I'm going to start it. I want to end it as I started. I want to say thank you so much to Madam Secretary contreras for all of her work.

I want to say thank you to Madam Secretary for advancing, of course, to Ms. Chin for everything that she does each and every time. And then to our attorney, Ms. Griffiths, for her work and prep as we moved into this first Committee, I want to say thank you so much to the Senators for their patience, as well as this is the First Committee of the Season for Senate rules and really excited and grateful to be working with each and every one of you.

We're going to see you next week. This Committee is now adjourned. Thank you so much.