1 1 2 STATE OF ILLINOIS 3 ADEQUATE HEALTH CARE TASK FORCE 4 5 6 7 Meeting Held 8 December 7, 2006 9 10:00 a.m. 10 11 12 Michael A. Bilandic Center 13 160 North LaSalle Street 14 C-500 15 Chicago, Illinois 16 17 18 19 20 21 22 Reported by: Donna T. Wadlington, C.S.R. 23 Tonja J. Bowman, C.S.R. 24 T.J. BOWMAN COURT REPORTING SERVICE, INC. (312) 220-9219

2 1 DR. WAYNE LERNER, Chairman 2 MR. DAVID KOEHLER 3 MR. JOE ROBERTS 4 MR. TERRY DOOLING 5 MR. KENNETH BOYD 6 MR. JIM DUFFETT 7 DR. NIVA LUBIN-JOHNSON 8 MR. JIM JORDAN 9 MR. ART JONES 10 DR. QUENTIN YOUNG 11 MS. COLLEEN KANNADAY 12 MS. MARGARET DAVIS 13 MS. CATHERINE BRESLER 14 MR. MIKE MURPHY 15 MS. PAM MITROFF 16 MR. GREG SMITH 17 MR. KEN SMITHMIER 18 MR. KEN ROBBINS 19 DR. CRAIG BACKS 20 MS. TRACEY PRINTEN 21 MS. RUTH ROTHSTEIN 22 MR. DAVE CARVALHO 23 MR. JAMES MOORE 24 MS. ELIZABETH COULSON T.J. BOWMAN COURT REPORTING SERVICE, INC. (312) 220-9219

3 1 P-R-O-C-E-E-D-I-N-G-S 2 CHAIRMAN LERNER: Ladies and 3 gentlemen, I would like to call the meeting to 4 order. We have a very, very important 5 discussion today, and a very important vote to 6 take this afternoon. 7 So let me kick off the meeting 8 and welcome you to the Adequate Health Care Task 9 Force. My name is Wayne Lerner. I'm pleased to 10 be the Chairman of the Task Force. I am also 11 pleased to be the president and CEO of Holy 12 Cross Hospital on the south side of Chicago. I 13 would like -- for the moment. 14 (Laughter.) 15 CHAIRMAN LERNER: Thank you, though. 16 I'll take the congratulations. 17 Before we get started, I'd 18 also like to make -- and before we go and 19 introduce everybody, I think we have a very 20 special guest in our midst today. 21 One of our own has been 22 elected to a major office in the State of 23 Illinois and when he introduces himself, I'm 24 sure he won't introduce himself this way, but I T.J. BOWMAN COURT REPORTING SERVICE, INC. (312) 220-9219

4 1 would like to introduce State Senator Elect 2 David Koehler. 3 (Applause.) 4 CHAIRMAN LERNER: Excuse me. For the 5 record, I'd like to be corrected. He is not the 6 State Senator Elect. He is State Senator with 7 standing. We need to pay homage to our friend. 8 UNIDENTIFIED SPEAKER: But that's a 9 better room to meet in. 10 CHAIRMAN LERNER: We'll all have our 11 requests of David when this is over in more ways 12 than one. So let me with that go around the 13 room. 14 SENATOR KOEHLER: Dave Koehler. For 15 another few weeks I'm the executive director of 16 the Peoria Area Labor Management Council and I'm 17 State Senator. 18 CHAIRMAN LERNER: Let me remind 19 everybody, since given the nature of this room, 20 we need to speak loudly and clearly because we 21 have folks in the audience who will not hear us 22 clearly and to the extent that I can I will call 23 on people by name so that everybody is aware 24 who's speaking. Joe. T.J. BOWMAN COURT REPORTING SERVICE, INC. (312) 220-9219

5 1 MR. ROBERTS: Joe Roberts, Caywood and 2 Associates. 3 MR. DOOLING: Terry Dooling, CJ 4 Schlosser and Company. 5 MR. BOYD: Kenneth Boyd, United Food 6 and Commercial Workers Union. 7 MR. DUFFETT: Jim Duffett, Campaign 8 for Better Health Care. 9 DR. LUBIN-JOHNSON: Dr. Niva 10 Lubin-Johnson, Prairie State Medical Society of 11 the National Medical Association. 12 MR. JORDAN: Jim Jordan, Division of 13 Insurance. 14 DR. JONES: Art Jones, Lawndale 15 Christian Health Center. 16 DR. YOUNG: Quentin Young, Physicians 17 for a National Health Program. 18 MS. KANNADAY: Colleen Kannaday, 19 President of St. Francis Hospital in Blue 20 Island. 21 MS. DAVIS: Margaret Davis, Healthcare 22 Consortium of Illinois. 23 MS. BRESLER: Catherine Bresler, 24 Trustmark Insurance Company. T.J. BOWMAN COURT REPORTING SERVICE, INC. (312) 220-9219

6 1 MR. MURPHY: Mike Murphy with 2 WellPoint and Unicare. 3 MS. MITROFF: Pam Mitroff, Mitroff 4 Consulting. 5 MR. SMITH: Greg Smith, Group 6 Marketing Services. 7 MR. SMITHMIER: Ken Smithmier, Decatur 8 Memorial Hospital. 9 MR. ROBBINS: Ken Robbins, Illinois 10 Hospital Association. 11 DR. BACKS: Craig Backs, Illinois 12 State Medical Society. 13 MS. PRINTEN: Tracy Printen, Illinois 14 State Medical Society. 15 MS. ROTHSTEIN: Ruth Rothstein. 16 MR. CARVALHO: Dave Carvalho, Illinois 17 Department of Public Health. 18 CHAIRMAN LERNER: And if we could go 19 through the audience, I would appreciate that as 20 well. Elissa. 21 MS. BASSLER: Elissa Bassler, Illinois 22 Public Health Institute. 23 MS. SREKOVICH: Catherine Srekovich, 24 Navigant Consulting. T.J. BOWMAN COURT REPORTING SERVICE, INC. (312) 220-9219

7 1 MS. DAVIDSON: Gwyn Davidson, Navigant 2 Consulting. 3 MS. TAYLOR: Lynn Taylor, Mathematica 4 Policy Research. 5 MS. CHOLLET: Deborah Chollet, 6 Mathematica Policy Research. 7 UNIDENTIFIED SPEAKER: I'm Dionne -- 8 (inaudible) -- with -- (inaudible) -- and I will 9 not take part. 10 CHAIRMAN LERNER: You have to speak 11 loudly so everybody can hear you. 12 UNIDENTIFIED SPEAKER: I hope to not 13 take part. 14 MS. BECKER: Stephanie Becker with 15 Health and Disability Advocates. 16 MR. YATES: Tom Yates, Health and 17 Disability Advocates. 18 MS. RISEN: Cynthia Risen with the 19 General Assembly. 20 UNIDENTIFIED SPEAKER: Dana -- 21 (inaudible) -- School of Public Health, U of I. 22 DR. JONES: Mike Jones, Illinois 23 Department of Public Health. 24 MS. CHAN: Cathy Chan, Illinois T.J. BOWMAN COURT REPORTING SERVICE, INC. (312) 220-9219

8 1 Department of Healthcare and Family Services. 2 UNIDENTIFIED SPEAKER: -- (inaudible) 3 -- Lutheran General hospital. 4 MS. ROSSENBERG: Marsha Rossenberg, 5 Access Living. 6 MS. VANDERBROOK: Stacie Vanderbrook, 7 Chicago Department of Public Health. 8 MS. NAJBERG: Beth Najberg 9 representing the individually insured. 10 MS. MAHER: Meagan Maher with the 11 Campaign for Better Health Care. 12 MR. RAMSEY: Mike Ramsey, Copley News 13 Service. 14 MS. GRAHAM: Judy Graham, Chicago 15 Tribune. 16 MR. PALMER: Mitch Palmer, independent 17 insurance agent. 18 MS. LIGHTNER: Shannon Lightner, 19 Office of the Governor. 20 MR. MCGRADY: Mike McRaith, Director 21 of the Division of Insurance. 22 CHAIRMAN LERNER: Thank you very much. 23 I want to thank all of you for being here today. 24 The process that we are going T.J. BOWMAN COURT REPORTING SERVICE, INC. (312) 220-9219

9 1 to use will be as follows, and this is following 2 in accordance with the discussions, 3 recommendations of the steering committee and 4 our meeting, our last meeting. 5 We will follow the agenda 6 that's been published and reviewed and approve 7 Task Force minutes and subcommittee -- subgroup 8 call summaries. We'll then talk about the 9 update of what happened at the subgroups and the 10 steering committee actions that took place in 11 October and November and then have Gwyn give us 12 a report on the revised hybrid models, portions 13 A and B. 14 And then we are going to take 15 a break. And we are going to spunge in all the 16 information we have taken in for the past 16 or 17 18 months or so. 18 And then in the afternoon we 19 are going to then engage in a vote to move 20 forward on the recommended model in accordance 21 with the notes that have been passed out to 22 everybody via e-mail. 23 After lunch David and I will 24 clarify the voting procedure because there has T.J. BOWMAN COURT REPORTING SERVICE, INC. (312) 220-9219

10 1 been a couple questions that have been raised 2 about abstentions and Roberts Rules of Order and 3 that kind of stuff, and we will clear that all 4 up after lunch. 5 And my hope is that the time 6 after our break, after lunch, will be solely 7 allocated to the actual vote that would be taken 8 on the model. 9 Remember the process. Process 10 is that we have to recommend a model or models 11 today that will then be written up by the 12 research group between now and our January 13 meeting. 14 And in January -- I don't want 15 anybody to leave thinking their attendance is 16 not important. In January we have to have a 17 quorum and then we have to have a majority of 18 the quorum present to actually make a motion 19 which of the models we are going to move forward 20 to the legislature. 21 So the January meeting will be 22 a short one, but it will be an important one as 23 well. Okay. Any questions? With that -- 24 MR. ROBBINS: Actually, I do. Maybe I T.J. BOWMAN COURT REPORTING SERVICE, INC. (312) 220-9219

11 1 wasn't paying careful enough attention. I 2 apologize. 3 What is the process we are 4 going to use this afternoon to get us to 5 January? Are we going to try to come to one 6 plan to give to the consultants and then they 7 come back and then that one plan is what we are 8 -- 9 CHAIRMAN LERNER: Well, it depends on 10 the vote. If you remember the work that David 11 just put out, you know, it could be more than 12 one plan. It could be two plans that we end up 13 going with. But, hopefully, we'll come to a 14 consensus over one plan that we would give to 15 the consultants, which does not preclude the 16 possibility of minority reports. 17 THE REPORTER: I can't see any of the 18 name tags. 19 CHAIRMAN LERNER: Ken Robbins. 20 When you speak, let me do 21 this, introduce yourself to the audience and 22 then go ahead and start. Quentin. 23 DR. YOUNG: Right before the last 24 exchange the Chair indicated it would be T.J. BOWMAN COURT REPORTING SERVICE, INC. (312) 220-9219

12 1 desirable to have one plan. I am not sure that 2 is true and I am certain it's not in the 3 statute. It says plan or plans and I think on 4 common good sense on the part of the legislature 5 to have that option. 6 CHAIRMAN LERNER: The Chair stands 7 corrected. That is Wayne Lerner, the Chair. 8 Plan or plans. 9 DR. YOUNG: Okay. 10 CHAIRMAN LERNER: One other 11 announcement that I forgot to make that I always 12 make. For those of you with portable phones, 13 BlackBerries, PDAs or other devices, please put 14 them on vibrate or silent. We'd really 15 appreciate that so we can go ahead and 16 deliberate. And also, because the room is set 17 up in such a way that communications will be a 18 little challenging. 19 All right. With that I would 20 like to have a motion to approve the minutes of 21 the Task Force of August 15 and September 26. I 22 don't know that we need a motion on the subgroup 23 call summaries except to accept them. I don't 24 think there is a motion that is required. T.J. BOWMAN COURT REPORTING SERVICE, INC. (312) 220-9219

13 1 MR. CARVALHO: A motion to accept 2 them. 3 CHAIRMAN LERNER: Okay. 4 DR. BACKS: So moved. 5 CHAIRMAN LERNER: Movant. 6 DR. YOUNG: Seconded. 7 CHAIRMAN LERNER: Moved by Craig Backs 8 and seconded by Quentin. 9 Any questions or comments, 10 additions or corrections? Hearing none, all in 11 favor please say aye. 12 RESPONSE: Aye. 13 CHAIRMAN LERNER: Opposed nay. 14 Abstentions? Great. 15 I have already given the 16 meeting purpose and process. And, you know, I 17 wasn't planning on going over the steering 18 committee actions, but I can do that if you want 19 or we can just get into Gwyn's commentary about 20 the subgroups and also about the model itself. 21 Gwyn, why don't you pick it up 22 from there. 23 MR. CARVALHO: Dr. Lerner, Dave 24 Carvalho. T.J. BOWMAN COURT REPORTING SERVICE, INC. (312) 220-9219

14 1 I think the context was that 2 the subgroups all discuss things and then the 3 steering committee synthesized that and said 4 okay do this, do this, do this and so in Gwyn's 5 presentation she will both describe the 6 discussion and then the action that was actually 7 taken as a result of the steering committee 8 direction. 9 CHAIRMAN LERNER: This is Wayne Lerner 10 again. 11 And all of that has been 12 published and available through the website and 13 through other communications we have sent out. 14 So there shouldn't be a whole lot of surprises 15 to anybody as we go through this morning 16 session. Gwyn. 17 MS. DAVIS: Sure. So I won't go over 18 the individual decisions in the steering 19 committee, but as I am going through the -- as 20 I'm going through the revised report, I will 21 point out where certain decisions were made. 22 Does that sound acceptable, 23 Dr. Lerner? Okay. Can you hear me back at the 24 end. I'll try and speak as loudly as I can. T.J. BOWMAN COURT REPORTING SERVICE, INC. (312) 220-9219

15 1 Just raise your hand if you can't and I'll speak 2 louder and more clearly. 3 So everyone should have a hard 4 copy in front of them of the revised seventh 5 hybrid model. It has tabs going down on the 6 right-hand side that's divided into different 7 sections. This is what was e-mailed out with 8 just a few minor changes based on the Task Force 9 call on Tuesday. So this is -- everyone has 10 that in their hand. 11 What I'm going to do is go 12 through this model and describe the major 13 components of the model and point out the 14 changes that we have made as a result of this 15 subgroup and steering committee meetings. 16 But please stop me as you have 17 questions. I am going to take about 20 minutes, 18 hopefully, to go through the different aspects, 19 and then I'm going to turn it over to 20 Mathematica to Lynn Taylor to talk a little bit 21 about the cost and coverage estimate and we can 22 answer questions about that as well. 23 If -- I am going to skip over 24 some of the details of the model just because we T.J. BOWMAN COURT REPORTING SERVICE, INC. (312) 220-9219

16 1 have been presenting a lot of those to you over 2 time. But if there is some area that we are 3 being too general about as I am presenting, let 4 me know and I am go into more detail. 5 So I would like to just walk 6 through the documents as we have it. We start 7 sort of just providing an overview of how this 8 model came to be in terms of the input that was 9 given by the Task Force as well as the 10 activities of the sixth or seventh subgroups and 11 then the steering committee's deliberations 12 about the results of those subgroup meetings. 13 And if you turn to Page 3, you 14 will see the main features of the model. So I 15 would like to kind of just walk through those 16 right now. The model maintains the current 17 SCHIP and Medicaid benefit packages. So it 18 doesn't have any provisions to restrict current 19 public program benefit packages. It keeps those 20 intact. 21 It has a comprehensive 22 standard benefit plan that's available on a 23 guaranteed issue basis to individuals and small 24 groups. And this benefit package is available T.J. BOWMAN COURT REPORTING SERVICE, INC. (312) 220-9219

17 1 in one of two ways. It depends on which version 2 of this model you would like to go with. 3 Under Option A, people or 4 employers would be able to access that plan 5 through private insurance carriers. And then 6 Option B, a State self-insured plan, would offer 7 that plan to individuals. 8 The idea behind option B is 9 that plan would use Medicaid providers and 10 that -- and it would be run by the State. So it 11 would hopefully achieve some administrative 12 efficiencies as well as capture the lower 13 provider rates that are found through the 14 Medicaid providers. 15 Right now the self -- State 16 self-insured plan is set at 105 percent of 17 Medicaid rates, and one of the important changes 18 in this model since the last time you saw it is 19 that through the subcommittee and steering 20 committee deliberations, payments to Medicaid 21 providers were set at an estimated hundred 22 percent of cost. So that's substantially higher 23 than what they are now. 24 And what that means is your T.J. BOWMAN COURT REPORTING SERVICE, INC. (312) 220-9219

18 1 Option B option, if you continue to adopt that 2 higher Medicaid provider payment rate, it would 3 be 105 percent on top of that higher rate. So 4 the cost effectiveness of option B is still 5 there, but it is not as large as it was before 6 when there was no Medicaid provider payment 7 increase. 8 MR. MURPHY: Mike Murphy with 9 WellPoint. 10 Can you tell us what the rate 11 reimbursement being recommended was in your 12 original hybrid? 13 MS. DAVIDSON: Six percent overall 14 increase. 15 MS. BRESLER: Catherine Bresler with 16 Trustmark. 17 So in total 105 percent 18 represents what percentage more than current 19 reimbursement rates? 20 MS. DAVIDSON: Sure. The initial -- 21 well, let me just step back and say when we 22 estimated the provider payment increase, there 23 are many -- in order to assess what is -- what 24 costs are for the different providers, you have T.J. BOWMAN COURT REPORTING SERVICE, INC. (312) 220-9219

19 1 to have cost reports for providers. So that's 2 very difficult to do across your range of 3 providers in the time that this project allows 4 for. 5 So what was agreed upon that 6 we would try to come up with an estimate for 7 increased payments for hospitals and for 8 physicians. And as a proxy per cost of 9 physicians we used Medicare rates. 10 So the increase that we show 11 in the cost and coverage numbers is not 12 complete. It is low because we are not able to 13 estimate that hundred percent of cost for all 14 providers. So I just want to caution people 15 that when you look at this increase it's not -- 16 it's not complete. It understates it. 17 MS. BRESLER: My question wasn't 18 answered. 19 MS. DAVIDSON: I'm sorry but I wasn't 20 done. 21 MS. TAYLOR: In the September 26 -- 22 I'm sorry, Gwyn. 23 MS. DAVIDSON: Go ahead, Lynn. 24 MS. TAYLOR: This is Lynn Taylor. T.J. BOWMAN COURT REPORTING SERVICE, INC. (312) 220-9219

20 1 In the September 26th version, 2 the providers under the State self-insured plan 3 were paid eleven percent more than they are now. 4 They got the six percent overall increase plus 5 five percent for being a provider in the State 6 self-insured plan. In this version that Gwyn is 7 discussing, now they are being paid 28 percent 8 more than they are paid now. 22 percent which 9 is our current estimate that's subject to the 10 caveats that Gwyn just said plus five percent. 11 CHAIRMAN LERNER: And remind us again 12 on Option A what the provider payment is. 13 MS. DAVIDSON: It is -- providers that 14 serve public programs, basically your Medicaid 15 providers, are paid at a hundred percent of 16 costs. So that's at 122 percent increase. But 17 that's just for the public programs. 18 So under Option B you have the 19 same thing, and you have the providers in the 20 State self-insured plan being paid at a hundred 21 five percent of those increased rates. 22 CHAIRMAN LERNER: Did people get it or 23 do they need some further explanation here? 24 DR. YOUNG: Further explanation. T.J. BOWMAN COURT REPORTING SERVICE, INC. (312) 220-9219

21 1 CHAIRMAN LERNER: Say it again, Gwyn. 2 MS. DAVIDSON: Sure. So under Option 3 A when Medicaid provider payments are increased 4 to a hundred percent of cost, so that has -- 5 that impacts current enrollment and then any 6 future enrollment for the expansion that runs 7 through Medicaid or SCHIP or through another 8 State-only funded program like the one that we 9 have in the model for the childless adults. 10 So you move over to Option B. 11 Same thing. Instead of offering that 12 comprehensive standard benefit plan through 13 private insurance carriers to negotiate whatever 14 rates they want to with providers, you run that 15 comprehensive standard plan through the State 16 self-insured plan and those rates are set at a 17 hundred five percent of Medicaid. 18 So the extent to which it 19 increases the Medicaid provider rates will then 20 impact that particular option, that State 21 self-insured plan provider rate. 22 CHAIRMAN LERNER: Are there questions? 23 Craig. 24 DR. BACKS: Craig Backs of ISMS. T.J. BOWMAN COURT REPORTING SERVICE, INC. (312) 220-9219

22 1 So to clarify, the A option is 2 market determined? 3 MS. DAVIDSON: For the comprehensive 4 standard plan in the small non-group market 5 includes both the non-group market and the small 6 group market. 7 DR. BACKS: Okay. 8 MR. CARVALHO: Dave Carvalho. 9 But also note that in A and B 10 for purposes of todays' presentation the 11 existing Medicaid program was re-costed at cost. 12 So A has gone up as well as B has gone up. It's 13 just the differential between A and B is now 14 diminished because before the new program -- 15 well, as she said. But the impact impacted A 16 and B. 17 CHAIRMAN LERNER: Craig Backs. 18 DR. BACKS: Perhaps this isn't the 19 best time to ask this question. You were going 20 to get to it. But one thing we did not 21 understand is in the A option what -- were all 22 the -- did the costs simply represent the costs 23 to the State public government program or do 24 they include the costs of premiums in the T.J. BOWMAN COURT REPORTING SERVICE, INC. (312) 220-9219

23 1 private market as well? 2 So in the apples and apples 3 comparison to be made in the overall costs 4 because it's -- you know, what was unclear to us 5 is it appeared that there was higher costs in 6 the Option A than in Option B and trying to 7 understand those differences. If you are going 8 to get to that later, I will wait. 9 MS. DAVIDSON: Sure. I think we can 10 address that more fully in the cost and coverage 11 estimates, if that's okay. 12 DR. BACKS: That's fine with me. 13 MS. DAVIDSON: Okay. 14 CHAIRMAN LERNER: Before I get 15 started, Wayne Lerner again. We have another 16 member of our Task Force that arrived. Beth, 17 would you introduce yourself. 18 STATE REP. COULSON: State 19 Representative Beth Coulson from the 17th 20 district and also a physical therapist. 21 CHAIRMAN LERNER: Thanks, Beth. Gwyn. 22 MS. DAVIDSON: All right. Any other 23 questions before I move on? 24 So in the model we continue to T.J. BOWMAN COURT REPORTING SERVICE, INC. (312) 220-9219

24 1 have an individual mandate which means that 2 everybody must obtain health insurance or face a 3 penalty and there are certain exemptions for 4 hardship. But the idea is that you have to -- 5 you have to sort of have a stick to pull 6 everybody into the market in order to achieve 7 coverage for as many people as possible but also 8 to bring as many people into the different 9 options to spread the risk. So we don't want 10 anybody out. We want everybody in participating 11 in the expansion. 12 We have expansions of public 13 programs to cover childless adults up to a 14 hundred percent of the FPL. We have that 15 modeled out using only state funds because we 16 don't think there is room enough for savings in 17 the Medicaid program to capture Federal match 18 for that population. 19 We also have an expansion of 20 the family care option to include additional 21 low-income parents. Right now it goes up to 185 22 percent of the FPL. This proposal expands that 23 up to 200 percent of the FPL. And then we also 24 have some selected expansions for disabled T.J. BOWMAN COURT REPORTING SERVICE, INC. (312) 220-9219

25 1 populations to allow them to obtain coverage and 2 continue to work. 3 We also have in here a 4 component where we have an employer assessment. 5 Based on the subgroup and steering committee 6 results, there wasn't a final determination made 7 on what the structure of an employer assessment 8 might look like. So what we have done is we 9 have stated in the model that there would be 10 one, but the final determination of what that 11 would look like has not yet been made. 12 One of the things to take into 13 consideration is that we have estimated using 14 the most recent version of the employer 15 assessment that we developed. We brought that 16 most recent estimate into the cost and coverage 17 numbers here, which means that you have close to 18 $1.5 billion commitment coming in from 19 employers. 20 So to the extent that in the 21 end if this proposal didn't have that extensive 22 of an employer assessment additional State 23 funding would be needed to be found in order to 24 make up that difference. So -- but we wanted to T.J. BOWMAN COURT REPORTING SERVICE, INC. (312) 220-9219

26 1 be very aware that to our knowledge there had 2 been no group decision in terms of what the 3 employer assessment would look like. 4 CHAIRMAN LERNER: Yes. Ken Robbins. 5 MR. ROBBINS: I understand that you 6 are not being precise here intentionally, but I 7 am trying to get my hands around the rough 8 dimensions of where we're going. 9 When you talk about an 10 employer assessment is the principal at least 11 that underlies all of this that there would be 12 an assessment of employers who did not 13 voluntarily or otherwise provide a certain level 14 of health care services? Or would it be an 15 assessment against all employers regardless of 16 whether they were providing health care 17 services? 18 MS. DAVIDSON: It's an assessment that 19 is applied to all employers. And it is -- so 20 you could be an offering employer already 21 offering coverage or non-offering employer. 22 And the way that the policy is 23 currently structured in our cost and coverage 24 estimate is to say as an employer you meet a T.J. BOWMAN COURT REPORTING SERVICE, INC. (312) 220-9219

27 1 certain minimum standard, and if you don't meet 2 that minimum standard, you either need to -- you 3 would have to pay an assessment and you could 4 pay a partial assessment, you know. 5 And when you get a credit 6 against the assessment, if you could prove 7 certain levels of coverage and that might be a 8 partial credit or a full credit. So we are 9 trying -- I'm sorry. 10 CHAIRMAN LERNER: But if your offering 11 is above the level, then you are free and clear. 12 MS. DAVIDSON: Exactly. 13 CHAIRMAN LERNER: So there's a minimum 14 standard that's established either through an 15 employer sponsored program and/or an assessment 16 and/or a combination of the two. 17 MS. DAVIDSON: That's right. Lynn, do 18 you want to add anything to that? 19 MS. TAYLOR: Gwyn is correct when she 20 says that every employer faces an assessment. 21 The best legal understanding right now is that 22 you have to structure it that way to get around 23 ERISA but then as was pointed out subsequently 24 we estimate currently about half of employers T.J. BOWMAN COURT REPORTING SERVICE, INC. (312) 220-9219

28 1 would get a full credit against the assessment. 2 So effectively they are not paying anything. 3 And we can -- we can talk about that more if we 4 need to clarify it. 5 CHAIRMAN LERNER: Ken, does that -- 6 MR. ROBBINS: Yes, it does. Thank 7 you. 8 MS. DAVIDSON: There is a provision -- 9 there remains a provision in the model where 10 small employers with a majority of low-wage 11 workers are encouraged to offer coverage by 12 allowing them to contribute a smaller amount of 13 cost of single coverage when they offer the 14 comprehensive standard plan. 15 So we are trying to build in a 16 component where we incent small low wage 17 employers to offer coverage because our 18 understanding of the research is that that is a 19 particularly vulnerable group of employers. The 20 model also includes State-funded premium 21 subsidies for people below 400 percent of the 22 federal poverty level. 23 And what you will see -- what 24 you have seen playing out in our cost and T.J. BOWMAN COURT REPORTING SERVICE, INC. (312) 220-9219

29 1 coverage estimates and you will continue to see 2 today is that in an individual mandate 3 environment you can't really distinguish who is 4 uninsured before and who is insured because now 5 everyone needs to be insured. So that premium 6 subsidy applies to anybody who currently has 7 coverage and is below 400 percent of the FPL or 8 is uninsured and needs to take up that coverage 9 through the individual mandate. 10 And that coverage if someone 11 has employer offer of coverage available to 12 them, they have to use the premium subsidy 13 towards that coverage. If they don't have 14 employer offer of coverage available to them and 15 aren't eligible for any of the public program, 16 they go to the small -- excuse me, the non-group 17 market and obtain the comprehensive benefit plan 18 in that market using the premium subsidy. 19 So we don't allow people to 20 say, no, I don't want to take up my employer. 21 I'm going to take my subsidy to the individual 22 market. And one of the reasons we do that is 23 because the individual market's premiums are 24 higher than through the employer and you can't T.J. BOWMAN COURT REPORTING SERVICE, INC. (312) 220-9219

30 1 capture that employer contribution to the 2 premium if they go to the individual market. 3 SENATOR KOEHLER: Dave Koehler. 4 There is also a difference in 5 terms of that subsidy, is there not, if you go 6 into the employer plan. Your subsidy is higher? 7 MS. DAVIDSON: If you go -- right. 8 The way that we have structured is that on 9 average you would be paying four percent of your 10 gross income towards your premium, and if you 11 get coverage through your employer, it would be 12 six percent in the individual market. 13 Lynn, I just want to make 14 sure. 15 MS. TAYLOR: Yes. 16 MS. DAVIDSON: And we wanted -- 17 because we wanted to make sure that we weren't 18 crowding out employer-based coverage. 19 SENATOR KOEHLER: Is there a benefit 20 to the employer then in that scenario? 21 I'm a little bit confused. The subsidy is 22 actually to the individual? 23 MS. DAVIDSON: Right. 24 SENATOR KOEHLER: Is that correct? T.J. BOWMAN COURT REPORTING SERVICE, INC. (312) 220-9219

31 1 MS. DAVIDSON: Right. 2 SENATOR KOEHLER: So the employer 3 doesn't really make any difference one way or 4 the other? 5 MS. DAVIDSON: Right. Although if the 6 employer has those employees taking up their 7 coverage, they can get a credit against the 8 assessment. So, you know, they have incentives 9 to have those people use that premium subsidy 10 with them. 11 SENATOR KOEHLER: Okay. 12 MS. TAYLOR: There is a -- Lynn 13 Taylor. 14 There's a modest incentive for 15 small low-wage employers, and I think Gwyn -- I 16 don't know if you had a chance to touch on that 17 yet. That's modest. 18 And the fact that the 19 employer-based coverage is more affordable to 20 the workers gives the employer also some 21 latitude in how they structure their benefit. 22 Maybe you can get more healthy workers. There 23 is a lot of things can happen given there is new 24 dollars in the system. T.J. BOWMAN COURT REPORTING SERVICE, INC. (312) 220-9219

32 1 MS. DAVIDSON: We also have a number 2 of changes to the insurance market which 3 includes a reinsurance program for the 4 comprehensive standard plan products, and we 5 have a minimum medical loss ratio of 85 percent 6 and tighter limits on the various and carrier 7 rates for all products. And then we have limits 8 on annual rate increases for the comprehensive 9 standard plan. 10 Now, these insurance market 11 changes are meant to be done in the context of 12 the individual mandate and combination of the 13 employer assessment because we want everybody 14 participating so the risk is spread broadly when 15 you ask the insurance market to conform to these 16 changes. 17 DR. LUBIN-JOHNSON: And where are 18 those changes noted in the document? 19 MS. TAYLOR: Is this insurance market 20 changes? 21 DR. LUBIN-JOHNSON: Yes. 22 MS. TAYLOR: Page 12. 23 CHAIRMAN LERNER: Excuse me. That was 24 Dr. Lubin-Johnson that was speaking. T.J. BOWMAN COURT REPORTING SERVICE, INC. (312) 220-9219

33 1 MS. CHOLLET: Section 5, Page 12. 2 MS. TAYLOR: And six as well. 3 MS. CHOLLET: And Section 6 -- the 4 second page of Section 6 for the individual 5 market. Deborah Chollet. 6 DR. LUBIN-JOHNSON: Section 6, page -- 7 MS. CHOLLET: Page 17. 8 DR. LUBIN-JOHNSON: Thank you. 9 MS. DAVIDSON: The plan also 10 establishes a new State administrative body 11 called the Illinois Health Education Referral 12 Center. We are going to refer to it as IHERC 13 for purposes of the discussion. 14 And this operates as an 15 enrollment broker and information clearing house 16 on the different coverage options. It's not 17 meant -- and this is one thing that was 18 clarified through the steering committee 19 discussions in the subgroup. This is not meant 20 to replace any existing public body or duplicate 21 functions of existing State departments but 22 coordinate with them or collaborate with them in 23 order to achieve these different functions. 24 We have in here, just moving T.J. BOWMAN COURT REPORTING SERVICE, INC. (312) 220-9219

34 1 to provider payments, increased it to a hundred 2 percent of cost and that's within public 3 programs within consideration of Federal upper 4 payment limit rules and other regulations. 5 IHERC would provide web-based information on 6 existing provider quality efforts. This is 7 something else that was clarified that IHERC 8 would not be establishing new quality 9 initiatives but would be providing information 10 and links to existing quality initiatives. 11 The State would also implement 12 long-term care partnerships to encourage the 13 takeup of long-term care coverage. 14 So that's the basic overview 15 of the model. I wanted to touch on a few 16 details that were decided in the steering 17 committee and subgroup. 18 There is a section of the 19 model that talks about trying to incent 20 additional people to become providers and serve 21 in underserved areas, and we added language into 22 the model that we talked about building on two 23 pre-existing programs, Illinois Medical Students 24 Scholarship Program and the Illinois Assistance T.J. BOWMAN COURT REPORTING SERVICE, INC. (312) 220-9219

35 1 Program to try to increase those efforts. 2 There was also a discussion 3 about the source of funding. What happened in 4 the subgroups was the decision to not specify 5 exactly what the source of funding for the State 6 funds that are sort of yet to be determined 7 would be to say that the proposal would be 8 funded through general revenue using the 9 broad-based revenue sources available to the 10 State. So it's -- that's the extent to which 11 the source of funding is decided. Yes. 12 STATE REP. COULSON: Representative 13 Coulson. 14 Did you include your work 15 force development costs in your estimates or are 16 those additional? 17 MS. DAVIDSON: In terms of additional 18 providers that would need to be trained to serve 19 additional people, no, that is not included 20 there. 21 STATE REP. COULSON: So anything we 22 would try to add to that would be in addition? 23 MS. DAVIDSON: That's right. 24 CHAIRMAN LERNER: Yes. Wayne Lerner. T.J. BOWMAN COURT REPORTING SERVICE, INC. (312) 220-9219

36 1 The clarification on this is 2 dating all the way back to the public hearings. 3 Just making people have access to health care 4 doesn't determine the distribution supplied 5 providers. So that's the issue. 6 DR. BACKS: Craig Backs. 7 On the provider payments on 8 Page 4 defined as hundred percent of cost, could 9 you clarify how that works for a physician and 10 where that's documented in the document. There 11 have been a number of references to increases to 12 Medicare payment rates, and we've been looking 13 for that. I know it's been addressed at some 14 point in some of the discussion, but I have been 15 unable to find it in the documents specifically. 16 MS. DAVIDSON: Sure. If you look to 17 Section 10 and Page 29 contains a one-page 18 description of how we estimated increases in 19 public provider payments. Now bear in mind that 20 this is how we estimated those increases for 21 purposes of our cost and coverage estimates. I 22 think that there will be an additional decision 23 to be made in terms of if this were to become a 24 program, you know, what type of determination T.J. BOWMAN COURT REPORTING SERVICE, INC. (312) 220-9219

37 1 would be made to identify a hundred percent of 2 cost for physicians. 3 For cost and coverage estimate 4 the discussion with the subgroup we had 5 estimated that at Medicare rates using the 6 locality '99 rates, which is outside of Chicago. 7 And certainly that's a very 8 general estimate, and if you wanted to do a more 9 precise one, you would be looking at what 10 proportion of physician services are provided 11 throughout the State and applying the Medicare 12 geographic rates to those different areas. 13 DR. BACKS: If I could also follow up 14 on that. With consideration of other payment 15 and other rules and regulations apply to various 16 provider groups, that's very unclear to me what 17 that applies to. Is that a hospital specific? 18 Because I don't think -- I don't understand that 19 from a physician's point of view. 20 MS. DAVIDSON: Sure. It is for all 21 providers. Basically, the Federal Government 22 says you can't pay more -- Medicaid has an upper 23 payment limit in terms of what they can pay 24 providers. They can't pay more than what has T.J. BOWMAN COURT REPORTING SERVICE, INC. (312) 220-9219

38 1 been paid under Medicare, generally speaking, 2 using Medicare reasonable cost estimates. 3 So for hospitals you could get 4 paid up to a reasonable estimate of what 5 Medicare would have paid and for physicians 6 often the determination is based off Medicare 7 rates. But there is some other ways to do that 8 as well. 9 But what we didn't want to 10 imply here is that you could increase provider 11 payments to whatever you wanted, you know. For 12 the public programs, there are certain federal 13 regulations that constrict going higher than 14 estimate of what -- 15 CHAIRMAN LERNER: We have a 16 clarification from Dave Carvalho. 17 MR. CARVALHO: One of the things that 18 was mentioned on Tuesday and I probably should 19 repeat here. There is two different things 20 going on here. 21 One is in words you all 22 adopting a plan or adopting a report saying XYG 23 should be part of a program and then in numbers 24 the consultants estimating the costs. But if T.J. BOWMAN COURT REPORTING SERVICE, INC. (312) 220-9219

39 1 you are -- but your recommendation are the 2 words. The numbers are the estimate of the 3 costs. 4 If your words, for example, 5 say that reimbursement should be at a hundred 6 percent of costs, if their estimates are, you 7 know, just estimates of what is that mean. Your 8 report is still recommending that the 9 reimbursement be at a hundred percent of costs. 10 It's not limited to the numbers that they used 11 as their estimates. 12 So their estimates are as good 13 as their estimates can be under this 14 environment, and it gives you guidance as to 15 what the impact of your words mean. But, 16 ultimately, the report will be your words. 17 CHAIRMAN LERNER: Art. 18 DR. JONES: Art Jones. 19 Under Option B, the large 20 employers have the option of purchasing their 21 insurance through the State plan? 22 MS. DAVIDSON: I'm sorry? 23 DR. JONES: Under Option B larger 24 employers who are currently with another T.J. BOWMAN COURT REPORTING SERVICE, INC. (312) 220-9219

40 1 insurance company will they have the option of 2 switching and purchasing insurance through the 3 State self-plan? 4 MS. DAVIDSON: Yes. They could get 5 the comprehensive. If they wanted to purchase 6 the comprehensive standard plan, they could. 7 DR. JONES: Okay. 8 CHAIRMAN LERNER: Jim. 9 MR. DUFFETT: Jim Duffett. 10 Did you run numbers? In terms 11 of a premium assistance there were that four 12 percent and six percent caps on that, but there 13 were no caps on out-of-pocket costs? 14 MS. DAVIDSON: All right. 15 MR. DUFFETT: Are there rough idea on 16 numbers on what that would add if these caps 17 also applied to individuals understanding that 18 the -- there is still maybe a lot of 19 administrative costs in trying to track that, 20 but I wondered if you ran numbers. 21 MS. DAVIDSON: Right. I mean, we 22 had -- one of the issues that had been brought 23 up -- just for the rest of the group that sort 24 of weren't able to be a part of these T.J. BOWMAN COURT REPORTING SERVICE, INC. (312) 220-9219

41 1 discussions. 2 One of the issues that had 3 come up in the separate steering committee is 4 that they are subsidizing the premium assistance 5 but what happens if the cost sharing that the 6 individual is exposed to is so high that even 7 though they have the premium, have the coverage 8 they can't really get the care. 9 And what we had done is 10 stepped back and looked at some cost sharing 11 arrangements to try to say, well, you know, how 12 much more would your costs be if you tried to 13 cover that cost sharing. 14 And from our general 15 conclusion was that you would -- in order to do 16 that you could see how you would do it in the 17 individual market. You could structure three 18 different benefit plans to -- depending on FPL, 19 they have smaller or larger point of service 20 cost sharing obligations. 21 But when you get over to the 22 employer you really have to be very prescriptive 23 to the employer in terms of where that -- where 24 that -- what kind of plan they could offer, and T.J. BOWMAN COURT REPORTING SERVICE, INC. (312) 220-9219

42 1 they would have to then distinguish between 2 their employees in terms of how -- you know, how 3 much they were earning, and we felt that that 4 was perhaps too administratively burdensome for 5 this particular model to work effectively. 6 But in terms of overall 7 numbers, Lynn, do you want to say something to 8 that? 9 MS. TAYLOR: Well, I am afraid -- Lynn 10 Taylor -- that the short answer is no. We did 11 not do any cost estimates. 12 In one of the tables, Exhibit 13 X2, we do have a line which shows our estimate 14 of total out-of-pocket costs. But it's a total. 15 It doesn't tell you anything about the 16 individual burden facing any one person. It is 17 just -- it was just outside the model that we 18 built to answer the questions. Did not contain 19 enough health status detail to really do what 20 you wanted to do. 21 CHAIRMAN LERNER: Art Jones. 22 DR. JONES: Who are the remaining 23 185,000 uninsured? 24 MS. DAVIDSON: Lynn, do you want to T.J. BOWMAN COURT REPORTING SERVICE, INC. (312) 220-9219

43 1 talk to that. 2 MS. TAYLOR: Well, we -- in our best 3 judgment these are people who either faced very 4 little penalty for not complying with the 5 mandate or perhaps a few renegades. There are 6 no programs where people comply fully. For 7 instance, automobile insurance or people who are 8 eligible for the EITC. Not everyone signs up. 9 So we simply thought it was a reasonable 10 assumption that not everyone would comply with 11 the mandate. 12 MS. PRINTEN: Tracy Printen. The 13 estimated public program premium costs, does 14 that -- is that an estimate that comes from DHS 15 or from Milliman or from -- 16 MS. DAVIDSON: Which costs? I'm 17 sorry. 18 MS. PRINTEN: The estimated public 19 program premium costs that you identified nine 20 percent of for the physician payments. 21 CHAIRMAN LERNER: Where are you? 22 MS. PRINTEN: On Page 29. 23 MS. DAVIDSON: Oh, sorry. 24 MS. PRINTEN: Of Section 10. T.J. BOWMAN COURT REPORTING SERVICE, INC. (312) 220-9219

44 1 MS. DAVIDSON: Yes. That is estimated 2 in the Department of Healthcare and Family 3 Services. 4 SENATOR KOEHLER: Dave Koehler. 5 Lynn, what you are talking 6 about in terms of -- that there would be some 7 people who in spite of the mandates would just 8 not fit into that. Is there a way -- I didn't 9 read in any of this. Is there a way to then 10 capture them when they do need health care? 11 MS. TAYLOR: Certainly. 12 SENATOR KOEHLER: So if they end up 13 having to somehow enter the health care system 14 then at that point they are assisted or 15 whatever. 16 MS. TAYLOR: We suspect that the 17 population who doesn't really face an effective 18 penalty for not complying overlaps strongly with 19 the population that's eligible for public 20 programs. And as it works -- as it happens now, 21 you show up at the hospital they will make every 22 effort to get you enrolled. 23 CHAIRMAN LERNER: Ken. 24 MR. ROBBINS: Ken Robbins. A point T.J. BOWMAN COURT REPORTING SERVICE, INC. (312) 220-9219

45 1 you made earlier and I wanted to be sure that I 2 understood it. 3 Under Option B an employer 4 could choose to purchase coverage through the 5 State program and that level of payment would be 6 the Medicaid payment rate at a hundred percent 7 of cost, whatever that exactly means. 8 MS. DAVIDSON: Plus five percent. 9 MR. ROBBINS: Doesn't that take -- 10 create the risk that a substantial population 11 presently insured through commercial entities 12 would suddenly end up in a public payment 13 program that would pay significantly less than 14 is already being paid by the commercial insurer 15 of that population? 16 MS. DAVIDSON: Right. I can see that 17 risk. 18 One of the thoughts between 19 these different options is that employer when 20 you go into the State self-insured plan you have 21 access to a Medicaid provider network and you 22 would have some -- you would have employers who 23 wouldn't want -- would want to remain with their 24 current provider networks and their employees T.J. BOWMAN COURT REPORTING SERVICE, INC. (312) 220-9219

46 1 would want them to remain with that network. 2 But I mean Lynn -- 3 MS. TAYLOR: Just to clarify, all 4 employer coverage is eligible for premium 5 subsidies, not just the State self-insured plan. 6 So the employer does not have to offer that plan 7 in order to make their eligible employees to 8 give them access to those premium subsidies. So 9 there is not -- you know, we believe that most 10 would stay with their commercial insurers. 11 DR. JONES: Don't you think the 12 premium would be lower because there certainly 13 is not going to the administrative costs that 14 there is with the insurance companies? 15 MS. TAYLOR: Yeah, but there are 16 trade-offs involved. I think that if an 17 employer's workers said we really want to stay 18 with our providers over here and they are not 19 Medicaid providers and they are getting a 20 premium -- they were already purchasing that 21 coverage, they now have a subsidy they didn't 22 have before, that they would stay with the 23 commercial providers. Nobody knows for certain. 24 MR. ROBBINS: In previous iterations T.J. BOWMAN COURT REPORTING SERVICE, INC. (312) 220-9219

47 1 didn't we have some protections against the 2 concept of crowd-out? 3 MS. TAYLOR: Yes. Those -- when an 4 individual mandate in a voluntary system 5 having -- tying these sorts of costs associated 6 with subsidized coverage to some crowd-out 7 provisions can be a very good idea. It's just 8 very difficult conceptually to make that work in 9 an environment, there is an individual mandate 10 in place and in theory everyone's covered and we 11 don't have any uninsured, if you are talking 12 about that type of crowd-out. 13 MR. ROBBINS: I am talking about when 14 an employer makes a choice to move from its 15 present commercial carrier to the public plan 16 under B. 17 MS. TAYLOR: Right, right. 18 MR. ROBBINS: I thought that we were 19 seeking to prevent that from happening so that 20 you would not unnecessarily enlarge the pool of 21 publicly paid for patients. 22 MS. TAYLOR: We had extensive 23 discussions about aligning the different 24 coverage options so that we'd preserve the T.J. BOWMAN COURT REPORTING SERVICE, INC. (312) 220-9219

48 1 employer's contribution, and they did not drop 2 coverage altogether and have their employees go 3 and purchase coverage in the non-group market 4 with subsidies. 5 And correct me -- somebody 6 jump in if I am wrong. I don't think we had 7 extensive conversations about the situation that 8 you're describing where the employer is still 9 contributing but they switched their coverage 10 from a commercial product to the State 11 self-insured plan. And I just don't remember 12 that Task Force discussion. 13 MR. ROBBINS: I thought we did have 14 those conversations and I see the principal to 15 be the same. If a whole bunch of people 16 presently insured in the private marketplace end 17 up in a publicly-sponsored program, it doesn't 18 seem to be particularly important what the 19 vehicle is for that movement. The fact is that 20 the movement occurred and is that what we are 21 trying to encourage. 22 MS. TAYLOR: Well -- 23 MS. DAVIDSON: I think that the way 24 the model was set up was to try to encourage T.J. BOWMAN COURT REPORTING SERVICE, INC. (312) 220-9219

49 1 employers who aren't currently covering coverage 2 to be able to do so through a lower cost option. 3 MR. ROBBINS: That's what I thought, 4 but what we created, I think, is the opportunity 5 for people who are providing coverage to make 6 that move. 7 MS. DAVIDSON: You are right. Option 8 B allows them to do that. 9 MR. ROBBINS: And isn't that 10 inconsistent with the point you just made two 11 seconds ago about trying to encourage other 12 options for employers who presently don't 13 provide insurance? 14 MS. DAVIDSON: Well, I think what I 15 was trying to say is under Option B if you 16 don't -- if employers aren't offering coverage, 17 Option B allows you a lower cost alternative to 18 start doing that. It does also offer the 19 opportunity for offering employers to move over 20 to that State self-insured plan. 21 CHAIRMAN LERNER: It's Wayne. Let me 22 just clarify. From my understanding it is 23 exactly as Ken stated it, which was that we were 24 going to try to avoid a crowd-out or movement in T.J. BOWMAN COURT REPORTING SERVICE, INC. (312) 220-9219

50 1 any way possible from the private market to 2 public market for a whole series of reasons. If 3 one of the unintended consequences of developing 4 Option B was this kind of movement opportunity, 5 people need to be aware of that as we get onto 6 the voting issue later on this afternoon. 7 MR. ROBBINS: That's what I am trying 8 to clarify. 9 CHAIRMAN LERNER: That's the 10 clarifying point. Art. 11 DR. JONES: We did have this 12 discussion because I remember commenting on it, 13 and the point is that I think employers should 14 have the option of choosing the most cost 15 effective plan. And if the State can present a 16 plan that's much more cost effective with the 17 same coverage, then I think the employer should 18 have the option to chose that plan. 19 They can be competitive in the 20 open market. They can choose it. If the thing 21 that is keeping them from doing that is the fact 22 that their provider is not in that group, then 23 that's fine. But it's open market. It's 24 competitive. But the people deserve it. T.J. BOWMAN COURT REPORTING SERVICE, INC. (312) 220-9219

51 1 I brought this up at the last 2 meeting because I think that is a very positive 3 point. My comment in the last meeting is that 4 very well may be to get the single payer plan if 5 it turns out, in fact, that is the cost 6 effective way of providing care to the State. 7 CHAIRMAN LERNER: And with that as a 8 note -- 9 MR. ROBBINS: At least we are in 10 agreement. 11 (Laughter.) 12 CHAIRMAN LERNER: And with that as a 13 note, let me -- I don't want to get into 14 debatable points among the models except for 15 clarifying points, and I think this is an 16 important clarifying point, regardless of where 17 it leads us down the path. 18 And that is, that there was 19 discussion about the misalignment, disalignment, 20 the alignment of incentives for people who are 21 currently accessing the private market to stay 22 in the private market vis-a-vis going into the 23 public market. There is the other point of view 24 that talks about low cost options. T.J. BOWMAN COURT REPORTING SERVICE, INC. (312) 220-9219

52 1 I think the easiest way of 2 saying this is that that is the choice -- Ken, I 3 want to make sure of this -- that that's the 4 choice between Option A and Option B. And that 5 one of the consequences of Option B is to go 6 this route which is to give businesses a choice 7 between the private market and the public 8 market. 9 Is that a fair way of saying 10 it? 11 MS. TAYLOR: Yes. 12 CHAIRMAN LERNER: Now, there was a 13 question here. Joe. 14 MR. ROBERTS: Joe Roberts. I was just 15 trying to follow up on that. 16 I think that was in the 17 context also of our conversation on our subgroup 18 that we made it a point to make sure that in 19 this plan there be a notation that this may be 20 one of those unintended consequences that needs 21 to be studied further. 22 CHAIRMAN LERNER: It's Wayne again. 23 It's all a matter of where you 24 sit and where you want to go. So there's T.J. BOWMAN COURT REPORTING SERVICE, INC. (312) 220-9219

53 1 obvious some concerns here on both sides and 2 that is why the models are laid out this way. 3 MS. MITROFF: I don't know if I missed 4 this or whatever. Pam Mitroff. 5 The comprehensive standard 6 benefit package or whatever we would have, how 7 does that compare to what most employers have 8 currently and have you factored any significant 9 differences into your cost estimates? 10 MS. DAVIDSON: Sure. The plan is 11 based on the State -- Illinois State Employee 12 Plan and is meant to look like a typical 13 commercial plan. It's also been adjusted to 14 include Illinois mandated benefits. 15 MS. MITROFF: Could you answer my 16 question? 17 MS. DAVIDSON: To model that plan we 18 chose one particular option for the cost and 19 coverage estimates, but we have not been 20 deliberately prescriptive in the benefit plan in 21 terms of the must offer X or Y. But it didn't 22 mean to represent a typical commercial plan. 23 MS. MITROFF: So you haven't done any 24 type of analysis about how many employers would T.J. BOWMAN COURT REPORTING SERVICE, INC. (312) 220-9219

54 1 have to change their plans or how many employer 2 plans currently meet this benefit? 3 MS. DAVIDSON: Well, in both Option A 4 and B we are not requiring employers to meet 5 that standard. What we are saying is if you 6 don't have employer sponsored coverage, you can 7 obtain that plan by going into the individual 8 market and an employer, if they want to, can 9 purchase that plan from insurance carriers, but 10 they are not required to offer it. 11 MS. MITROFF: But isn't the assessment 12 tied into that? Maybe I'm lost or -- 13 MS. DAVIDSON: The assessment is tied 14 into the way that's it's currently run for these 15 costs and coverage estimates, not the -- the 16 Task Force did not decide on a current 17 structure, but it's tied into one of two things; 18 meaning a certain minimum number of employees 19 taking up the employer's coverage and a certain 20 percentage of payroll. 21 So it's not saying you have to 22 achieve a certain level of benefit package. It 23 does -- the reason that we did do a percentage 24 of payroll though was to say there may be some T.J. BOWMAN COURT REPORTING SERVICE, INC. (312) 220-9219

55 1 employers who might say, well, I am going to 2 offer a very, very -- you know, just a 3 bare-bones benefit package just to provide the 4 assessment and, you know, hoping that 60 percent 5 of my employees take it up. So we wanted to 6 guard against that and so benefits wouldn't slip 7 away by establishing that percentage of payroll 8 by trying to say, you know, if you are not 9 paying enough in benefit out to your employees 10 you are likely not providing a rich enough 11 benefit package. 12 MS. MITROFF: And what is that 13 percentage of payroll again? 14 MS. DAVIDSON: Lynn, it's 4.8 percent 15 across total payroll. 16 MS. TAYLOR: Yes. 17 MS. MITROFF: And you derived that 18 based on -- 19 MS. TAYLOR: Well, as has been pointed 20 out by others, the exercise of examining 21 different possible structures for the employer 22 assessment, there is no specific recommendation. 23 So what has been done simply for modeling 24 purposes is to pick a structure that was T.J. BOWMAN COURT REPORTING SERVICE, INC. (312) 220-9219

56 1 examined closely and estimate the assessment 2 that would be collected in conjunction with 3 that. And this structure, which again is not a 4 specific recommendation, it's part of the 5 modeling exercise, has targeted the assessment 6 kind of at the mid-employer -- approximately 7 where the mid-employer contributes to coverage. 8 On average in the State of 9 Illinois employers cover about 60 percent of 10 their workers, and they might -- they spend 11 roughly eight percent of payroll. We needed to 12 make that a little bit lower than that because 13 we are targeting the lower payroll firms. We 14 just did a little dance in there in terms of 15 what we thought was a manageable effort on the 16 part of employers. Is that helpful? 17 MS. MITROFF: Let me see if I can -- 18 because I think you did answer my question. 19 MS. TAYLOR: Okay. 20 MS. MITROFF: You made an assumption 21 that employers currently spend, if they offer 22 coverage, about eight percent of payroll, and 23 you set the assessment at four percent of 24 payroll. T.J. BOWMAN COURT REPORTING SERVICE, INC. (312) 220-9219

57 1 MS. TAYLOR: Well, the eight percent 2 of payroll comes out of employer survey data. 3 It's not an assumption. That is just what we've 4 observed from -- 5 MS. MITROFF: I didn't mean assumption 6 in a negative way. 7 MS. TAYLOR: Okay. And the 4.8 is a 8 lower amount, sort of examining the group of 9 employers that are likely to be subject to the 10 assessment, i.e., the below average employers. 11 MS. MITROFF: Okay. 12 MS. TAYLOR: A little average in terms 13 of contribution to health coverage. 14 CHAIRMAN LERNER: Pam, do you have any 15 further follow-up? 16 MS. MITROFF: No. I think she 17 answered my questions. 18 CHAIRMAN LERNER: Okay. 19 MS. DAVIDSON: I want to stop. Ms. 20 Bresler, I wasn't sure if you had questions. It 21 seemed like perhaps maybe we needed to clarify 22 that the information maybe wasn't ringing true 23 for you. 24 MS. BRESLER: I am just not -- I am T.J. BOWMAN COURT REPORTING SERVICE, INC. (312) 220-9219

58 1 not sure where the -- I am not even sure what my 2 question is. I think my question is what's the 3 trigger then. So if employers are paying 4.8 4 percent, I think you said, if employers are 5 paying out 4.8 percent of their payroll for 6 health insurance coverage, then they get a 7 credit on the assessment because all employers 8 are being assessed; isn't that correct? 9 MS. DAVIDSON: That's right. Lynn, do 10 you want to give sort of a -- Dr. Lerner, if we 11 can just spend five minutes describing the 12 employer assessment structure, I think that 13 might help address some of the questions because 14 we are sort of getting at it piecemeal. 15 MS. TAYLOR: And is that in their 16 books or no? 17 MS. DAVIDSON: That's right. If you 18 look on page -- and I think it will be -- I 19 think it's -- well, it's helpful to refer to it 20 but I think Lynn will be giving sort of a good 21 verbal cheat sheet but it's on -- 22 MS. TAYLOR: Oh, is it separate? 23 MS. DAVIDSON: It's C1. Behind C at 24 the very back of your book. T.J. BOWMAN COURT REPORTING SERVICE, INC. (312) 220-9219

59 1 MS. TAYLOR: So let me try to do this 2 very quickly but from the top. 3 For the reasons of ERISA, 4 technically every employer in the State is 5 subject to an assessment. However, by meeting a 6 minimum threshold -- a minimum threshold 7 financial contribution to health care, and it's 8 simply financial in what's estimated here, you 9 can get a full credit against that assessment, 10 which means you pay nothing. And in the 11 estimates included in Appendix C, roughly half 12 of employers pay nothing. 13 If you don't -- if you offer 14 coverage but you don't meet these minimum 15 thresholds, then you get a partial credit which 16 is the equivalent to saying you pay a partial 17 assessment. 18 And those employers in 19 table -- let me just turn as an example. If you 20 go to tab three in your Appendix C, I'm on Page 21 C3-1. Employers who offer but they are below 22 these minimum thresholds and are subject to a 23 partial assessment, on average they pay about 24 two percent of payroll as their assessment. T.J. BOWMAN COURT REPORTING SERVICE, INC. (312) 220-9219

60 1 Then you have employers who 2 don't offer. By definition they are subject to 3 the full assessment. That full assessment is 4 equal to 4.8 percent of payroll. That's subject 5 to a cap. So not surprisingly their assessment 6 is equal to 4.8 percent of payroll. 7 And because these tend to be 8 low-wage firms, the average assessment per 9 worker as you can see on that table is $836. 10 That's the non-offering employers subject to the 11 full assessment. 12 And I think that your question 13 was, well, what are those minimum thresholds. 14 There is a couple. One is, what are you paying 15 at the percent of payroll. Another is are you 16 covering at least 60 percent of your workers. 17 So if you don't -- if you fail 18 to meet either of those, we have a formula that 19 results in your partial assessment. Let me stop 20 there. 21 MS. KANNADAY: Colleen Kannaday. 22 Would that be on a sliding 23 scale? 24 MS. TAYLOR: Because it's a percent of T.J. BOWMAN COURT REPORTING SERVICE, INC. (312) 220-9219

61 1 payroll, it is on a sliding scale and it is 2 subject to a cap. 3 MS. KANNADAY: Okay. 4 MS. DAVIDSON: And the reason that 5 it's subject to a cap is if you're an employer 6 that has employees with very high salaries, if 7 we just base it on a percentage you would be 8 unduly penalized. And if you are a low-wage 9 employer, you want it on a percentage for that 10 same reason. 11 What is not -- what we have 12 not performed as part of our work are estimates 13 of, you know, how this impacts businesses in 14 Illinois, and that's something that is included 15 here. That's something that the General 16 Assembly should study. 17 Now, we just want to emphasize 18 that we try to structure a policy that intends 19 employers to continue to offer coverage and 20 doesn't unfairly penalize smaller low-wage 21 employers or, you know, high-wage employers that 22 there is an additional study that would be 23 needed around this. 24 CHAIRMAN LERNER: Dave. T.J. BOWMAN COURT REPORTING SERVICE, INC. (312) 220-9219

62 1 MR. CARVALHO: Dave Carvalho again. 2 To clarify because several of 3 the questions I think were based on some 4 misunderstanding and so I want to underline what 5 Lynn was saying. 6 The comprehensive plan, the 7 references to the comprehensive plan, the 8 references to the State alternative, the 9 references to the commercial alternative are for 10 purposes of the plan that would be available to 11 people who don't have coverage. They have no 12 relevance to the issue of whether or not you are 13 subject to an assessment. If you offer 14 something that looks like the comprehensive 15 plan, the costs, the amount that Lynn indicated, 16 you get a full credit. 17 If you offer something that 18 doesn't look anything like the comprehensive 19 plan, but it costs the amount and reaches the 20 number of employees that Lynn mentioned, you get 21 a full credit. There are two different things 22 that are confusing because they are in the same 23 document, but they are wholly unrelated. 24 MS. TAYLOR: Can I offer one T.J. BOWMAN COURT REPORTING SERVICE, INC. (312) 220-9219

63 1 clarification. Gwyn said something to the 2 effect that we didn't look at this for Illinois 3 employers. These estimates are best efforts to 4 weight them for the types of employers in 5 Illinois, and I think you were referring to 6 greater impacts beyond what happens when you're 7 subject to the assessment. 8 CHAIRMAN LERNER: Craig. 9 DR. BACKS: If I could ask a question 10 that relates to the definition of a 11 comprehensive benefit plan. 12 My understanding is that does 13 not necessarily dictate any particular cost 14 sharing structure or network inclusiveness or 15 non-inclusiveness. In other words, as long as 16 it's offering -- for instance, a plan has to 17 include certain screening procedures or certain 18 frequency of coverage for medically necessary 19 care. May exclude certain things like cosmetic 20 surgery or the like. But it doesn't say it has 21 to be on a certain product. It could include a 22 PPO, HMO product. It could include a 23 traditional indemnity product. It could include 24 an HSA-type product. T.J. BOWMAN COURT REPORTING SERVICE, INC. (312) 220-9219

64 1 MS. DAVIDSON: Well, right. Although 2 I am not sure that -- I think it's something we 3 decided whether or not that would be a high 4 deductible health plan. 5 DR. BACKS: Well, to me -- that is why 6 I am asking the question because to me it's 7 silent. The document is silent on those 8 specifics. And, therefore, I would assume 9 permissive. But if that's not the 10 understanding, I think the words as we said 11 earlier need to reflect what's being prohibited 12 or what's being permitted. 13 MS. TAYLOR: I think the consensus 14 items are in here, right. 15 MS. DAVIDSON: Yes. 16 MS. TAYLOR: I believe the high 17 deductible was a low consensus item, so it's 18 addressed in the document in that context. 19 DR. BACKS: Well, that is very 20 indirect. I mean, I think there's another 21 thing. I would prefer that it would be, you 22 know, addressed head on and directly because -- 23 here's the analogy that I would encourage us to 24 consider. T.J. BOWMAN COURT REPORTING SERVICE, INC. (312) 220-9219

65 1 In the Medicare Part D 2 program, there are a variety of different types 3 of plans, including the one that everybody 4 refers to as the donut hole plan. But many of 5 my patients have no donut hole plan because they 6 chose plans that were actuarially equivalent to 7 that plan, but offered, in essence, first dollar 8 coverage but at a higher premium cost. You 9 know, higher deductible at lower premium costs. 10 And I would urge us to look at 11 that as more the model of being actuarially 12 equivalent plans as opposed to being too 13 prescriptive against any particular type of 14 benefit structure. Because I think that 15 eliminates an opportunity for the market to do 16 work in a way that it actually has worked quite 17 well in the Medicare Part D program based on the 18 evidence available. So I think that is 19 something that needs to be clarified in the 20 final report. 21 MS. DAVIDSON: I think for purposes of 22 thinking about this model, the comprehensive 23 standard plan would not be a high deductible 24 plan. T.J. BOWMAN COURT REPORTING SERVICE, INC. (312) 220-9219

66 1 DR. BACKS: See, that's the problem. 2 I think that's a problem because comprehensive 3 benefit plan means what's covered. Doesn't say 4 how it's covered and that's -- that makes 5 certain assumptions about -- you know, that 6 moves into. 7 I understand why they are 8 muddled because they often are kind of very much 9 mixed together. But there may be employers 10 who -- I mean, it limits the choice of employers 11 in terms of how they structure it, and I think, 12 therefore, it makes a privately market driven 13 approach less attractive in many, many ways. 14 And I think that's -- I would go on record as 15 saying a mistake. 16 CHAIRMAN LERNER: It's Wayne. 17 I am not sure what to do about 18 it, however, because the model was composed of 19 high consensus and high need consensus items. 20 And the high deductible is a low consensus item 21 that was not included so... 22 DR. BACKS: Well, then the document 23 should state that we are excluding high 24 deductible plans. T.J. BOWMAN COURT REPORTING SERVICE, INC. (312) 220-9219

67 1 CHAIRMAN LERNER: And I think we have 2 got in there, at least in the previous version, 3 which items were high and medium and low 4 consensus so we could pull it out that way. 5 I actually heard you say -- 6 I'm trying not to focus on the specifics, but I 7 am trying to focus on the theory that you put 8 forward which we need to be cognizant of the 9 actuarially specific implications of any of 10 these actions and not be bound by specific 11 structure. A high deductible plan is a 12 structure. The actuarial estimates of the cost 13 related to a model may or may not relate to a 14 specific structure. 15 So when we get to the point, 16 Gwyn, of talking about areas of further study, I 17 think that's where we start to -- we can take 18 some leeway here to say if this is the model or 19 one of the models that we recommend that there 20 are some gaps and there are some issues that we 21 need to consider. And we've given ourselves 22 some wiggle room in Section 11 I think it is 23 which I want us to talk about also before the 24 break and this may be where we bring up concepts T.J. BOWMAN COURT REPORTING SERVICE, INC. (312) 220-9219

68 1 like that. So I would like to separate out 2 those two issues. David. 3 SENATOR KOEHLER: Dave Koehler. 4 Again, the philosophy here is 5 in terms of trying to put forward, you know, in 6 the State of Illinois mandating health care 7 coverage is that what I'm hearing here and I 8 guess I'm hearing it in a little different way 9 is that we try to determine that by using 10 something that is very definable. That is, how 11 much employers are spending on a payroll on 12 health care, not trying to define what is a plan 13 design that we are going to push forward. 14 So -- and I know there's some 15 problems with that, but what I'm hearing is 16 there's a philosophy to keep it simple and to 17 keep it definitive so that it can be determined 18 as to either you are or you aren't. 19 Because we can all argue that 20 what is an adequate plan design for, you know, 21 X, Y or Z company, but the fact is that we are 22 determining that based on your proposal at this 23 point on a number that reflects just a cost to 24 the employer. T.J. BOWMAN COURT REPORTING SERVICE, INC. (312) 220-9219

69 1 CHAIRMAN LERNER: Art. 2 DR. JONES: When we are recommending 3 this to the legislature, are we recommending it 4 with both options? And if so, are we -- are we 5 giving our preferences for which option? 6 CHAIRMAN LERNER: Let me clarify that 7 point. When we get to the vote this afternoon, 8 what we have said in the steering committee 9 meeting, and in the minutes, in fact, where we 10 have our seven models before the Task Force, the 11 five original proposals, plus Option A and 12 Option B. 13 And so the Task Force members 14 will vote on a plan or plans to move forward. 15 Option A is a plan and Option B is a plan and so 16 you have your choice. You have your choice 17 between in a month accepting the proposals. 18 MS. DAVIDSON: There were just a 19 couple points related to things that are being 20 discussed here today. I just wanted to touch on 21 one and it might not be very abundantly clear. 22 But the employer assessment is 23 not tied into the overall State funding needed. 24 There is no links between the two. Any monies T.J. BOWMAN COURT REPORTING SERVICE, INC. (312) 220-9219

70 1 collected from the assessment help fund any 2 expansions of coverage, but it's not an 3 assessment where you estimate your -- you know, 4 what you might spend on the coverage and then 5 you make your assessment -- your employer 6 assessment match that. That connection does not 7 exist. I just wanted to make sure that was 8 clear. 9 And then the other two things 10 that have been brought up on subgroups related 11 to this or one of them was that if you have an 12 employer that has a very minimal benefit 13 package, so minimal that it's not very 14 attractive, you have someone who is under 15 400 percent, should that person have the option 16 of saying, you know, this benefit package is so 17 paltry that I should be able to go and use my 18 premium incentive in an individual market to 19 purchase comprehensive standard plan. 20 And that was brought up as an 21 area of -- for future consideration, but I just 22 wanted to mention it because it seems relevant 23 to the discussions here. 24 The other thing is in our T.J. BOWMAN COURT REPORTING SERVICE, INC. (312) 220-9219

71 1 model we don't say for premiums assistance in -- 2 through an employer if that -- that doesn't need 3 to be applied to high deductible plan. So if 4 the employee only has a high deductible plan 5 plus they use that premium assistance to that. 6 This is -- this does not consider that option 7 yet. It does not make a decision on that. 8 So based on our discussions on 9 high deductible plans, I just wanted to point 10 that out. 11 CHAIRMAN LERNER: You want to finish 12 up on Page 5. 13 MS. DAVIDSON: I think that I may 14 be -- I think what I would like to do now is 15 turn it over to Lynn to talk about the overall 16 cost and coverage estimate. 17 CHAIRMAN LERNER: Okay. 18 MS. TAYLOR: There is just a few 19 slides, but if everybody could turn to the cost 20 and coverage implication. And for those of you 21 that were riveted by the cost and coverage 22 implications from September, a lot of these 23 numbers will look familiar. They have changed 24 slightly but they are not -- T.J. BOWMAN COURT REPORTING SERVICE, INC. (312) 220-9219

72 1 CHAIRMAN LERNER: Lynn, if I could 2 interrupt please. We have another member of our 3 Task Force. If you could introduce yourself. 4 MR. MOORE: Jim Moore, OSF Health 5 Care. 6 CHAIRMAN LERNER: Thank you. 7 SENATOR KOEHLER: You took the train, 8 right? 9 MR. MOORE: The train was delayed. 10 Almost two hours late. 11 CHAIRMAN LERNER: We are glad you are 12 here. 13 Okay, Lynn. 14 MS. TAYLOR: Gwyn's getting the 15 electronic version which I appreciate it, but we 16 will talk from our paper version. 17 First we're going to talk from 18 the paper version for a minute while Gwyn helps 19 out with the computer. 20 The first slide is just to 21 remind everyone roughly of what are the 22 populations that we're talking about with this 23 model. We have a very large population in the 24 State of Illinois that experiences no change in T.J. BOWMAN COURT REPORTING SERVICE, INC. (312) 220-9219

73 1 coverage. We believe they will keep the 2 coverage they have now. They are eligible for 3 subsidies. Their coverage options will remain 4 the same. That's the big white area. 5 We do have a population about 6 the size of about two million who are covered 7 now, but will be newly eligible for subsidies, 8 and that is due to the absence of crowd-out 9 provisions for reasons that we have already 10 touched on. 11 And then we have a newly 12 covered population of about 1.5 million. And as 13 we also discussed previously already, there is a 14 small population that we believe will not comply 15 with the mandate and will remain uncovered. 16 The net result of all this is 17 that 98 percent of the non-elderly population is 18 covered under our estimate. 19 We have a new slide, the next 20 slide, that is designed to help understand how 21 are these newly covered people -- what kind of 22 coverage are they getting. About 23 percent of 23 the newly covered populations, those that were 24 previously uninsured, are in the new public T.J. BOWMAN COURT REPORTING SERVICE, INC. (312) 220-9219

74 1 program options. That's our small family care 2 expansion to 200 percent of poverty and our much 3 larger new childless adult coverage option. 4 We also -- due to the mandate 5 we expect significant new enrollment in existing 6 public programs under existing eligibility 7 rules, and that comprises another 20 percent of 8 the newly covered population. So a total of 9 23 percent are in public program options. 10 Eight percent is in -- are 11 receiving subsidies for an employer offer of 12 coverage that either they already have or they 13 are newly receiving due to our small low wage 14 initiative, which again is modest. 15 And that may seem like a small 16 number, but it's a result of the fact that if 17 you have employer coverage offered to you now 18 you are probably taking it. We do have people 19 who don't take their employer offer of coverage 20 but it's a small number. 21 Lastly, 32 percent are 22 receiving subsidies to purchase in the non-group 23 market because they don't have a employer offer 24 of coverage available to them, and then we have T.J. BOWMAN COURT REPORTING SERVICE, INC. (312) 220-9219

75 1 a significant population who is -- we will do 2 the manual method. We have a significant 3 population that is not eligible for subsidies, 4 but they are subject to the mandate. They are 5 over 400 percent of poverty, so they go out and 6 they have to get coverage on their own. We 7 don't subsidize them. Either that or you face a 8 penalty at income tax time. 9 STATE REP. COULSON: Beth Coulson. Do 10 you have the actual numbers because percentages 11 really don't tell me anything. But the actual 12 numbers would tell us something. 13 MS. TAYLOR: Yes. 14 STATE REP. COULSON: And the other 15 question is why -- and maybe this is a Task 16 Force meeting I missed -- why are we not doing 17 the elderly population? 18 MS. TAYLOR: Well, the exercise -- 19 early on when we were comparing across proposals 20 we made a decision to do the non-elderly 21 population because the elderly already have very 22 good access to coverage. You know, the exercise 23 was really about the non-elderly population. 24 STATE REP. COULSON: Do we have a T.J. BOWMAN COURT REPORTING SERVICE, INC. (312) 220-9219

76 1 number then of who in the elderly do not have 2 access because I am not sure? 3 MS. TAYLOR: Well, in the sense that 4 they are uncovered, I mean, naturally that's 5 like less than one percent. 6 STATE REP. COULSON: Yes, but I would 7 like an actual number in Illinois. 8 MS. TAYLOR: Okay. I do not have 9 that, but I think we can try to get that and 10 maybe send it around. Yes, Art. 11 DR. JONES: Have you maximized the 12 number of people that are being newly covered 13 under Medicaid or CHIP and if so why is it -- 14 one thing I can't understand is why is one of 15 the models have 392,000 and you only have 16 230,000. If you look here at this -- 17 MS. TAYLOR: Okay. You are looking 18 at -- 19 DR. JONES: I am looking at this. I 20 am trying to figure out why would they be able 21 to have more people listed under Medicaid or 22 CHIP in your program if you're maximizing the 23 enrollment. 24 MS. TAYLOR: Well, are you looking at T.J. BOWMAN COURT REPORTING SERVICE, INC. (312) 220-9219

77 1 the campaign estimate? 2 DR. JONES: I am looking at the 3 selected members of insurance industry. They 4 are saying under their plan there would be 5 392,000 people newly covered under Medicare and 6 then you only have 230,000. 7 MS. TAYLOR: When we did our analysis, 8 we did not believe -- the numbers in that row 9 are only people that were modeled as being 10 eligible for the Federal match. Whereas, when I 11 say public program, that's a slightly larger 12 concept. 13 Our childless adult expansion 14 up to one hundred percent is not eligible for 15 Federal match. We don't believe the State of 16 Illinois has the funds to get Federal match for 17 that population. In the insurance industry's 18 proposal they wanted it modeled as receiving 19 Federal match. Does that help? 20 DR. JONES: Yes. So this 392,000 is 21 really not realistic for one thing. 22 MS. TAYLOR: We think it would be very 23 difficult to get match for that population is 24 why we did not go down that route. T.J. BOWMAN COURT REPORTING SERVICE, INC. (312) 220-9219

78 1 SENATOR KOEHLER: David Koehler. 2 A question that came up and 3 then when I was looking at this that I forgot 4 about. If somebody -- quite often you see 5 people opting out of their employer-based 6 coverage because their spouse has coverage 7 someplace else. How does -- I am assuming that 8 there is a way of protecting an employer from 9 that if we are basing everything on percentage 10 of payroll. 11 MS. TAYLOR: Well, protecting the 12 employer in a sense that they are not assessed 13 for the employee who just decides to go on the 14 spouses. 15 SENATOR KOEHLER: Right. 16 MS. TAYLOR: The way it's structured 17 right now, which again is not part of the 18 recommendation, is that they are not protected. 19 You have a work force. We want you to make a 20 minimal financial contribution to coverage for 21 that work force. And if all of your workers 22 decide to get coverage through their spouses, we 23 actually still want that contribution from the 24 employer to sort of level the playing field. T.J. BOWMAN COURT REPORTING SERVICE, INC. (312) 220-9219

79 1 DR. JONES: Who covers the kid? 2 MS. TAYLOR: It doesn't say here in 3 the model. We were trying to keep the employer 4 assessment, which is still difficult to 5 understand, simple so it's just per worker, and 6 as Gwyn said it's not tied to the total amount 7 of money we are trying to collect. It's more 8 trying to establish a minimal financial 9 contribution from employers. 10 SENATOR KOEHLER: Go back to my 11 question then. Why is it important that we 12 would still make that assessment even if people 13 have coverage? 14 MS. TAYLOR: Well, one point of view 15 is that small employers fall shift to large 16 employers and that that's unfair. Large -- some 17 employers have strong incentives to try to 18 either not put dependents on the policy or they 19 might have strong incentives -- they might give 20 you cash back through a cafeteria plan if you 21 don't take the coverage and go get it through 22 yourself and that's a savings to that particular 23 employer and a cost to the employer that ends up 24 covering the family. T.J. BOWMAN COURT REPORTING SERVICE, INC. (312) 220-9219

80 1 And so one way to look at it 2 is that we want to make the playing field more 3 level and everybody makes the contribution to 4 health care coverage to their workers. I feel 5 like I'm saying the same thing. 6 CHAIRMAN LERNER: I don't mean to be 7 too ridiculous but the illogical conclusion to 8 that is that all the employers stop offering 9 family coverage and offer only individual 10 coverage and then forge the issue because you 11 are going to get assessed one way or the other 12 in order to level the playing field. 13 MS. TAYLOR: I would consider that 14 unlikely because -- 15 CHAIRMAN LERNER: I am being 16 facetious, but I am not. There's an unintended 17 consequence of this where people could be ending 18 up paying several times. I understand what you 19 are trying to get to. And probably the 20 assessment that you are talking about is built 21 into the source of cash to support the program. 22 MS. DAVIDSON: Well, the employer 23 assessment helps fund the expansion program, but 24 it's not -- the actual amount of the employer T.J. BOWMAN COURT REPORTING SERVICE, INC. (312) 220-9219

81 1 assessment isn't tied to an amount needed to 2 expand. 3 CHAIRMAN LERNER: Yes. So it's a 4 hospital. We offer family coverage. You opt 5 out to go on your wife's coverage. I'd still 6 have to pay for you and that money goes into the 7 source of cash to support the overall program. 8 That's what I understand the algebra to be. 9 MS. TAYLOR: Right. But then there 10 are these countervailing labor market forces 11 that we believe would maintain the provision of 12 the coverage by employers because there are many 13 advantages to the employee to receiving through 14 their employer versus non-group, and so they 15 would face those pressures. 16 CHAIRMAN LERNER: But let me just 17 suggest that this is another item to be on the 18 parking lot of issues that we look at both the 19 intended as well as the unintended consequences 20 of this, not just to the employers but to the 21 funding of the program as well. 22 I think that this is one of 23 those things that are on both sides of the equal 24 sign. We need to be very worried about what we T.J. BOWMAN COURT REPORTING SERVICE, INC. (312) 220-9219

82 1 are trying to do, the good work we are trying to 2 do and what might end up happening. 3 So given where we are in our 4 model development and cost estimates, we haven't 5 got time to play around at all. Jim. 6 MR. DUFFETT: Wondering what 7 percentage of employers having no assessment at 8 all because they are providing health insurance 9 to their employees are also providing spousal 10 support there. 11 And there is something inside 12 of me -- while I agree it's an important issue, 13 there is something inside of me that I feel 14 there's a small number of employers that would 15 maybe have to be assessed because most of them 16 are either providing health insurance to the 17 vast majority of their workers with the over and 18 above the 60 percent. And I just wondered if 19 you know those numbers at all. 20 MS. TAYLOR: Well, we looked at the 21 data that we could get our hands on that showed 22 a distribution. We looked at both Illinois data 23 and national data because the survey data -- the 24 employer survey data for Illinois is pretty T.J. BOWMAN COURT REPORTING SERVICE, INC. (312) 220-9219

83 1 limited. It's hard to get the distributional 2 information that would answer your questions. 3 So we also looked at national data. And on 4 average they cover 60 percent of their work 5 force. And then there is good reasons. Some 6 are on the health insurance of their spouses. 7 All I can say is that that's 8 the exercise we went through, and we felt that 9 the assessment set at this point where we set 10 it, about 50 percent of employers over 25 11 workers or more would face either a full or in 12 most cases a partial assessment. And you made 13 the observation that the ones who get a full 14 credit against the assessment which are the 15 larger more generous employers they probably are 16 covering families. I mean, you know, that's 17 almost certainly true. 18 The distribution in terms of 19 employer efforts on the part of health care 20 coverage for their employees is huge, and 21 there's a huge difference among employers. And 22 when you look at it as a percent of payroll, it 23 becomes even larger because payroll varies so 24 much. You have firms where the average is T.J. BOWMAN COURT REPORTING SERVICE, INC. (312) 220-9219

84 1 17,000 and firms where the average is 80,000. 2 So there's a huge variety of employers out there 3 and it is hard to assess how it would be. 4 So maybe we can just go back 5 to this for a minute. There was a question 6 about the non-elderly. Was there any more 7 unanswered questions before I moved on? 8 STATE REP. COULSON: At some point I 9 would like to get the actual numbers. 10 MS. TAYLOR: There are numbers -- it's 11 the same thing. But if you go to Section 10, 12 Tab 10 in here. If you turn to Tab 2, Section 13 10, this shows you -- it looks something like 14 this. It shows you for Option A -- everybody 15 can read this, right. 16 This shows you for Option A 17 and Option B the detailed cost and coverage 18 estimates for the different programs. So to 19 answer your question moving to the right of the 20 overall column, we have a column that's the 21 public program family care expansion and two 22 more over is the childless adult expansion and 23 those are the underlying numbers that sit under 24 my 23 percent here as to who enrolled. T.J. BOWMAN COURT REPORTING SERVICE, INC. (312) 220-9219

85 1 STATE REP. COULSON: But I was 2 wondering the actual number of people, not the 3 cost. 4 MS. TAYLOR: No, people are in here. 5 If you look at Roman Numeral II -- are you going 6 to help her out? Are you on Page 32? Total 7 estimated program costs. 8 MS. CHOLLET: Actually, Roman Numeral 9 III. Newly covered is your -- 10 MS. TAYLOR: Oh, on the newly covered. 11 Thank you. Okay. Does that work? 12 STATE REP. COULSON: Yeah. It looks 13 like they're dollars because of the dollar 14 signs. 15 MS. TAYLOR: They are. We have 16 struggled with how to present this data and, 17 obviously, we will continue to do so. 18 You have seen these numbers 19 before. We have 1.5 million that are newly 20 covered and this is the distribution by type of 21 coverage. This is the same information that we 22 just looked at in the pie chart, and we just 23 thought we would point out that the average 24 State cost per person is about $2,300 for these T.J. BOWMAN COURT REPORTING SERVICE, INC. (312) 220-9219

86 1 people. 2 This population, the ones that 3 are currently insured but receiving a subsidy 4 under the model, is larger. But the average 5 cost is much lower. It's $578, and that's 6 because of this huge red area, which are people 7 who are in employer-sponsored insurance. The 8 subsidies they are receiving on average is very 9 low. It's about $100, and so it brings the 10 average cost way down. 11 And in the section that we 12 were just looking at together, you can see the 13 average cost by each program component, and I 14 can talk about that a little bit if you want or 15 we will move on. I don't want to take up too 16 much time. 17 So how does -- this is the 18 cost of covering all those people. We are 19 spending 428,000,000 in Medicaid and SCHIP 20 funds. This is slightly higher than it was in 21 September, and that's due to the provider 22 payment increase. It goes 408, some number like 23 that back then. 24 We also in -- we have to come T.J. BOWMAN COURT REPORTING SERVICE, INC. (312) 220-9219

87 1 up with significant monies that are not matched 2 by Federal Medicaid and SCHIP funds, and that 3 depends on what option you are in. In Option A 4 the number is slightly higher, although I do -- 5 at the risk of confusing things, it's also -- 6 this is higher than Option B. This number is a 7 little lower than you saw in September. 8 The reason is in discussions 9 with -- at the last steering committee we 10 mentioned that some lower trends, medical trend 11 assumptions had come out since that meeting. 12 Would they like us to adopt them and we decided 13 that we would. So a slightly lower medical 14 trend assumption is underlying all the numbers 15 that you are looking at. That affects every 16 model component, and that's why this number is 17 slightly smaller than it was in September. 18 This number is slightly larger 19 because there is a lot more Medicaid providers 20 being paid under this option because of the 21 State self-insured plan that Gwyn discussed. So 22 this is a little higher than it was in 23 September. The provider payment increase in 24 this option overwhelms that new lower medical T.J. BOWMAN COURT REPORTING SERVICE, INC. (312) 220-9219

88 1 trend assumptions. The numbers aren't vastly 2 different from September, but those are the two 3 main reasons they are a little bit different. 4 The sum of these numbers 5 including -- and this is net of the provider 6 payment, net of the -- I'm sorry, net of the 7 employer assessment. If we succeed in 8 collecting the $1.5 billion that we have 9 estimated under this structure that we have 10 described the State would have to come up with a 11 total of $3.6 billion under Option A and $3.1 12 billion under B. 13 And we were asked to net out 14 the impact of the provider payment increase just 15 so you could see what -- the impact that has on 16 that total. Without the provider payment 17 increase, it would be 2.8 and about $2 billion. 18 MR. DUFFETT: Two questions. This is 19 Jim Duffett. 20 Is that -- this includes if it 21 was all implemented all at once? This isn't 22 broken down in like over a three-year period? 23 MS. TAYLOR: Yes. What we have done 24 throughout the modeling exercise is these are T.J. BOWMAN COURT REPORTING SERVICE, INC. (312) 220-9219

89 1 the annual costs of one year of program 2 operation, and we tried to put everything in 3 2007, and it doesn't include implementation 4 costs. You know, just taking the sum of the 5 people we think are covered times what we think 6 it will cost to cover it. 7 MR. DUFFETT: And the other question 8 is we have got no barometer to base that on, 9 what could end up happening on those figures. 10 MS. TAYLOR: You mean like from 11 uncompensated care and things? 12 MR. DUFFETT: Well, also purchasing 13 power and other costs. We don't know what 14 savings that could be there and we have got 15 nothing to base it on if we do nothing what the 16 costs would be. 17 MS. TAYLOR: Correct. There were many 18 things that had to be outside the scope for 19 reasons of time and budget. 20 And I think what -- Craig, you 21 had the question about are premiums included in 22 these estimates. Should I speak -- not anymore. 23 DR. BACKS: Well, explain in general 24 why the costs to the -- I presume this to be the T.J. BOWMAN COURT REPORTING SERVICE, INC. (312) 220-9219

90 1 public spending costs to what State spending is 2 defined as the State of Illinois writes the 3 check or checks why it costs more to subsidize 4 Option A than to provide full coverage in Option 5 B. 6 MS. TAYLOR: That's a good question. 7 The costs in Option A is -- the cost of the 8 public program options are the same, between A 9 and B, the models' public program components, 10 and you can see that under Tab 2 where we have 11 all the details. 12 What differs is the cost of 13 the comprehensive standard plan. That plan, 14 that component of the model is more expensive in 15 Option A for two reasons. As we have modeled 16 it, providers are being paid more and 17 administrative costs are higher. We are using 18 commercial provider payment rates and commercial 19 administrative expenses subject to the 20 medical -- the new medical loss limits that have 21 been imposed on the non-group and small group 22 markets. 23 Under Option B providers are 24 being paid less, even with the provider payment T.J. BOWMAN COURT REPORTING SERVICE, INC. (312) 220-9219

91 1 increase. They are still being paid less than 2 commercial rates and administrative costs are 3 lower. There are public program administrative 4 costs, and that's what drives the difference 5 between the two. Enrollment is very slightly 6 different but the big driver are those 7 assumptions. 8 CHAIRMAN LERNER: Art. 9 DR. JONES: I don't know if this is 10 open for discussion or not. I feel a little 11 uncomfortable when we vote on this voting either 12 A or B. And I personally think we should vote 13 on this and then give our preferences at 14 committee but let the legislators have the 15 option of saying it's a trade-off. It's a 16 trade-off between how economically capable is it 17 to adopt this plan by a half billion dollars 18 versus keeping providers and insurance companies 19 happy under the other plan and I think that the 20 legislature should make that decision. 21 I think we should voice, have 22 a vote. If we adopted this plan we vote and say 23 this is the committee's preference A versus B. 24 But my concern is if we vote, then you vote one T.J. BOWMAN COURT REPORTING SERVICE, INC. (312) 220-9219

92 1 or the other, you really have taken away the 2 choice. Besides that it's really a very similar 3 plan. 4 CHAIRMAN LERNER: Let me respond to 5 that. I think we need to remember what Senator 6 Trotter said one or two meetings ago, my 7 interpretation of his words. Don't look to 8 create and deliver the magic bullet. Because we 9 are going to take what you gave us. We're going 10 to look at the data. We are going to have our 11 hearings, and we are going to go to work on it, 12 which is why the statute allows us to recommend 13 a plan or plans, and that's why the steering 14 committee and the Task Force have agreed that 15 regardless of what plan or plans we recommend 16 minority reports can be submitted. 17 And so we can certainly 18 entertain that idea, Art, but I am not under any 19 delusion that if there is a plan or plans that 20 we recommend that it will de facto, garner the 21 support of the champion, the legislature, and 22 then that will be without being effected and 23 implemented later on. So I think there is 24 plenty of room to have that conversation. T.J. BOWMAN COURT REPORTING SERVICE, INC. (312) 220-9219

93 1 Senator. 2 SENATOR KOEHLER: But what he is 3 saying is it possible that's the role of the 4 group. 5 CHAIRMAN LERNER: Well, we have to go 6 back then and talk about that because the 7 steering committee, if you recall, the steering 8 committee did give guidelines for how we want to 9 operate. I presume those guidelines could 10 change if the Task Force felt otherwise, but the 11 steering committee did lay out a voting 12 procedure. 13 DR. JONES: Could we vote on that 14 option? Could we vote on that proposal? 15 CHAIRMAN LERNER: Let's finish the 16 morning up first; okay. And then get to the -- 17 and get to the voting issues after all the 18 questions are addressed and issues are addressed 19 about the model. Craig. 20 DR. BACKS: In essence, do we not in 21 fact have ten plans on the table, six provided 22 by the -- that four different hybrid options? 23 CHAIRMAN LERNER: How do we have four 24 hybrids and you're confusing me already. T.J. BOWMAN COURT REPORTING SERVICE, INC. (312) 220-9219

94 1 DR. BACKS: Well, the hybrid has two 2 options for public versus -- (inaudible) -- and 3 then they have the mandate versus voluntary 4 component to it as well. 5 CHAIRMAN LERNER: Gwyn, do you want to 6 -- where are you, Gwyn? 7 MS. DAVIDSON: I'm here. 8 MS. TAYLOR: She gave up. 9 CHAIRMAN LERNER: Are there ten 10 options, Gwyn? 11 MS. DAVIDSON: Well, I think our 12 instructions were to only look at the model with 13 the individual mandate in it and that would be A 14 and you would have A or B under it. 15 DR. BACKS: We are down to eight. 16 CHAIRMAN LERNER: Yes. Time out. 17 The steering committee, if you 18 are going to do this, and I am already slightly 19 confused, but if you are going to do this we 20 have to go back then and deal with what the 21 steering committee talked about. Because the 22 steering committee did talk about the five 23 original proposals that we entertained, plus 24 two. Hybrid A and Hybrid B. So let me just T.J. BOWMAN COURT REPORTING SERVICE, INC. (312) 220-9219

95 1 hold that. Pam. 2 MS. MITROFF: I just have one other 3 point of clarification on the hybrid models, 4 whichever ones we are talking about. I am 5 assuming based on just the overview that we are 6 basically talking about Medicaid as it is today 7 with the only changes being enhanced payment 8 rates. Is that a fair assumption? 9 MS. DAVIDSON: Well, there are 10 expansions to the Medicaid and SCHIP programs. 11 MS. MITROFF: But no other structural 12 changes? 13 MS. DAVIDSON: That's correct. That's 14 correct. 15 CHAIRMAN LERNER: I would like to 16 finish out one part of the morning before we get 17 into debate about how many models we really have 18 and get into the discussion items. 19 Gwyn, could you just walk us 20 really quickly through Section 9. No, no, no. 21 Section -- I think it's 11. It's the things 22 that we put into the parking lot. No, no, no. 23 Section 9. 24 MS. DAVIDSON: And I can hear from the T.J. BOWMAN COURT REPORTING SERVICE, INC. (312) 220-9219

96 1 discussion here that -- I'm sorry. 2 CHAIRMAN LERNER: Hold on. 3 MR. CARVALHO: Just to follow up and 4 again clarify on the most recent answer to Pam. 5 I think, again, they have 6 modeled using Medicaid as it currently exists 7 and the hybrid describes using Medicaid as one 8 of the vehicles for expansion. But I don't 9 think that they were to be interpreted by the 10 legislature one way or the other as to say 11 Medicaid should be ossified the way it is today 12 or Medicaid shouldn't be ossified. 13 If we are only using Medicaid 14 as the name of the public model, they have to 15 model it based on the existing Medicaid, but you 16 all can certainly suggest one way or the other 17 that, by the way, you know, you might want to 18 think about how Medicaid is structured or decide 19 on that issue. But I don't think your report 20 will be interpreted as saying Medicaid should 21 stay exactly the way it is. 22 CHAIRMAN LERNER: Okay. Section 9. 23 MS. DAVIDSON: Sure. In Section 9 we 24 were listing unintended and intended T.J. BOWMAN COURT REPORTING SERVICE, INC. (312) 220-9219

97 1 consequences or issues for further 2 consideration. And I can tell from the 3 conversation today that if this were to go 4 forward we have things to add to this list. But 5 let me just go over what we have right now. 6 We have a subsidization of 7 cost sharing and what I had touched on in terms 8 of saying, you know, you are subsidizing 9 people's premiums in the hybrid model. But you 10 are not subsidizing any of their co-payments, 11 any of their point of service cost sharing, and 12 with that cost sharing presents access problems 13 to people. So that's sort of a parking lot 14 issue in terms of something that this model does 15 not address. 16 Also discussed the ability of 17 people who are -- who have premium assistance so 18 they are under 400 percent of the FPL. And if 19 they have no clear offer of coverage, this model 20 requires them to take that offer to use the 21 premiums assistance to that offer of coverage. 22 And the idea was raised in different 23 discussions, you know, are there any conditions 24 under which an individual could take that T.J. BOWMAN COURT REPORTING SERVICE, INC. (312) 220-9219

98 1 premium assistance and go to the individual 2 market. 3 So, for example, the benefit 4 package that the employer is offering is so 5 small and undesirable that they should be 6 allowed to go to the individual market. 7 That's really just to the use 8 of their premium assistance in the hybrid plan. 9 The individual could always go to the individual 10 market to purchase coverage. But in the model 11 we are saying if -- to get the premium 12 assistance you have to stay with your employer, 13 if you have got the offer of coverage. 14 There was also -- on Page 25 15 there was a recommendation for further study on 16 the employer assessment policy in terms of 17 trying to quantify the number of uninsured who 18 would be covered by proposal by different 19 categories and where they might fit in in terms 20 of employers. I think there has also been 21 discussion just in terms of saying, well, this 22 is incentives for employers to leave the State. 23 What other consequences might this have on the 24 overall market in Illinois. T.J. BOWMAN COURT REPORTING SERVICE, INC. (312) 220-9219

99 1 There is also a list of 2 studies of the proposed group and non-group 3 insurance market changes. So wanting to look at 4 the impact of the changes that are proposed here 5 on premium levels, to look at -- to analyze the 6 impact on the regulations using Illinois Care's 7 enrollment and premiums information. Also to 8 look at the medical loss ratios over time and do 9 an analysis of this 85 percent medical loss 10 ratio requirement and how that might play out in 11 the Illinois market. 12 And the one thing that isn't 13 on this list that would be in the final report 14 would be a study of what would happen if nothing 15 were done. That was one of the recommendations 16 of that study. 17 CHAIRMAN LERNER: And then any other 18 items that we have raised this morning that are 19 items of highlight that need to be included in 20 here are just issues that we have raised or 21 clarifications that -- so that if we were to 22 recommend Option A or Option B that it would be 23 clear about some of the gaps that we see in the 24 material that we are presenting to the T.J. BOWMAN COURT REPORTING SERVICE, INC. (312) 220-9219

100 1 legislature. 2 MS. DAVIDSON: And the items that I 3 have so far on that list and the issue of Option 4 B are incenting employers to stop taking 5 coverage from private carriers and go to the 6 State self-insured plan. 7 There has also been a 8 discussion of the employer assessment and 9 whether or not it doesn't effectively recognize 10 employers that are offering dependent coverage. 11 But I think that might depend -- putting that 12 issue in might depend on whether or not you want 13 to take a particular employer assessment policy, 14 you know, in this model and also the issue of 15 high deductible plans and whether or not that 16 would be allowed, comprehensive standard benefit 17 plans or whether or not that would -- how would 18 that impact premium assistance. 19 CHAIRMAN LERNER: Okay. Questions, 20 comments about the hybrid models so we can get 21 clarity before we break for lunch. David. 22 SENATOR KOEHLER: Just tell you 23 specifically how Peoria would deal with this -- 24 and Jim can correct me if I am wrong here -- T.J. BOWMAN COURT REPORTING SERVICE, INC. (312) 220-9219

101 1 MR. MOORE: (Inaudible.) 2 (Laughter.) 3 CHAIRMAN LERNER: Jim Moore said that. 4 SENATOR KOEHLER: When you have a 5 community that has a giant like Caterpillar in 6 it where everybody opts to take Caterpillar's 7 insurance this would not fly unless there was 8 some way that we could adjust it. 9 What we don't want to do is 10 end up penalizing employers who do provide 11 health insurance. But because everybody that 12 works for them have their employees work for 13 Caterpillar and then you penalize them anyway, 14 that is just not going to fly. You have to look 15 very specifically at communities that have this 16 kind of scenario. Peoria is one that does. And 17 there is not anybody in Peoria that doesn't take 18 Caterpillar insurance if it's somehow offered to 19 them. 20 CHAIRMAN LERNER: Ken. 21 MR. ROBBINS: A clarification. 22 Throughout the document, the hybrid document, 23 when reference is made to paying Medicaid at 24 full cost, does that embrace the other public T.J. BOWMAN COURT REPORTING SERVICE, INC. (312) 220-9219

102 1 payment programs of the State like SCHIP and 2 others that would be created as a result of 3 this? 4 MS. DAVIDSON: That's right. It's 5 meant to be public programs, so Medicaid, SCHIP, 6 State only funds. 7 MR. ROBBINS: Not just the Medicaid 8 program as we know it today? 9 MS. DAVIDSON: That's right. 10 CHAIRMAN LERNER: Art. 11 DR. JONES: Correct me if I am wrong. 12 I am trying to reconcile these costs. 13 If you look at the costs here 14 and the costs here, it doesn't add up. If you 15 look at Option A, it says $2.3 billion and then 16 you add the State, which is 4.28, it looks like 17 you add federal dollars in to get to your costs. 18 CHAIRMAN LERNER: Where are you 19 looking? 20 DR. JONES: Compare those two sheets. 21 It looks like you added federal dollars into the 22 State's costs and you came up with this sheet. 23 MS. DAVIDSON: You are comparing the 24 last page on the slide to that one. T.J. BOWMAN COURT REPORTING SERVICE, INC. (312) 220-9219

103 1 DR. JONES: I am. 2 CHAIRMAN LERNER: Time out. 3 (WHEREUPON, a discussion 4 was held off the record.) 5 CHAIRMAN LERNER: It's just murmuring 6 among the committee. Time out. 7 DR. JONES: Sorry. 8 CHAIRMAN LERNER: Art, you want to 9 clarify your clarification. 10 DR. JONES: Yes. I was looking at 11 Option A 2.3. I'm totally wrong. Sorry. 12 MS. TAYLOR: What goes into the 13 calculation of the 3.6 billion can be most 14 clearly seen on Exhibit X1, and it shows the 15 components that are added up to get to the 2.6. 16 So that may help if there is any remaining. 17 DR. JONES: If the total cost to the 18 State is 2.8 billion plus 428 million, is that 19 the cost to the State? 20 MS. TAYLOR: Well, under A it's 2.7. 21 DR. JONES: 2.78 billion, right? 22 MS. TAYLOR: Yes. 23 DR. JONES: Plus 428 million? 24 MS. TAYLOR: Right. Plus. T.J. BOWMAN COURT REPORTING SERVICE, INC. (312) 220-9219

104 1 DR. JONES: Plus what? 2 MS. TAYLOR: 3B which is the cost 3 increases associated with Medicaid and provider 4 payment rate increases connected to the existing 5 public program population. So it's not a new 6 coverage option, but it's a new cost to the 7 State because of the provider payment increases. 8 DR. JONES: And how much is that? 9 MS. TAYLOR: That is 410. 10 DR. JONES: And that just doesn't show 11 up on this table. 12 MS. TAYLOR: Yes. But it's in this 13 exhibit. 14 DR. JONES: Okay. 15 CHAIRMAN LERNER: All right. Just to 16 clarify this, as far as today's point, these 17 numbers still hold and that the difference in 18 the total State spending between Option A and 19 Option B is half a billion dollars, right? 20 DR. JONES: Sorry. 21 CHAIRMAN LERNER: Okay. Other 22 clarifying comments or questions about the 23 hybrid model? Representative Coulson. 24 STATE REP. COULSON: Yes. On this T.J. BOWMAN COURT REPORTING SERVICE, INC. (312) 220-9219

105 1 form that's the dark blue it says many currently 2 insured residents eligible for subsidies, and 3 I'm just -- I'm not -- I don't remember when we 4 discussed that that was part of what we wanted 5 to do, and I just want to clarify. I may have 6 not been here. Or is that just part of your 7 model because it worked into your assumptions? 8 MS. DAVIDSON: Right. The issue is 9 when you apply an individual mandate everybody 10 must have insurance. So when you offer premium 11 assistance you can no longer distinguish between 12 we are only going to get the premium assistance 13 to someone who was previously uninsured. You 14 end up offering premium insurance to anybody 15 under a certain income level. 16 STATE REP. COULSON: Based on your 17 assumptions? 18 MS. DAVIDSON: That's right. 19 If you didn't do an individual 20 mandate, you could fill in a provision so that 21 you would only offer that assistance to people 22 who have been uninsured for a certain period of 23 time. 24 CHAIRMAN LERNER: Follow-up question. T.J. BOWMAN COURT REPORTING SERVICE, INC. (312) 220-9219

106 1 STATE REP. COULSON: No, I just wanted 2 to clarify why that assumption was made. 3 CHAIRMAN LERNER: All right. Anything 4 else from anybody? 5 Okay. Thank you, Lynn. And 6 thank you, Gwyn. 7 I would like to get some 8 guidance about how we are going to handle lunch 9 here. 10 MR. CARVALHO: Let me and then also 11 Elissa. 12 First off, obviously, I 13 apologize for these unusual arrangements, but 14 want to thank Elissa. The space that we are 15 supposed to be in became unavailable yesterday 16 and so she scrambled to find space for us. Got 17 us this. 18 The arrangements for lunch are 19 we'll be eating in another room. I'd ask you to 20 take your materials with you because we are 21 going to go back to the room that you used to 22 meet in. That is the big square that you can 23 all see each other and you're not all stretched 24 out like this. T.J. BOWMAN COURT REPORTING SERVICE, INC. (312) 220-9219

107 1 So the stuff will get moved 2 during the lunch period. So you may all go over 3 there. But if you want to -- if you've written 4 notes on your materials, you probably should 5 take them with so you that they are 6 individualized. 7 Anything else, Elissa? 8 MS. BASSLER: Lunch is all set up and 9 ready to go. 10 CHAIRMAN LERNER: All right. We'll 11 get back together at 1 o'clock. 12 (WHEREUPON, a luncheon recess 13 was held.) 14 (WHEREUPON, there was a change 15 of reporters.) 16 CHAIRMAN LERNER: We are here to kick 17 off the Adequate Health Care Task Force. We are 18 ready to go. The process for this afternoon is 19 pretty simple. I am going to ask David to 20 review the voting procedures that the Steering 21 Committee acted on at its last meeting; we need 22 to clarify at least one issue that I know that 23 was raised, it had to do with how abstentions 24 were going to be dealt with in the voting T.J. BOWMAN COURT REPORTING SERVICE, INC. (312) 220-9219

108 1 procedure. And then we were going to move into 2 the process of the Steering Committee suggested. 3 So, David, want to start out? 4 MR. CARVALHO: Thank you, Wayne. By 5 the way, you all started your meetings on a 6 stage, and you almost (inaudible) them on a 7 stage too. It was nice we were able to get this 8 room. It's a little more conducive to our 9 discussion. 10 At the Steering Committee 11 meeting on the 29th, the Steering Committee 12 discussed the decision-making process. 13 As you know, your bylaws, 14 which you adopted at your own authority, says 15 that motions require a majority of the votes of 16 the members present. And so under Robert's 17 rules that would mean on a motion you would 18 tally up all the members present, a majority of 19 those is the required vote. 20 So the one ambiguity that was 21 in the communication I sent you earlier, when do 22 abstentions count or how do abstentions count, 23 when you combine your bylaws with Robert's 24 rules, abstentions effectively count as a "no" T.J. BOWMAN COURT REPORTING SERVICE, INC. (312) 220-9219

109 1 vote. So a "no" or an "abstain" are effectively 2 each are the same thing. 3 What the Steering Committee 4 discussed was what process should be used to get 5 to a decision. And so they made some 6 determinations on how to proceed. The first was 7 to take all of the proposals that were on the 8 table, which, as we discussed earlier this 9 morning, was there is some question of how you 10 enumerate that. But for purposes of now let's 11 say six or seven, I take all the proposals on 12 the table and have a roll call vote where every 13 member indicates which proposal they support. 14 At the end of that process, 15 which would be sort of in the nature of a 16 nomination, because there is not a motion on the 17 table, given to identify, in effect, poll 18 members on their preferences, the process would 19 be to take the three of those that are the top 20 vote-getters and take them to the next step. 21 And that next step similarly poll all the 22 members in a roll call, indicate among those 23 three their preferences, and then take the top 24 two and do the same thing. T.J. BOWMAN COURT REPORTING SERVICE, INC. (312) 220-9219

110 1 As I wrote this up afterwards, 2 I talked with Wayne, and I said, this won't a 3 hundred percent guarantee you that are going to 4 get to a result; you haven't covered every 5 possibility in terms of what if there is a tie 6 and so forth. And so my suggestion to him was 7 to take this one step at a time. 8 This is a body that by its 9 bylaws will act on the motion approved by a 10 majority of its members, and where the Chair is 11 to make reasonable determinations along the way; 12 and if the members support those reasonable 13 determinations, if it came to a vote, you then 14 proceed. But it didn't make a whole lot of 15 sense to develop a process that dealt with every 16 possible permutation until we actually saw what 17 the process it involved. 18 So, the Steering Committee 19 adopted that as a process; and the one thing was 20 open is how do abstentions count. And they are 21 saying clarify that now. Abstentions 22 effectively count as a "no." 23 For purposes of that 24 whitling-down process, abstentions effectively T.J. BOWMAN COURT REPORTING SERVICE, INC. (312) 220-9219

111 1 don't count as anything. Because an abstention 2 gets the most votes, it doesn't mean an 3 abstention now moves into the second round. But 4 by chance in the first round there were 15 votes 5 for one and three for another and two for 6 another, you could move right to a motion to 7 approve that one that had 15 and bypass the next 8 couple of steps. 9 CHAIRMAN LERNER: So we are voting on 10 the proposals. And then at the end -- and I 11 think we had it down here -- that even at the 12 end if there were two plans, if I am not 13 mistaken, you can entertain a motion at this 14 point. And the motion also has to be passed by 15 a majority. And we accept at the very beginning 16 now the super majority is the majority of votes 17 cast. 18 So how many voting members are 19 here today? 20 Elissa, we have got a list? 21 MR. CARVALHO: I guess I can't say 22 this, everybody that was here this morning left. 23 Why don't I take a roll call 24 real quick. T.J. BOWMAN COURT REPORTING SERVICE, INC. (312) 220-9219

112 1 Dr. Backs. 2 DR. BACKS: Here. 3 MR. CARVALHO: Dr. Barbados is not 4 here. 5 Mr. Boyd. 6 MR. BOYD: Present. 7 MR. CARVALHO: Ms. Bresler. 8 MS. BRESLER: Yes. 9 MR. CARVALHO: Mr. Carrigan. 10 MR. CARRIGAN: Here. 11 MR. CARVALHO: Representative Coulson. 12 REPRESENTATIVE COULSON: Here. But I 13 may have to leave. So I guess my question is 14 going to be -- 15 MR. CARVALHO: Talk fast? 16 REPRESENTATIVE COULSON: Well, no. Or 17 should I just not be present? Which is fine 18 with me. 19 MR. CARVALHO: I think you 20 participate -- 21 CHAIRMAN LERNER: While you're here. 22 MR. CARVALHO: -- as long as you can. 23 CHAIRMAN LERNER: Okay. Like you to 24 be here. T.J. BOWMAN COURT REPORTING SERVICE, INC. (312) 220-9219

113 1 REPRESENTATIVE COULSON: I just don't 2 want to -- 3 MR. CARVALHO: No, no. 4 Ms. Daker I don't believe is 5 here. 6 Ms. Davis. 7 MS. DAVIS: Here. 8 MR. CARVALHO: Mr. Dooling. 9 DR. DOOLING: Here. 10 MR. CARVALHO: Mr. Duffett. 11 MR. DUFFETT: Present. 12 MR. CARVALHO: Dr. Jones. 13 DR. JONES: Here. 14 MR. CARVALHO: Ms. Kannaday. 15 MS. KANNADAY: Yes. 16 MR. CARVALHO: Senator Koeler. 17 MR. KOELER: Here. 18 MR. CARVALHO: Dr. Lerner. 19 CHAIRMAN LERNER: Here. 20 MR. CARVALHO: Dr. Lubin Johnson. 21 DR. LUBIN JOHNSON: Here. 22 MR. CARVALHO: Senator Martinez is not 23 here. 24 Ms. Mitroff. T.J. BOWMAN COURT REPORTING SERVICE, INC. (312) 220-9219

114 1 MS. MITROFF: Here. 2 MR. CARVALHO: Mr. Moore. 3 MR. MOORE: Present. 4 MR. CARVALHO: Mr. Murphy. 5 MR. MURPHY: Here. 6 MR. CARVALHO: Representative Coulson 7 is not here. 8 Ms. Printen. 9 MS. PRINTEN: Here. 10 MR. CARVALHO: Mr. Robbins. 11 MR. ROBBINS: Here. 12 MR. CARVALHO: Mr. Roberts. 13 MR. ROBERTS: Here. 14 MR. CARVALHO: Ms. Rothstein. 15 MS. ROTHSTEIN: Here. 16 MR. CARVALHO: Mr. Smith. 17 18 MR. SMITH: Here. 19 MR. CARVALHO: Mr. Smithmier. 20 MR. SMITHMIER: Here. 21 MR. CARVALHO: Senator Trotter is not 22 here. 23 Mr. Villanova is not here; and 24 Dr. Young. T.J. BOWMAN COURT REPORTING SERVICE, INC. (312) 220-9219

115 1 So there are one, two, three, 2 four, five, six, seven -- 22 members here. 3 So long as 22 members are here 4 and voting. There are 13 for a majority. I am 5 sorry, 12. 6 CHAIRMAN LERNER: Quick counting. 7 Don't worry. 8 MR. CARVALHO: Got ahead of myself. 9 The Steering Committee decided 10 to use that whitling process to get down to two. 11 But in order to style this in the format that 12 the bylaws have contemplated in a motion to 13 approve with the majority of the members present 14 thought that at that stage where you have it 15 down to two, then you could take a vote on a 16 motion to approve the top vote-getter in that 17 poll of two; and if that motion carries that 18 would be your decision. 19 CHAIRMAN LERNER: If neither of the 20 two got the majority? 21 MR. CARVALHO: Right. If that motion 22 did not carry, someone could make a motion to 23 send them both. Again, if that got a majority 24 that would carry. If someone could -- T.J. BOWMAN COURT REPORTING SERVICE, INC. (312) 220-9219

116 1 If in fact you get through 2 this whole process and nothing gets the majority 3 at that stage, then you need a revised voting 4 procedure. As staff we have developed some 5 things to offer to you as suggestions, but we'll 6 hold that until that time. 7 CHAIRMAN LERNER: If we get to that 8 point I'm locking the bathrooms and I'm locking 9 the doors. 10 Mike? 11 MR. MURPHY: This may be obvious 12 because we are talking about what it takes to 13 prevail for a motion to prevail. 14 I assume that the Task Force 15 members will be given an opportunity to express 16 their opinion with a negative vote as well as or 17 a no vote on any proposal? 18 MR. CARVALHO: Yeah. I mean, well -- 19 CHAIRMAN LERNER: Absolutely. 20 MR. MURPHY: Yes, no, abstention? 21 MR. CARVALHO: We wouldn't be going 22 through and saying, for example: Mr. Murphy, of 23 these seven can you give me a yes or no on every 24 one of them? T.J. BOWMAN COURT REPORTING SERVICE, INC. (312) 220-9219

117 1 The first round you can say -- 2 CHAIRMAN LERNER: This is the one I am 3 voting for. 4 MR. CARVALHO: Number 2. 5 But at the end it can be yes, 6 no, abstain. 7 CHAIRMAN LERNER: Ken, did you have a 8 question? 9 MR. ROBBINS: I guess my question is 10 this: When we look at hybrid 7 as presented to 11 us, is that one proposal or two proposals? And 12 my suggestion would be to consider it as one 13 proposal on the front end, and then you could 14 have a conversation on the back end on whether 15 it should be changed in any way. 16 MS. ROTHSTEIN: I'm not sure I 17 understand that. 18 MR. ROBBINS: So you have one hybrid 19 proposal that's on the table, as we do the 20 whitling down process. 21 At the end of that, if there 22 are those who would wish to say, I want to make 23 a change to a hybrid in one way or another, then 24 there could be a vote or an amendment or T.J. BOWMAN COURT REPORTING SERVICE, INC. (312) 220-9219

118 1 something on that. 2 But ease of getting to the 3 end, I would suggest -- 4 MS. ROTHSTEIN: So you are collapsing 5 it at this moment. Now I agree with that. I 6 agree with that. 7 MR. ROBBINS: Anybody can always make 8 a motion to that. 9 CHAIRMAN LERNER: Let me see if I 10 can move this along. 11 MR. ROBBINS: I'm further ahead than I 12 usually am. 13 CHAIRMAN LERNER: I am going to build 14 on this wonderful vibe. 15 Steering Committee had 16 suggested that there were seven proposals on the 17 table which should be in the first round for 18 both. Is there a change in the process that 19 someone would like to suggest? 20 MR. ROBBINS: I think I'm going to 21 make a motion. 22 CHAIRMAN LERNER: You need to make a 23 motion? 24 He made a motion. T.J. BOWMAN COURT REPORTING SERVICE, INC. (312) 220-9219

119 1 MS. ROTHSTEIN: Second. 2 MR. SMITHMIER: Hold on. Want to make 3 sure -- 4 CHAIRMAN LERNER: Did you want to move 5 that we change from seven proposals to six? 6 MR. ROBBINS: Yes. 7 CHAIRMAN LERNER: Okay. Thank you 8 very much. 9 So the motion on that, Mr. 10 Robbins; seconded by Ms. Rothstein -- 11 MR. ROBBINS: Yes. 12 CHAIRMAN LERNER: -- is that we 13 collapse options A and B within the hybrid 14 proposal; we have six proposals before the 15 Committee. It's been moved and seconded. 16 Any comments or questions? 17 MS. PRINTEN: I have a question. 18 CHAIRMAN LERNER: Tracey. 19 MS. PRINTEN: Just with the option at 20 the later point -- 21 CHAIRMAN LERNER: I didn't say that. 22 Just that we are collapsing the models -- 23 MR. MOORE: But the Chair would 24 entertain a motion to collapse. T.J. BOWMAN COURT REPORTING SERVICE, INC. (312) 220-9219

120 1 CHAIRMAN LERNER: Sure. It could 2 entertain a modal -- or a motion any time you 3 want, or a modal motion. 4 MS. MITROFF: I have a question. The 5 hybrid has gone through numerous iterations. So 6 are we disregarding all the prior iterations 7 without ever entertaining a vote on there; is 8 that what I am hearing? 9 CHAIRMAN LERNER: The hybrid that was 10 last submitted, the one we discussed this 11 morning is the one that's on the table. 12 So there's a motion on the 13 table to collapse options A and B within the 14 modified seven -- hybrid iteration; and it's 15 been seconded. 16 Any other additional questions 17 or comments? 18 You can't call the question, 19 you seconded. 20 MS. ROTHSTEIN: Second, I did. 21 Somebody please call. 22 CHAIRMAN LERNER: All in favor of the 23 motion to collapse options A and B into one 24 proposal, please say aye. T.J. BOWMAN COURT REPORTING SERVICE, INC. (312) 220-9219

121 1 (CHORUS OF AYES.) 2 CHAIRMAN LERNER: Anybody opposed? 3 UNIDENTIFIED: I oppose. 4 CHAIRMAN LERNER: Anybody abstained? 5 DR. YOUNG: I abstain. 6 CHAIRMAN LERNER: One opposed? 7 DR. YOUNG: I abstain. 8 CHAIRMAN LERNER: One opposed, one 9 abstention. 10 Twenty for the motion, one 11 against, one abstention. 12 So now what we are going to 13 do, the process is that we will now entertain 14 six proposals, the five original proposals that 15 we had entertained. And there should be a 16 document someplace in front of you that you can 17 use as a reference point. 18 We have the Campaign For 19 Better Health Care and Health and Disability 20 Advocates Proposal. We have the Illinois House 21 Association proposal; we have the single payer 22 proposal; we have the proposal that was 23 submitted by selective members of the insurance 24 industry; we have Healthy Illinois Citizens T.J. BOWMAN COURT REPORTING SERVICE, INC. (312) 220-9219

122 1 Action proposal; and we have the singular 2 modified 7th hybrid proposal. We have six 3 proposals in front of us. 4 Let me remind you, as we are 5 going through this process, that this does not 6 preclude the submission of a minority report in 7 accordance with the guidelines that have been 8 established both by the Steering Committee and 9 then approved by the Task Force. 10 So, at this point what we 11 would like to do, Mr. -- 12 DR. JONES: Question. 13 CHAIRMAN LERNER: Sir? 14 DR. JONES: Can I make a comment? 15 CHAIRMAN LERNER: Yes. 16 17 DR. JONES: I know you guys have all 18 met and made this, but the problem you have with 19 this approach is that you could vote for a 20 particular option out of principal but say, I 21 could live with one of these other options, 22 okay, and that option not even be a possibility. 23 Because the other option of 24 doing this is to go through and go up and down T.J. BOWMAN COURT REPORTING SERVICE, INC. (312) 220-9219

123 1 on each one; and if there is a majority of 2 people feel that that is a viable option, those 3 are the options that remain and you vote for 4 those. And that allows us to now make sure we 5 really get something in place that people feel 6 comfortable with. 7 Because I could sort of see 8 you stick to your principals. For example, I 9 mean, I just found that it's not unclear that I 10 like the single payer. Well, I could vote for 11 the single payer. I feel very good about the 12 hybrid model. But the hybrid model may not be 13 around because I voted for single payer. You 14 understand what I'm saying? And that's the 15 difficulty with this approach. And I don't 16 think it necessarily gets the consensus of what 17 the Committee really feels. 18 CHAIRMAN LERNER: As we just did, if 19 the Task Force, as a body politic, wants to 20 change the process, we can certainly do that. 21 So it's up for discussion. 22 We debated all kinds of 23 approaches, weighting approach, and modified 24 ranking approach, and the third approach, and T.J. BOWMAN COURT REPORTING SERVICE, INC. (312) 220-9219

124 1 this was what we had come up with, recognizing 2 the frailties of this approach. 3 MS. ROTHSTEIN: But he could change it 4 by a motion. 5 CHAIRMAN LERNER: Well, we just 6 changed -- 7 Which one of the things? 8 DR. JONES: Well, that's my motion. 9 CHAIRMAN LERNER: What's your motion? 10 DR. JONES: My motion is that we go -- 11 we take a vote on each model up and down; and 12 those that remain, at least a majority of people 13 say, I can live with that. If we have a 14 majority, then we vote among those options that 15 are -- 16 CHAIRMAN LERNER: Let me see if I can 17 get it clear. 18 A majority of the votes for 19 each proposal -- 20 So it'd have to be 12 that 21 affirm that? 22 DR. JONES: Right. The up and down 23 for each one. And if they receive a majority of 24 the votes, okay, those are the ones that remain T.J. BOWMAN COURT REPORTING SERVICE, INC. (312) 220-9219

125 1 in the pool. And then you vote among those that 2 remain after that. 3 CHAIRMAN LERNER: So after that your 4 motion would be -- Let's say we had seven. I'm 5 just clarifying -- that we have seven and now 6 we're at five. So you are going to vote each 7 one of the five separately, then take a roll 8 call, and each one of the five that you have 9 the -- 10 DR. JONES: If you had five that were 11 left, the majority of the Committee said, I 12 could live with those five, then you would vote 13 on those five. But I don't think you would have 14 five, okay. If that turned out to be clear -- 15 CHAIRMAN LERNER: I'm not clear. 16 DR. JONES: Okay. You start with six. 17 You go around and everyone votes yes or no on 18 those -- for each one of those six. And if any 19 of those six remain, have a majority of the 20 people say, yeah, I could live with that, that's 21 what you are left on, and you vote them up -- 22 CHAIRMAN LERNER: And so the next 23 round of vote I'm asking -- 24 DR. JONES: Of those that got a T.J. BOWMAN COURT REPORTING SERVICE, INC. (312) 220-9219

126 1 majority, those are the ones you vote on. 2 CHAIRMAN LERNER: And so the next 3 round you vote each one of them up and down 4 again? 5 DR. JONES: No. Then you choose. 6 CHAIRMAN LERNER: I'm just trying to 7 clarify. 8 DR. JONES: I'm sorry. 9 CHAIRMAN LERNER: So the motion is 10 that we vote each one proposal up or down, the 11 ones that receive the 12 votes or more 12 affirmative would then be in a pool? 13 DR. JONES: Correct. 14 CHAIRMAN LERNER: And then each member 15 then in the next round would vote for the 16 proposal that they would prefer? 17 DR. JONES: One of those that remain 18 in the pool. 19 CHAIRMAN LERNER: Of the remaining 20 models? 21 DR. JONES: Yes. 22 CHAIRMAN LERNER: A motion? 23 DR. JONES: Yes. 24 CHAIRMAN LERNER: Is there a second? T.J. BOWMAN COURT REPORTING SERVICE, INC. (312) 220-9219

127 1 DR. JONES: Yes. 2 DR. BACKS: One minor amendment. That 3 the initial votes be by show of hands, rather 4 than roll call, just to save time. 5 DR. JONES: Sounds good. 6 MR. CARVALHO: It won't take much time 7 because I'm going to have to write down which 8 way you voted anyway. 9 DR. BACKS: This whitling-down 10 process, you have to have that information? 11 MR. CARVALHO: I have to have 12 information on any vote taken by -- 13 DR. BACKS: Okay, if that's what you 14 have to do. 15 MR. CARVALHO: Would you retract your 16 friendly -- 17 DR. BACKS: I'll retract it. It 18 wasn't seconded anyway. 19 MR. CARVALHO: If that's what you 20 want. 21 MS. ROTHSTEIN: What did he want? 22 CHAIRMAN LERNER: He wanted a recorded 23 roll call vote on this sort of like we're doing 24 a roll call on rest of the votes. T.J. BOWMAN COURT REPORTING SERVICE, INC. (312) 220-9219

128 1 MR. CARVALHO: Dr. Backs, let me -- I 2 thought you were something that -- 3 If you are saying in this 4 process -- 5 DR. BACKS: Until we get to the end of 6 adopting one, I don't know why there would be a 7 roll call vote on every one of these individual 8 things. 9 If we have a roll call at the 10 very end as to what our recommendation is -- 11 MR. CARVALHO: Okay. But now I'm 12 hearing -- 13 You can choose to have a roll 14 call, and someone could request a roll call -- 15 MR. ROBERTS: Let me just say from 16 experiencing perspective, I was the one that 17 asked for a roll call on the whitling-down 18 process. So we can maintain some uniformity of 19 what the voting process is. 20 CHAIRMAN LERNER: And under 21 Robert's -- 22 Where bylaws are silent we 23 defer to Robert's rule. And I guess when you 24 request a voting request, you requested a roll T.J. BOWMAN COURT REPORTING SERVICE, INC. (312) 220-9219

129 1 call. So it's roll call vote. 2 So we have a motion on the 3 table. As Art had mentioned, it's been 4 seconded. It's going to be a roll call vote. 5 Are there any other questions 6 or comments, additions or corrections? 7 (NO RESPONSE.) 8 CHAIRMAN LERNER: Somebody want to 9 call a question? 10 DR. LUBIN JOHNSON: I call a question. 11 CHAIRMAN LERNER: Thank you. 12 All in favor of the motion to 13 vote each proposal up or down, and that the ones 14 that receive 12 affirmative votes would then 15 create pools under which we do the second round 16 of vote, please say aye. 17 (CHORUS OF AYES.) 18 CHAIRMAN LERNER: Any opposed? 19 One, two, three, four. 20 Any abstentions? 21 (NO RESPONSE.) 22 CHAIRMAN LERNER: Eighteen for; four 23 against. 24 So we will vote each proposal T.J. BOWMAN COURT REPORTING SERVICE, INC. (312) 220-9219

130 1 up or down. Any proposal that receives 12 votes 2 or more will then create the secondary pool; and 3 then we'll start voting on the secondary pool 4 proposals. Okay? 5 MR. SMITHMIER: Will there be time for 6 discussion of each of these as we -- prior to 7 casting those votes, or not? I don't care. 8 CHAIRMAN LERNER: Preferably yes; but 9 if it therefore saves time. 10 I'd like a motion to strike 11 the Illinois Hospital Association proposal from 12 your consideration. 13 DR. LUBIN JOHNSON: Second. 14 MALE UNIDENTIFIED: Second. 15 CHAIRMAN LERNER: Okay. It's been 16 moved and seconded. Been moved and seconded to 17 pull the Illinois Hospital Association proposal 18 out of the initial pool. 19 MR. MOORE: I'd like to add amendment 20 and add the Campaign's proposal under your 21 proposal to strike it too. 22 DR. LUBIN JOHNSON: Second. 23 CHAIRMAN LERNER: I accept that. 24 We have now had a motion and a T.J. BOWMAN COURT REPORTING SERVICE, INC. (312) 220-9219

131 1 friendly amendment to pull the Illinois Hospital 2 Association and the Campaign proposal out from 3 the additional pool of six proposals. It's been 4 seconded. 5 Any questions or comments? 6 DR. YOUNG: I have one. Can we have a 7 brief explanation (inaudible)? 8 MR. SMITHMIER: I'm simply trying to 9 save us time because I don't think the IHA 10 proposal -- 11 (Group discussion, overlapping 12 of speakers.) 13 MR. CARVALHO: Keeping track of the 14 votes for Dr. Lerner. Should I count that as a 15 no? 16 MR. SMITHMIER: In my case I'm simply 17 saying that I think we have advanced well beyond 18 where we were when this was submitted. We are 19 talking about something that we all would like 20 to have be more expansive. And I'd rather not 21 waste my time on that. 22 MS. ROTHSTEIN: You'd rather not what? 23 MR. SMITHMIER: I'd rather not waste 24 our time on something that isn't particularly T.J. BOWMAN COURT REPORTING SERVICE, INC. (312) 220-9219

132 1 embracing. 2 DR. LUBIN JOHNSON: Mr. Chair, I'd 3 like to call a question. 4 CHAIRMAN LERNER: All right. The 5 question has been called -- 6 The question has been 7 called -- 8 DR. YOUNG: Let me hear. I heard him. 9 I didn't hear him. 10 CHAIRMAN LERNER: Time out. 11 MR. DUFFETT: I would just echo what 12 Ken's comments are. 13 MR. CARVALHO: Just to clarify, 14 calling a question doesn't call a question, 15 calling a question is a motion to cancel a 16 debate; you have a roll call vote, it's not a 17 motion. 18 If there is no further 19 debate -- 20 CHAIRMAN LERNER: I was trying. 21 Okay. So we answered 22 Quentin's question? Any other questions? 23 (NO RESPONSE.) 24 CHAIRMAN LERNER: All in favor of the T.J. BOWMAN COURT REPORTING SERVICE, INC. (312) 220-9219

133 1 motion to pull the IHA Campaign proposals out 2 from the initial pool of six models, please say 3 aye. 4 (CHORUS OF AYES.) 5 CHAIRMAN LERNER: Any opposed? 6 (CHORUS OF NAYS) 7 CHAIRMAN LERNER: Okay. Time out. 8 How many? One, two, three, 9 four, five, six, seven. So 15 for the motion; 10 seven against. 11 (Group discussion, overlapping 12 Of speakers.) 13 CHAIRMAN LERNER: Time out. You want 14 a visual vote? We'll go back. 15 All members for the motion to 16 pull the Campaign and IHA models out from the 17 initial pool of six, please raise your hand. 18 One, two, three, four, five, 19 six, seven, eight, nine, 10, 11, 12, 13, 14, 15. 20 Fifteen for. 21 All opposed, please raise your 22 hand. 23 DR. LUBIN JOHNSON: Mr. Chair, we only 24 go to 25. T.J. BOWMAN COURT REPORTING SERVICE, INC. (312) 220-9219

134 1 CHAIRMAN LERNER: I can vote and my 2 son can vote. 3 DR. LUBIN JOHNSON: This is Chicago. 4 CHAIRMAN LERNER: The motion passes. 5 All right. Now we have got 6 four models -- four models: Single payer, 7 Insurance Industry Model; Healthy Illinois 8 Citizens Action, and modified seventh hybrid. 9 And we'll take them in the order I just 10 mentioned. We vote it up or down. Okay? So 11 we'll do a roll call vote. Mr. Carvalho. 12 MR. CARVALHO: First one is single 13 payer. If each member can just say "yes" or 14 "no." 15 Dr. Backs. 16 DR. BACKS: No. 17 MR. CARVALHO: Mr. Boyd. 18 MR. BOYD: Yes. 19 MR. CARVALHO: Ms. Bresler. 20 MS. BRESLER: No. 21 MR. CARVALHO: Representative Coulson. 22 REPRESENTATIVE COULSON: No. 23 MR. CARVALHO: Ms. Davis. 24 MS. DAVIS: Yes. T.J. BOWMAN COURT REPORTING SERVICE, INC. (312) 220-9219

135 1 MR. CARVALHO: Mr. Dooling. 2 DR. DOOLING: Yes. 3 MR. CARVALHO: Mr. Duffett. 4 MR. DUFFETT: Yes. 5 MR. CARVALHO: Dr. Dooling. 6 DR. DOOLING: Yes. 7 MR. CARVALHO: Ms. Kannaday. 8 MS. KANNADAY: No. 9 MR. CARVALHO: Senator Koeler. 10 SENATOR KOELER: No. 11 MR. CARVALHO: Dr. Lerner. 12 CHAIRMAN LERNER: Yes. 13 MR. CARVALHO: Dr. Lubin Johnson. 14 DR. LUBIN JOHNSON: Yes. 15 MR. CARVALHO: Ms. Mitroff. 16 MS. MITROFF: No. 17 MR. CARVALHO: Mr. Moore. 18 MR. MOORE: No. 19 MR. CARVALHO: Mr. Murphy. 20 MR. MURPHY: No. 21 MR. CARVALHO: Ms. Printen. 22 MS. PRINTEN: No. 23 MR. CARVALHO: Mr. Robbins. 24 MR. ROBBINS: No. T.J. BOWMAN COURT REPORTING SERVICE, INC. (312) 220-9219

136 1 MR. CARVALHO: Mr. Roberts. 2 MR. ROBERTS: No. 3 MR. CARVALHO: Ms. Rothstein. 4 MS. ROTHSTEIN: Yes. 5 MR. CARVALHO: Mr. Smith. 6 MR. SMITH: No. 7 DR. JONES: Mr. Smithmier. 8 MR. SMITHMIER: No. 9 MR. CARVALHO: Dr. Young. 10 DR. YOUNG: Yes. 11 CHAIRMAN LERNER: Okay. Let me count. 12 (PAUSE.) 13 CHAIRMAN LERNER: Vote came out as 14 follows: Nine yes; thirteen no's. Single payer 15 is not considered in the secondary pool. 16 Next is the insurance industry 17 proposal. 18 MR. CARVALHO: Dr. Backs. 19 DR. BACKS: No. 20 MR. CARVALHO: Mr. Boyd. 21 MR. BOYD: No. 22 MR. CARVALHO: Ms. Bresler. 23 MS. BRESLER: Yes. 24 MR. CARVALHO: Representative Coulson. T.J. BOWMAN COURT REPORTING SERVICE, INC. (312) 220-9219

137 1 REPRESENTATIVE COULSON: No. 2 MR. CARVALHO: Ms. Davis. 3 MS. DAVIS: No. 4 MR. CARVALHO: Mr. Dooling. 5 DR. DOOLING: No. 6 MR. CARVALHO: Mr. Duffett. 7 MR. DUFFETT: No. 8 MR. CARVALHO: Mr. Dooling -- Dr. 9 Dooling. 10 DR. DOOLING: No. 11 MR. CARVALHO: Ms. Kannaday. 12 MS. KANNADAY: No. 13 MR. CARVALHO: Senator Koeler. 14 SENATOR KOELER: No. 15 MR. CARVALHO: Dr. Lerner. 16 CHAIRMAN LERNER: Sure. Yes. 17 MR. CARVALHO: Dr. Lubin Johnson. 18 DR. LUBIN JOHNSON: Yes -- No. No. 19 MR. CARVALHO: Ms. Mitroff. 20 MS. MITROFF: Yes. 21 MR. CARVALHO: Mr. Moore. 22 MR. MOORE: No. 23 MR. CARVALHO: Mr. Murphy. 24 MR. MURPHY: Yes. T.J. BOWMAN COURT REPORTING SERVICE, INC. (312) 220-9219

138 1 MR. CARVALHO: Ms. Printen. 2 MS. PRINTEN: No. 3 MR. CARVALHO: Mr. Robbins. 4 MR. ROBBINS: No. 5 MR. CARVALHO: Mr. Roberts. 6 MR. ROBERTS: Yes. 7 MR. CARVALHO: Ms. Rothstein. 8 MS. ROTHSTEIN: No. 9 MR. CARVALHO: Mr. Smith. 10 MR. SMITH: Yes. 11 MR. CARVALHO: Mr. Smithmier. 12 MR. SMITHMIER: No. 13 MR. CARVALHO: Dr. Young. 14 DR. YOUNG: No. 15 CHAIRMAN LERNER: Vote is six yes; 16 sixteen no. The insurance industry proposal 17 will not be considered in the second round. 18 The third model is Healthy 19 Illinois Citizens Action model. 20 MR. CARVALHO: This is Healthy 21 Illinois? 22 CHAIRMAN LERNER: Yes, Healthy 23 Illinois. 24 MR. CARVALHO: All right. Okay. T.J. BOWMAN COURT REPORTING SERVICE, INC. (312) 220-9219

139 1 Dr. Backs. 2 DR. BACKS: No. Bresler. 3 MR. CARVALHO: Mr. Boyd. 4 MR. BOYD: No. 5 MR. CARVALHO: Ms. Bresler. 6 MS. BRESLER: No. 7 MR. CARVALHO: Representative Coulson. 8 REPRESENTATIVE COULSON: No. 9 MR. CARVALHO: Ms. Davis. 10 MS. DAVIS: No. 11 MR. CARVALHO: Mr. Dooling. 12 DR. DOOLING: No. 13 MR. CARVALHO: Mr. Duffett. 14 MR. DUFFETT: No. 15 MR. CARVALHO: Mr. Jones. 16 DR. JONES: No. 17 MR. CARVALHO: Ms. Kannaday. 18 MS. KANNADAY: No. 19 MR. CARVALHO: Senator Koeler. 20 SENATOR KOELER: No. 21 MR. CARVALHO: Dr. Lerner. 22 CHAIRMAN LERNER: No. 23 MR. CARVALHO: Dr. Lubin Johnson. 24 DR. LUBIN JOHNSON: No. T.J. BOWMAN COURT REPORTING SERVICE, INC. (312) 220-9219

140 1 MR. CARVALHO: Ms. Mitroff. 2 MS. MITROFF: No. 3 MR. CARVALHO: Mr. Moore. 4 MR. MOORE: No. 5 MR. CARVALHO: Mr. Murphy. 6 MR. MURPHY: No. 7 MR. CARVALHO: Ms. Printen. 8 MS. PRINTEN: No. 9 MR. CARVALHO: Mr. Robbins. 10 MR. ROBBINS: No. 11 MR. CARVALHO: Mr. Roberts. 12 MR. ROBERTS: No. 13 MR. CARVALHO: Ms. Rothstein. 14 MS. ROTHSTEIN: No. 15 MR. CARVALHO: Mr. Smith. 16 MR. SMITH: No. 17 MR. CARVALHO: Mr. Smithmier. 18 MR. SMITHMIER: No. 19 MR. CARVALHO: Dr. Young. 20 DR. YOUNG: No. 21 MR. CARVALHO: Okay. That was easier 22 to count. 23 CHAIRMAN LERNER: No votes for. 22 24 votes against. T.J. BOWMAN COURT REPORTING SERVICE, INC. (312) 220-9219

141 1 The Healthy Illinois model is 2 eliminated from the secondary pool. 3 I guess we vote the hybrid up 4 or down. 5 DR. JONES: Or we go home. 6 CHAIRMAN LERNER: I guess we have to 7 vote the hybrid up or down. 8 MR. CARVALHO: So the hybrid, Dr. 9 Backs. 10 DR. BACKS: Yes. 11 MR. ROBBINS: Can I ask a clarifying 12 question? 13 CHAIRMAN LERNER: Yes. 14 MR. ROBBINS: Is it clear that after 15 this vote, it would be in order to make an 16 amendment to modify whatever is voted through -- 17 DR. LUBIN JOHNSON: The motion. 18 MR. ROBBINS: -- the motion? 19 CHAIRMAN LERNER: We then create the 20 secondary pool but just compose the one model. 21 And then what we need is a motion to move the 22 model or do something with the model. That's 23 all we've done. 24 MR. ROBBINS: A submitted amendment T.J. BOWMAN COURT REPORTING SERVICE, INC. (312) 220-9219

142 1 would be in order? 2 CHAIRMAN LERNER: Any number of things 3 could be in order. 4 DR. BACKS: Just as a point of order, 5 I mean, if we voted up the collapse going up or 6 down, we have adopted that -- 7 CHAIRMAN LERNER: No, all we've done 8 to the motion is to create the pool under which 9 we'd entertain a motion about when we go 10 forward, as I understood our motion. Is that 11 correct? 12 MR. ROBBINS: It's either pool of one 13 or pool of none. 14 (Group discussion, overlapping 15 Of speakers.) 16 CHAIRMAN LERNER: All right. Let's 17 go. 18 MR. CARVALHO: Dr. Backs. 19 DR. BACKS: Yes. 20 MR. CARVALHO: Mr. Boyd. 21 MR. BOYD: Yes. 22 MR. CARVALHO: Ms. Bresler. 23 MS. BRESLER: No. 24 MR. CARVALHO: Representative Coulson. T.J. BOWMAN COURT REPORTING SERVICE, INC. (312) 220-9219

143 1 REPRESENTATIVE COULSON: Yes. 2 MR. CARVALHO: Ms. Davis. 3 MS. DAVIS: Yes. 4 MR. CARVALHO: Mr. Dooling. 5 DR. DOOLING: Yes. 6 MR. CARVALHO: Mr. Duffett. 7 MR. DUFFETT: Yes. 8 MR. CARVALHO: Mr. Jones. 9 DR. JONES: Yes. 10 MR. CARVALHO: Ms. Kannaday. 11 MS. KANNADAY: Yes. 12 MR. CARVALHO: Senator Koeler. 13 SENATOR KOELER: Yes. 14 MR. CARVALHO: Dr. Lerner. 15 CHAIRMAN LERNER: Yes. 16 MR. CARVALHO: Dr. Lubin Johnson. 17 DR. LUBIN JOHNSON: Yes. 18 MR. CARVALHO: Ms. Mitroff. 19 MS. MITROFF: No. 20 MR. CARVALHO: Mr. Moore. 21 MR. MOORE: Yes. 22 MR. CARVALHO: Mr. Murphy. 23 MR. MURPHY: No. 24 MR. CARVALHO: Ms. Printen. T.J. BOWMAN COURT REPORTING SERVICE, INC. (312) 220-9219

144 1 MS. PRINTEN: Yes. 2 MR. CARVALHO: Mr. Robbins. 3 MR. ROBBINS: Yes. 4 MR. CARVALHO: Mr. Roberts. 5 MR. ROBERTS: No. 6 MR. CARVALHO: Ms. Rothstein. 7 MS. ROTHSTEIN: Yes. 8 MR. CARVALHO: Mr. Smith. 9 MR. SMITH: No. 10 MR. CARVALHO: Mr. Smithmier. 11 MR. SMITHMIER: Yes. 12 MR. CARVALHO: Dr. Young. 13 DR. YOUNG: No. 14 CHAIRMAN LERNER: Sixteen affirmative. 15 Six no's; no abstentions. The secondary pool is 16 composed of the modified hybrid plan, which is 17 inclusive of both options A and B. 18 So now under our rules I guess 19 we can kind of skip to our last step, which is 20 we need to entertain a motion from a member of 21 the Task Force about how you would like to 22 proceed. You can -- 23 SENATOR KOELER: Let me start -- 24 CHAIRMAN LERNER: A discussion would T.J. BOWMAN COURT REPORTING SERVICE, INC. (312) 220-9219

145 1 be in order. 2 SENATOR KOELER: Speaking personally, 3 I would like to be able to vote on both A and B, 4 and have it recorded as a group as to what our 5 choices are; so if I want to vote for both A and 6 B, then I can vote for both A and B; or those 7 that just want to vote for this one or the 8 other, or not vote for any, would be allowed as 9 well. 10 So I would move that we take 11 an up or down vote on each component A, and then 12 have an up or down vote on B, and then send the 13 total proposal as the hybrid to the Legislature 14 with that recorded vote. 15 CHAIRMAN LERNER: So the motion that 16 Senator Koeler has put on the table is that we 17 vote option A up or down, option B up or down; 18 but that the whole report as submitted -- or as 19 edited with our changes this morning be 20 submitted to the Legislature with the vote on A 21 and B recorded and noted. Is that the motion? 22 SENATOR KOELER: Yes. 23 CHAIRMAN LERNER: Is there a second to 24 the motion? T.J. BOWMAN COURT REPORTING SERVICE, INC. (312) 220-9219

146 1 MS. DAVIS: Second. 2 CHAIRMAN LERNER: It's on the table. 3 Discussion? 4 MR. CARVALHO: If I can ask a 5 clarifying question on this, person recording 6 this: Would you like, for example -- would you 7 like for there to be a tally on A, a tally on B, 8 and a tally on A or B, or a tally on neither or 9 -- 10 DR. LUBIN JOHNSON: We have done 11 neither. 12 SENATOR KOELER: Up or down on each 13 part of it. 14 Again, what I'm wanting to do 15 is to be able to vote yes on both A and on B. 16 Because our task here is to send this as a 17 proposal to the Legislature for their 18 consideration. This is not by any means a done 19 piece of legislation, this is a concept; and 20 it's got a lot of pieces to that. And I think 21 that politically to me that makes sense. 22 CHAIRMAN LERNER: Representative 23 Coulson, did you have something that you wanted 24 to say? T.J. BOWMAN COURT REPORTING SERVICE, INC. (312) 220-9219

147 1 REPRESENTATIVE COULSON: No. Sorry, I 2 have to leave. Moving right along, and I think 3 we have a report already. 4 CHAIRMAN LERNER: Have a good holiday. 5 MR. CARVALHO: Mr. Moore. 6 MR. MOORE: I guess I need a 7 clarification. We are going to vote on A and 8 vote on B, but if one of them fails to achieve a 9 majority, are we still submitting both A and B, 10 or are we just submitting the one that achieved 11 the majority of votes? 12 SENATOR KOELER: My motion is that we 13 submit the whole package, both, but that we 14 record what the preference is of the Task Force 15 in terms of that vote. Again, this is a body of 16 information that we spent a good deal of time 17 on, and those issues are there regardless of 18 whether we pass them on or not. 19 I think that, you know -- 20 again, I am looking now at the political nature 21 of this thing, and that is going to take another 22 life of its own when it gets to the Legislature. 23 And I guess because we've done 24 such a body of work here, it really would be T.J. BOWMAN COURT REPORTING SERVICE, INC. (312) 220-9219

148 1 important to send the whole thing there, but 2 again, let everybody have their preferences as 3 to what's acceptable or not. But just because 4 we voted something down or not doesn't mean that 5 it's not going to be picked up by somebody else 6 anyway. 7 CHAIRMAN LERNER: Mr. Robbins. 8 MR. ROBBINS: And what I'm about to 9 say -- 10 MS. ROTHSTEIN: Can't hear you. 11 MR. ROBBINS: What I'm about to say, 12 I'm trying to reflect on a lot of conversations 13 that have taken place this morning among a 14 variety of people. 15 I think all of you know that I 16 would prefer A over B. But I'm wondering if 17 what I am about to propose comes close enough to 18 what you suggested to give us a direction. So 19 we will try. 20 It will be an amendment that 21 would insert in the language of the report the 22 following which we would then have to vote on: 23 By a majority vote, the Task Force expressed a 24 strong preference to opposition A, but is also T.J. BOWMAN COURT REPORTING SERVICE, INC. (312) 220-9219

149 1 is willing to include option B for public 2 consideration. 3 MR. ROBERTS: We don't know that. 4 DR. LUBIN JOHNSON: Or vice versa. 5 MR. ROBBINS: Does that satisfy what 6 you are trying to achieve? 7 SENATOR KOELER: Let's take a vote 8 first, and maybe that becomes a subsequent 9 motion. Let's see how that falls first. And I 10 think that however it falls, we can pick up that 11 kind of a language and say, and this is how we 12 want to pass that report on. But I think we 13 don't know that yet, that we actually have an up 14 or down vote both on A or B. 15 MR. ROBBINS: I guess my problem is 16 that it's not -- I don't know that it's possible 17 for me to know what my final vote would be until 18 I knew what the answer to that question is about 19 A or B; so therefore, will there be an 20 opportunity to cast a vote on whatever the final 21 option is that you seem to be going toward? 22 SENATOR KOELER: However that vote 23 comes out, I think the language you are 24 suggesting is very appropriate. T.J. BOWMAN COURT REPORTING SERVICE, INC. (312) 220-9219

150 1 MR. ROBBINS: If accurate. 2 SENATOR KOELER: So we'll find out 3 what folks feel about A and about B. There may 4 be some that can support both. I can support 5 both. 6 I think that it's important, 7 as we move this to the Legislature now, that we 8 give them the opportunity to see the full body 9 of work that we have done. 10 DR. BACKS: Assuming that the minutes 11 of this deliberation are available, or the votes 12 are available, they have that full body of work, 13 I think the Task Force needs to go on record if 14 it has -- if collectively we have a preference 15 to have that available; therefore, I would -- 16 And the other issue is that 17 some of us, I am sure, see the two options as 18 very different from one another, and some of us 19 likely to see them as variations on a theme. 20 But I think a more appropriate 21 way of voting on this would be a vote up or down 22 on A, a vote up or down on B, and a vote up or 23 down on sending it with no preference for either 24 one to the Legislature. And if any of those T.J. BOWMAN COURT REPORTING SERVICE, INC. (312) 220-9219

151 1 gets a majority, then that's the adoption of our 2 policy as a task force. If two get a majority 3 then we send them both options. 4 CHAIRMAN LERNER: That's a 5 possibility. We can entertain a motion to that 6 effect. 7 DR. BACKS: But I am not sure where we 8 are parliamentary right now with the motion -- 9 CHAIRMAN LERNER: There's a motion on 10 the table which has been seconded, which is a 11 procedural motion that we are still 12 discussing -- 13 DR. BACKS: I'm not sure if I am 14 offering an amendment to your motion or -- 15 SENATOR KOELER: Here's what I don't 16 want to be forced into doing, picking A or B 17 over one or another. I can live with either. 18 Okay. I want to be able to vote on both. If 19 you force me into voting on one or the other, 20 then I'd probably go with B. 21 MS. ROTHSTEIN: That's my problem. 22 SENATOR KOELER: See, that's the 23 problem that some of us have. How can you allow 24 me to support A and support B without having to T.J. BOWMAN COURT REPORTING SERVICE, INC. (312) 220-9219

152 1 choose one or the other? Because I think what 2 we have done here is a significant piece of 3 work, and we need to have that go forward. 4 DR. BACKS: Well, my suggestion would 5 allow you to vote for neither A or B and to vote 6 for -- 7 CHAIRMAN LERNER: David's saying 8 something different. He's saying this body of 9 knowledge is a good body of knowledge, along 10 with the tons of work that we have done. He 11 wants to submit this but he wants us to express 12 on the front cover sheet the preferences of the 13 Task Force between A and B. It may turn out to 14 be equal, if the same number of people voting 15 affirmatively for A, then you have them voting 16 affirmatively for B. But he's saying he doesn't 17 want to divy up the report. That's the way I 18 heard the motion to be. 19 Ann Marie. 20 MS. MURPHY: I just have a question on 21 how someone would interpret that, for those that 22 are listening here. 23 If you do that, that's a good 24 idea. There are certain things, there are T.J. BOWMAN COURT REPORTING SERVICE, INC. (312) 220-9219

153 1 people that think that both plans are acceptable 2 but they still have a preference for one over 3 the other. 4 So when you do it that way in 5 some sense, a little, you no longer know whether 6 if I or anyone here thinks A or B are 7 acceptable, do you also have a preference? 8 CHAIRMAN LERNER: An equivalent, Ann 9 Marie, in my mind, one of the options that we 10 entertain as a Steering Committee is that the 11 votes could come out that we would have ended up 12 recommending two plans, or three plans, not 13 minority reports, but actually recommending two 14 plans to the Legislature, which in this case 15 would have shown no particular preference. I 16 see the dilemma. 17 DR. JONES: I think she makes a good 18 point. I think the way you can get around that 19 is you can go up and down A, up and down B, and 20 then you go around and ask for a preference. 21 And I think all that information should be 22 recorded. 23 MR. CARVALHO: So conceivably, you 24 could have 16 people say yay on A, and 16 people T.J. BOWMAN COURT REPORTING SERVICE, INC. (312) 220-9219

154 1 say yay on B, and then you record a preference? 2 DR. JONES: Right. 3 4 MR. MURPHY: I think there will be 5 admittedly a small minority on the Task Force 6 who would be averse to being put in a position 7 to express a preference for neither of these 8 options because they would be opposed to both. 9 CHAIRMAN LERNER: Vote no. 10 MR. MURPHY: And this third option 11 would then poll of what's your preference of, 12 something you voted -- 13 CHAIRMAN LERNER: We can abstain that 14 too. It still requires 12 votes. We still 15 require 12 affirmative votes to pass anything 16 today. 17 MR. ROBBINS: Will be the second time 18 I agree with Art. 19 DR. JONES: Probably the last. 20 DR. BACKS: If you agree one more 21 time, I'm going to let you two sit together. 22 MR. CARVALHO: Again, to clarify -- 23 Taking a poll. A has ten; and 24 "no" on A has 11. It doesn't mean that A drops T.J. BOWMAN COURT REPORTING SERVICE, INC. (312) 220-9219

155 1 out of the report, it just means that that is 2 reflected in the report that, when polled among 3 A and B, A had ten, B had whatever. 4 CHAIRMAN LERNER: But that the full 5 report was submitted? 6 SENATOR KOELER: I think it may be 7 clear on what to do after we take this vote. 8 MR. CARVALHO: I am just 9 distinguishing a poll from a motion. 10 There is a vote on the table 11 from the motion to do what you said. If that 12 passes, then we'll be taking several polls, 13 which will not resolve the motion as to the 14 poll. 15 CHAIRMAN LERNER: Pam. 16 MS. MITROFF: The vote that we had 17 that was 16 to 6 on the hybrid, that was not a 18 vote on the hybrid, that was just a vote to move 19 it forward? 20 MR. CARVALHO: Right. 21 CHAIRMAN LERNER: It was a vote to 22 include the hybrid in the models that we would 23 then vote on. It simply was a first cut. 24 MS. MITROFF: So could we finesse this T.J. BOWMAN COURT REPORTING SERVICE, INC. (312) 220-9219

156 1 by having a vote on the hybrid in its entirety 2 and then you get your preference? It sounds 3 like maybe we are going backwards. 4 CHAIRMAN LERNER: David's motion was 5 that we would -- his motion was that the Task 6 Force should recommend the full report, but that 7 we, by vote, express our preferences on A and B; 8 and all that information would then be passed on 9 to the Legislature. 10 MS. MITROFF: So all I'm suggesting is 11 that it sounds like really you are almost 12 assuming in some way that the 16 to 6 was a 13 vote. 14 Maybe the process is to take 15 the vote on the hybrid, assuming it would be 16 16 to 6, or some number like that, and then you get 17 to your preference piece -- 18 SENATOR KOELER: We would vote for my 19 motion here, we would be approving the report. 20 And we are doing that. And then we would take 21 two subsequent votes that would give us a chance 22 to vote on A and a chance to vote on B. So I 23 think we are doing exactly what you are saying. 24 MR. ROBBINS: I don't think that's T.J. BOWMAN COURT REPORTING SERVICE, INC. (312) 220-9219

157 1 what Art -- 2 DR. JONES: That's not -- and the 3 third, which is to express our preference A or 4 B. So I can go up on A, I can go up on B, but I 5 can also say I prefer one or the other. 6 CHAIRMAN LERNER: I don't think that 7 was your motion. 8 DR. JONES: That's an amendment to his 9 motion. 10 MR. ROBBINS: I would second that. 11 CHAIRMAN LERNER: Now we have to vote 12 on the amendment. 13 SENATOR KOELER: He can do it as a 14 substitute motion. If you want to make that a 15 substitute motion, we'd have to vote on that 16 first, before you get to my motion. 17 CHAIRMAN LERNER: You want to repeat 18 that, Art? 19 DR. JONES: I'm saying that we should 20 vote -- Everyone should have an option to say 21 they could live with A up or down, they could 22 live with B up or down; then they also say which 23 of those two they prefer, if they wish to 24 express a preference. If they wish not to T.J. BOWMAN COURT REPORTING SERVICE, INC. (312) 220-9219

158 1 express a preference, then they could abstain. 2 CHAIRMAN LERNER: I'm not sure I 3 understand the difference between voting -- 4 DR. JONES: Because I could vote both. 5 I could live with A. I can live with A, I can 6 live with B, but I would prefer B. And I think 7 that's what Ann Marie was saying. 8 People that are trying to 9 interpret our vote need to know that. 10 SENATOR KOELER: The third vote is 11 really as to whether we choose to as individuals 12 have a preference; and I can just say, I don't 13 have a preference or I can say I do have a 14 preference? 15 DR. JONES: Right. Exactly. 16 SENATOR KOELER: I don't have a 17 problem with that. 18 MR. DUFFETT: Would that be a friendly 19 amendment? 20 SENATOR KOELER: I would accept it as 21 a friendly amendment. 22 Who is the second to that? 23 CHAIRMAN LERNER: We have to vote now 24 on the friendly amendment? T.J. BOWMAN COURT REPORTING SERVICE, INC. (312) 220-9219

159 1 MR. CARVALHO: No. 2 SENATOR KOELER: So what Art just 3 suggested is what our motion is before us. 4 CHAIRMAN LERNER: Does everybody have 5 it clear what we are doing? 6 Can we restate the motion? 7 DR. JONES: Okay. We are each going 8 to vote up or down on A, up or down on B; and 9 then if we have a preference, we are going to 10 express our preference A over B or B over A? 11 CHAIRMAN LERNER: And what does up or 12 down do for us? 13 DR. JONES: Up or down says, I agree, 14 I could live with that plan; I endorse that 15 plan; if this plan went with A, I could endorse 16 that approach; if it went with B, I could 17 endorse that approach; and which one would I 18 prefer to see. 19 SENATOR KOELER: After this motion 20 here, this one passes, and we have three other 21 votes today, okay? So remember the body of my 22 motion was that we approve this and pass it then 23 on to the Legislature, that we have now three 24 things indicated, one is what the vote is on A, T.J. BOWMAN COURT REPORTING SERVICE, INC. (312) 220-9219

160 1 what the vote is on B, and then the third is 2 what our preference is? 3 DR. JONES: Right. 4 MALE UNIDENTIFIED: Technically, don't 5 you then need a vote on the whole thing? 6 MALE UNIDENTIFIED: Well, that's 7 what's going to end in January. 8 CHAIRMAN LERNER: Yeah. January is 9 going to be the approval of the report. 10 So this -- approval of this 11 motion means, in a sense, that we've agreed to 12 send this on to the Legislature, now we're going 13 to delineate what that means, A, B, and what our 14 preference is. 15 I am personally having a hard 16 time distinguishing in my mind the difference 17 between preference and living with. But if 18 that's the motion of the Act -- of the Task 19 Force, I'll deal with it. 20 FEMALE UNIDENTIFIED: Saving a 21 marriage. 22 MALE UNIDENTIFIED: Big difference. 23 Been there a number of times. 24 T.J. BOWMAN COURT REPORTING SERVICE, INC. (312) 220-9219

161 1 (Group discussion, overlapping 2 Of speakers.) 3 MR. CARVALHO: One thing we need to 4 clarify, however, you want to make sure that 5 however you word this that Senator Koehler's, "I 6 can live with both," and, not to presume, but 7 Ms. Mitroff's "I don't like either" don't have 8 the same vote. You are no preference to -- you 9 don't either, and you have no preference to be 10 like both. 11 SENATOR KOEHLER: We're going to send 12 the report out with as much detail as to how we 13 feel about it as possible. I think these three 14 areas can do that. 15 CHAIRMAN LERNER: So the motion is 16 we're going to move this hybrid model forward as 17 our model of choice. And the motion is now 18 we're now going to see if we can live with A -- 19 we're going to vote with whether we can live 20 with A, whether we can live with B; and then 21 after that is done, what our preference is. 22 MR. ROBBINS: I would suggest not 23 "live with" but "endorse." 24 CHAIRMAN LERNER: Whether we can T.J. BOWMAN COURT REPORTING SERVICE, INC. (312) 220-9219

162 1 endorse A, whether we can endorse B, and then 2 finally, if we have a preference. 3 MR. ROBBINS: Will we in this 4 conversation have an opportunity to say why one 5 of us might prefer A over B, or vice versa? 6 CHAIRMAN LERNER: If you keep it 7 short. 8 MR. ROBBINS: I don't want to explain 9 my vote. 10 CHAIRMAN LERNER: Okay. 11 MR. CARVALHO: So the motion now is to 12 do that process? 13 CHAIRMAN LERNER: That's correct. 14 This is just to vote on this motion. Okay? All 15 our voting is on this motion. 16 DR. BACKS: It's just the way it's 17 worded is you could vote for A and A plus B. 18 And that really doesn't -- 19 You know, I think seems we 20 were trying to delineate whether we think it 21 should go with one or the other or both. And if 22 you vote for one, it would seem kind of odd to 23 vote for both. 24 CHAIRMAN LERNER: But people come from T.J. BOWMAN COURT REPORTING SERVICE, INC. (312) 220-9219

163 1 different positions. People come from different 2 positions. 3 MR. MURPHY: I think as long as we're 4 in the discussion phase. I think your original 5 motion would achieve exactly what we are trying 6 to get to without going through this and in a 7 little bit fuzzy way getting to a stated 8 preference. Kind of does leave some of us in a 9 position of not being recorded black or white as 10 a position. 11 CHAIRMAN LERNER: And may have to 12 abstain. 13 MR. MURPHY: I think your original 14 motion actually does a better job. 15 CHAIRMAN LERNER: The motion on the 16 table simply a process motion. 17 SENATOR KOEHLER: It's more than that. 18 The motion is approving the plan, but then it's 19 further delineating what we mean by that. 20 MR. ROBBINS: Now I am confused. This 21 is a vote on the substance of the plan. We 22 don't have a chance to vote independently with 23 the plan with A or the plan with B and then a 24 preference. T.J. BOWMAN COURT REPORTING SERVICE, INC. (312) 220-9219

164 1 SENATOR KOEHLER: Here is what my 2 motion was -- 3 MR. ROBBINS: I'm talking about what 4 the friendly amendment calls for. 5 SENATOR KOEHLER: Right. The gist of 6 the motion is that we send this as our plan to 7 the Legislature; but that we further then are 8 really delineating what we mean by that in terms 9 of the group vote on A, on B, and then what our 10 preference is. 11 CHAIRMAN LERNER: The motion on the 12 table is that we approve the plan, and that we 13 subsequently take three votes, can you endorse 14 A -- do you endorse A? Do you endorse B? And 15 what is your preference? That's what I heard. 16 Is that correct? 17 DR. JONES: Yes. 18 CHAIRMAN LERNER: That's correct. 19 DR. JONES: Right. 20 CHAIRMAN LERNER: So we endorse the 21 plan, presenting the plan forward, and then we 22 have three pieces of information that follow 23 along with it. 24 Jim? T.J. BOWMAN COURT REPORTING SERVICE, INC. (312) 220-9219

165 1 MR. DUFFETT: If I don't like B, I 2 need to vote "no" at this time, right? 3 MR. MOORE: Because if this happens, 4 it's all gone, A and B are gone, if I object 5 to B. Because access to care is an issue, and 6 the barrier to access to care is proper payment, 7 and I don't believe B makes proper payment, then 8 I need to vote "no" at this point in time. I 9 just want to make sure I interpret the motion. 10 CHAIRMAN LERNER: Yeah. That's a 11 significant point of view; or you can just 12 express your preferences and say that you don't 13 endorse B. 14 MR. MOORE: I need to make sure I 15 understand what a vote means. 16 CHAIRMAN LERNER: Craig? 17 DR. BACKS: I just think it would be 18 cleaner if we approve the entire plan and then 19 express a preference for either A, or B, or 20 abstain. Because when you get to that A plus B 21 preference, that's where things get all muddied 22 up. I think this vote, then two more votes; are 23 you for A; are you for B; or an abstention. 24 CHAIRMAN LERNER: But we have an T.J. BOWMAN COURT REPORTING SERVICE, INC. (312) 220-9219

166 1 amendment motion on the table. 2 DR. BACKS: I don't even know what 3 we're voting at this point. 4 CHAIRMAN LERNER: I'm going to close 5 off discussion. 6 We have a motion on the table. 7 The motion is to endorse the plan, with that 8 bringing forward three subsequent pieces of 9 information, you endorse A, you endorse B, what 10 is your preference. That's the motion on the 11 table. Correct? 12 Dr. Jones? Correct? 13 DR. JONES: Correct. 14 CHAIRMAN LERNER: Okay. We are voting 15 on that motion. 16 You want a roll call or show 17 of hands? 18 MR. CARVALHO: The right answers are 19 now "yes" or "no." 20 Dr. Backs. 21 DR. BACKS: I'd have to say no. 22 MR. CARVALHO: Mr. Boyd. 23 MR. BOYD: Yes. 24 MR. CARVALHO: Ms. Bresler. T.J. BOWMAN COURT REPORTING SERVICE, INC. (312) 220-9219

167 1 MS. BRESLER: No. 2 MR. CARVALHO: Ms. Davis. 3 MS. DAVIS: Yes. 4 MR. CARVALHO: Mr. Dooling. 5 DR. DOOLING: Yes. 6 MR. CARVALHO: Mr. Duffett. 7 MR. DUFFETT: Yes. 8 MR. CARVALHO: Dr. Jones. 9 DR. JONES: Yes. 10 MR. CARVALHO: Ms. Kannaday. 11 MS. KANNADAY: Yes. 12 MR. CARVALHO: Senator Koehler. 13 SENATOR KOEHLER: Yes. 14 MR. CARVALHO: Dr. Lerner. 15 CHAIRMAN LERNER: Yes. 16 MR. CARVALHO: Dr. Johnson. 17 DR. LUBIN JOHNSON: Yes. 18 MR. CARVALHO: Ms. Mitroff. 19 MS. MITROFF: No. 20 MR. CARVALHO: Mr. Moore. 21 MR. MOORE: No. 22 MR. CARVALHO: Mr. Murphy. 23 MR. MURPHY: No. 24 MR. CARVALHO: Ms. Printen. T.J. BOWMAN COURT REPORTING SERVICE, INC. (312) 220-9219

168 1 MS. PRINTEN: No. 2 MR. CARVALHO: Mr. Robbins. 3 MR. ROBBINS: I really dislike the way 4 this is questioned. I'll vote "yes," because a 5 vote "no" would be against the entire plan. But 6 I strongly dislike being able to express my vote 7 in this way. 8 MR. CARVALHO: Mr. Roberts. 9 MR. ROBERTS: No. 10 MR. CARVALHO: Ms. Rothstein. 11 MS. ROTHSTEIN: Yes. 12 MR. CARVALHO: Mr. Smith. 13 MR. SMITH: No. 14 MR. CARVALHO: Mr. Smithmier. 15 MR. SMITHMIER: Yes. 16 MR. CARVALHO: Dr. Young. 17 DR. YOUNG: No. 18 CHAIRMAN LERNER: The motion passes. 19 Twelve affirmative votes; nine negative votes. 20 So the motion on the table -- 21 MR. CARVALHO: How many votes? 22 CHAIRMAN LERNER: 12 affirmative; nine 23 negative. 24 The Representative left. We T.J. BOWMAN COURT REPORTING SERVICE, INC. (312) 220-9219

169 1 still need 12 for a majority. 2 DR. LUBIN JOHNSON: Actually now we 3 need 11. Lost her. Majority is 11. Eleven, 4 ten. 5 CHAIRMAN LERNER: Thanks. I was a 6 math minor. 7 SENATOR KOEHLER: So now we vote A, 8 and now we vote B. 9 CHAIRMAN LERNER: Next vote is, do you 10 endorse option A. Is that right? 11 SENATOR KOEHLER: Right. 12 CHAIRMAN LERNER: Art? 13 DR. JONES: Yes. 14 MR. CARVALHO: No, he is just 15 saying -- 16 CHAIRMAN LERNER: Question? 17 DR. JONES: Yes. 18 CHAIRMAN LERNER: Ken, did you have a 19 comment? 20 MR. ROBBINS: Is this the opportunity 21 to discuss A or to discuss B? 22 DR. LUBIN JOHNSON: Do we have to? 23 MR. ROBBINS: I do. 24 CHAIRMAN LERNER: Fine. T.J. BOWMAN COURT REPORTING SERVICE, INC. (312) 220-9219

170 1 DR. LUBIN JOHNSON: Is there a motion 2 on the floor? 3 CHAIRMAN LERNER: No. 4 DR. LUBIN JOHNSON: I'd like to move 5 that we submit option A. I guess is that the 6 motion? 7 SENATOR KOEHLER: No. No. 8 CHAIRMAN LERNER: He wants to have a 9 discussion. 10 SENATOR KOEHLER: We got the second 11 part of that there's a motion on the floor, A, 12 B, or a preference. So we're just having a 13 discussion on that first part. 14 DR. LUBIN JOHNSON: So wait a minute. 15 So we are discussing something before we have a 16 motion on the floor? 17 CHAIRMAN LERNER: The motion has 18 already passed. 19 DR. LUBIN JOHNSON: I know the motion 20 has passed. We have a motion on the floor, we 21 do have discussion? 22 MR. CARVALHO: The motion called for a 23 poll. We are now about to take that poll. And 24 Mr. Robbins just wanted to make a comment before T.J. BOWMAN COURT REPORTING SERVICE, INC. (312) 220-9219

171 1 the poll is taken. 2 DR. LUBIN JOHNSON: I gotcha. Okay. 3 MR. ROBBINS: Let me tell you why I 4 said that previously what made me uncomfortable. 5 I think there is a very large 6 difference between option A and option B. And 7 in speaking for option A, I need to try to 8 express what I think that difference is. 9 Under option B there are at 10 least two very significant legs that that chair 11 is sitting on; one is the assumption that it 12 will be payment by Medicaid at a hundred percent 13 of cost. 14 I have been in Illinois at the 15 Association since 1976. Never in my 16 professional life has the State agreed to pay a 17 hundred percent of cost on Medicaid services; 18 nor do I ever expect to live to see that day. 19 Secondly, without the 20 crowd-out provisions that make it attractive for 21 commercially-insured patients or their employers 22 to move to a Medicaid program, I think we have a 23 net loss in the quality of coverage that we 24 could have, if we went with option A. T.J. BOWMAN COURT REPORTING SERVICE, INC. (312) 220-9219

172 1 And so for that reason, I 2 would vote for A and against B. But I see them 3 to be qualitative differences, not just 4 differences of degree. 5 CHAIRMAN LERNER: Thanks, Ken. 6 MS. ROTHSTEIN: Don't they both have a 7 hundred percent of costs? 8 MR. ROBBINS: No. If anything, have a 9 larger number of commercially-insured patients 10 who will be paying at more than a hundred 11 percent of costs, because no provider can only 12 get paid cost and continue to exist. 13 MS. ROTHSTEIN: Right. 14 CHAIRMAN LERNER: All right. Thank 15 you. 16 So now the next procedural 17 item is to vote endorsement of A, endorsement of 18 B, and then your preference. Correct? 19 DR. JONES: I knew we couldn't agree 20 forever. 21 I think what offsets that is 22 the fact that right now -- right now we have a 23 lot of hospitals and other providers that are 24 taking significant costs of uninsureds. Okay. T.J. BOWMAN COURT REPORTING SERVICE, INC. (312) 220-9219

173 1 And I think the reason that I like B is a couple 2 things, is that, first of all, it lops off a 3 half a billion dollars. It makes it much more 4 feasible that you are going to move ahead with 5 B, okay, just because it's more cost effective. 6 And I do think down the road, 7 I think there is significant savings in the 8 system if we do move towards the single payer, 9 which is where I think, and as you did agree 10 with me earlier, it's going to go. 11 And obviously, there's risks 12 to providers when there is a single payer. But 13 there also is -- 14 I think we have also seen 15 other countries have done that, and very 16 cost-effectively, with significant savings. So 17 I can live with that. 18 I am going to vote up on A, 19 because I certainly think that that's much 20 better than any of the other options that we 21 have had. 22 But I do think that B has some 23 unique things that I agree with you. And that 24 can be scarry for providers, because providers T.J. BOWMAN COURT REPORTING SERVICE, INC. (312) 220-9219

174 1 need to look at the total amount of money that's 2 being put into the pot. And I see, correct me 3 if I'm wrong, 2, 3 billion dollars of additional 4 money under B is going into that pot of money 5 that's going to providers. 6 MR. ROBBINS: And I just think it 7 requires a leap of faith over experience to 8 think that that money will actually materialize, 9 based on the way the General Assembly has 10 traditionally funded the Medicaid program. 11 CHAIRMAN LERNER: All right. So let 12 me cut it off. Let's move it along; otherwise, 13 we will be here until Christmas. 14 The roll call vote is on, do 15 you endorse -- would you endorse, do you endorse 16 option A? Correct? 17 DR. JONES: Correct. 18 CHAIRMAN LERNER: Mr. Secretary. 19 MR. CARVALHO: Dr. Backs. 20 DR. BACKS: Yes. 21 MR. CARVALHO: Mr. Boyd. 22 MR. BOYD: Yes. 23 MR. CARVALHO: Ms. Bresler. 24 MS. BRESLER: No. T.J. BOWMAN COURT REPORTING SERVICE, INC. (312) 220-9219

175 1 MR. CARVALHO: Ms. Davis. 2 MS. DAVIS: Yes. 3 MR. CARVALHO: Mr. Dooling. 4 DR. DOOLING: Yes. 5 MR. CARVALHO: Mr. Duffett. 6 MR. DUFFETT: Yes. 7 MR. CARVALHO: Dr. Jones. 8 DR. JONES: Yes. 9 MR. CARVALHO: Ms. Kannaday. 10 MS. KANNADAY: Yes. 11 MR. CARVALHO: Senator Koeler. 12 SENATOR KOEHLER: Yes. 13 MR. CARVALHO: Dr. Lerner. 14 CHAIRMAN LERNER: Yes. 15 MR. CARVALHO: Dr. Lubin Johnson. 16 MS. DAVIS: She is not here. 17 MR. CARVALHO: She will come back. 18 Ms. Mitroff. 19 MS. MITROFF: Yes. 20 MR. CARVALHO: Mr. Moore. 21 MR. MOORE: Yes. 22 MR. CARVALHO: Mr. Murphy. 23 MR. MURPHY: No. 24 MR. CARVALHO: Ms. Printen. T.J. BOWMAN COURT REPORTING SERVICE, INC. (312) 220-9219

176 1 MS. PRINTEN: Yes. 2 MR. CARVALHO: Mr. Robbins. 3 MR. ROBBINS: Yes. 4 MR. CARVALHO: Mr. Roberts. 5 MR. ROBERTS: No. 6 MR. CARVALHO: Ms. Rothstein. 7 MS. ROTHSTEIN: Yes. 8 MR. CARVALHO: Mr. Smith. 9 MR. SMITH: No. 10 MR. CARVALHO: Mr. Smithmier. 11 MR. SMITHMIER: Yes. 12 MR. CARVALHO: Dr. Young. 13 DR. YOUNG: No. 14 MR. CARVALHO: Dr. Lubin Johnson. 15 DR. LUBIN JOHNSON: Yes. 16 CHAIRMAN LERNER: We have 15 yes; six 17 no. We will endorse option A. 18 Next vote is on whether you 19 endorse option B. Roll call. 20 MR. CARVALHO: Mr. Backs -- Dr. Backs. 21 DR. BACKS: No. 22 CHAIRMAN LERNER: Didn't hear you. 23 DR. BACKS: No. 24 MR. CARVALHO: Mr. Boyd. T.J. BOWMAN COURT REPORTING SERVICE, INC. (312) 220-9219

177 1 MR. BOYD: Yes. 2 MR. CARVALHO: Ms. Bresler. 3 MS. BRESLER: No. 4 MR. CARVALHO: Ms. Davis. 5 MS. DAVIS: No. 6 MR. CARVALHO: Mr. Dooling. 7 DR. DOOLING: No. 8 MR. CARVALHO: Mr. Duffett. 9 MR. DUFFETT: Yes. 10 MR. CARVALHO: Dr. Jones. 11 DR. JONES: Yes. 12 MR. CARVALHO: Ms. Kannaday. 13 MS. KANNADAY: No. 14 MR. CARVALHO: Senator Koeler. 15 SENATOR KOEHLER: Yes. 16 MR. CARVALHO: Dr. Lerner. 17 CHAIRMAN LERNER: No. 18 MR. CARVALHO: Dr. Lubin Johnson. 19 DR. LUBIN JOHNSON: No. 20 MR. CARVALHO: Ms. Mitroff. 21 MS. MITROFF: No. 22 MR. CARVALHO: Mr. Moore. 23 MR. MOORE: No. 24 MR. CARVALHO: Mr. Murphy. T.J. BOWMAN COURT REPORTING SERVICE, INC. (312) 220-9219

178 1 MR. MURPHY: No. 2 MR. CARVALHO: Ms. Printen. 3 MS. PRINTEN: No. 4 MR. CARVALHO: Mr. Robbins. 5 MR. ROBBINS: No. 6 MR. CARVALHO: Mr. Roberts. 7 MR. ROBERTS: No. 8 MR. CARVALHO: Ms. Rothstein. 9 MS. ROTHSTEIN: Yes. 10 MR. CARVALHO: Mr. Smith. 11 MR. SMITH: No. 12 MR. CARVALHO: Mr. Smithmier. 13 MR. SMITHMIER: No. 14 MR. CARVALHO: Dr. Young. 15 DR. YOUNG: No. 16 CHAIRMAN LERNER: We have five 17 affirmative; 16 negative. Option B will not be 18 endorsed. 19 The next vote is what your 20 preference may be. 21 How do you want to take this 22 vote, A, B or -- 23 MR. CARVALHO: A, B, or neither. 24 CHAIRMAN LERNER: A, B, neither, or T.J. BOWMAN COURT REPORTING SERVICE, INC. (312) 220-9219

179 1 both. I mean, that's what it's got to be. 2 Right? 3 DR. LUBIN JOHNSON: So you would 4 express -- your answer would be A, B, neither? 5 CHAIRMAN LERNER: A, B, neither, or 6 both. 7 MR. SMITHMIER: Because you've already 8 voted yes for A or B; you've expressed a 9 preference for both, or you've expressed 10 agreement or acceptability of both. Now you 11 need to say the preference between the two. 12 CHAIRMAN LERNER: Right. 13 SENATOR KOEHLER: Either A, B or 14 abstain? 15 MR. CARVALHO: Can I make a suggestion 16 just for the recording of this? 17 What Mr. Smithmier says is 18 true. However, the only somebody can do that is 19 to go through a grid and prepare it all. 20 If I could just record it, it 21 would have the same effect. At least it will 22 all be in one place. 23 MR. SMITHMIER: Fine. 24 MR. CARVALHO: So the correct answers T.J. BOWMAN COURT REPORTING SERVICE, INC. (312) 220-9219

180 1 are A, B, neither, or both. Okay? 2 Dr. Backs. 3 DR. BACKS: A. 4 MR. CARVALHO: Mr. Boyd. 5 MR. BOYD: A. 6 MR. CARVALHO: Ms. Bresler. 7 MS. BRESLER: Neither. 8 MR. CARVALHO: Ms. Davis. 9 MS. DAVIS: A. 10 MR. CARVALHO: Mr. Dooling. 11 DR. DOOLING: A. 12 MR. CARVALHO: Mr. Duffett. 13 MR. DUFFETT: A. 14 MR. CARVALHO: Dr. Jones. 15 DR. JONES: B. 16 MR. CARVALHO: Ms. Kannaday. 17 MS. KANNADAY: A. 18 MR. CARVALHO: Senator Koeler. 19 SENATOR KOEHLER: A. 20 MR. CARVALHO: Dr. Lerner. 21 CHAIRMAN LERNER: A. 22 MR. CARVALHO: Dr. Lubin Johnson. 23 DR. LUBIN JOHNSON: A. 24 MR. CARVALHO: Ms. Mitroff. T.J. BOWMAN COURT REPORTING SERVICE, INC. (312) 220-9219

181 1 MS. MITROFF: Neither. 2 MR. CARVALHO: Mr. Moore. 3 MR. MOORE: A. 4 MR. CARVALHO: Mr. Murphy. 5 MR. MURPHY: Neither. 6 MR. CARVALHO: Ms. Printen. 7 MS. PRINTEN: A. 8 MR. CARVALHO: Mr. Robbins. 9 MR. ROBBINS: A. 10 MR. CARVALHO: Mr. Roberts. 11 MR. ROBERTS: Neither. 12 MR. CARVALHO: Ms. Rothstein. 13 MS. ROTHSTEIN: A. 14 MR. CARVALHO: Mr. Smith. 15 MR. SMITH: Neither. 16 MR. CARVALHO: Mr. Smithmier. 17 MR. SMITHMIER: A. 18 MR. CARVALHO: Dr. Young. 19 DR. YOUNG: Neither. 20 SENATOR KOEHLER: Not a lot 21 accomplished, but I feel better. 22 CHAIRMAN LERNER: Figure it out. What 23 do we got? 24 We have 14 for A; 1 for B; and T.J. BOWMAN COURT REPORTING SERVICE, INC. (312) 220-9219

182 1 6 for neither. 2 So the motion is that we are 3 submitting the plan that we endorse in our 4 preference is option A. That is correct? 5 MR. CARVALHO: So that the consultants 6 will now write up the report reflecting the 7 entirety of the hybrid proposal and indicate 8 that there is an option A, there is an option B, 9 and the endorsement of A by 14, B by 1, and 10 nine neither. 11 CHAIRMAN LERNER: I want to thank 12 everybody for their activities. 13 Before you leave, we have to 14 get together -- the meeting was set for June -- 15 January 9th. 16 MR. CARVALHO: The Steering Committee 17 is to meet right after this, to finalize the 18 details because this meeting was delayed from 19 when it was originally scheduled. We need to 20 meet as a Steering Committee and affirm that we 21 still have the time need to have the full Task 22 Force meeting in January, and still get the 23 report to everybody with sufficient time for 24 them to review the minority report, et cetera. T.J. BOWMAN COURT REPORTING SERVICE, INC. (312) 220-9219

183 1 So the Steering Committee needs to meet to 2 finalize our schedule. 3 The meeting of the full Task 4 Force will be January 9th or later by a week or 5 ten days. 6 CHAIRMAN LERNER: And it will be 7 obviously a very short meeting, because we are 8 really there just to approve the documents, 9 right? 10 MR. CARVALHO: Yes. 11 MS. DAVIS: I would like to recommend 12 a later date, because that's the Inaugural 13 dates. And I think that you should probably 14 push it back a little bit to at least that 15 Thursday or something. 16 MR. CARVALHO: Before I came to the 17 meeting I got the whole calendar put in here, so 18 I can work around the whole Legislature. 19 MR. SMITHMIER: And the meeting is 20 really kind of perfunctory document-approval. 21 It would be nice if we had a 22 Springfield location maybe, a telephone hookup, 23 rather than a lot of us coming up here, six 24 hours roundtrip, to do that. T.J. BOWMAN COURT REPORTING SERVICE, INC. (312) 220-9219

184 1 CHAIRMAN LERNER: We'll work out the 2 mechanics. I'm just not sure what it requires. 3 But yes, casualties, although real sensitive to 4 Jim to the train schedules. 5 MR. MOORE: Meeting the next day so 6 I'm going to come in. 7 CHAIRMAN LERNER: Are there any other 8 actions before the body? 9 (NO RESPONSE.) 10 CHAIRMAN LERNER: I want to note if we 11 finish, we're finishing ten minutes earlier. 12 (APPLAUSE). 13 SENATOR KOEHLER: If we do meet 14 January 9th, I will not be able to meet with 15 you. The Legislature does go into session on 16 7th, the 8th, the 9th, and the morning on the 17 10th. But I just want to let you know that in 18 my new role, I will carry your passion and your 19 energy on this issue. And we are going to make 20 something happen. I feel very fortunate I've 21 been able to be involved in discussion and 22 involved with such good friends. Thank you. 23 (APPLAUSE). 24 CHAIRMAN LERNER: Need a motion to T.J. BOWMAN COURT REPORTING SERVICE, INC. (312) 220-9219

185 1 adjourn. So ruled. 2 DR. LUBIN JOHNSON: Second. 3 CHAIRMAN LERNER: Merry Christmas. 4 5 WHICH WERE ALL THE 6 PROCEEDINGS HELD ON THE. 7 ABOVE-MENTIONED DATE IN THE 8 ABOVE-ENTITLED MATTER. 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 T.J. BOWMAN COURT REPORTING SERVICE, INC. (312) 220-9219

186 1 STATE OF ILLINOIS ) ) 2 COUNTY OF C O O K ) 3 4 5 We, DONNA T. WADLINGTON and 6 TONJA JENNINGS BOWMAN, Certified Shorthand 7 Reporters, doing business in the County of Cook 8 and State of Illinois, do hereby certify that we 9 reported in machine shorthand the proceedings in 10 the above entitled cause. 11 We further certify that the 12 foregoing is a true and correct transcript of 13 said proceedings as appears from the 14 stenographic notes so taken and transcribed by 15 us this 20th day of February, 2007. 16 17 _____________________ 18 DONNA T. WADLINGTON C.S.R. No. 084-002443 19 20 21 _____________________ 22 TONJA JENNINGS BOWMAN C.S.R. No. 084-000299 23 24 T.J. BOWMAN COURT REPORTING SERVICE, INC. (312) 220-9219