everything to comply with the spirit and letter of the law, which is to make money available to employees for their personal health care. to that, i have to say that 55% reimbursement rates for medical reimbursement accounts, i think, is a really good goal. if that is what the city can do with all of the city's outreach, education, language -- we have a very educated and active workforce. we have an engaged work force. we have organized labor that is very active. that is, i think, a great goal, a beginning. it would be great to have it at 80% or 90%, but maybe that is not even a goal. if you are one of these young 23 year olds who does not get injured but in three years needs

it for something, or has multiple accounts, i just see the benefits to the hra for the small employer. i would ask that the people who work for the city really look at making sure that we have access to an important tool that was created at the beginning of this program that is important to manage these expenditures on behalf of our employees. the other thing i wanted to communicate to you is that for many employers they meet and exceed the spending requirement for their total employees. i'd just want it to be remembered that if an employer is retaining use of the funds before they make an expenditure to their employees, then in many cases they are using it for

their employee health care. we are at age -- we are age- banded. my 23-year-olds do not cost very much for health insurance. the 62-year-old and the 55-year- old i have are three and four times the cost. we provide the same benefit. so i just want to let -- just want you to know that companies are using their health care dollars across the work force, and many times at a much greater rate than is the spending requirement. this is a policy. i just want you to be aware of this, when you are talking to our small companies and what they are facing. providing fair and flexible benefits that benefit our employees -- these are some things i really want you to consider on behalf of the small

businesses. supervisor campos: we have considered them. we are here to listen as much as we can to what you have to say. the vast majority of businesses, as you noted, are trying to do the right thing, not only under the letter but the spirit of the law. i think that one of the things that is frustrating about this process is there are many arguments that people make about the impact that healthy san francisco would have on the local economy. those arguments were made repeatedly to argue against healthy san francisco. but the reality is that the parade of horribles that people anticipated did not occur. it did not occur even though there were many sacrifices that

were made and continue to be made by businesses. people may want to the engage in that debate again, but that is not the point here. we have the program in place. this is about making sure that to the extent we are requiring employers to follow the rules, let us make sure the rules apply fully to everyone and there is a level playing field that protect the workers and protect other businesses who are doing what they were supposed to do. commissioner clyde: to that end, i agree with the intent absolutely. i just am very concerned about the implementation as this legislation is currently written, if it will disadvantage highroad employers who are complying and using these to comply. i would like more information about that. >> great. thank you very much. president o'brien: i will later,

but i want to give the other commissioners -- commissioner dooley: i wanted to ask tangerines some questions. could you give me the statistics on the complaints coming into your office of employers violating their notification, their excess ability to their employees? also, what is the enforcement procedure on that? can you walk me through that? >> i do not think we have actually had any complaints from employees who asked us -- you mean him. ok. >commissioner dooley: no, you. >> you are talking about the medical reimbursement account. commissioner dooley: i just

wanted to know how many complaints have been filed for violation. >> i think you want matthew. >> won distinction or confusion is which agency is responsible for what function. essentially it is the office of labor standards enforcement that enforces this requirement. one of the methods for meeting the requirement is to speak to tangerine at healthy san francisco. in the three years the law has been in place, we have initiated a little over 300 enforcement investigations. there are different ways to look at bat. we have received hundreds of inquiries and have worked with employees and employers informally to ensure that employers are meeting the requirements of the law and employees are getting the

benefits that are required. some complaints do not rise to the level of investigation. with respect to the enforcement law -- enforcement arm, between 304 hundred cases have been opened during this process. commissioner clyde: how long does it take to be reimbursed from a medical reimbursement account? >> it takes anywhere from three weeks to four weeks from submission. commissioner clyde: i have noticed that healthy san francisco has a wide ranging education campaign or advertising campaign. it is in neighborhood newspapers across san francisco. this is your goal to increase participation?

>> our campaign is designed for individuals who are uninsured who may or may not be participating as a result of their employer. you are correct that one can call 311, or go to our website. we have lots of fliers about the program. in terms of an employer -- commissioner clyde: this is just for the program. is the program working to increase participation? >> i think it is important to look at it from the perspective of how many uninsured adults there are in san francisco's. there is an estimated 64,000 uninsured adults in san francisco based on the california health service. there are about 64,500 uninsured adults currently in san francisco. we currently have a take up rate of about 88%.

we do not accept all uninsured individuals who want to enroll. commissioner clyde: do you know how many are employed outside of san francisco? >> no one can be enrolled in healthy san francisco and be a non-san francisco resident. commissioner clyde: employed outside of san francisco. i thought all san francisco residents who do not have insurance -- if they are employed in alameda county, san mateo county -- as residents, they are eligible for the program. is that correct? how many people are employed by employers outside of the city and county of san francisco? >> we do not maintain that information. employment status is not relevant. we do not care about your employment status or immigration

status. we do not ask that information. >> for me, as a resident of san francisco and a san francisco taxpayer -- if one of the goals of this program is to protect the san francisco taxpayer, i would like to know how many employers are being defective subsidized by our taxpayer dollars. -- being de facto subsidized by our taxpayer dollars. when we look at shifting this $52 million relatively quickly, and people starting to shift their game plan around, it would not be good to continue the exodus of opportunity outside of our borders while our residents continue to be -- continue to live here, but will be employed outside our city and will continue to receive health care

here. i understand you do not ask it. it is a status question. but i think in fairness to the business community it is an apropos question. president o'brien: any further questions from commissioners? i would like to ask a couple of questions myself. mr. goldberg, if i could ask you a couple of questions, and supervisor campos. maybe the question might be more directed to you. it seems to me from what i have heard tonight, which i must confess is purely educational -- i have tried to read some of it in education -- in preparation, but am trying to get most of my learning from testimony. is it fair to summarize our big problems are house some questionable employers are behaving in terms of implementing this program, what

that offer, the spirit of the law, so to speak, and the other being that some people, some employers, are not giving this money back to the poor are back to the employee? would it be fair to summarize the problems we are trying to tackle with this legislation as the way that some employers are implementing it and the fact that sometimes this money goes back to the employer? would it be fair to say the goal of the legislation is to make sure the money never goes back to the employer? >> yes. i think that despite a lot of complexity and nuances of the testimony -- you have hit it on the head that the intention is to make sure the money remains with and goes to the employee. it essentially redefines and clarifies the definition as one

that irrevocably remains with the employee, rather than reverting to the employer. i think it can next to another comment associated with it. -- i think it comes next to another comment associated with it. if you can keep open the idea that the money that is going to come back to you, that provides an incentive to proceed with some of the types of

perspectives that could be reimbursed. president o'brien: to play this out a little bit, an employer who puts money into the space of a year -- is it a goal of this legislation that they would receive some of the money that was set aside for that year? >> that money would remain available to the worker in that account, even after the employee has left the employment. the money remains available to that worker to reimburse future medical expenses,.

-- medical expenses. you are working for an employer who are spending money to put into this account by healthy san francisco. you may not have access that money, in part because you have been healthy. when and if you leave that, as you may or may not have moved on to another job. that money remains available in that account. that was designed to achieve parity with that and to reach the same practice, in effect. the money was put into health reimbursement accounts as permitted by the irs and the tax code. it would remain available to workers. president o'brien: this brings a whole new dimension to the proposal, the logistic associated with it, the accounting of that going to a lifetime of someone's career.

that scares me a little bit. i would also say that to me, i do not know what the supervisor's intentions were, but i think that he came to the realization one day that is -- that it is a tragedy that somebody can be medically infected with something, really need help, and cannot get it because they do not have insurance. i see that as a noble problem, a noble cause to tackle the problem like that. i think it is an ongoing risk control mechanism that we are talking about. i think it is a good idea for the purposes of managing risk that there is some sort of periodic reassessment when you get through the year without it, like a car insurance policy.

it is not the same league, but if you have been lucky and did not have a problem, having the employer take responsibility of resources to manage that risk for that year, the problem we have really identified is let us not have some of san francisco uninsured. i think we can do it in a way that is not going to be so devastating. that is probably not fair. but it is going to be onerous. i am sure we are going to hear testimony. but those are thoughts i wanted to put out there. if you want to respond, supervisor, you can. >> i can give one technical response to how this is administered. healthy san francisco uses a large third-party broker to administer and handle these accounts we have been talking about.

it is exactly the kind of company and broker that manages health reimbursement arrangements. it appears as though there would be third party agents like the one san francisco uses who would administer these accounts in a way that is consistent with supervisor campos's legislation. it does not appear there would be any concerns about the ability to administer these accounts in this way. there are practical examples already. president o'brien: thank you. supervisor campos: great questions tonight. we certainly will be taking on your comments into consideration. the couple of points that i know are really important to trying to meet the intent of what then- supervisor amiano was trying to accomplish -- we hear from a lot of workers that this loophole is

referred to as the "don't get sick in january" loophole. if you get sick in january, the money accumulated is going to be -- you start from scratch. that is one of the unintended consequences of what we have. the second thing, which is for purposes of the legislative process, is to really clarify what was said earlier, which is this notion that when the law said the employer is supposed to make reasonable health expenditures that somehow making those expenditures would not mean actually spending the money, but simply creating an account where the money sets. that was not the intent of healthy san francisco. supervisor amiano will tell you that when he wrote making the

expenditures, the idea was that it would be made so health care could be provided to the employee. we are trying to clarify that in a common-sense way. president o'brien: thank you. commissioner o'conner: a couple of questions or points to you, supervisor campos. some people here in the room were involved with the development of the legislation. some much more so than others. i at the time served on this task force the mayor created. i would like to address a couple points going back to that time. i think they are relevant to this time and to making healthy san francisco work as best as possible. i am not sure to what degree you followed it before you became

supervisor. the process was ridiculously fast. it was set with a 60 day window of time line by the mayor and supervisor amiano. among the various hearings we have here on this commission, i do not know if any commissioners here were on the commission at that time. there were a lot of hearings here, as well as -- i do not actually think there was much of a hearing at this board of supervisors. various things that i brought up at the time are that the weight it is written we are not going to raise the amount of money we need to provide the spirit or the goal of the program. there were way too many loopholes, many that i brought up. i think the 20-person marker has

a lot of issues. the lot of businesses want to make sure they stay under that cap. that is loss of revenue. this was so predictable, this one. the other issues of how many of these businesses have skirted right out to south of san francisco -- i know several. it was all predictable. it was all done way too fast, quite frankly, so that our former mayor had some trophy for his statewide campaign, in my opinion. i keep it real. there are some anythings in this legislation that need to be reworked to create the best possible healthy san francisco for san franciscans, for

workers. if i am going to pay into it, like i do -- i do not know if any other commissioners pay into it. i do not know how many people in this room pay into it. i pay into it. i want it to work. i want it to be good. also, the people who are behind the scenes -- none of this is transparent. it all got written behind the scenes. every issue i brought a at this task force was completely ignored from a small business perspective. and here we all are, as i knew we would be. i knew i would be able to sit here and say what i am saying right now. do it right. make something that works so that -- it was great that it got done. it was great there was the political will at the time. but now is a time to take a look back. you are going to be a supervisor

for i do not know how many years, but you will be here for a little while. you inherited the seat of a supervisor who did a lot of heavy lifting. keep your eye on the ball with this issue. this is not going to be the last time this issue comes before you. it is going to keep coming before you to make it as good as possible. supervisor campos: i appreciate the perspective, commissioner. i think it is important for us to have these discussions. what i would say is i understand that we need to go back and look at these issues. it is important to clarify that i am not here tore- debate the question of whether or not we should have -- i am not here to re-debate the question of whether or not we should have helped the san francisco. -- healthy san francisco. that ship has sale. for me, it is how we make rules

that make sense and are fair and how they are applied. but clearly, the issues around health care are big issues. and by the way, it is not just this specific issue. we have spent a lot of time working on these issues. we put forward a health services master plan so the city could do a better job at looking at the entirety of our need not only as a city, but neighborhood by neighborhood. we are looking at some of the practices that hospitals are engaging in. that in turn is impacting health-care rates, which are a big reason why some of the businesses are facing some of the challenges they are facing. we need to continue to deal with this issue as a city. but from my perspective i have to represent the entirety of my district, all of district 9, and i have to make sure there is a level playing field so that all

businesses are following the same rules and competing under the same guidelines. that is what a big part of this is about for me. commissioner dooley: i was wondering how this would affect an employee who would leave san francisco. supervisor campos: by the way, i wanted to acknowledge that i know the room full of people have been waiting to speak. i want to thank the people on both sides of this issue for taking the time to be at this meeting. >> with respect to the money that is placed into health reimbursement accounts, the ordinance clarifies requirements about the amount of money put into these accounts. the employer puts the money into the account for the worker and that remains available.

that would be true if the worker is no longer working there or if the worker moves out of san francisco. essentially, the employer put that money into an account for the worker. it essentially would be available to the worker into the future. it is analogous bank accounts. commissioner dooley: is that a lifetime benefit? >> as written, yes. help savings accounts work the same way. that money is held in trust by a bank. it is yours in perpetuity, regardless of where you live. commissioner kasselman: i have to follow up on that. what about members of healthy san francisco that leave the city? >> if a medical reimbursement is

established for an employee and that employee moves, it does not matter if they reside in san francisco or another county. that account is still eligible to be withdrawn by that employee. they can go online in any state or county they live in and pulled down the information and submit a form for reimbursement respective of the county they live in. commissioner kasselman: and the hillary ronen -- healthy san francisco portion of your program? >> that is only available for individuals who reside in san francisco. if they move outside of the county but are still working for that employer, what will happen is that any future deposits on behalf of that employee will be subject to a newly created -- will be put into a newly created mra once they have left the city

as their city of residence, if they are still working for that employer. commissioner kasselman: the onus is on the resident to notify of address changes? how does the account follow them? >> the account follows them because it is an online account. an account was created for them on line, so they can access information on their account at any given time. if they have an address change, so that they have to inform us of a change in the address for the quarterly statement, they can make that address change on line, or they can also call our dedicated employee call center and give us the updated address. commissioner kasselman: if it is never claimed, does