>> okay, colleagues, any other questions? great. just a quick question for the department of public health. i remember, you know, a number of conversations we had with director garcia and all the health professionals, from my perspective, it looks like more people will be able to buy health insurance. i assume that from the department of public health, that's a good thing? >> that is absolutely a good thing and we've said while healthy san francisco is a fantastic program, it is limited by its nature and health insurance is always better than healthy san francisco. >> that's great. >> i have a couple of questions for colleen, i *f i'm sorry i missed the present tais and i'm waiting on the handouts, i may ask questions that you may have already addressed. when i look at healthy san francisco, i know people in the baby community that would

qualify for healthy sf, but don't know about the problem, and so where i'm concerned with that is if people don't know about healthy san francisco, it's been on the market and out there for a bit of time, how are you going to do a better job of doing outreach and enrolling people in the affordable health care act that of which we'll be able to do in the fall? >> so, our first method of enrolling people is to look at who we have on healthy san francisco, as you said, there's a gap between your residents and healthy san francisco participants, we're looking specifically at converting the healthy san francisco participants into health care coverage. we recently applied for an outreach and education grant which we were not successful in getting probably because we have too much outreach to our population already, we identified in the process of applying for that grant, we identified certain populations in our city that need extra

attention in outreach and the southeast core door, in addition to asian and latino adult, small business and sole proprietors and young adults in school, so we intend to do a concerted outreach effort in the absence of the grant to those specific populations that we know will need outreach. >> this is exactly what i'm concerned about, about -- you understand there's a need for extra attention to outreach, at least i haven't heard and i haven't seen a plan on what exactly outreach is going to look like. i'm thinking we need to develop a system that is more or less similar to the census, remember when there was census data that bewere collecting, people that were cultural competent and it was an economic engine, it helped go door to door and get people to fill out their census

form. so, i would like to see something similar like that, so that would require the department of public health doing some kind of partnering with cover california when it comes to finding monies available to make such an effort come into a reality, or folding into the department of public health budget as well, there are grass roots organizations organizing right now in the latino as well as chinese communities that need extra help, meaning financial support, on their outreach, but before we can do outreach, it's a level of education that needs to happen and there are resources that need to be developed and quite frankly purchased and paid for to get out there, so i don't know if your presentation discussed about this but this is something that i'm really sensitive ant because we don't have the opportunity, we are talking about people's lives here to allow this gap that --

to exist. there are a lot of people that now qualify for health care, for coverage. we need to make sure we are capturing every single person, every family that's out there and in this universe and getting them enrolled and i think the department of public health is going to need more health than just relying on their public clinic partners and allies, we need to be enrolling the non-profiteer and is the housing authority, they're always left off the table and i think we also need to be organizing with our churches and i already said our non-profits, so that is really my position. supervisor campos? >> i wanted to add something to that, supervisor. one of the thing eswith os we are plan tog do is hold a series of hearings and the next hearing we're planning to hold which i would love to work with you is on this issue of what is

our plan for enrolling people into the exchange, what kind of outreach, and my hope is that between now and the time we hold a hearing in september because the enrollment begins in october that we will get from the department of department health a robust plan for outreach. >> i'm feeling an incredible sense of urgency, it's still going to need some money and some resources and i don't know where those are going to come from. non-profit is already stressed and probably don't have accessed money and a budget to do this kind of work, but why not hire some of the people to go door to door and knock and have them begin to do some peer to peer education. >> so, i have a couple of responses to that. first, we are working on a citywide communications plan and work witching the mayor's office on outreach and education plan for the city, we are planning to apply for the

second round of funding with the same application that we had previously, with the some computations we had previously. in addition, we -- just this week, the department pulled together all of its community based organization contractors and in that discussion with them, we talked about the health reform implementation and the importance to get everybody covered on health insurance for which they're eligible. we asked them to consider being a sister, application enrollment as sisters under the cal foreign yo program because that does come with money, for everybody who is enrolled with california, any person who's enrolled into covered california, they get 58 dollars, for every person you enroll, that's 58 dollars, so it could help support the enrollment. >> that sounds like the triple

c bounty program, and again, i don't want to drop the ball on this because i would be really upset. if i get upset, i'm going to put a bug on campos's ear, and it will be contagious and you have a whole board of upset supervisors, so in your partnership with the mayor's office, loop us in, particularly those that are your partners that are working and representing the communities that are often left off the table. this is absolutely critical. thank you. >> yes. >> believe you me, it's a lot worse when you see supervisor cohen upset. i think the point though, one point that i will make and we talked earlier about the convening of the universal health care council which is a good thing, if it's so important, it's too bad that it's only happening three months before the implementation, and another point i think, it's like i wish we had had this discussion before adopting the budget of

the department of public health, of the health services agency because to the extent that more resources would have been needed, that was the time to have that conversation. >> one thing i neglected to mention to you is that cover california is also kind of running to keep up and there aren't resources available right now to even train application as sisters, so we're in a little bit of an education only place, we can't move to action until they move forward as well. >> thank you very much, i know we want to get to public comment, i have one question or one point that i think is important to clarify and if i may, i'd like to ask our deputy city attorney, john gibner who's here with us, there has been a lot of talk from a lot of different folks, you know, about the legality of the health care ordinance and whether or not it's preempted by federal law and as our legal

council for both the board of supervisors, the mayor and the department of public health, can you say something about that, what's the city attorney's view on that? >> sure, deputy city attorney, john gibner. the affordable care act has -- includes some language that states that it does not pre-empt local and state laws like the health care security ordinance. in termser of other questions that have arisen, based on the federal guidance we've received to date, there's no indication 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 tha 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 cc