lot about insurance companies and making sure that people with insurance had the same same access the same rules the same fairness a better approach to appeals that people w physical illnesses but i want to talk about two other issues where i think we have to think about when we think about equality and one is the people who don't have health insurance to begin with and this is more of an issue today than it was a month ago in my mind because of the supreme court's decision i'm struck by the supreme court upheld the affordable care act but they gave states the option the option about whether they were going to cover all of the single adults up to  hundred thirty eight percent of poverty level that's people with incomes up to fifteen thousand dollars a year every state gets to make that decision now every week so every state has to make a decision about whether those very poor people with a lot we know a lot of problems that we're talking about here today have insurance to begin with we also have a look at the a c l u and believe me there's a lot of great things that help reform but i think you know a lot of those are not whole list them all but one there are some decisions we have to make as a state to make sure we have equality because we've been providing care to a lot of people under minnesota care program and we're looking at what counts as essential best benefits and how people can be treated in the exchange we need to make sure we're not going backwards here in minnesota it's a several people have said we've been a leader here and we've been a leader in banking share in our medicaid in minnesota care program we have good mental health benefits and we need to back away from those another way we have to think about whether we have a quality is not just the quality not just the quality in the insurance world but into liveries system world as well when i became commissioner a year and a half ago th that surprised me the most him believe me if you follow the papers there are a lot of if you surprised me but was that people with the serious and persistent millner us live on average twenty five years less their counterparts not because of subsampling directly related deceptions abuse or mental illness but because of heart disease because of diabetes because those chronic care conditions they're not getting treated fairly so we've got to bring changes in the delivery system worlds where we get integrated and this is one where i can just say a few things we're doing a really good job out here in minnesota you know one health care homes we started those before that they were put in their formal care act we now have two thousand minnesotans who are being served by a clinic that certifies a health care home someone's going to integrate that behavior hopefully and that this go health care we've got the diamond project to die i'm in depression screening collaborative in seventy clinics are trying to screen for depression in primary care we've got what i had exactly what they call expert but basically it's screening for substance abuse in primary care though it's been a big project the bars the department and we're really trying to spread it around around the state so we can catch those problems early intervening get them into treatment our new psychiatric consultation they were starting next month with the mayo clinic so that any primary care and so we've been leading away on so many ways in here in minnesota but even as a leader we have such a long way to go to true parity to true equality and so i just want to thank you all for being people here who will be engaged with us on that trip thank you