this is antitiering preventions in contracts and it prohibits fair competition. we have to do something about this. >> could you repeat that for everyone, so if a provider or insurance carrier chargers us more, we can't charge our members more? >> that's correct. not every contract has this prevision, but many of the biggest hospital systems in the state have antitiering preventions. they say you can't disadvantage any of my hospitals that you contracted for. they have to be on the same playing field as everybody else. >> so it falls on us as a government to pick up those costs? >> the payers have to just pay. our choices are really to pay or a shift cost to members through premium increases. >> okay. >> the catalyst for payment reform and we'll have a speaker later in hearing. she gave california a d on our legislation and our efforts to get to transparency and health care. i think she'll tell you that even the a's, i think were at 60 percent, so it's not like a d was good. i mean a d was -- i'll let her tell you more about that. what's the solution? transparenc

prevent information from being disclosed. the gag clauses that we've discussed and there's antitiers and steering previsions which was spoken of this earlier. this prevent ensurers to using information. with the gag clauses, these are the con track you'll -- there maybe be instances where you have to take ale step further. we have some anecdote evidence of entities not writing these kinds of clauses into the contract. so that it's an agreed upon thing that the client won't be disclosed to there's no non disclose you are agreement but it's something that the ure agreement but it's something that the parties may agree upon. >> another barrier to transparency is from providers and consumers saying that the health care information is a secret. whether it's a matter of law it's an instance for the state to decide. states can differ on whether or not they agree of this. the california and 46 other states adopted the uniform act which has some consistence. in california the basic requirements to qualify as a trade secret has two basic elements. first the secret see must provide a competitive advantage and second that the owners must