Transcript Highlights:

• Thank the panel for their service.
• The county doesn't have medical service, not in VFDs? No, but you have an ambulance service?
• No emergency services came to them.
• I'm not sure if your service can help with that. I'm not sure if your service can help with that.
• So the combination of services to provide the manpower here to service the Hill Country?

Summary: The joint Senate and House disaster preparedness and flooding hearing opened with quorum calls, prayer, testimony time limits, and remarks from legislative leaders emphasizing decorum, respect, and the goal of learning from the July 4 flood to prevent future loss of life. Lieutenant Governor Dan Patrick and Speaker Dustin Burrows said the special session and hearings were intended to hear directly from local officials and residents, and that the state would pursue immediate and longer-term legislation and continue working beyond the current session. The committee then heard invited testimony from Kerr County, Kerrville, Kendall County, Real County, and the Upper Guadalupe River Authority, followed by member questions. Kerr County Judge Rob Kelly, Sheriff Larry Leitha, and emergency management coordinator William B. Thomas described the flood as a sudden, unprecedented event that overwhelmed local systems before many officials or residents understood the danger. They said the county received multiple National Weather Service and IPAWS alerts, but the rain fell in remote upstream areas with limited gauges, and the flood rose too quickly for normal response. They detailed the emergency response, including dispatchers handling heavy call volumes, deputies and volunteer firefighters conducting rescues, and state and federal partners assisting. County officials said 108 people died, including 37 children, and two remained missing. They called for better real-time flood detection, stronger rural emergency management resources, improved broadband and cell coverage, and more funding for swift-water rescue and warning systems. Kerrville Mayor Joe Herring and City Manager Dalton Rice said the city had floodplain rules, emergency plans, and prior preparedness efforts, but the event exposed gaps in communications and regional warning capacity. They urged the Legislature to fund a flood warning system, whether sirens, automated alerts, or a hybrid, and asked for support for predictive weather modeling, broadband expansion, a hazard mitigation fund, and disaster recovery resources. The Upper Guadalupe River Authority said it had long funded gauges and pursued flood-warning and mitigation projects, including a new software-based flood prediction system and possible retention dams, and planned to dedicate reserve funds to feasibility studies and infrastructure improvements. Kendall County Judge Shane Stolarczyk said his county’s emergency action plan and early alerts helped prevent deaths there, and he recommended easier access to alerting tools, a river-wide warning system, simpler grant applications, and regional coordination. Real County Judge Bella Rubio said rural counties face major challenges because of limited cell service, broadband, staffing, and funding, especially for camps and visitors along the Frio and Nueces rivers, and argued that reliable alert systems should be treated as a necessity, not a luxury. Members asked about the timeline of the flood, low-water crossings, communications failures, sirens, bridges, and funding, and several witnesses said the key lessons were better communications, better warning systems, and more investment in rural flood mitigation and emergency response.

Transcript Highlights:

• sexual and reproductive Health Services sexual and reproductive Health Services Grants<00:28:04.559
• <00:52:49.280> that abortion alternative services that abortion alternative services that
• for non-abortion services.
• restrict them from accessing a service restrict them from accessing a service from<01:12:24.120>
• offer or refer services for non-abortion services<01:13:20.080> but<01:13:20.320> evidently

Keywords: 1183, house

Transcript Highlights:

• First Prevention Services.
• the Family First Prevention Services. the Family First Prevention Services.
• for Community Based Services. for Community Based Services.
• services uh broadly. services uh broadly.
• service regions.

Keywords: Meeting Start 00:00:00 Attendance Roll Call 00:00:19 DCBS 00:01:58, 958, all

Transcript Highlights:

• We changed full functioning of current services to counties to $1 million in each year.
• . services. services.
• Local Aid: as debt service is expiring, we reduce the general fund correspondingly.
• , so long as the deputy providing the service is paid $20 an hour.
• We increase support for juror compensation to $25 per day for jury service.

Keywords: Meeting Start 00:00:00 Roll Call 00:00:23 HB 503 Discussion 00:01:00 HB 503 Vote 00:02:17 HB 504 Discussion 00:02:53 HB 504 Vote 00:04:48 HB 500 Discussion 00:05:19 HB 500 Vote 00:29:18 HB 900 Discussion 00:32:02 HB 900 Vote 00:33:00, 958, all

Summary: The Kentucky Senate Appropriations and Revenue Committee met with a quorum and first took up House Bill 503, the legislative branch budget, adopting a committee substitute and reporting it favorably. The chair said the Senate version fully funds defined calculations, provides 2% raises in each fiscal year for legislative employees, removes a paragraph on operating expense reductions, and includes $1 million in the first year for a judicial branch salary study. House Bill 504, the judicial branch budget, was then amended and reported favorably; changes included 2% annual raises for judicial employees, revised operating expense language, $1 million each year for county current services, retention of Boyle County fit-up language, reporting requirements for smaller capital projects, full funding for nine judges added in 2022, and removal of furlough prohibitions and certain budget implementation language. Both bills passed the committee unanimously with favorable expressions to the floor. The committee then considered House Bill 500, the executive branch budget, adopting a committee substitute before hearing a lengthy summary of major spending and policy changes. The chair described statewide 2% annual employee raises, agency base reductions with many exemptions, increased school safety and 911 funding, veterans and military funding, local government and severance-related changes, attorney general and auditor funding, pension and retirement system support, education funding changes including SEEK, postsecondary and scholarship provisions, public safety and corrections funding, and multiple capital projects. The chair also highlighted Medicaid-related provisions, including added waiver slots, increased state-directed payments, a 2.5% reduction in managed care vendor payments for plan years 2027 and 2028 with savings redirected to fee-for-service rates, and additional funding for behavioral health and public health programs. The bill was reported favorably after members explained their votes, with several noting they had only recently received the full 228-page bill and wanted more time for detailed review. Finally, the committee adopted a committee substitute for House Bill 900, an appropriation measure for government agencies, and reported it favorably. The chair said the bill remains a work in progress and that one-time funding requests from across the Commonwealth and across party lines would continue to be addressed as the process moves forward. All measures considered during the meeting passed the committee with unanimous or near-unanimous favorable votes, and the meeting adjourned after no further business.

Transcript Highlights:

• waiver for dental services for special needs populations.
• apply those services either.
• services for all adults.
• Lab services are a mandatory service by CMS.
• Lab services are a mandatory service by CMS. Every Medicaid state has to offer them.

Summary: The Administrative Rules Subcommittee of the Arkansas Legislative Council reviewed several agency rules and requests. The Insurance Department’s amendment to its holding company system rule was reviewed and approved, as were two State Board of Election Commissioners rules: one clarifying poll watcher conduct, vote challenges, and provisional voting, and another increasing pay for certified election monitors and defining training, observation, and report-writing compensation. The Arkansas Financial Education Commission also had its rule reviewed and approved after removing membership requirements tied to DEI language to comply with Act 938. The committee held over the Department of Education’s request to be excluded from reporting requirements for one month to allow further discussion about who should write or implement the rules. A major portion of the meeting focused on the Department of Human Services’ request to be excluded from reporting requirements for Acts 567, 568, 967, and 1025. DHS said CMS had raised comparability and other federal approval concerns, especially for the dental and diagnostic lab provisions, and that it might not be able to meet the acts’ effective dates. DHS described several possible paths forward, including broader benefit changes, waivers, or splitting the dental provisions so the pediatric rate increase could move separately from the special-needs adult cap increase. The Arkansas State Dental Association disputed DHS’s conclusion that the acts could not be implemented as written, argued that Act 1025 is workable, and urged DHS to continue pursuing implementation and preserve the September 1 effective date where possible. Public testimony also supported expanded dental access for adults with disabilities and special needs. After discussion, the committee voted not to exclude DHS from reporting requirements for those acts. The committee then reviewed the Division of Higher Education’s Act 781 report. The division said it has 32 rules in effect, asked to repeal three rules—two replaced by new rules and one no longer supported by authority or current law—and to continue the remaining 29 rules. The committee approved that request, with the repeals effective upon adjournment of the Legislative Council meeting on January 16, 2026. The meeting concluded with no questions on the remaining written rulemaking updates from prior and current sessions, which were filed without further action.

Transcript Highlights:

• So last school year uh we serviced<01:09:46.159> 3,637 serviced 3,637 serviced 3,637 students.
• . services. services.
• for direct services? for direct services?
• This is the service. These are group. This is the service.
• How they record their services and match the service to a Medicaid code?

Keywords: 912, senate, all

Transcript Highlights:

• we actually get or services, which is essentially the or services, which is essentially the CMHC<00:
• . services. services.
• . service. service.
• Trips are frequently services.
• you're not eligible for the service. you're not eligible for the service.

Keywords: 958, all

Summary: The Medicaid Oversight Advisory Board first approved the September 24 minutes and then heard a presentation from four certified community behavioral health clinic providers: Pathways, NorthKey, Seven Counties Services, and NewVista. The presenters explained the difference between traditional community mental health centers and CCBHCs, describing CCBHCs as an enhanced model that integrates behavioral health, primary care, wraparound services, and crisis response. They reviewed the federal history of the model, Kentucky’s entry into the Medicaid demonstration in 2022, and the scheduled end of the enhanced federal match on December 31, 2027. They also emphasized required services such as 24-hour mobile crisis, care coordination, and services for veterans, and described care coordination as a key feature that helps patients follow up after hospital or emergency discharge, manage medications, and connect to transportation and other supports. The presenters gave examples of improved outcomes, including a patient who was able to remain living independently because of coordinated home-based and telehealth support, and they argued that CCBHCs are helping Kentucky build a more responsive crisis system through 988, mobile crisis teams, and crisis stabilization units. They said the model is data-driven, uses performance metrics, and has led to stronger collaboration among community partners. One speaker said more than 100 agencies participated in a Jefferson County community health needs assessment and continued meeting afterward to reduce redundancies and barriers to care. They also said crisis call hub compliance and mobile crisis outreach compliance improved significantly over the past year. Members asked about how navigators and connectors fit into the model, how CCBHCs work with managed care organizations, and how the program could expand statewide. The presenters said navigators are not built into the CCBHC model but may be used through referrals, while the CCBHCs continue to bill MCOs the same way and receive a Medicaid wrap payment for the enhanced rate. They said the goal would be for all community mental health centers to become CCBHCs, but that a state plan amendment would be needed and could not be limited only to CMHCs if submitted to CMS. They estimated about $28 million would be needed statewide to continue the program in the next biennium, combining the loss of enhanced federal match and the state share of enhanced service costs. The board also discussed transportation, with one presenter explaining that their program arranges Medicaid transportation for eligible appointments, and members raised concerns about mental inquest warrant transport and whether sheriffs should remain involved. No votes were taken on the CCBHC or transportation items during the discussion.

Transcript Highlights:

• There is a great need for quality oral health services.
• Regarding page 16, where there are referrals to under-need services, there aren't behavioral health services
• I think people with money can get out-of-state services, private services... ...or whatever, so they
• Deferred from formal services.
• Services. CARE is unique.

Transcript Highlights:

• But thank you, all veterans, for your service.
• She was one of the six service members to die The most recent among the more than 1.3 million US service
• We need to respect that and service to this country.
• Obviously, the service you provide to this House cannot.
• I appreciate her service to the House over the past eight years.

Bills: HCR1030, HB1370, SB893, SB2, SB1589

Keywords: legislative procedure, session calendar, deadline schedule, bill deadlines, joint resolution, Oklahoma Legislature, 61st Legislature, regular session, adjourn sine die, floor deadline, third reading, committee deadlines, bill drafting, appropriations, budget bills, ethics commission, agency rules, administrative procedures act, local and special laws, pension legislation

Transcript Highlights:

• I don't see Representative services.
• municipal EMS services, volunteer EMS municipal EMS services, volunteer EMS services,<00:15:45.920>
• So that half a million divided by 1,000 services is $500 per service.
• <00:26:02.320> But<00:26:02.480> in services is $500 per service.
• But in services is $500 per service.

Keywords: 1191, senate, all

Transcript Highlights:

• I'm Dan Ryan, Chair of the Public Service Committee, and I would like to welcome you all to the 13th
• hearing of the Joint Committee on Public Service.
• hearing of the Joint Committee on Public Service and the 194th General Court.
• of public health services for our member communities.
• Seeing none, we appreciate your testimony and your service. Thank you.

Keywords: 995, all

Summary: The Joint Committee on Public Service heard testimony on a wide range of retirement, municipal workforce, and public employee labor bills. Early testimony focused on H. 2749, a Plymouth home rule petition to classify Plymouth harbormaster employees as Group 4 for retirement purposes. Supporters, including local officials and retirement board representatives, argued the employees perform law-enforcement and rescue duties comparable to police and fire personnel, that the change would be fair, and that it would have little or no fiscal impact on the town. A separate harbormaster-related bill, H. 2743, was also introduced later in the hearing. The committee also heard testimony on provisions of the Municipal Empowerment Act (H. 56), including a temporary critical-shortage exemption allowing retired state or municipal employees to return to work in hard-to-fill positions, and a renewed OPEB commission to study retiree health care costs. Administration and municipal officials said the measures were needed to address staffing shortages and rising benefit liabilities, while emphasizing the shortage exemption would be time-limited and require proof of recruitment efforts. Related retirement bills drew support and caution: advocates for higher COLA bases and enhanced COLA benefits urged relief for retirees, but some asked the committee to wait for recommendations from the special COLA commission before acting. A major portion of the hearing concerned labor rights at the Massachusetts Water Resources Authority and the Committee for Public Counsel Services. Union representatives and employees backed bills to extend just-cause protections, promotional rights, and collective bargaining rights to MWRA and CPCS workers, arguing they currently lack protections available to most other public employees. Testimony described unfair discipline, delayed promotions, and high turnover, and committee members indicated prior favorable action on similar MWRA bills and expressed support for addressing CPCS labor rights. The committee also heard from representatives of the Massachusetts Municipal Association and public higher education employees in support of H. 2820, which would require timely funding of ratified state employee contracts, with witnesses describing long delays in receiving negotiated raises and back pay. No votes were taken during the hearing, and the chair repeatedly invited written testimony and closed each panel after questions.

Transcript Highlights:

• Get that slot before you can actually receive the services, so you can't retroactively apply those services
• “The pediatric rate increase for children's dental services.
• pay for anesthesia services for all adults?”
• Do we have something similar to that within fee-for-service Medicaid?
• Lab services are a mandatory service by CMS. Every Medicaid state has to offer them.

Summary: The Administrative Rules Subcommittee of the Arkansas Legislative Council reviewed several agency rules and requests. It approved without objection an Insurance Department amendment implementing Act 261’s holding company system requirements, two State Board of Election Commissioners rules on poll watchers/provisional voting and certified election monitors, and a Treasurer of State rule removing DEI-related membership requirements to comply with Act 938. The committee also held over for a month a Department of Education request related to excluding a rule from reporting requirements so it could be discussed further with the Department of Commerce. A major portion of the meeting focused on the Department of Human Services’ request to be excluded from rulemaking for Acts 567, 568, 967, and 1025. DHS said federal CMS guidance created comparability and other issues for the Medicaid-related dental and diagnostic lab provisions, making it difficult to implement the acts as written by their effective dates. DHS outlined possible paths, including broader adult dental coverage, waivers, or splitting the dental rate increase from the special-needs cap increase. The Arkansas State Dental Association disputed DHS’s approach, arguing Act 1025 is workable, that the pediatric rate increase should move forward separately, and that DHS should continue pursuing the law rather than stop rulemaking. Committee members questioned both sides extensively about CMS correspondence, waiver timelines, fiscal impact, and whether the acts could be severed. After testimony from DHS, the Dental Association, and a public commenter, the committee adopted a motion not to exclude DHS from reporting requirements for Acts 567, 568, 967, and 1025, meaning DHS must continue the normal rulemaking/reporting process. The committee then accepted the Division of Higher Education’s report, which recommended repealing three of its 32 rules and keeping the remaining 29 in effect. It also received routine written updates on older and newer rulemaking items and filed the monthly updates without further action.

Transcript Highlights:

• AB 2233 does not expand benefits or mandate new services.
• As a result, he will likely go without services during that week, not because funding is unavailable
• I work with a single mother raising two children, both authorized to receive ABA services.
• Thank you for your time and your service to the people of the state.
• At the Gender Health Center, we provide low-barrier services to our community.

Keywords: 987, senate, all

Transcript Highlights:

• But when you make the link between taxes and governmental services, answers change.
• services, investments.
• There is no cut in services based on this tax cut.
• Again, no essential services are being cut by what we're doing here today.
• But again, no cuts in the services. Any other discussion?

Summary: The Senate Revenue and Tax Committee met to consider Senate Bill 1, sponsored by Senator Jonathan Dismang, which continues the state’s long-running effort to reduce Arkansas income tax rates. Dismang said the bill would lower the personal income tax rate retroactive to January 1, 2026 and delay the corporate income tax change until the following January, bringing the rate down from 7% to 3.7%. He also said the bill would use existing surplus funds and estimated that a person making $65,000 would see their effective tax burden reduced by about 45% compared with earlier rates. The committee heard several witnesses in opposition, including a United Methodist pastor/social worker, a parent describing her son’s disability and need for supported living services, representatives from Arkansas Appleseed and Arkansas Advocates for Children and Families, and a Marshallese community advocate. They argued that Arkansas should preserve revenue for public schools, health care, food assistance, housing, rural hospitals, early childhood education, and disability services, and said the tax cuts would disproportionately benefit higher-income taxpayers while providing little relief to working families. Several speakers cited low state spending relative to national averages and warned that further cuts would worsen existing service gaps. In closing, Dismang and other supporters said the state can be both compassionate and competitive, that no essential services would be cut by the bill, and that Arkansas has continued to grow revenue despite prior tax reductions. Members emphasized balancing service funding with economic competitiveness and noted the legislature’s focus on lower-income tax brackets in earlier reforms. The committee then voted to do pass SB1, and the bill was approved.

Transcript Highlights:

• Department of Children and Family Services.
• It is their standard measures where we look at preventive services, any services, and... ...standard
• measures where we look at preventive services, any services, and treatment services.
• services rates.
• Blue is treatment services. Goldenrod or yellow is prevention services.

Keywords: 962, all

Summary: The MAPOC Women and Children’s Health Subcommittee heard a presentation from Kate Parker Riley, executive director of the Connecticut Dental Health Partnership, on the Husky Dental Program and efforts to improve oral health during pregnancy. She reviewed the structure of Connecticut’s Medicaid dental benefit, the ASO model, provider network, utilization trends, and member barriers to care. She noted that children’s dental measures remain above the national median, but adult utilization is lower and the dental provider network has been shrinking, with longer wait times in rural areas. A major focus was the state’s goal to raise the rate of oral evaluation during pregnancy from about 17.5% to 25% by 2030. Riley described planned outreach to OB/GYN practices using a draft “snapshot” report showing each practice’s pregnancy oral-health rate compared with the state average, along with education materials based on ACOG and AAP guidance. Committee members and guests discussed barriers such as lack of provider training, workflow burden, access to dentists who will see pregnant patients, and the need for stronger referral bridges. Suggestions included adding simple oral-health screening questions in OB settings, using human support to make appointments, and exploring co-located dental hygienists or other embedded models. Riley also highlighted partnerships with DSS, DCF, Head Start, WIC, Read to Grow, YMCA programs, refugee resettlement agencies, and school-based and hospital partners, as well as data-sharing and navigation efforts. She said pregnant members newly identified through HUSKY will now receive outreach and navigation support. DSS dental director Carolyn MacArthur introduced herself and said she supports the initiative, noting the literature linking untreated maternal dental disease to poor child oral-health outcomes. No votes were taken; the meeting ended with thanks and a preview of upcoming July presentations on integrated behavioral health and home visitation programs.

Transcript Highlights:

• Adult Mental Disability Services.
• Adult Mental Disability Services.
• Leslie Fiske, Secretary of Shared Administrative Services.
• The Division of Services for the Blind is a little different.
• with the Division of Services for the Blind.

Keywords: 1204, all

Transcript Highlights:

• And I think of those as our due process services.
• Solving courts deliver the services in a way that we use.
• A gate of in forensic services and criminal justice information services with bad and Pollard Deputy
• certain disciplines and all of our additional services while supplementing the services to the county
• And we always meet the rest case requests, forensic services.

Keywords: 999, senate, all

Transcript Highlights:

• environmental service. environmental service.
• out for lead service line replacements. out for lead service line replacements.
• Paul Regional Water Services.
• Paul Regional Water Services.
• service line replacement. service line replacement.

Keywords: 1183, house

Transcript Highlights:

• Most of our locals that we represent provide an ambulance service.
• That goes for the fireground and emergency medical services.
• It was a full-service, acute care hospital.
• It was a full service, acute care hospital. standard inpatient care.
• It was a full-service acute care hospital.

Keywords: 995, all

Summary: The committee first heard testimony on H. 3599, a bill concerning access to historic Indian lands and easements for landlocked tribal parcels in Massachusetts. Witnesses, including members of the Mashpee Wampanoag and Herring Pond communities, said the bill would restore access to family lands that have long been treated as landlocked and had been denied easements by necessity in prior court rulings. They described heavy tax burdens, prior litigation, and support from the Mashpee Wampanoag Tribe, with conditional support from the Aquinnah Wampanoag Tribe pending language changes. Committee members asked about the tax assessments and the status of tribal support, and the chair said the committee would follow up on possible amendments. The committee then took up S. 2922, which would authorize an underground easement at Magazine Beach in Cambridge for the Greater Cambridge Energy Project. Eversource representatives said the easement is needed for a transmission line connecting the Brighton and Kendall Square substations, supporting grid reliability and the Commonwealth’s clean energy transition. They said DCR would receive fair market value and replacement land in Wendell to satisfy Article 97 requirements. No objections were raised, and the panel’s testimony concluded without a vote recorded in the transcript. Most of the hearing focused on H. 5047, which would authorize the Commonwealth to take the Norwood Hospital site by eminent domain so the hospital can be restored. Sponsors, local officials, hospital task force members, EMS and fire representatives, a chamber of commerce leader, and a former hospital administrator all argued that the 2020 flood and Steward’s bankruptcy left the region without adequate care, causing longer ambulance transports, emergency room boarding, staffing strain, and economic losses. They said the site remains a partially completed shell, that the state should be able to acquire it and bring in a nonprofit operator, and that the taking would not require state funding because an operator would pay the acquisition costs. Committee members from both chambers expressed support and asked about costs, timing, infrastructure, and whether a nonprofit operator is being pursued. The chair took the bill under advisement after extensive testimony; no vote was taken in the transcript.

Transcript Highlights:

• some tertiary services offered by hospitals. ...and then some tertiary services offered by hospitals
• You enhance statutory provisions around access to care services.
• And services are available 24-7, 365 days a year.
• But now when you cut patient services, you are cutting the providers.
• We really are cutting frontline staff as we're cutting services.

Summary: The committee heard a JLARC presentation on the Department of Health’s oversight of hospital inspections, complaints, and reporting. JLARC said DOH was late on 72% of acute care hospital inspections as of December 2024, had not verified that third-party accrediting standards were substantially equivalent to state standards, did not consistently require proof of those inspections, did not review adverse health event corrective plans, and could make hospital data more accessible. JLARC also raised a possible language-access barrier in the complaint system. Members asked about complaint filing by staff, the meaning of adverse health events, inspection outcomes, and whether the audit compared DOH to other agencies. JLARC said it had not reviewed inspection results or cross-agency comparisons, but noted inspectors were dedicated and working long hours. DOH later said it concurred with the recommendations and outlined a strategic plan with target dates for improving timeliness, verifying accreditation standards, expanding language access, reviewing adverse event laws, and improving public data access, with annual reporting to the Legislature expected. The committee then heard a Department of Health presentation on certificate of need modernization. DOH described the current certificate of need process, which reviews need, financial feasibility, quality, and cost containment for certain facility changes and new services, and said the program has not been modernized since the 1980s. DOH proposed 10 statutory modernization recommendations, including clarifying the program’s purpose, creating a planning entity, adding flexibility, reducing legal costs, updating access-to-care standards, expanding oversight to freestanding emergency departments and urgent care, addressing equity, improving cost control coordination, strengthening long-term funding, and using better data systems. Members asked about oversight of freestanding urgent care and EDs, funding sources, and whether the process could be streamlined or made more responsive to complaints or other triggers. A third panel discussed artificial intelligence in health care. Lucy O’Rourke of the Coalition for Health AI described CHAI’s work on responsible AI principles, technical standards, model cards or “nutrition labels,” testing and governance tools, and educational resources for providers. She said the group is focused on trust, transparency, fairness, safety, security, and privacy, and noted Washington’s AI-related policy work as among the more progressive in the country. No questions were asked. The final portion focused on the financial impact of federal and state health care policy changes. The Washington State Hospital Association said hospitals are facing low or negative operating margins, service reductions, layoffs, and closures, and that state cuts and taxes enacted in 2025, combined with federal HR1 changes, will significantly worsen finances. Providence Swedish leaders described staffing reductions, service cuts, delayed capital investments, and pressure from denials, tariffs, and reimbursement changes, while emphasizing that frontline staffing cuts are tied to service reductions rather than nurse-to-patient ratio changes. The Washington Health Benefit Exchange then began a presentation on expiring federal ACA premium tax credits, state Cascade Care Savings assistance, and eligibility changes affecting lawfully present non-citizens, with examples showing large premium increases for customers if federal subsidies expire.