is not thought out well enough, the intention -- the achievements that it is going to insure. it is going to cover the health costs that the city is incurring. we need to ba throwback to the drawing board on that. supervisor campos: supervisor campos: thank you very much. one of the reasons we asked mr. goldberg to do a brief presentation on how the health care security organs works and how that differs from help the san francisco is because it became very clear in the main, and that commissioners made that there was a real lack of understanding of how the law works. that is one of the reasons why we wanted to provide some context. because the comments and statements really do not align with the reality of how the actual ordinance covers.

>> i just wanted to thank you on your willingness to spend so much time on an issue that should be taken care of quickly. i am a rabbi in san francisco. i began my career 42 years ago as a chapel in the united states air force, spending t a beale years in southeast asia. i address you today not as a rabbi. i am a strong believer in the separation of church and state. i want to speak to you as a resident of our great city and as a customer at a restaurant, and i want to tell you that i feel deceived. i was so proud when i first learned that a portion of the bill that i am paying is going to health care for workers. 21 and a half years ago, i was diagnosed with lymphoma. chemotherapy, stem cell, transplant, the works. today, i go every year.

medicare gets billed $11,000 every single month. i know the value of health care. and i feel deceived because what i thought was such a good moral, ethical thing is not being carried out the way in everyone i know who is aware of this believes their money is going to. i do not want to speak as a rabbi, but i will tell you that my tradition teaches -- do not put a stumbling block before the blind. we are blindly walking into the restaurant, and i think a police are also blind when they think they are getting a fund for health care and they are not. i hope you do what i think is the right thing. supervisor campos: thank you. next speaker. >> i am with health access california, and i wanted to address the rollover issue, which has not been addressed yet. the issue is that the ordinance

currently does not require hra's to have a rollover ability. i would submit to you that that is an essential issue addressed by the amendment, and that would not be addressed by other forms of solutions. first of all, only 10% of hra's nationally do not have a rollover capacity. this is really an allied air. on the front end, the reason to allow funds to roll over from year to year is the prevention issue. the fact that employees are not currently using the hra's is not a good argument. fact is that the national health care reform debate was fundamentally about moving towards a culture of coverage, a culture of prevention and primary care. people who are not used to having health insurance and young people used to being healthy do not tend to see primary and preventive care. it is no more a reason to stop

providing them access to that care than when the city started to do recycling and people were not feeling their bins -- not filling their bins. you do a mass of publication effort -- a massive public education effort to normalize the behavior. on the back end, the reason we need the rollover is the medical debt issue. medical debt is a huge and growing issue in this country. bankruptcies in california went up 14% in 2010 alone. we are now at 1.5 million bankruptcy's in the state per year, and we know that approximately 2/3 of those relate to medical debt. young people in particular, those who work in these restaurants -- they may not have care on the front end, but when they have a hospital bill, they should need to have money accumulated in the account on

the back in. supervisor campos: thank you. i have a couple more speaker cards. >> i am a restaurant owner in san francisco, and we use the hra program. we are fully in compliance. we do allow rollover year after year. 80% of our employees have been with us for more than three years and have been happy and since this health care act has come into play, had used the services and the funds. we do have many that do not. the question is -- why? one of the things that mr. chiu had mentioned was -- what are the solutions? i think education is really the solution. they do not understand what it will cover, so they do what they always do. they go straight to the emergency room and figure the taxpayers will pay for it.

i am a taxpayer as well, so that does not help me, either. maybe in the emergency room, there is a box that you have an hra plan, that gets used first and applied to the bills' first. maybe that is also a solution. another solution would be to educate them more about instead of going to the emergency room, that there is an opportunity for them. i think education is key. we try to do our best. we had employee handbooks. we actually give seminars to new employees that come in. our process is simple -- you fax the receipt and fell out the forms. not complex. i am always surprised when employees do not take advantage of it when they have the funds available year after year. they are all informed about it, but they did not take the time to use it. that is all i wanted to say about it. supervisor campos: thank you

very much. >> good afternoon. jim lazarus, chamber of commerce. we appreciate the efforts you are making to update the legislation that we all work on with supervisor ammiano in 2006, but i think we need to get this back in meeting with the health department, which held the san francisco, with the office of labor -- with healthy san francisco. the important part of this is job loss in san francisco. i was surprised to hear your experts say that our economy has 600,000 jobs. supervisors, we have not had 600,000 jobs in this city since 2000. has been 11 years. it costs a minimum wage employer hiring entry-level " sanford cisco 40% more to employ folks in the city than it did six years ago.

higher minimum wage, health mandate, sick leave mandate. those are good public policies, but you have to understand it has an impact on employment. during the recession in 2002- 2003, we will -- we lost 90,000 jobs in san francisco. there was a recovery, but we never got back to 600,000 jobs. the first recovery from a recession we track at the chamber that did not get us more jobs than we had before the recession. will we have another jobless recovery at this recession? this city has more people living in it than any time in the history of the city. 805,000 people in the last census, but we have 80,000 people less that work in san francisco than we did in 2000. there is something wrong here. this is not the time for this legislation. clearly, there are notice issues, communication issues, but you are throwing out the baby with the bath water when

you're dealing with so many good employees -- [bell rings] supervisor campos: thank you, mr. lazarus. next speaker please. >> good morning, supervisors. i am with the chinese progressive association and progressive workers alliance. our main campaign we are working on right now is not health care. our main campaign is a campaign to end wage that wagetheft -- wage theft. we have been trying to educate workers on basic labor law protections. we're doing our campaign because the fact that workers have wages stolen from them " as the economy. i wanted to acknowledge and thank all the members of the community, all the employers here today expressing their interest in providing health care coverage for employees, expressing their interest in protecting jobs and making sure that workers get employment, and

invite all of you to join the progressive workers alliance in our work to increase enforcement of labor laws in san francisco as well as create jobs for san francisco workers. i also want to note that we are coming here with actually a very simple matter. everyone agrees that health care insurance is a week -- a good way to go and what employees to have access to health care. we are down to a very simple question -- do all businesses play by the same rules or do they not? if everyone in the room agrees workers should have health care coverage, then we have to look at the facts. and% of businesses in san francisco are spinning out their money buying health insurance or paying healthy san francisco -- 90% of businesses in san francisco. by closing the loophole, that is how we even the playing field and make sure workers have access to health care. thank you.

supervisor campos: thank you. next speaker please. >> i am a restaurant owner in san francisco, and i would like to address my remarks directly to some of the questions president chiu ask. i appreciate it. some of the questions you ask were really good. i would like to shed and on the ground business owner's light on those questions. we have an hra. we fully notify our employees. we provide any coverage that can be covered. dental, medical, so on and so forth, but utilization rates are still low. president chiu ask the question about 20% compared to 55%. there may be an assumption that is incorrect. we are assuming all things are equal. in healthy san francisco, i believe these are people who sought out health care and applied for it because they knew they needed to access the health care system. in our hra's, utilization rates

are lower -- nobody argues that young people never access health care, but young people dollar for dollar probably access health care a lot less than older people. i have a lot of young employees, and they are noticed about the hra, and simply do not use it as much. one thing you brought up that i would like to address -- the perpetuity of holding these liabilities on our balance sheets would be catastrophic. i got to try to find financing for my next unit, and i have tens of thousands or hundreds of thousands of liabilities on my balance sheet that will never be redeemed or go anywhere. i'm not going to get financing. i'm not going to create jobs. if this passes, i will shut down one of my restaurants. there is no question about it. if it passes, my next unit -- i'm trying to save up here and there -- i can assure you, it will not be in san francisco. i will have to the oakland, san jose, berkeley -- i will have to go somewhere else because it is

tough out there. the economy is hard. our margins are thin. we want to provide health care, but this is not the way to do it. supervisor campos: thank you. next speaker. >> could i ask for 10 more seconds? supervisor campos: next speaker. [applause] >> good morning, supervisors. i work at a small bookstore in the mission that employs 17 workers and has one employer. i want to thank you for this amendment. i am here at the behest of my employer. because numbers are so low at our business, my employer is not required to provide health insurance, and yet, he does. he has provided health insurance for workers for the last 10 years fully. the only people who are not covered are people who have spousal coverage through their marriage. he feels it is a moral obligation to provide us with health care coverage, and it is

part of his business plan. small business owners, do not give me this. it is doable. he also provides massage for us every two weeks, so that we do not get carpal tunnel syndrome because we are mostly a computer-based business. are we happy? are we motivated? are we productive? you bet your bippy, we are. i will conclude with a quotation from martin luther king, a remark he made in connection with the civil rights laws that were passed in the mid-1960's. he said, "these lots will not change hearts, but they will change behavior, and perhaps sometimes, hearts will follow -- these laws will not change hearts."

so i beg business owners, please pay your fair share. [applause] >> i am the executive director of the committee on jobs. let me first say that we support the health care security ordinance and believe that the program works. we also understand the concerns raised by supervisor campos. but we believe the current form of legislation will hurt the local economy, local businesses, and ultimately those who live and work in san francisco. in particular, it is clear that after a few conversations with local employers that the number of jobs lost will be significantly larger than what was reported today in the economic report. the fact is that this measure would hit local businesses and their employees harder than any single tax increase proposed or adopted in san francisco in the past 20 years and would come at a worse time for employers in decades. in 2006, then supervisor ammiano said this was a way to increase employee access to health care

services. he was right, and that is what the hcso has done. can it be improved? absolutely, but this is not the way to do it. san francisco does not operate in a vacuum. we have to compete with other businesses in the region and with the whole world. passing this legislation will continue to push costs higher and leave more san franciscans unemployed. health care policy is extremely important. yet, and even more complicated issue -- sweeping mandate should not be adopted in haste and without careful consideration of the facts -- sweeping mandate should not be adopted in haste -- sweeping mandates should not be adopted in haste. we believe we can allow employees to enjoy the flexibility of these accounts. additionally, by providing employees more and better reminders, we will certainly see the increase in usage.

with the city's economic recovery still in question -- [bell rings] supervisor campos: thank you, sir. next speaker. >> i am a registered nurse and member of seiu 1021. i want to talk briefly about the young person who has asthma who has no access to an inhaler and an antibiotic to the ends up with life-threatening pneumonia in the emergency room. there really are ways for this to work, but i have to tell you -- i am outrage that someone who lives in san francisco and paste that $2 and thinks it is really going to health care -- i am outraged that someone who lives in san francisco and pays that $2 and thinks is going to health care and their argument against not going to closing the loophole is, "we swear we are not guilty of cheating, but in case we want to cheat in the future, we have to leave the loophole open."

that does not make sense to me. i am in favor of this ordinance. it is unbelievable. i go to a restaurant and order lobster and they gave me a hamburger, i would be totally outraged. you are handing me a bill that says you paid for health care for someone, and then pocketed the money, and you need it as your private source for creative financing? i do not get it. thank you. supervisor campos: thank you. next speaker. >> i admit, you're so tired of hearing small businesses and restaurants being vilified -- i am tired of hearing small businesses and restaurants being vilified. what a perfect example of what is wrong with this amendment. we have six stores. we have been here for 25 years. we have been a great san francisco citizen. we feed hospices. we feed the tenderloin after- school program. we tried to be a good citizen

and try to treat our employees in a benevolent fashion. all our employees get health care from us, but if this amendment passes, the impact is a $200,000 a year cost. we have six stores. two make money, two break even, two lose money. it this amendment is enacted, we are a true example of job loss. we will close two stores, and 40 people will lose jobs. that stands in stark contrast with what was expressed here. we are 1 business where you will lose 40 jobs right away from us. we are a prime example of what is wrong with this amendment. once again, i want to speak to the integrity of small businesses and restaurants that do business here and do it in the spirit of san francisco, which is a benign spirit. supervisor campos: thank you. next speaker. >> i am the executive director

of the san francisco labor council. we represent over 100,000 men and women who do have health care because they have effective bargaining agreements, and we were extremely proud to be part of the team the past the san francisco health care security ordinance in the year 2006. it was a 15-month campaign, extremely difficult to move forward with this. there were lots of studies, and ultimately, as people have said, this passed unanimously. by the way, i want to thank president chiu for cosponsoring the legislation, and thank you, david campos, for initiating it. the main piece we never anticipated what happened -- because healthy san francisco works -- tens of thousands of more people now have access to health care because of this wonderful legislation.

we never ever thought that there was going to be the type of data that we are now seeing today. we have been monitoring this over the last five years to see how it works. we like to see if legislation works. when we found out that over 80% of the money that is supposed to be going into health care savings accounts was going back into the pockets of the employers, we thought there was something vitally wrong. so we fully support this amendment to this great legislation, and we are urging you to make sure this goes to the full board of supervisors at the next meeting. thank you. supervisor campos: thank you. next speaker please. >> i am here with san francisco pride at work. the majority of our members are young people who work in san francisco, and i say the majority of them -- probably over 80% -- use healthy san francisco and otherwise would have no access to health care at all. when the legislation was

originally passed, we never expected that the accounts would be used as a loophole for employers and by closing the loophole, we will be bringing the legislation in line with the original intention, which is to provide health care for everyone who works in san francisco that otherwise would have no access. this is really important to young lgbt people and the city, and thank you, campos, for introducing it. supervisor campos: thank you. next speaker. >> i am an elected officer with seiu local 1021, and i work at a nonprofit in the tenderloin. over the last four years, we have suffered millions of cuts. we had deskilled our workers and reduce the availability of cyc beds. we have merged clinics and seen many layoffs. our public health system has been cut to the bone.

we cannot allow anyone to continue to cheat the system. the taxpayer's burden is about $600 for every blood pressure check. several thousand dollars for every emergency room visit, and at least $1,000 for every camp -- every ambulance ride. the idea that young people do not need access to health care, in countries with cervical cancer among young women, who is primarily affect women in the 20's, is the second cause of death, in this country because of regular checkups, it is the 14th cause of death among women, but those numbers go very high for women who are uninsured and do not have access to health care. in addition, the idea that young people do not need health care -- i do not know who you think there's children, but is usually young women. -- i do not know who you think bears children, but it is usually on women. it is very important that we

close this loophole, moved in the intent of the original legislation, and i thank you for your leadership. thank you. supervisor campos: thank you. next speaker. >> supervisors, i am with seiu 1021. i was part of the team that worked to pass the legislation when it originally passed. i can tell you without hesitation, having actually sat in the room when it passed this specific provision that it was never intended to be abused in this way. to reward bad actors seems wrong. leveling the playing field is the direction to go. i also just want to know, having sat through the hearings on the original legislation, the same arguments were made by almost the same people about job loss,

how this is going to hurt businesses. as history has shown, supervisor ammiano was correct. the supervisors and the mayor's office, who were willing to be courageous around the most important issue that faces america today and being a leader on the most important issue was the right thing to do. history has shown that that was the correct course. by closing the loophole today, you will show again that san francisco is the leader on health care and is willing to make sure that uninsured and those that are low-income have the kind of health care that they deserve. i just want to thank the board of supervisors for holding this hearing today and revisiting what is clearly a loophole that should never have been created. had we known, we would never

have done this, and i am happy to see that you guys are doing the right thing today. supervisor campos: thank you. next speaker please. >> good afternoon. i have lived in san francisco for 59 years. i would like to make my comments from a different point you. with this health-care ordinance, obviously, this -- there is disagreement. one area that everyone should agree -- if the department of public health had administered the different older programs more efficiently instead of wasting money, then we would not be in such a bad state of affairs. i admit that i am not fluent on these items, but one thing i am fluid is that if our agencies were to use the money more effectively and with less waste, we would not be here arguing for over two and a half hours about

one particular loophole -- one thing i am fluent on. one has to take a realistic point of view. if you are a businessman in san francisco, it is pretty clear that no matter how big of a heart you have, you cannot take care of everyone in every way you want to. it is kind of like the homeless problem. you take care of 100, there will be 200 more. you take care of 200, there will be 300 more. that is why a lot of my colleagues in different parts of the country actually congratulate me and say, "san francisco, you are doing a hell of a job solving problems for us in the east, the north, and the south. keep it up. you have such a big heart. we are glad we do not live in san francisco." my final piece of advice is no matter how much we want to help everyone, we have to be

realistic. we cannot solve everyone's problems. it is better to teach them to solve them themselves. supervisor campos: thank you. next speaker please. >> good evening. i am from the golden gate restaurant association. i am here today to talk about what i think is a way forward that will address the issues that have been raised, without the negative economic impact we have also heard today. one of the things that people have said -- and i think we need to clarify -- there's a, that keeps being said that there is not access -- there is a comment that keeps being said that there is not access. the purpose of the legislation when it was originally drafted was trying to create health access so that people did not first access health care at the emergency room. that was the design of the

program. a reimbursement account does that. provides for reimbursement for going to doctors, for going to the clinic. provides the level of health access, which is what the program was designed to do. however, if employees do not know about that benefit, then they cannot take advantage of it, and it undermines the intent of the law. we strongly believe that a mandate regarding notice would be appropriate. it could be a quarterly notice. it could be one that discusses how much of the benefit the employee has, how much they could accrue at the current rate over the course of the year, how the employee can access that benefit, and list the eligible expenses that they can be reimbursed for all on the notice to the employee. in addition, if we believe that there are bad actors and employers so limiting their program that they are not