that the health care security ordinance is preempted or otherwise adversely affected by the affordable care act and as you subjecting earlier, supervisor campos, the local law complements in many ways the affordable care act. >> thank you, i just want the hear it from the horse's mouth, if you will, because i want to make sure that everything's on the table. yes, supervisor cohen? >> thank you very much, so what does reetcher -- pre-empt mean, just to be clear? >> basically under the u.s. constitution, federal law is supreme and in many cases, if a local agency or a state adopts a law that directly conflicts with a federal law, the federal law trumps, in other situations, there's a federal

law that occupies the entire field of an area and when the federal government adopts the law that occupies an entire field, congress may say local jurisdiction, you can't meddle with this subject, in this case, the affordable care act allows local jurisdictions like san francisco to adopt ordinances like the health care ordinance. >> thank you for that clarification. >> thank you very much, why don't we go on to public comment and we have a large number of people here, so normally i give each speaker which is the maximum which is 3 minutes, but i don't want to lose our quorum, so we will limit to 2 minutes, so why don't i read off a few names. (calling speaker names).

>> good afternoon. i'm ken jacobs, i'm the chair of the uc berkeley labor and education and one of the co-principle investigators for the simulation of market and is the primary model being used for projections in how health coverage will change in california as a result of the affordable care act and has been used by state, counties and covered california for their planning purposes. i was also a member of the universal health care council. >> is it possible to ask speakers to use the other podium and if i may ask you to maybe line up to your right, my left, my apology, thank you very much. >> no problem.

>> so, it's helpful to put the health care security ordinance in context. when it was caoe aided in san francisco, we were in the midst of a downward trend in job base coverage in california and in the u.s. as a whole. the security ordinance along with the healthy san francisco partners was also preserved to help job base coverage in san francisco in the context of workers having greater access to public programs, a study found that as a result of the program, 29% of covered employers reported that they added new health offerings, 27% increased employer insurance contributions, 18% contributed to healthy san francisco and 14% contributed to hra's and that goes against the broader trend of what we see in job base coverage in the united states and california. there's no question the affordable care act is going to

-- that significantly expands options for health care in san francisco, but as noted earlier, there will be a large number of remaining uninsured, we estimate 3 to 4 million remaining uninsured statewide about which a million will be undocumented and 800 thousand will not have an option of coverage, looking in the bay area, we estimate of the working population that will remain uninsured, roughly half -- >> mr. jacobs, 's, i'd like to ask you the finish what you were saying because i think the information you're talking about is very important. i just want to make sure we have that information. *frjts so, half will not be eligible for affordable care act program and is if we look at those who are eligible for healthy sarn fra*ns, that goes down to a little over about 43% will not be eligible for programs, so if i can just quickly finishing up, for those who will be eligible for the

program, and it's important to say this is a big expansion and for many people, the cost of coverage through covered california will be much less than they would pay today and for a much better plan but it will still be costly for many. for a full time worker earning $15 an hour, 30 thousand dollars a year, they would still pay 200 dla, a month for a health care plan with a 2 thousand dollar deductible and 45 dlarp co-pay, the take up of covered california of the subsidy population, would be 20 to 44% in 2014 rising by 2019, so the result is we still will have a large residual uninsured population in the state and in san francisco. there will still be insignificant need for the safety net system and the health care security ordinance can continue to play an

important role both in shoring up health care coverage so we don't see a shift into public programs and through the public option to make sure people have the resources they need to be able to get coverage and to participate in coverage. er >> thank you, next speaker. >> mr. chair, honorable supervisors, the health of san francisco and the affordable care act, many people are left out of the affordable care act. we need to defend healthy san francisco now, more than ever, many immigrants are completely ineligible for health coverage through covered california, the h health care exchange, they depend on healthy san francisco for their health care. that includes tens of thousands of san francisco resident, 10 thousand more that work in san francisco but do not live in

san francisco, san francisco has been a huge success, all it takes to perceive for the future is to get the obama administration to recognize that it's a unique program and make some regulatory allowances unique for its design, this should not be controversial, healthy san francisco has a [inaudible] for healthy care reform and our national representative ares at the forefront of making the aca as strong as they could, but during this, we will ensure the health of san francisco remain a model for others to follow and doesn't allow us to enroll backwards. some people currently receive coverage through healthy san francisco will require for medi cal care and many will not, we

estimate 3 to 4 million californians will remain uninsured even after the aca is fully implemented at the same time public hospitals will face cuts and dsh payment and the alignment fund, employers payment under health care sans fra*ns will be crucial. thank you, sir. >> thank you, sir, i'm going to read a few more names and i apologize if i mispronounce your name. (calling speaker names). go ahead. >> good afternoon, everyone, i just want to start out by appreciating supervisor campos for calling this hearing to highlight how important san francisco health care security ordinance is for all of us and also thank the health care

advocates whose presence is strongly felt here today. as an author of san francisco's health care security ordinance, assembly member am yan noe is committed to ensures that workers who are enreceiving health care continue to receive coverage through the affordable care abing. we know that healthy san francisco has served as a model for health care reform nationally, as this transition happens, we know hou,backer thousands of workers will receive limited or no action under obama care, now that health care is a mandate, it's important that employers contribute to helping their workers in paying health insurance. when healthy san francisco is drafted, the employer spending requirement in san francisco's health care security ordinance was always meant to help workers access what would otherwise be unaffordable health care and nothing about obama care changes this reality. we can't allow healthy --

health care security ordinance to be undermined by a few businesses that are trying to avoid their responsibilities, to workers, the patrons and the workers of san francisco, our office looks forward to working alongside of all of those to benefit from the ordinance and that it serves our community, thank you. >> thank you very much, next speaker. >> supervisors, thank you, ian lewis, hotel and restaurant workers local 2, i want to address renewed attack we saw in the paper recently in the spending requirements, it's really easy to get lost in all the jargon and all the technical discussion about health care, but this is not a complicated issue. it's quite straightforward. for the past 89 years, the golden gate restaurants association and other business groups have done everything they could be to undermine san francisco's security ordinance, they sued the city, they gouged

customers with phony surcharges, they exploited a loophole that let them keep most of the money that bewere obligated to provide for their benefits and now they're beating the drum again to have another go at it. obama care does many good things but it was not designed as supervisor campos said earlier, it was not designed for high cost cities like our own. if you are a typical restaurant worker in the city making $14 an hour and an out rao*efrp worker contacts you to go to the covered california web sited, you're going to look there and you're going to find that a basic plan costs 200 dollars a month and that's before you have to go and get care and pay high co-pays and deductibles, last month, the median rent for a studio apartment was nearly 2 thousand dollars, if you're making $14 an hour and you're paying those kinds of rents, there's no way you're going to pay 200 dollars

for a basic 730 plan in covered california unless you're exceptionally sick, you're going to go without. thank tos the health care security ordinance, however, san franciscans have another option, their employer can pay into the city option, workers can use that money to buy insurance and that's the way it is today. that's the way it should remain. >> can i ask you the wrap up your comments, please. >> sure. i just want to point out that this money grabbed by some of the city's worst bottom feeder employers is going to make people in this city sick e we have to do everything to prevent that and not let working people get pushed out even more. >> next speaker. >> good afternoon, supervisors, i'm going to do the translation, can i have a little bit more time? >> yes. you get double the time for

translation. >> (speaking through translator). >> hi, my name is angela and aoem a member of chinese progressive association. after learning more about health care reform, it's good that medi cal income eligibility will be higher. but san francisco is an expensive place and it costs so much money to live. the bar is really low, for us low-income immigrant, we come to america because we want to work hard and fight for a better life and then be able to

contribute back to society. it's really hard to do that because once we go over the thing like medi cal limit, it becomes really hard and expensive to be able to buy health insurance. even though we might get credit to buy, have insurance in the health care exchange, but it's not enough to make it actually affordable to us.

mruz there's a lot of things that is not covered in the exchange like vision or dental care. health care is a maou man right, everyone should be able to get health care regardless of who you are or how much you make. so, it's really important to protect these local laws so families can still work hard

and be able to afford health care. thank you. >> thank you very much. next speaker. >> hi, good afternoon, supervisors, my name is stephanie chan and i'm with the chinese progressive association and youth movement of justice organizing, in 2011, we participated in collecting over 800 surveys of community members who told us what their health needs are and what were barriers to accessing the services they need. we presented these survey findings and our recommendations to the planning and health committee and last week at the presentation for the draft report of the health care master plan. so, our survey show that one in five residents rely on healthy san francisco for health care. one of the recommendation ins the health care services master plan is about preserving healthy san francisco, we're here today to talk about why

healthy san francisco and the health care security ordinance is still really important even with obama care, so locally under the health care security ordinance, the minimum workers is 20 but if the ordinance was replaced by the affordable care act, the minimum would be raised to 50. this is important because lez people would be covered or get health care and businesses and instead businesses should also share the profits by helping the workers get health care. the health care security ordinance would secure that more workers would get health care and health care is the human right and everyone should have the right to access health care regardless of their income. thank you. >> thank you. i'm going to call a few more

names. (calling speaker names). next speaker. >> hi, supervisors, my name is judy and i'm a resident of the easier neighborhood and i'm part of the chinese progressive association, i parent panted in klektsing surveys and presenting our recommendations to the health care services master plan task force. as was said earlier, a lot of companies are cutting their employees' hours because they don't want to pay for health care, that's not fair and i don't want that to happen in san francisco, our local law limits employers to do this because they have to put aside for their workers' health care based on each hour the employer has worked and my family can't afford private insurance, this is a lot of the case of other

health care workers in san francisco who work in restaurants or retail, they need health care security ordinance so everybody can have access to affordable quality health care. thank you very much. >> thank you very much, next speaker, please. >> good afternoon, supervisors, my name is wayne lee, i've been a resident of san francisco for the past 8 years, i'm a member of chinese progressive association, so i'm here to share why it is important for our city and community members, my family is documented which excludes us from the affordable care act, we are not able to buy insurance from the exchanges but the only solution for us is through healthy sf, i have an older brother who was

diagnosed with brain cancer three years ago, my parents were worried he would not be able to sur va*if because we couldn't afford expensive treatment, lucky a doctored was able to make sure my brother was taken care of and with radiation and surgery, he's home after recovering from rehabilitation, i'm happy he got the treatment he needed and healthy sf will give him the opportunity to complete his road to recovery, for my family's sake, it must not stop there. without healthy sf, i don't know how my brother would have gotten better. they -- i didn't know my family would be illegible for healthy sf, it is the only

option for indocumented residence, even passing the immigration requirement in congress, under the current proposal, undocumented residents are being intentionally left out of accessing health care, and having access to health care is a human right. as a city that is strong to have equality for all, please show this regulates to how we treat san francisco residents health care. >> thank you. i just want to note for the audience, we want to move the meeting along, to i would ask that you refrain from applause, you can do hand signals if you want, but we want to make sure we respect your time and we give everyone an opportunity to speak, so thank you very much for your patience, go ahead. >> hi, supervisor, my name is

susan fang, i'm a health policy [inaudible] with the chinese progressive association, i was also born and raised in san francisco, i'm currently a medical student, so you know, i'm really proud that san francisco, having been born and raised here, that san francisco has taken leadership to making health care accessible to everyone and achieve health equity. so, we talk about how folks are being left out and how some people are still not going to be covered and not be able to afford health care even with the subsidies, in the exchange, a high cost city like our, but i want to challenge us for why health care is good for business and rethink what it means to be a good business and push beyond just thinking about maximizing profits. we want to think about -- i

want to think about the employer spending requirement as like an investment into the business, just as we would invest in, you know, reservations in a business, the spending requirement is an investment in the business and the workers making sure that folks are able to live and sustain themselves, increase -- studies have shown it increases worker productivity, it's good for businesses. and so it -- yes, it does increase a little bit of cost for businesses but when surveyed, employers in san francisco, a lot of them, the majority of them supported the ordinance, so i just want to help us reshape our thinking about what this means for businesses and also in terms of health care costs to the city, it's important that we still invest in prevention and healthy san francisco, health

care securing the ordinance and help us do that. >> let me read a few more names. (reading speaker names). >> hi, good afternoon, my name is nu, i am a documented, i'm here represented aspires, a group that's with the pacific islanders as well asing prehealth dreamers, a group that's wanting to become doctors and nurses, and i'm here to really continue to add to how important healthy san francisco is for the undocumented community. originally from thailand, i lived in the bay area since i was 9 years old and growing up, my family was never rely relied on going to the doctor to treat our illnesses because we didn't think anything was out there

that we would be eligible for and we lived to the best of our ability to not get sick and it was in 2007 that my mom was rushed to the emergency room after she fainted from excessive bleeding and that was when we found out she had tumors and cysts in her ovaries and you know the doctor say if we waited any longer, she could be in real danger and it was because she was uninsured and she didn't have the preventive care that would have prevented her from needing to have the surgery that she did, and healthy san francisco would have done that for her, it is doing that for thousands of undocumented families in the time it's been in existence, with the uncertainty around [inaudible] in the national level, programs like healthy san francisco is the only

option that undocumented families have, any sort of health care and as a huge step as the aca, but a lot of folks will be covered, thousands will be left over, so this is an opportunity. >> thank you for sharing your story. i hope your mom's doing better. thank you, next speaker. >> hi, good afternoon, my name is akiko, i'm a nursing student at san francisco state university, and i'm here representing the undocumented community, for the last 14 years, my family did not have access to medical care. my mother is in her 60's and though she is young at heart, her back pain is becoming more intense and her headaches are becoming more frequent, she has been taking medication like she's drinking water.

i pleaded her to go to the doctor but her answers remain the same, she says, if i die, you can sell all my jewelry and my possessions so you can bury me without a debt but if i go to the hospital, i will bury you in debt. i was afraid to get sick because i know my family can't afford it, in high school, i hurt my knee playing soccer, for two month, i was limping baring the pain, i was always asked why i didn't see the doctor, i would smile and say, it didn't hurt that much anyway. it will heal all by itself, i didn't realize the impact it will have on my knee and i had to stop playing soccer and stray away from extraneous physical activity. at the time, i wasn't a san francisco resident, but if i was, i wouldn't have been so

scared to access health care services because regardless of my immigration status, health sf would afford me preventative care, my mother's a cna who cared for older population, i'm a nursing student, we are not able to care for ourselves due to lack of resources available to us, with the creation of healthy sf, families like mine are able to live healthier lives, while the government undocumented families from buying coverage on health care exchanges. >> thank you, thank you very much. again, i would ask you to refrain from the actual applause, you can do hand gestures, next speaker. >> good afternoon, my name is alissa messer and i'm president of aft 2121 which represents the state college of san francisco, i'm also vice-president of political affairs for the san francisco labor college, at city college of san francisco, we have about 1600 faculty these days and

about half of those are part time, half of those have access through city college of san francisco to benefit, others access healthy san francisco now because they don't make enough and there are some of those who would fall through the cracks if we didn't have healthy san francisco. one of the unintended consequences of the aca is the fact that employers are going to appear to be driving down hours for many workers so that they don't need to provide insurance and that's something that is happening all over the country to part time adjunct contingent faculty members all over the country. there are teachers, professors who are not getting the same number of classes or the same number of hours. we're already seeing health care access diminished as city college of san francisco for our part time faculty and we ask that you defend healthy san francisco so that there will be some place for them to go and so that there will be some place for the thousands of others who need to have access

through healthy san francisco and won't get it otherwise. thank you. >> i have a few more names. (speaker names being called). >> next speaker, please. er >> good afternoon, supervisors, my name is olivia fang, i am the founder and executive director to have latino breast cancer act si, a small non-profit organization based here in san francisco. through our organization, we use this low-income uninsured weekend to access breast cancer screening services including follow up, diagnostic care without cost and without barrier, many of the women who have come to our program have lost tha*ir insurance as their employers have cutback their hours, these women rely on