welcome to conversations with l mcfarlane today we're presenting the program from the minneapolis mn league in a glass to be here glad to have you along those who are watching on television and those listening on k f a i today's program is an important one we're talking about health insurance for minnesota it's got a new program called men sure and it's a product of the federal legislation for health care reform i'm pleased to have to speak about that april tot mom love who is executive director of men sure joining us in this conversation two pillars in the community two advocates two people who deliver value to the health of our community stella whitney west is c e o of north point health and wellness and michel davis is the intersection director of the minneapolis urban league thank you all for being here and first of all april taught memoir thank you for being here let's let's begin by sort of men sure one hundred one what is it and what does it mean for minnesota to new idea novel idea and a great opportunity i believe for many many more minnesotans to have health insurance absolutely absolutely thank you for having me it's great to be here so i think what you could say about minister is about exchanges generally are four key things one is that the purpose of minister is it's really a new marketplace to find health insurance and the first key thing is that it's supposed to make things simpler and easier i think we all understand that health care is way too complicated most people have a very hard time understanding it there's a lot of terms that are very hard to understand and so really it's to make health insurance much easier for for people to understand and for people to find coverage so it's one place for coverage regardless of the source or type so it includes public programs private coverage for individuals and small businesses or two the second purpose of men sure is to make health care coverage more affordable and that is really done in two ways one is that it's a place where financial assistance that came under the affordable care act will be available so people have access to tax credits to help them purchase insurance some people may also be eligible for free coverage depending on what their income is and then thirdly it also provides a mechanism to encourage insurers to be more innovative and more competitive with each other so that's number two number three is it provides more freedom of choice of health care options and so it's going to provide people with information to help them make the choice that's best for them and their families and so this is particularly of interest for small businesses where in the past small businesses have typically picked one plan and their employees are all in one plan this allows the employees to pick the plan that's best for them and taking that employer contribution to help them afford that coverage and then fourthly what i would say is that it also provides more assistance and localized assistance and it helps people where they're at so if people want to go online to get that help they can absolutely do that in the comfort of their home if they want to use the phone and calling it such and get help from someone  over the phone they can do that and we'll also have people on the ground in local communities that can also help individual communities with the needs that they have and so those are really the four pillars of what insurers decide to do the concept of exchange some people are going to be and an online shopping mall for people to find information i think the reason why it's called an exchange is that early in its development it was kind of kind of referred to as a kind of stock exchange where people go to buy and sell products and information is relative readily available so i think that's where the word exchange came from but really it is it it is meant to be a simple shopping mall for health insurance seeing the information online correct that is the goal that we try to make this as simple as possible possible so that a person can do this on their own online so what does it mean walk me through it i'm a person who lives around the corner here in north minneapolis and maybe had health insurance at my company but they've cut back because of all kinds of reasons but i still need insurance i've been waiting for obamacare to kick in because i think there should be something for me but i don't know exactly what that should be walk me through the process  few things people can do first you can just go on line and see what it is so you can see what products are available you can see what the price is you can look and see information on customer satisfaction on the quality of both the health plan and of the healthcare providers that are associated with that plan so you can just shop and see what's available that's one thing you can also go and see what you might be eligible for so you can enter in some personal information like your name and your address and it can cross check some information about your income for example to see if you might be eligible for tax credits or even free coverage to see what that would be still see what you're eligible for and then based on those two sources of information you can decide what's best for you so do you want certain providers in your network do you want a certain cost to pay premium or an important to you or is cautioning more important to you really they can they can base that decision on what is what is most important to them maybe in the  under the affordable care act health insurance is changing for everyone and so we're trying to decide in minnesota if it makes sense to have minnesota care continue or not there is an option where minnesota care could continue up to two hundred percent of the federal poverty level which is about forty four thousand for a family of four but right now it's at the legislature and so that that decision needs to be made at the legislature by the end of this may and so we will know by then whether or not that continues as a program or whether or not people  able to get tax credits to purchase private coverage at those income levels when we listened to the president in the congress debate affordable health care so that kept coming out was that this is going to require and  provide opportunity for everybody it's one hundred percent how does that shake out in minnesota number one does minshew or become the vehicle for universal coverage for every minnesotan that's question number one i've got five more after that but start with that was not with that one well i definitely think there's the opportunity there to get close with that really it is myn sure is there for all individuals and small businesses but but we know that that probably won't reach everyone i think you know the estimates that are there at the national level is that you'll probably reach sixty percent of the uninsured there are still some out there that just won't have insurance and don't want to buy it and there will be a variety of reasons for that but but i really think this gets gets us a long way there but it won't it won't reach probably won't reach everyone yet quite yet so describe the landscape the terrain for insurance and insurability in minnesota how does it look right now if the goal is to reach sixty cent  is that sixty percent of men are still to be insured what's the current status and what would it take to get us to closure two hundred percent so in minnesota today we have about five hundred thousand individuals that are uninsured our projections  that will get down to about two hundred thousand or less that are there i think a few of the things that are changing that will help with that is one the financial systems that i mentioned people get financial systems to purchase coverage hopefully will also be much easier for people in the application process will be much simpler today to get access to financial assistance often takes a couple of months with a lot of information to provide and it often is quite daunting i think for people to do so making it easier so so really it's  to to make choices easier to make things more affordable for people and to provide them the assistance that they need one other thing that i'd mention to that is very different in the future of than it is today is that people can't be denied for health insurance anymore so today based on your health status insurers can deny you they can no longer do that in the in the future they can't deny you based on your health status they can't say you have a preexisting health condition that we're not going to cover they can't charge you more because you're sick that all goes away and so i think that will encourage people to to to come to the door and get insurance and so explain then or describe the use of insurance in inner city communities one of our missions today is to talk about men sure and its impact or the opportunity represent to african americans and people of color and if you would give us sort of a primer on what the state's experience has been in providing coverage or of people of color getting coverage in minnesota well i think minnesota does have a lot of disparities in terms of health insurance coverage populations of color are you know two three four times less likely to have insurance and i think you know one of the reasons to really have health insurance is that safety and security to know that there's care there when you need it that you can get it wherever wherever you need it i think as well there's also to consider from the small business perspective as well is that you know if you have employees with health insurance you have a much more healthy and productive workforce and so this also provides small businesses more opportunities makes it easier for them to have insurance and i think when you have that you have again more productive employees that helps not only just someone's health but also helps the health of communities as well and so you know i think from a public health perspective and so my colleagues would probably agree with us as well that if you can provide people safety and security both in their jobs and in their health that also helps just the health of the community generally what's the general plan for getting people in roll d when do you start getting people in road in miniature and how will you let people know that the resources available and get him signed up a few different ways and maybe i'll start from when open enrollment starts and walk backwards a bit so open enrollment starts october first of two thousand and thirteen and people can enroll during a six month period from october through march of two thousand and fourteen so there'll be that open enrollment period prior to that we'll be opening a call center  in september so that will be open a month prior to so people can call with any questions that they have and then during the summer there's a lot of work that we're going to be doing in getting the message out in a variety of ways one is through just standard marketing so you'll start see commercials and radio ads and billboards and those types of common things but we also will have what are called navigators and in person a sisters and brokers and agents that you use today that will also be trained in local communities to help those  small businesses and individuals get information and help them start to get ready to for open enrollment in october great barriers to getting to the black community getting people to understand the value and to embrace the opportunity i think there i think there is a lot of work to do there i think that the disparities that we do have in coverage there's definitely some extra effort that we're going to have to put in to those communities and we're really trying to through our navigators  person to sisters and brokers and agents make sure that there are people in the community that have experience with those communities that are ready to serve and help people understand what is coming their way and i think we've we've tried to have a strong  a strong sense to try to use minister to reduce health disparities was one of the key pieces that was mentioned in the legislation that it was passed as it was passed is that one of the key goals is to really reduce health disparities and make sure that where we're getting coverage everyone how is men sure organized what's the structure of that agency who do you report to what's the governance structure for mature so sure is a state board that's how the legislation was it was enacted and so  will report to a board of directors the board of directors has seven members six of them are appointed by the governor and confirmed by the house and senate and one of them will be a standing member which is the commissioner of human services  right now and how large would it be when it's fully operational in terms of people or one and also in terms of budget what's the cost of this enterprise so people in terms of actual bodies on the ground we are roughly eighty to ninety employees that are projected to work at mensch are and our budget ranges between forty to sixty million dollars depending on enrollment so the more unreal myth that we bring in the more funding that we will need for customer service to make sure that we have people out there helping providing assistance what's needed so that leads to the policy question and it's a question i ask all my guests and that's a question of engagement and inclusion i'm interested in knowing what strategies you've begun with to ensure that black people and people of color people of color are part of your organization your workforce and that your business operation not only provides the goods and services but provides extended  what's the right word for it collateral benefits for communities of color you get the feeling of the question i think so so how do you engage what do you plan to do to make sure that the governor's vision of inclusion is thoroughly and consistently available and clear and actionable in this organization well i think even before the legislation was passed we started on a few of those things and so one of the first things was the creation of the health insurance exchange task force  we really tried to make sure we had broad participation throughout the state underneath the task force we had well over ten different technical working groups on a variety of really technical topics to bring in the assistance that that we needed to get all perspectives men should start to be developed and there was also feedback coming in from those groups as well as to how that legislation should be drafted so we really tried to start from the beginning to get all of those perspectives in addition one of the other things in the legislation that is included is that we make sure that the board is advised by a series of advisory groups and those advisory groups will be representing consumers and small businesses and industry so we want to make sure that we have everyone's perspective included in that and that has always been a strong commitment that we've had and we definitely intend to make sure that we have that commitment in the future because if we're not getting those perspectives we're not going to be successful and so what's your background how did you come to this position what will you bring to the table my background while prior to coming into this position i was minnesota state health economist served in that role prior to that i worked at united health group and i was in two separate positions one of them was in competitive intelligence and so essentially what that means is understanding how health insurance works and how you make products competitive to compete with your competitors and then i also was the vice president communications and strategic analysis for government opportunity i think that we can do a lot of great things and i would definitely not want to be anywhere else other than here thank you for being here let me broaden the conversation and bring in two voices of people that i can feel and i call stewards of the health of our community they're on the ground floor they're trench fighters they make health happen in our community every day all day and they do stellar work in projecting both the value and providing  service that our communities desperately need and that they so aptly fill stella whitney west is the c e o of north point health and wellness it's an institution in this community that represents our will to serve ourselves and if service ourselves with quality and with professionalism bill tendo is her counterpart from my point of view as the leader of southside medical they may not see themselves as kind of y advocate and did never value and service to our community so i want to ask you both to weigh in on the question of the insurance exchange uninsured but first start by telling us about your organization what northpoint is doing to serve the health needs of our community and how the men sure afford with health care act program it's one to support what you do sell we start with you thank you for exchange or the men sure it was great to hear april talk about all of the components of it i was a part of the advisory task force forty five years we'll be celebrating their comprehensive clinic where the second largest community clinic in the state of minnesota there are seventeen across the state so we have medical dental behavior health we have onsite pharmacy we also provide a number of social services as well as food shelf was probably our largest social services program and many people are familiar with that we also have a number of community health outreach programs a couple of the members in the audience that reminded me of women of distinction which is a very distinguished group of elders who had been meeting at north point for a number of years and meet monthly to talk about various health topics that relate to seniors in really relate to the entire community so almost eighty five percent of our patients are people of color we have a patient base about twenty three thousand patients annual basis and about thirty percent of our patients are uninsured and for us that certainly means that having access for insurance to large segment of our community and our patients is extremely important it's important for a lot of the reasons that april talked about a sense of security that that you know that you have insurance in the the fact that through their fordable care act you cannot be denied insurance due to a preexisting condition and a number of procedures prevention again minnesota is on the cutting edge the last time that i was checking there only eighteen the states i believe that are operating in their own exchange states had an opportunity to  submit a plan for their own exchange or they would then it would be the federal government then they would operate your exchange and there's a couple of states i think only a few that are in a partnership with the exchange and i think minnesota certainly stepped out early as the leader and pulling together all of the members of the community to develop this exchange now as as it is with anything new coming out the door there's going to be problems there's going to be opportunities we're going to have to tweak this exchange one of the things they we were concerned about was the fact that the seven member governing board in some people will say it's a good thing some of us think well you kind of missed some folks so there's a conflict of interests on the governing board so members of that board cannot have any affiliation with health care so bill and i who is if you has said al are on the ground in the community we would not be eligible to serve on that board so we would not be able to represent the voices of the communities however there is an opportunity on the advisory board so we're looking forward to being able to to do that i would certainly advise members in the community members of the particularly the communities of color to watch this to make sure that your needs are being met this is a great opportunity is certainly will members of the the minnesota association of community health centers and we're also fairly qualified health centers where we provide benefits for people who are uninsured and under insured and like stella we have not as many patients as she has we are not as big but we do provide a lot of the same services we provide vision care we've been i don't care medical care but in probably if any of you have been out in any community events he saw the community van which is part of south side and they work in conjunction with caroline and we also have a mobile dental van that travels around basically locally around here south side it's been around for forty three years not as long as north point we've served south minneapolis for that whole period of time and we were actually created by vista volunteers back in the  seventy s and the vista volunteers started on lake street and then they moved down to forty to forty fourth avenue south which is currently the same place that we housed right now we have probably about seventy employees and one of the things that we've done based on the four noble care act is that we've tried started beefing up our staff to handle what we feel is going to be the big push in that one is that we have our each department so we have a community health worker who will be working with a care guide who works inside the clinic and then we've also hired a referral coordinator who is going to be dedicated to building relationships what specialists so that our patients can get specialty care whenever they need it we see the affordable care act as an opportunity but at the same time i'm kind of unclear about how this is all going to look and i think a lot of other people are to maybe no more than i know but i see it as a great opportunity for health care for all communities it's doing a number of things that i think are needed one of the little things about that is i was looking at  one of the documents i have here is just trying to limit executive compensation who provides care to people who are uninsured and under insured and people across the country and that's a very important thing because a lot of times people take ho and dollar salaries that probably would better serve the community especially communities of people who just don't have any health care at all so we hope that this would be a benefit for all of us let me ask you both  explain to your customers the people that you serve how this process will affect whether they are a minnesota care recipient or partner a member or whether they use blue cross or health partners you care all the plans that are available and i think there may be a perception that if you are poor or poor earner you simply don't have the opportunity to use what you may think are more quality services in the private marketplace where that's true is not a question but that's a perception so how do you address people's concern i think people want to get the best service they can get and how do you advise what do you think think i'm kind of unsure right now what minnesota care is going to look at look like and think april might have a better idea than i do my understanding is that minnesota care will be a program where people who don't make the exchange or don't i don't want to use exchange would fall into that category but i see most people being able to go into the exchange of say especially people who don't have the money to to afford health care so like i said earlier i'm a little bit unclear about how this is all going to shake out and i think a lot of people are trying to build word being the building it as we go is what i think health care and health care policy he is the intersection director for the minneapolis urban league mitchell thank you for hosting us here today at the urban league and you started off being focused on health as one of the major intersections for the delivery of services for this organization but you came to the organization haven't served our state as the director of the office of minority health you've got a great sort of bird's eye view of the health concerns of people of color  minnesota how does this transition towards men sure look from your point of view from having been a leader at the state in developing policy and now one of the people involved with creating structures and access at the ground level through the work of the minneapolis urban league that's a loaded question it's a lot to his resume but it's good to be here and also that we're talking about me and sure today one of the key this health insurance i remember some of these districts we would look at through the minnesota department of health statistics disparities and everyone hears that word now so it doesn't have much as much impact as  it does for many years ago but one key thing is we know health disparities basically account we know you can look at any of the chronic diseases from diabetes to heart disease stroke excedrin we know that there's a huge gap between a majority population and a population of color and the main shore which i'm really pleased to know in here more about every single day is we know it's going to expand access to care as we know that it's going to in abuses of insurers we know that it's critical that health care is more affordable it is very expensive if you don't have insurance and for many that evil listing today even if they do have insurance and you are in the private market that you have bought it yourself it is extremely expensive and then the fourth piece is that it creates jobs that this miniature these health exchanges are creating real well paying jobs and is going to target health care benefits to the most vulnerable and those who are in need able talked about the online marketplace that website if you will one of the key thing is just as a community based organization the minneapolis our beleaguered many others that we know that minnesotans will be able to find health care they'll be able to compare it they'll be able to choose and purchase health care coverage that best fits their family needs and their personal needs so those those strong foundational points of those four four pillars if you will will certainly provide a better avenue but if you've started in the game either way i used to run track in high school and when a member of our coach would always say i want you to be well seasoned i want to be well conditioned and then i know that you'll do your very best out there but just say that you at that starting line and you're ready to everyone's in the blocks and aerated take off but instead of shooting that gun in the air one of us a hit in the knee with that bullet and so when and i'll say i'm the african american so i'm hit in the knee with that so i'm going to be crippled right off the back as soon as that race starts off the way i look at this is we have been crippled for a long time because when you look at the insurance rates african americans hispanics american in these indians in particular have much higher rates than the majority population and so now this is going to hopefully level some of the field but there's of course more work to be done there's access to care there's of course we've talked about affordable care we've also knowing that how do we make sure that our families our friends our grandparents  aunts and uncles that don't have any care right now and don't have a clue about well how does this work where will they begin so last year we held about four forums here at the urban they did talk about here's how it will work but of course that was quite a while ago so we're interested as bill is said to to say how will the more of these details shake out in the very near future october one is right upon us the summer is going to be very very packed because not only will individuals have to learn about it how it works how it does not work but also they'll be able quite a bit of training i understand to for those in sisters and also navigators who want to be participants and partners of this of course policy means to me how do you not only is there the law in place but how does how do i actually access it and use it so that i can be in better health than when i don't have any insurance at all you mentioned one of the objectives would be to end abuse is what we were talking about what were you referring to when you said this process might help and abuses in the health care system or the health care insurance system well some of those this is a article that was very helpful from health and human services when we were starting to do these forums i contacted the centers for medicare and medicaid talk with them at length they came into and also did some presentations department of commerce also came here state that was really engaging period but here are some of the ones that we talked about i'm a sure insurers cannot cancel your coverage if you become sick because of an intentional mistake on an application now i have asthma and i remember a fork insurance carriers ago i made a mistake on a medication and put down one that i did not take and so they came back and denied me the insurance so if i don't take that one little tail in that puffer when i'm bicycling or playing basketball then i'm it's very difficult for you to believe this is like hand squeeze in your lungs that you can't breathe at all insurance cannot cap the dollar amount they will pay in the health care for person over a lifetime i was also in the market when our family was much younger when we had insurance and then the premiums were so they went up over four hundred dollars one year so i went from three hundred dollars and it went up to nine hundred dollars a month and so as i wife and i we sat down and looked and we looked at our two children chanelle and mentioned we said no way we can pay this so we went on the market and got a family package that was much more affordable but they had a cap they said how much they would spend so we want to make sure we stayed as healthy as possible that year third one if insurers and i care or payment for services consumers and new health plans w have a new appeal process states have new resources to review large rate increases and crack down on premium hikes there was a comment earlier about very very large salaries for health care executives and when i worked at a hospital that was a major concern a matter of fact there were several i would say not boycotts but just people just came from all over surrounded by hospital and made the chant that you must reduce salaries and i was saying to myself i'm not making enough as it is i don't want to reduce mine but that is the the perception the son of perception when you're working in a health care provider or insurance field and then of course start in twenty fourteen when will no longer be charged higher rates by insurance companies due to gender al status wife's insurance policy hers was much higher than mine but it didn't make any sense at all both of us were held so those were some of the wonderful thing that you can expect to be able to deliver more services to more people and if that means business but it also means creating jobs i've often said that one of the challenges of our community is that  we be able to organize ourselves to benefit from the revenue streams associated with solving problems in the past it seemed to me as often as not and this is a kind of and now macfarlane statement you know they get the money we get the misery they make money off of our misery the disparities reflect the presence of a lot of misery in our community and the question is can you look at that just as misery and walk away or can you and should you look at it as an opportunity to provide healing to provide deliverance to provide improvement in the lives of individuals and in the lives of families and community i think we have to say that where there is misery that's not a static and permanent condition it's an opportunity to engage our best minds our best energy and i best desires to develop human beings and so we have plenty of opportunity but in the past still we would celebrate new west i've said too often they make a lot of money on our misery we have to figure out how we put ourselves in the problem solving side of the equation so that we become the deliverer of the service and that we are paid for that in a way that's reflective of market and of the value of the service we're providing what do you think how do we use this opportunity to make sure that we get our share of the money we need to serve our people effectively and to grow our capacity to end misery in our community still with us what do you think well i mean  you're you're definitely right on i've been saying all along since i've been in the health care industry and tried to encourage and recruit others is that it is definitely and has always  been an industry where there was plenty of jobs in the industry that has a lot of money in still has a lot of money and so a lot of opportunity i think certainly what president obama has done what they are affordable care act is to help to begin to level the playing field and i say began to level the playing field because  those of us that watched the the struggle that he went through to get this pass know that it was met with a lot of opposition and when you think about health care why would anyone appalls having health care available to all citizens that this is something it should be a basic right of every american every human being should have a right to health care yet you have to think about why would someone be opposed to that and then always say follow the money it's because it is big business and so let's not let this opportunity  said he's gearing up we certainly are doing the same thing at our center we're actually looking at partnerships with the urban league as well for health careers and training there are a significant number of jobs  where they can find enough people but people have to be prepared you have to go into the training in a lot of these jobs do not require four year college degrees it requires short term vocational training where you can get in and you can get in at the ground level we hired people all the time community health workers is one is the entry level position there are certainly opportunities to be into training in and to be in some of those positions i was telling my staff that i'm looking to hire people that can help in our lobbies right now our lobbies are crowded and i saw it as an opportunity for intervention where so i'm going to be looking for some of my community folks to be able to come in and talk with people what a great way of educating people about the availability of insurance through the health exchange where they're sitting in the waiting room waiting for their appointment having a conversation with them so i think that those of us that are in leadership positions we also have a not only opportunity but a responsibility to make sure that there is  openings for the community i think to that we also have a responsibility not only making sure that minnesota is accountable and to make sure that  the the spirit that is in this health exchange is is certainly one that goes forward i think april and i got to know her when i was on the taskforce i think she comes with not only a lot of knowledge and skill but i think she comes with a lot of passion for this work and that makes a lot of difference so i don't believe that she left a good job at united health care which is a big player in the health industry to become a public servant because she's concerned about money you don't make that kind of transition if you're concerned about money and so i believe that that she is a raise the kinds of questions i'm raising i raise the question of equity of parity of engagement of inclusion as a citizen as a taxpayer as a resident as a business owner want to  turn to the exchange into all of state government city government county government and say look i pay taxes here and i demand i expect a fair opportunity to be involved in the process of delivering value goods and services the businesses the the services that my family need i may need the opportunities that our community ought to have how do i do you hear us and how do you respond to that what can you do to assure a person like al mcfarlane in that you know others like him around town that we really want to engage you in being a partner in delivering a healthier state and community but what i'd say is we we definitely want to be creating all of those partnerships and i think some of the ones that we have are great and we definitely want to build on a lot of those we're looking towards developing as many opportunities as we can for  that through the task forces through our in person assisters the on the ground types of mechanisms but we also want to hear from communities as what would be most helpful for you i think one example of that is we made final today our our rules for our in person navigator and broker programs and really took some of the feedback when it was explained so one part of our federal requirement and of the legislation is that we need to have a program that provides in person assistance for individuals and we need to have that done by the end of april so we had about a month to get those rules out there was a twenty one day comment period and then a week for us to take in those comments and we really took those comments and into heart and i think there's a few things in a few changes in there that people will see that  hope they view as as good good reaction to some of the feedback that we got is that one is around meeting communities where they're at and so one of the one of the pieces of feedback that we got was that we're going to be providing online training for in person assisters and navigators and brokers to be able to provide assistance to individuals and the have to pass a competent and online competency test we got feedback from a variety of different communities that they would like to provide that training in person in their communities and we said absolutely you can do that you can take the content you can provide that training you can see you can target it to the needs of your communities and you know then you just need to pass that test so we really did  a lot of that too to respond to that the other thing that that you'll see in there as well is that we set up the metrics on the compensation for those in person assisters and navigators to reflect a few different things  and one key one is really paying for performance and paying to reduce health disparities so we're going to be encouraging enroll meant and coverage for populations that have struggled to get coverage in the past and we're going to make sure that we encourage ordinary people in our neighborhood to pay attention stylists that funnel the money that's always good advice but what does that mean in terms of us having the knowledge to raise the right questions to get the right answers that we need will certainly the policy in the laws already been written that is that takes a lot of time and effort and watching and listening in and but the good thing now i would say where we want to focus now is october one is right around the corner it's less than five months away that's going to be the open enrollment period and so are our community our families our children from faith based community based organizations to the family kitchen when we go out for meals thus the time now for us to start to talk about this now there's i know al in the inside news there's been some great articles in there that is a great place to start just take one of those articles and sit around the table and just go through it we will urban league will be having more forums as we continue to watch and observe and see what the pace is i suppose the other piece follow the money is always a good thing because there is to mindy's amount of resources in health care in many times and i'm going to want to touch on something else because we talked about jobs before and i want to make a parallel there is jobs at men sure that's going to be opening up there is good jobs now and for those who look at watch the watch the website and watch the state job board but there is a good jobs that are going to be opening up that are at i mean sure and they pay well one thing that i hope that men sure will do i want to acknowledge their presence of the owners of the minnesota sports from the corner here in the audience today norma jean williams but the spokesman quarter  inside news are legacy media players in this market and i'm hopeful that what you're talking about is encouraging men sure to engage resources like ours to deliver the opportunity for work to our community so so go ahead the other thing is we all have children and other friends who are students and they go into school for doctors physician assistants nurse practitioners or behavior mental health specialists those are also educational supports now that means this is going to be able to repay some of those educational loans and so forth at a larger degree than what it is presently so we want to keep that in mind as well and then the career training  grants to community colleges and other education institutions workforce investment board short is called that is also going to be a to miss area that we're going to still see more growth and so those jobs are going to be real and there's not only jobs to be nurses and physicians is the whole business side of health care that also we want to keep an eye on and also encourage our young people and others who are changing careers to start to look at so that would be a start michel thank you so much want to thank all of you for being here i want to close with one one idea i've recently personally embarked on a personal health and fitness mission for al mcfarland and in the process i wrote about this concept called and so i'm wondering what would it take to make north minneapolis and stuff many apple is built on and some university area these are the areas that have the highest impact of health disparities right the worst numbers in the marketplace to me again that's opportunity so how do we look at this as an opportunity to convert our neighborhoods our families into a blue zone experience i'll leave that out there as a thought and maybe we can put our heads together and talk to april and other policy makers about engaging in creating a public mind a public identity in which we see ourselves as the healthiest people on the planet how do we get from here to there it can be done m l mcfarland this is conversations business we have to make it so thank you so much