and positions ourself to offer an opportunity for permanent employment. for more information >> good afternoon, everyone, and welcome to the july 25, 2013 special meeting of the board of supervisors neighborhood services and safety committee, my name is david campos and i'm the chair of the committee, we're here with eric mar, we will be joined later by supervisor malia cohen bho is currently chairing the government of audits and oversight committee and sthe will be filling in for

supervisor norman yee, the clerk of the committee is mr. derek evans, we want to thank sfgtv staff for covering the meeting today, mr. clerk, do we have any announcements? >> thank you, mr. chair. please make sure to silence all cell phones and electronic devices, completed speaker cards should be submitted to to the clerk, items acted upon will appear on the board of supervisor's agenda. >> before we move to our item, i would like to entertain a motion to excuse supervisor norman yee, so we have a motion by supervisor mar, if we can take that without objection. i know that there are a number of people here for item number 1, we have a very small item that's coming up on item 2, so i would like to take that out of order, so if you can call item number 2 and i know we'll try to make it quick so we can move to the main item of this meeting. >> item number 2 is a hear

toinger consider the premise to premise transfer of a type 21 off-sale general license from 810 mission street to 810 mission street, district 6, to sylvain montassier for tamer sf. >> and if i can call on the applicant. >> good afternoon, supervisor. >> if you can identify yourself, please. >> my name is sylvain montassier, i'm the cfo, it's a corporation that has the sf deli and wine in san francisco. >> i imagine you have already reached out o the district supervisor, this is in district 6. >> we have reached out to our supervisor and to the public. >> why don't we now hear from

the san francisco police department, either inspector fong or gordon. >> thank you. >> good afternoon, supervisors, i'm inspector fong, abc liaison region, he filed an application seeking a type 21 off-sale general license for 810 mission street. this permit is currently operating with an existing type 21 license and is seeking approval from the committee to extend the license to conduct the newly constructed entrance of the floor, police called for service from april, 2012 to april, 2013 is 0, there's no residents within 500 feet of this premises and a notice of the public was posted on may 22, 2013. this premises is located on

plot number 222, it has 210 police reports reported for 2012, so the applicant's premises is located in a high criminal area. this is 176.01, the off-sale license authorizes by this tract is 7 and the active off-sale license is 9, so the applicant premises is located in an undue concentration area. there are no protests is recorded with the california department of alcoholic beverage control and letter of support is located with the california beverage control. there's no opposition from police station and alu recommendation is approval. >> thank you very much, inspector, colleagues, any questions for inspector fong? why don't we now open it up to public comment. is there any member of the public who would like to speak on this item? seeing none, public comment is

closed. again, we heard from the applicant, we heard from the police department. there are no speakers. i know that the district supervisor in in support of this request, so if we can entertain a motion. >> i did want to say that though my office is working with supervisor kim and cohen on getting stores to display more healthy options in the front of their store, especially whole grains frush produce and non-fat milk, many types of items as opposed to junk food, alcohol and cigarettes, but i still see that this is supported by the district supervisor and i'll be supportive of this item. >> great, thank you, supervisor mar, so if we can have a motion. >> i'll move that we approve this permit. >> great, thank you, and if we can include that to support it as the committee report so that it can be considered at the

next board of supervisor's meeting, great, so if we can have that motion and we will take that without objection. thank you, the matter will be in regarded, congratulations. mr. clerk, if you can call item number 1. >> item number 1 is a hearing on how the department of public health is planning to implement the affordable care act with implications there are for healthy san francisco and the health care security ordinance and how the affordable care act's implementation will affect various communities in san francisco including undocumented san franciscans. >> the main objective here today is to hear from all the members of the pun lick and the community and the business community included who are here. let me say that i'm very grateful that because of the amazing work of president obama and our incredible and amazing leader congresswoman nancy pa loes si, in march of 2010,

president obama signed the comprehensive health reform that we probably have heard a lot in the last couple of years. it is the patient protection and affordable care act which many people referred to as the aca or obama care which is something that we have affectionately appropriated because the term was use ined a derogatory way, we think it's a positive way, this law does many things but perhaps most importantly, it makes preventive care more accessible and more affordable for so many americans and i'm excited to be here to begin a series of hearings that we will be holding on the affordable care act so that we have in san francisco a smooth as transition and implementation as possible. today's hearing will focus on how the aca and our local health care security ordinance work in tandem to make health care and health insurance truly accessible to as many san

franciscans as possible. you know, the thing about the health care security ordinance, it was really an example of how san franciscans can come together, you had labor, community activist and is the business community coming forward and passing an ordinance that set an example for how you can have universal health care for the rest of the country. in september of this year, i plan to hold a hearing on how to enroll for health insurance in california's exchange which is called the covered california. right now, i know that san franciscans are getting ready for enrolling in the aca which the enrollment begins on october 1 of this year for coverage that would then begin january 1, 2014. later on this year, and we're thinking around october, we plan to have a hearing that will focus on women's health and how women's health will be

impacted by the implementation of the affordable care act. in the coming months, i look forward to a lot of lively discussion about the exciting moment in history in the history of this country where quality health care will become more accessible to so many americans. i wanted to start off the series of hearings on the aca with a discussion about the importance of maintaining our landmark health care security order and as you remember, this law was authored by my predecessor, former district 9 supervised sore now assembly member tom am yan noe, this serveesed as a model for the country for how to do health care reform and we know that we have heard from many moses if washington dc before the aca was passed that they were looking to san francisco as a model. my driving concern is that during this period of transition, here in san francisco, that we continue to be that model for the rest of

the country, and that the health care dollars that san francisco workers have been receiving from their employers for the last 7 years, that those dollars are not taken away during this transition. the health care security ordinance contains two components, both of which will be crucial to maintaining -- to ensuring full access once the aca is implemented, the first component is the healthy san francisco program which is a program that provides health care access to uninsured san francisco residents and which will continue to be crucial for those residents who are left out of the affordable care act, namely undocumented residents here in san francisco and other parts of the country. the second component of the health care security ordinance is the [inaudible] it was included by assembly member am ya*n know that worked on this

landmark piece of legislation. on the belief that employers should contribute equitably to the health care needs of their employees and employee provided health care is not only reserved for the high paid workers here in san francisco, the employers spending requirement was never really meant to be a primary funding mechanism for healthy san francisco, for the healthy san francisco program, although we recognize a small portion of this money does help the program solvent. the employer's spending requirement was meant to encourage employers to provide and to continue to provide health insurance to their employees or in the absence of health insurance, to provide economic assistance so that they have as much access as possible to quality health care. many of us believe that the employer spending requirement is needed now more than ever because under the aca, individuals are required to

meet an individual mandate and purchase health insurance, while cal foreign's health exchange, the cover california that i referred to before will make health insurance more affordable to many individuals in high cost cities like ours, like san francisco where according to recent reports during the most recent quarter, a one bedroom apartment in san francisco will cost you an average of 779, in these high cost, lower wage employers will find health insurance unaffordable, because of the health care security ordinance and the spending requirement in that ordinance, we hope the workers we're talking about will be able to use this money to meet their individual mandate and if workers can use the employer contribution to purchase health insurance, we believe the aca will be an enormous success in san francisco and we believe that

san francisco will be the model for the rest of the country on how to maximize its success of the aca because of the health care security ordinance. there's a last point that i want to highlight here before asking the department of public health to come and present, in 2015, the aca will include a requirement that employers provide insurance or pay a penalty if they do not provide health insurance to employees that work over 30 hours a week. what's going to happen as a result of this unfortunately, in many parts of the country to the extend that the threshold is at 30 hours a week, there's an anticipation that many employers will be lowering the number of numbers that employees work to 29 or under and because of the health care security ordinance, we know here in san francisco, an ordinance that goes beyond the coverage that the current law provides, we believe that, that

trend will not happen in san francisco because the health care security ordinance ensures that employees that work more than 8 hours are covered. this is yet another example of how the health care security ordinance and especially the employer spending requirement aspect of the ordinance can work very well with the aca to provide meaningful access to health care to all san franciscans, so with that, i want to thank all of the members of the public, members of the community, the business community, labor who are here, and so it is now my pleasure to call on our fabulous deputy director of public health, colleen chala who is going to make a brief presentation. is that okay? >> good afternoon, supervisors, i'm glad to be here on behalf of the health department. i am as you side colleen,

deputy director of health at the health department, i'm here on behalf of director garcia, she regrets she's unable to participate in the hearing today, but she is as we speak engaged in negotiations related directly to dpl's delivery system for the affordable care act. i also was hoping for the overhead too. san francisco has a long history of supporting health and health care in san francisco long before there was health reform, san francisco recognized the importance of health insurance and health care access and adopted cutting edge policies x programs that extended health insurance to more san franciscans, these included the healthy kids program which provides health insurance to low-income children, the health care accountability ordinance which requires contractors and less sees of city property to provide health insurance to

their employees and the health care accountability ordinance which you will hear about more today and healthy san francisco, our flagship program as supervisor campos mentioned. as employee of the public health system, i'm pleased to work in a place that puts high priority on health and access to health care and it's because of the citywide commitment that all san franciscans have a good health care home, we are doing this by connecting people to the insurance they're eligible for and to those that have no other options. we cannot afford to keep individuals on locally funded programs that are subsidized by the state or federal government. it will not be simple, it will require coordination and education and support and individual responsibility, but it is possible. what i'll talk about today will hopefully provide the foundation for today's discussion. today i will provide a general overview of health reform, kind of a health reform 101, talk a

little bit about the impact of health reform on the uninsured in san francisco, also about the aca implementation activity that dph and noel simmons will talk about the aca implementation verses at the human services agency. so, as supervisor campos said, it was assigned into law by president obama to expand health care coverage, it is the biggest initiative since the creation of medicaid and medicare, as a result of health reform , the rate of uninsurance will be reduced by half, and 92% of all u.s. residents will have health

insurance. locally, approximately 56 thousand san franciscans who are uninsured today will have access to health insurance. how does health reform propose to expand access too insurance? it requires that people have insurance and it gives them more options to obtain it. the requirement for people to have insurance is called the individual mandate as the supervisor mentioned previously. most but not all u.s. residents will be subject to the mandate which becomes effective on january 1. those that are not subject to the mandate include undocumented individuals, that will be the largest proportion of individuals not subject to the mandate. those experiencing hardships such as homelessness, people with incomes below the threshold for filing federal tax returns which is about 9750 dollars per year, the incarcerated, those are the religious exemptions.

>> my apologies, do you have copies of the slides for the committee. >> i'm sorry, i do not, i apologize. >> continue, please. >> anyone who is subject to the individual mandate and fails to show klein which will be done through their tax return, financial penalties will apply, the penalty in the first year is $95 which is low in acknowledgment of this new requirement but it creases to 695 dollars in 2016, it expands public insurance for low-income citizens through the medicate program, it creates the amazon.com of health insurance, it incentive employers to offer coverage, it makes health insurance more accessible and for all of these, i'll review the expanded options in brief. for the lowest income

individuals, health reform expanded medicate which is called medi cal in california, prior to health reform, only certain low-income individuals were eligible for medical, primarily, children, seniors, and families with disabilities, they compromise a significant portion of the insured, health reform changes this beginning january 1, adults ages 18 to 64 with incomes between 0 and 138% of the federal po*rt level which is about 15 thousand 800 dollars for a single person will be eligible for medi cal, the current medi cal program that serves these people will be unchanged. those newly eligible will enroll into managed medi cal, it's important to note that eligibility does not equal enrollment, enrollment is not automatic, even today, about 1.3 million californians are already eligible for medi cal

but have not enrolled, individuals will have to apply for medi cal which they can do at any time during the year. our exchange is called cover california, cover california is an online marketplace where individuals can purchase health insurance. individuals who have incomes that are above the medi cal threshold and californians can buy health insurance on this stage. there are four standard tiers that will be offered, they're called bronze, silver, gold and platinum, the difference is their percentage of annual cost that is the health plan covers, bronze covers 60% of cost, silver, 70, gold, 80 and platinum, 90, there's a catastrophic plan that also will be available.

there are sliding scale subsidies available to low-income individuals on covered california up to 400 % of poverty which is about 46 thousand dollars a year for a single adult. half of the individuals expected to get health insurance through covered california [inaudible] currently five health plans are approved for offering in san francisco under undercover california, they are anthem blue cross, blue shield, the chinese community health plan, health net and kaiser. technically, there is no mandate on employers to provide health insurance under the affordable care act, instead there are incentives and penalties for employers to offer coverage. they can offer for affordable coverage on the exchange, and for more full time employers,

there is a financial penalty structure if employers offer no coverage or unaffordable coverage, no coverage is defineesed as an employer who offers coverage for fewer than 95% of its fte's and the employer is imposed if one employee receives a low-income subsidy on covered california, [inaudible] health insurance that covers less than 60% of health care expenses or costs an employee more than 9.5% more of their income, a penalty is imposed if one employee receives one subsidy. [inaudible] at a cost to an employee of no more than 9.5% of their family income would avoid any penalty. these provisions were scheduled

to become effective in 2014 but the obama administration delayed their implementation until 2015. and finally the final category under health reform that is making insurance more accessible is through the marketplace reforms, these set more standards for health surfers, subchaser guaranteed issued and renewal which refuses to [inaudible] that individual or group used in the prior year x the inability to deny individuals due to preexisting condition, creating a minimum essential benefit package, extending dependent coverage up to age 26 and eliminating cost sharing for prevention services. so, now i'll talk a little bit about the ill pact of health reform on san francisco's uninsured. the 2011 american community survey which is part of the

u.s. census estimates the rates of insurance and uninsurance, these data show that approximately 84 thousand san franciscans are uninsured, 60 thousand aof these are enrolled specifically designed to protect the unschroeder, healthy san francisco was created in 2007 to coordinate care for san franciscan's uninsured, this is by the department of public health as well as clinic, hospitals and physicians across the city, more than 50 thousand participants have access to more than 37 health care homes and they are provided with specialty services, pharmacy services, primary care services and more. sf task is a program that began, sf path is similar to san francisco but it's available to those people who

will be available for medi cal come january 1, 2014. the current 10 thousand enrollees were enrolled, they will be all the nautically enrolled in medi cal in january where the sf path program will end. these two programs, healthy san francisco and sf path have put san francisco well ahead of the health reform implementation curve compared to other states in the nation, healthy san francisco was created in 2007 and because of this long history we have of coordinating scare for the uninsured, we have largely add deed pent up demand, it is a spike in utilization that occurs when an uninsured person first gets access to health insurance. we've promoted the medical home model, our uninsured are already used to the medical home, our managed care and

which will be most prevalent under health reform. we have more providers in our community who are committed to serving our low-income population and more importantly, we know who and when are uninsured are for the most part, for 71% of our uninsured, we can send them a let e call them on the phone and text message them, we can tell them of the changes that are coming with health reform and help them enroll into health insurance, sf path has given us some experience to create a managed care environment because it is subject to all the rules as a managed care plan, we have documented the challenges to providing enrollment into federal programs and highlighted management care access strategies, approximately 2 thousand enroll lees will transfer without the need to apply. this graphic shows the estimates of coverage transitions for healthy san

francisco and sf path members under health reform. you'll see at the top, about 60 thousand members are currently enrolled in healthy san francisco or sf path, we estimate that about two-thirds of them, 40 thousand 500 will be eligible for some kind of health insurance. 28 thousand will be eligible for medi cal and 12 thousand 500 will be eligible for covered california, 19 thousand 500 will be ineligible for coverage, those will be the undocumented residents or people who have other reasons not being subject to the mandate. eligibility does not equal an enrollment and people will have to actively enroll into health insurance to get the coverage they are entitled to, so of the 40 thousand 500 we think are eligible, about 25 thousand will access insurance. this is based on a 62.5% rate of retention that we currently experience in the healthy san

francisco program, so we have anticipate hated our retention rate which is quite good for our program will translate into health insurance enrollment. this leaves about 15 thousand 500 who represent those who may be eligible but do not enroll in health insurance. and they might not enroll for any number of reasons, enrollment is complex, they may choose to pay the penalty rather than enroll in insurance, they may choose to pay the penalty rather than enroll in insurance, this group plus the 29% that are not already in sf path are the individuals we will have to focus our outreach efforts on. >> just a quick question. do you have any more specific information on the 35 thousand that you're talking about in terms of, you know, what that group looks like, any

demographics, ethnicity, lgbt or not, do you have a sense? >> we do, and i will -- 19 thousand 500 of them are largely going to be undocumented residents we anticipate. they may be other people who are not subject to the mandate because of hardship or other reasons but largely undocumented. the 15 thousand 500 will likely be those that are at the highly end of the healthy san francisco limit, it cares for people up to 500 % of poverty and those who are medi cal eligible will be able to apply to medi cal without no cost to thel, so that will be an easy decision, as the income gets higher, the cost sharing gets higher. >> what percentage will be lgbt? >> i do not have that percentage. >> thank you. >> within the department of public health, we really have a two-fold focus on health reform implementation.