Transcript Highlights:

• , and gave future rate-setting authority to the Pension Funding Council. ...and gave future rate-setting
• rates on the prior slide.
• rate column, the PERS employer rate reflects an underlying minimum rate of 4.6%.
• We saw that for PERS, where the combination of the minimum rate... ...2027-29 biennium rates.
• This would invite a motion to adopt the rates. I make a motion to adopt the rates. Thank you.

Keywords: 904, all

Transcript Highlights:

• That kicks off our rate-setting process. So 2025 is the basis for 2027 rates.
• for 2027 rates.
• for 2027 rates.
• year 2027 rates.
• So for 2027 rates, OHA is moving to release the rate model on August 12th to provide 21 2027 rates.

Keywords: 907, all

Summary: The committee held an informational hearing focused first on Oregon Medicaid coordinated care organization (CCO) finances and rate setting. Oregon Health Authority staff explained how 2025 CCO financial results will inform 2027 capitation rates, including reserve requirements, subcapitation arrangements, and major cost drivers such as behavioral health, pharmacy, rural hospital costs, and dental directed payments. They said the Legislature’s added 2025 funding materially improved CCO margins and that, without it, the program would have been negative overall. Members asked about retained earnings, subcapitation, behavioral health utilization, ABA therapy, and whether outcomes are being evaluated; OHA said rate setting is actuarial and that CCOs, OHA, and other partners all play roles in monitoring efficacy and access. OHA also reviewed House Bill 4039 changes intended to increase transparency and give CCOs earlier access to rate information and reconciliation exhibits. CCO representatives then testified that the system is under significant financial pressure and that behavioral health state-directed payments, benefit changes, and federal uncertainty from H.R. 1 are reducing flexibility. CareOregon said it has lost more than $500 million over the last couple of years and is now making provider terminations and other network changes to align spending with available funding, while emphasizing that CCOs must make hard decisions about which services and providers can be sustained. Eastern Oregon CCO said rural and frontier factors, cost-based hospitals, air ambulance needs, and statewide efficiency adjustments are not fully reflected in rates, and that dental funding is especially strained. Trillium similarly warned that state-directed payments and benefit expansion pressures are constraining the global budget model and that H.R. 1 could worsen acuity and volatility. Members pressed the witnesses on who is responsible for evaluating treatment effectiveness, especially for ABA and psychotherapy, and on how utilization limits and reimbursement changes are being used to control costs. The committee then shifted to an overview of the Affordable Care Act and Oregon’s commercial insurance market. Department of Consumer and Business Services staff explained actuarial value, metal tiers, premium tax credits, medical loss ratio rules, and the main drivers of premium rates: cost trend, utilization trend, and administrative costs. They said mandates have likely added only a limited amount to premiums over the past decade, though the exact effect is difficult to isolate, and they gave examples of how high-cost, low-volume services versus broad, high-utilization services can affect rates differently. Staff also noted that Providence Health Plan and PacificSource Health Plans are withdrawing from the individual market, though consumers should still have at least three insurer options in every county and may have four in many counties. The division said it is in the middle of reviewing proposed 2027 rates and will continue its public rate review process, including hearings and written comment.

Transcript Highlights:

• Any questions on the rates, committee? Any questions on the rates, committee?
• How do you establish a rate, a leave day rate that might be different than the full rate?
• It's different than the flat rate. It's a little more complicated than the flat rate.
• We work on their rates in December for a January 1 rate year. And just, Mr.
• One flat rate would be preferable if you're going to do a flat rate. One flat rate.

Keywords: 908, all

Summary: The committee first took up Senate Bill 2399, concerning therapeutic leave days for psychiatric residential treatment facilities (PRTFs). Sarah Aker from the Department of Health and Human Services explained the current Medicaid rate-setting methodology, how occupancy affects rates, and why paying the full rate for leave days would create additional fiscal impact. Members debated whether the bill should pay the full Medicaid rate, a flat reduced rate, or a tiered rate, and discussed whether a cap or department authorization should be used to control use of leave days. The department said it was not supporting the change as it was not in the governor’s budget, though it supported family engagement in care. After discussion, the committee settled on a compromise motion to set therapeutic leave days at a $500 daily rate and require department authorization of the number of leave days. The motion passed 6-2, with Representative Anderson voting no and the rest of the recorded members voting yes. The committee then moved on to Department of Corrections and Rehabilitation budget materials, where Michelle Zander walked through detailed population and rate calculations for women’s and men’s facilities, county holds, deferred admissions, transitional facilities, work release, and proposed reentry, man camp, and Grand Forks-related costs. Members asked about the county jail reimbursement rates and the overall pool of funds, and Zander explained the calculations and noted the proposal was roughly break-even depending on assumptions. The committee also heard an overview of DOCR IT requests from Amy and NDIT staff, including data processing, medical modules, a new client management system, body scanners, data management tools, facility management software, medical software upgrades, college solutions, and body cameras/tasers. Staff explained that the new client management system would likely be a multi-phase project with a wide cost range based on vendor selection and scope, and that the current request was for phase one. Members emphasized the importance of better data tracking, staff safety tools, and information that could help explain programming and release outcomes to the public. The committee planned to continue with Veterans Affairs the next day and then return to Senate Bill 2015.

Transcript Highlights:

• When it comes to recurring rates, most jurisdictions adopt a rate formula to set a cap.
• We publish the rate, give them the rate which is $12.50 is what we charge. OK, OK.
• rate of return.
• With the PUC to raise rates, then we were raising rates and I'm not exaggerating.
• where a rate may not exceed either the existing pole attachment rate.

Transcript Highlights:

• On the rate issue, I'm happy to address that. We're using a blended rate.
• We don't have that many, and our rates are way below the FCC rate.
• No attacher actually has used that rate; they've negotiated a different rate.
• As far as the FCC rate being a good enough rate for the IOUs, remember, values have a guaranteed rate
• Support this rate anymore.

Bills: HB3445, HB3448

Keywords: telecommunications, electric cooperative, rights-of-way, infrastructure, provider access, right-of-way, pole attachment, regulatory access, 1184, house, all

Transcript Highlights:

• than 10% from a previously filed rate.
• than 10% from previously filed rate.
• Right now, it's a process where they get to file the rates, use those rates, and then they are scrutinized
• And yes, rates have continued to go up, but just because rates are going up does not mean that the system
• rates for their policies.

Summary: The committee first took up several bills and voted them out favorably without amendment: SB 2857, relating to prescription drug purchasing proof for certain health benefit plan issuers and employers; SB 1307, relating to the biennial health coverage reference guide; and SB 527, relating to health benefit coverage for general anesthesia for certain pediatric dental services. Each of those motions passed on a 7-0 roll call. The main discussion centered on SB 1643, which would require prior approval from the Texas Department of Insurance for property and casualty rate changes above 10% from a previously filed rate. The chair framed it as a response to rate volatility and rising homeowners and auto premiums, while several members questioned whether it would slow a market that is already stabilizing and could encourage insurers to file repeated increases just under the threshold. Witnesses from consumer groups supported tighter oversight and argued for a lower threshold, while insurance industry representatives opposed the bill, saying Texas’s file-and-use system and competitive market work better and that the proposal could increase costs or create uncertainty. After testimony, SB 1643 was left pending. The committee then heard SB 1642, which would replace the single Texas Department of Insurance commissioner with a three-commissioner structure and an executive director. Supporters said it could improve accountability and transparency, while opponents argued the current single-commissioner model is more efficient and avoids confusion and added cost. Witnesses also raised concerns about open meetings issues, administrative expense, and the lack of a clear model from other states. SB 1642 was also left pending. Finally, the committee heard SB 2530, the Texas Windstorm Insurance Association omnibus bill. The bill would make a number of changes to TWIA’s governance and finances, including exempting TWIA from certain taxes, moving its headquarters to a coastal county, changing board composition and voting rules, and lowering the probable maximum loss standard from 1-in-100 to 1-in-50. Supporters said the bill would strengthen TWIA’s reserve funding and improve local relevance, while opponents warned it could increase assessments, reduce reinsurance protection, and create operational risks by relocating the headquarters to the coast. The bill was left pending, and the committee then adjourned.

Transcript Highlights:

• So, my question is: if you don't know the rates for National Grid, then how do you say that the rates
• Most people have no idea what a good rate is or what is not a good rate.
• service rate.
• rate-making study.
• pump rates across the utilities.

Keywords: 995, all

Summary: The committee heard testimony on several energy-related bills, with the main focus on H. 3534/S. 2255, which would ban or sharply restrict residential third-party electric suppliers, and on related reform proposals. Supporters included the Attorney General’s office, municipal and regional planning officials, environmental justice groups, consumer advocates, and city officials from Boston and Chelsea. They argued that the residential competitive supply market has produced higher bills, deceptive sales tactics, auto-renewals into higher rates, and disproportionate harm to low-income residents, seniors, communities of color, and people with limited English. Witnesses cited AG reports estimating hundreds of millions of dollars in overcharges over time, described door-to-door and storefront marketing abuses, and said municipal aggregation programs have saved residents money while offering more stable rates. Several supporters said the Legislature should either ban residential competitive supply or adopt strong guardrails such as ending automatic renewals, banning incentive-based commissions, and capping rates relative to basic service. Opponents or industry representatives from the Retail Energy Advancement League, Vistra, and Constellation argued that the market can provide savings, longer-term price stability, and value-added products such as renewable options and time-of-use offerings. They said Massachusetts has already improved consumer protections through DPU proceedings, that complaints are relatively few compared with the size of the market, and that a ban would eliminate consumer choice. They also defended direct sales and commissions as normal features of a retail market, while saying they would support additional protections, licensing, bonding, and stronger oversight of bad actors. Committee members pressed both sides on whether the market truly saves money, whether automatic renewals should be banned, and whether the AG’s proposed reforms would be enough. The committee also heard testimony on H. 3972, a bill to extend utility shutoff protections during extreme heat, with Rep. Mindy Domb arguing that Massachusetts should treat extreme heat like extreme cold and protect customers facing financial hardship. Rep. Barrett also testified for H. 3450, a municipal broadband/right-of-way bill, arguing that communities need easier and cheaper access to utility poles and public rights of way to build municipal broadband. In addition, Senate Majority Leader Creem testified for S. 2239, which would bar utilities from recovering ratepayer funds for lobbying, promotions, trade association dues, and similar expenses. No votes were taken during the hearing.

Transcript Highlights:

• , RATE PAYERS, AND 61.6% HIGHER THAN THE NATIONAL AVERAGE AMONG RATE PAYER WHICH IS SEEMS TO CONTRADICT
• It was about the rate cases, so utility companies come forward to the P.S.C. and they bring a rate case
• And that would assume that a formal rate case is happening in this four-month cycle, and when a rate
• That keeps our rates down.
• That keeps our rates down.

Keywords: 993, senate, all

Summary: The Senate convened, approved the prior journal, and then took up a series of utility and public service bills and resolutions. A resolution sponsored by Senator Scarcella-Spanton designating April 9, 2026, as Yellow Ribbon Day was adopted after remarks honoring veterans, active-duty service members, and their families. The chamber then moved through several Public Service Law measures focused on utility affordability, consumer protections, and PSC procedures, with some bills laid aside and others advanced. Among the bills passed were measures by Senators Mayer, Cleare, Hinchey, Comrie, and Parker. Debate on the Mayer bill centered on limiting utility expenses and fees recoverable in rate cases; supporters said it was part of a broader package to reform PSC practices, while opponents argued it would not lower current bills and had been softened from earlier versions. The Webb bill creating a residential utility usage monitoring program drew extended debate over whether it would meaningfully reduce costs, who would pay for the program, and whether it could lead to government monitoring of household usage; supporters said it would give consumers more control and transparency, while critics said it would not lower rates. The Gonzalez bill, which would add consumer protections during PSC investigations and delay shutoffs in certain circumstances, also passed after questions about whether it applied to rate cases, with the sponsor saying rate cases were explicitly excluded. Several members explained their votes, with supporters emphasizing affordability, transparency, and consumer protection, and opponents arguing the package would not address immediate rate relief and could burden ratepayers or encourage nonpayment. Senator Tedisco and others criticized PSC appointments and state energy policy, while Democratic sponsors argued the bills were part of a longer-term effort to reform utility regulation and address climate and affordability concerns. The chamber restored multiple bills to the non-controversial calendar before final votes, and the recorded results showed passage of the major utility bills by substantial margins, along with one amendment appeal being ruled nongermane and rejected.

Transcript Highlights:

• HOURLY RATE?
• THE RATES ARE STANDARDIZED.
• THE RATES?
• WHEN YOU FACTOR IN THE RATES? WHEN YOU LOOK AT THE RATES?
• AND DOES THIS RATE DO THAT?

Transcript Highlights:

• <00:03:02.400> in in 2024 auto insurance rates in in 2024 auto insurance rates in Minnesota
• used by insurance companies to set rates used by insurance companies to set rates determine<00:04
• So since that about 10% uninsured driving rate, we have seen an incredible increase in those rates that
• disproportionately these higher rates disproportionately these higher rates are<00:18:46.760>
• pay it off quickly which means her rate pay it off quickly which means her rate of<00:19:38.720>

Keywords: 1183, house

Transcript Highlights:

• <00:04:31.440> that now the low ma reimbursement rates that now the low ma reimbursement rates
• and behavioral health home rates to the DHS study calculation, as these rates do not have an equivalent
• equivalent as well as increases rates equivalent as well as increases rates for<00:08:36.120>
• > almost<00:08:56.000> all rate increases impact almost all rate increases impact almost
• health reimbursement rate.

Keywords: 919, house, all

Summary: House File 105 was presented by Representatives Beerman and Baker and then laid over for possible inclusion in a future omnibus bill. The bill would implement the remaining mental health and physician service recommendations from DHS’s rate study, including raising certain Medicaid reimbursement rates to at least 100% of Medicare where a Medicare equivalent exists, increasing community-based children’s and adult mental health rates and behavioral health home rates, and phasing in additional increases over three years. The authors said the proposal also addresses master’s-level clinician reimbursement and fee-for-service hospital inpatient mental health services, and they emphasized that the changes are intended to improve access, transparency, and provider stability. Both authors argued that low MA reimbursement rates are driving access problems across Minnesota, especially for children, families, and rural communities. They said providers are struggling to hire and retain staff, clinics are closing or shrinking, and patients are facing long waits, boarding in hospitals, or delayed care. Representative Baker said the issue is personal and described the bill as a phased, long-term approach because of state budget limits and the size of the cost, which he said is in the hundreds of millions but still awaiting a fiscal note. Public testimony was strongly supportive overall. A family physician said higher rates would improve access, keep clinics open, and help patients avoid emergency care, while a Children’s Minnesota mental health leader described more than 1,200 pediatric boarding episodes in 2024 and said outpatient investment is needed to reduce pressure on emergency and inpatient services. A rural provider said her organization had to close an in-home children’s mental health program because of insufficient reimbursement, harming access in underserved counties. A psychologist testifying for the Minnesota Psychological Association supported the bill’s general direction but objected to repealing the pay differential for doctoral-level psychologists, arguing that doctoral training is more extensive and that eliminating the differential could worsen workforce shortages. After testimony and member questions about the bill’s scope and cost, public testimony was closed and the bill was laid over.

Transcript Highlights:

• Residential rates, compared to 2023, increased by 4.5 percent in 2024, while residential rates only saw
• been for a rate payer.
• Bolduc:** Windstorm rates are determined by our board of directors, and any increase in rates must be
• Or if they've charged anybody in that time frame, if the rate—not all rates immediately go in.
• If the rate, so not all rates immediately go in. Into effect.

Keywords: 1185, senate, all

Transcript Highlights:

• THE NEXT SLIDE WILL HAVE INFORMATION ON THOSE RATES.
• RATE WE WOULD SHOW FOR THIS MARKET.
• HIKES, I SAW ONE RATE HIKE OVER 51% AND SOME OVER 40%.
• Cassel: GOING BACK TO SLIDE 10 TALKING ABOUT THE RATES WE KNOW THE APPROVAL RATES ARE FOR THE COMING
• WELL WE SEE A DECREASE IN THE RATES? LONGER REASONABLE. WELL WE SEE A DECREASE IN THE RATES?

Transcript Highlights:

• growth rate. growth rate.
• It's a slower growth rate than the nation's rate of 6%.
• > unemployment rate, the women's unemployment rate, the women's unemployment<00:14:19.199> rate
• rate.
• rates.

Keywords: 1183, house

Transcript Highlights:

• State Ratings for Fitch Ratings, and I think Mr. Kim is via Zoom. Yes, I am. Oh, there you are.
• My name is Eric Ben—I am an analyst at Fitch Ratings. I manage the rating stream.
• rating that process happens in a rating rating that process happens in a rating committee<00:12:
• <00:13:04.959> and rating is we publish that rating and rating is we publish that rating and
• <00:13:52.320> for<00:13:52.560> US ratings data our average rating for US ratings

Keywords: 1187, senate, all

Transcript Highlights:

• So, lower rate, but it would still be a rate, not the same as today.
• So, lower rate, but it would still be a rate, not the same as today.
• in rate cases usually.
• in rate cases usually.
• in rate cases usually.

Keywords: 912, senate, all

Summary: The joint Senate hearing focused primarily on SB 1201, a wildfire measure that would create a wildfire recovery fund and allow securitization for electric utilities. Hawaiian Electric strongly supported the bill, saying it would help protect customers, property owners, insurers, and the broader economy from future catastrophic wildfire liability while improving the utility’s credit profile and lowering financing costs. Support also came from DCCA Consumer Advocacy, the Attorney General’s office on written comments, Ulupono Initiative, Clearway Energy Group, IBEW Local 1260, Par Hawaii, KIUC, the Chamber of Commerce Hawaiʻi, Plus Power, and numerous organizations and individuals. Opponents or commenters raised concerns about the liability cap, victim compensation process, and fund structure, including the Hawaiʻi Association for Justice, the Hawaiʻi Regional Council of Carpenters, and the Hawaiʻi Insurance Council; Henry Curtis of Life of the Land supported the concept of a fund but questioned the catastrophe threshold and whether the fund would be empty without a prudency finding. Much of the discussion centered on whether the proposed fund would actually help restore Hawaiian Electric to investment grade, with senators comparing the proposal to California’s wildfire fund. Hawaiian Electric said the bill was only one part of a broader process, alongside physical risk reduction and settlement finalization, and argued that without the bill the utility would not regain investment grade. Senators also questioned the proposed $1 billion fund size, the fairness of ratepayer contributions versus shareholder contributions, and whether customers should pay for consulting and administrative costs; Hawaiian Electric said its proposed amendment would remove those consulting-related charges. The company also said the fund would accrue interest and, if unused, could be returned to customers, and that there would be replenishment and supplemental contribution mechanisms if the fund were exhausted. The Attorney General’s office said it still had further amendments to discuss, and the departments had not yet resolved where the fund should reside administratively, though Hawaiian Electric said it believed DCCA was the appropriate place but was open to alternatives. KIUC requested two amendments. No vote or final committee action was taken during the hearing, and the measure remained under discussion with questions and proposed amendments still outstanding.

Transcript Highlights:

• 114 staff to energy rate-making and 29 staff for water rate-making.
• as other proceedings that can impact rates outside of the general rate cases.
• PG&E's rate case, San Diego Gas & Electric's rate case, for example.
• the rate case.
• Demand response proceeding is rate setting because we're authorizing... The rate case.

Summary: The committee first heard Issue 1 on trailer bill language to redirect funding for emergency demand-response programs. The Department of Finance proposed using about $26.9 million in General Fund originally set aside for the Distributed Energy Backup Assets program to bolster the Demand-Side Grid Support Program for summer 2026, and using about $70 million in CalCHAP interest to support ratepayer-funded demand response in summers 2027 and 2028. The CEC and CPUC said they are working on a transition from DSGS to ELRP or a successor program, while the LAO noted the General Fund money would otherwise revert to savings. Members pressed the administration on whether demand response remains important, whether DSGS has been successful, and whether the state should keep funding it through the CEC rather than shifting to a ratepayer-funded CPUC program. The CEC and CPUC said the programs are not directly comparable, emphasized different cost structures and enrollment metrics, and said a CPUC rulemaking is underway with a proposed decision expected in Q3 2026. No vote was taken in the transcript. The committee then took up Issue 2, a budget proposal tied to SB 254 and the new transmission accelerator. GoBiz and the California Infrastructure and Economic Development Bank described a five-year, roughly $26 million request to staff and administer the accelerator and manage Proposition 4 and AB 1207 funds for transmission financing. Members asked about state liability, ownership of financed lines, FERC revenue requirements, and whether the program would help underserved regions and offshore wind development. Staff explained that the accelerator would only consider projects already identified through CAISO’s competitive transmission planning process, and that state financing would be a small portion of large projects intended to lower overall costs to ratepayers. The LAO said it had no specific concerns but urged the Legislature to ensure the final language matches its intent. The committee also heard Issue 3 on petroleum market oversight. The CEC and its Division of Petroleum Market Oversight requested additional positions and funding to implement ABX2-1 and continue work on supply stabilization, refinery monitoring, and transportation fuels analysis. Members questioned why the work was funded through the Energy Resources Programs Account, whether existing staff from the paused price-gouging work could be reassigned, and whether the program had produced evidence of price gouging or improved supply conditions. CEC and Finance said the new positions are needed because the workload has expanded, while some existing staff remain on related analysis and reporting duties. The discussion ended without a vote in the transcript.

Transcript Highlights:

• from having a rate case today. from having a rate case today.
• mandatory rate hikes.
• It equals mandatory rate hikes. thing. It equals mandatory rate hikes.
• c> rate.
• rate decrease? rate decrease?

Bills: HB475

Keywords: 923, senate, all

Transcript Highlights:

• Rebase Medicaid rates for ambulance service. So this isn't increasing rates.
• When we say rebase, that's really kind of aligning the rates to a new target rate.
• rate.
• And so again, it would align those rates to the Medicare lowest rural quartile rate. Mr.
• It really should be in the rate.

Keywords: 908, all

Summary: The Senate Appropriations HR Division met with all members present to review the medical services portion of the HHS budget. Sarah Aker, Executive Director of Medical Services, walked the committee through several budget items, including HCBS cost-to-continue adjustments, the DD bed assessment, expansion of value-based purchasing, targeted rate increases for home health and QSP services, and the cross-disability waiver. Members generally supported the targeted increases for home health and QSP, and Aker explained that the cross-disability waiver funding would support startup work, service design, and infrastructure ahead of a planned July 1, 2028 implementation. The committee spent significant time on rate-setting and provider payment issues. Members discussed ambulance rate rebasing, with several senators expressing concern that the proposed increase was too high relative to peer states; the committee ultimately moved toward reducing that item to $1 million rather than zero so it could be revisited in conference committee. They also discussed a House-added critical access hospital networking grant and similarly leaned toward reducing it to $1 million. Aker explained the department’s value-based purchasing plans, including use of a vendor selected through RFP, and clarified how the department’s existing Medicaid managed care and hospital value-based programs work. A major portion of the meeting focused on long-term care and basic care payments, including a House-added extension of the $5 per day basic care add-on and a proposed shift in nursing facility incentive grants toward a withhold-based model. Senator Mathern indicated he would bring an amendment to delay or modify the withhold change, and Aker said the department would prefer language that directly addresses whether a withhold may be implemented. Members also discussed 1915(i) services, FMAP changes, the Medicaid legacy system modernization carryover, and a House-added legislative intent section on medical assistance. The committee adjourned for the morning with plans to return later to continue Human Services budget work and revisit unresolved items in conference committee.

Transcript Highlights:

• Rate can be set by the ambulance company, whatever rate they want.
• rate I mean it rate or somebody sets the rate I mean it it<00:18:37.880> will<00:18:38.039>
• per of Medicare rate of Medicare per of Medicare rate of Medicare rate<00:25:22.520> is<00:25:
• c> rate<00:25:35.000> must<00:25:35.200> be mandate the rate must be mandate the rate
• rates the board of rates I don't set the rates the board of fire<00:59:46.119> Commissioners<

Keywords: 928, house, all

Summary: The subcommittee discussed three ambulance reimbursement bills and tried to distinguish their approaches. House Bill 185 would require insurers to pay the full amount billed by an ambulance provider when there is no contract rate, with no balance billing to the patient; the Insurance Department clarified that emergency ambulance services are already covered under the benchmark plan, so the bill’s reference to policies without ambulance coverage is effectively meaningless. House Bill 725 would set reimbursement at 325% of the Medicare rate for non-contract ambulance services and prohibit balance billing. House Bill 316 was described as addressing the broader problem that Medicare/Medicaid rates are low and that current balance billing shifts costs to patients or municipalities; its sponsor said the bill would require insurers to pay a rate that gives providers a fighting chance to remain in business, and he viewed 325% of Medicare as the most logical option. Members debated whether insurers should pay the billed amount, a negotiated in-network rate, or a regulated percentage of Medicare. Some argued that out-of-network ambulance providers are underpaid and that in-network rates are often too low to sustain service, especially for emergency providers who cannot steer patients. Others said ambulance companies should not be able to bill whatever they want and questioned the fairness of charging insured patients or insurers more than the service is worth. There was also discussion of whether rate schedules should be reviewed by an oversight body and whether different costs in rural areas justify different reimbursement levels. A recurring issue was balance billing and who ultimately bears the shortfall. Several members said balance billing harms patients and often does not get paid, leaving cities and towns or property taxpayers to cover the difference for municipal ambulance services. Others argued that shifting the cost to insurance premiums would spread the burden more fairly, though it could raise premiums by a few dollars per person per month. No vote or final action was taken in the excerpt; the discussion focused on clarifying the bills and weighing their policy tradeoffs.