available for everybody. again, i applaud san francisco for having health care for everyone. i look forward to this loophole being closed. supervisor campos: thank you. next speaker please. i have a few more speaker cards. [reading names] >> my name is laurie baker. my husband and i opened a restaurant a year and half ago. it was a lifelong dream, and i am happy that we were able to do it. we created 30 full-time jobs by opening our restaurant. nothing would make us happier than to provide full insurance for each and every one of our employees.

i am sure you know, running a food service industry is such a small profit margin, it is not possible at this time. we encourage everyone of our employees to use their hra's. i just want to put my 2 cents in and say that if there were more incentives or tax breaks for small business owners to provide full health insurance to their employees, instead of something like an hra, i think that would be money well spent . i also want you to think about the jobs that will be lost by closing the profit margin for small restaurateurs with the passage of this amendment. supervisor campos: thank you. next speaker please. >> good afternoon.

i am the senior director of benefits, compliance, and compensation for camden hotels and restaurants. i want to thank you for your time in allowing us to speak today. also, clarifying some of this legislation for everybody. i would also like to say that we offer an hra, in addition to comprehensive benefits that we offered to full-time employees. we do not charge surcharges at our restaurants, so we are not pocketing money as an added profit. our employees receive notice of eligibility together with the claim form and authorization for a direct deposit. samples of reimbursable expenses. the explanation is written in a

clear question and answer format. the service that we used to deliver our hra does provide spanish translation. we do have a number of chinese- speaking employees. we have a good working relationship with our employees about the understanding of their benefits. these materials are mailed directly to employee homes. they do have the option to opt out of the benefit. employees who want it are taking the advantage. we understand not every employee eligible for the benefits takes advantage. we offer comprehensive benefits to our full-time employees. we would love for all of our employees to be covered. as someone who runs a benefits program, i understand the

importance of health care. supervisor campos: thank you. next speaker please. >> i am the owner of arcadia home care. i oppose this amendment. i am disappointed to hear you continually use language like it is a non-starter, when there is a solution available. my industry does not charge a surcharge. we do not put money in our pockets. we provide services to seniors. this will continue to provide, to increase the cost of remaining in one's own home, our own relatives, forcing the industry to go underground without protections, supervision. adult protective surgeonservicey

is already neglected. there is a solution. this should not be passed on to employers who already complied with every letter of the law. supervisor campos: thank you. next speaker please. >> i would like to get the supervisor's attention. i am speaking on behalf of a restaurant -- there are about 11 of them in the financial district. we are a business that believes in health care for our employees. we provided health care well before 2006, and continue to seek to provide health care. we do not have that 3% tax because it has always been a cost of doing business. however, this legislation, as it is written, is counterproductive

to the idea of universal health care, and this is why. right now, employers are faced with health insurance or a use or lose it hra. most will choose insurance because it is a better option. the with the legislation is set up now, the hra continues to grow, like a pension plan. now when faced with a pension plan, $2 more an hour, they made choosethe hra. if there is a catastrophic accident, the person choosing the hra is going to get screwed. i really believe this legislation, as it is written, is counterproductive. supervisors have raised a great question. where does the money go? what happens if the employee changes jobs and has full health-care benefits?

where does that money in the hra go? these issues are not addressed in the current legislation. we provide health care to our employees. we want to level the playing field, close loopholes, but this legislation, as it has been written, has not been thought out well enough. supervisor campos: thank you. next speaker please. >> i am a third-generation owner of a san francisco business. i pay taxes, 100% in compliance with all the laws. but my business does not reside in san francisco. my office is in daly city. you talk about leveling the playing field. the playing field does not even level with the current provisions for healthy san francisco. it does not cover any employers

that are under 20, and it has two different rates, so the rate of 1.37 or $2. the provision itself is not leveling the playing field. you also do not cover the cost of health insurance. you want universal health insurance, but you cannot talk about it in open session. you have to go into closed session. if you want health insurance -- all my people get notices. they wanted to use it. 38% was used. everyone knows they can take that money and apply it to health insurance. why do 62% of my employees, for the last 30 years, choose not to purchase insurance? perhaps it is cost. perhaps it is another blank check to drive up health-care costs. medicare pays $10,000 in dues

for home care agencies in certain associations. i have to pay $72,000 in workers' comp or somebody to take their daughter to a weight- loss clinic in the philippines. you are not dealing with cost. you say that all employers should pay this. this should be a benefit that all employers pay. based on the fact that i have always followed the law and everyone gets their quarterly notices, i do not restrict, and only 30% of my money is gone. there must be something wrong. supervisor campos: i have a few more names. [reading names] >> good morning, supervisors. our employees do have hra

accounts. we do not have a use it or lose it provision. the balance accumulates year over year. they receive quarterly notices, they make special accommodations for the employee to access their hra account. i have never had any complaints about getting reimbursements. however, i oppose the amendment to this ordinance as written for the following reasons. the cost of administration has not been calculated yet. it is impossible -- at least i cannot figure out how small businesses will comply with tracking employee's accounts after they have left the company. it is a burden that will become increasingly expensive over time and will provide very little benefit. the second part of the amendment is that the care expenditures have to be available within five

days after the end of the quarter. the administration of the hcso is extremely burdensome within a small business. we can are they calculate our debt to our employees within that five days and then get it off to the third-party administrator, who absolutely cannot turn it around in that timeframe. it will be impossible to comply with that aspect of the amendment. for those two reasons, i oppose the amendment as it is written. supervisor campos: thank you. next speaker please. >> my name is beth carey. i work for a temporary home care agency. we provide hra's to our employees using a third party. a small percentage of our employees actually use it. what i want to say is, this

issue is also about the health care of our seniors. our biggest competition -- this is not a level playing field because our biggest competition our domestic referral agencies. instead of hiring employees, they hire independent contractors. they do not pay taxes, they do not pay workers' comp, they do not pay insurance. they did not supervise their employees because they do not have any. their employees are independent contractors. that means that this is giving an incentive to people to pay independent contractors, who are not supervised, or people who advertise on craigslist, because the cost is lower. we cannot recruit this cost -- recoup this cost because that

would put us at a huge competitive disadvantage. we need to figure out a way to put domestic staffing into consideration -- in this proposal. if there is a way to close that loophole -- because i feel like this bill is giving an incentive to people who are not doing the right thing. you guys are talking. can i have more time? supervisor campos: finish your statement, please. >> this is already not a level playing field. closing this loophole for us will make it even less of a playing field because we have other competitors not paying insurance. supervisor campos: thank you. next speaker please. >> i am ruthie norton.

me and my assessment provided to some information. we provide services to many small and midsize companies in san francisco, and we are concerned about the added burden that this will impose on businesses. these changes are of special concern when we are in a hurting the economy and businesses are struggling to stay afloat. the bay area offers lots of retail opportunities beyond san francisco. any unused funds in an employee account must carry over year to year and be were available to the employer, spouse, a family member. what happens when an employee is terminated? this would be subject to cobra, which means an employer must make and minimum contribution.

any plan changes must comply with the regulations. if you take the choices out of the plan the election, it may not qualify under kroeber or the irs. this may impact industry that have high turnover. any employee that works eight hours or more per week will be able to accrue hcso and discourage any casual employers. this is what they what. focus on enforcing the current plan. the enforce the provision now is limited to receiving a corrective review. was supporting evidence necessitates any change? this is an administrative nightmare. supervisor campos: thank you very much.

[reading names] >> i am the owner of a staffing service called the people connection. we also had an hra. i am surprised that we are talking about an amendment when there is a minority of people that have abused this. we follow the hra. it is in the employee handbook. they are given time to use it. after they terminate with us, they get 90 days to use the funds. those funds are readily available for all of our employees. the majority of our employees, after they leave us, go to a full-time position. in effect, my employees leave us and they will be double dipping. this amendment is unfair to us who have complied and have the good spirit of the hra. supervisor campos: thank you. next speaker please.

>> my name is adam levin. i run several pizza parlors in the city. we cannot pass on any of the health care costs in additional fees. just an example of one store that does not make enough to pass on -- to take on additional expenses. one-third of the crew is full time, two-thirds is part time. in the past, before the city passed its mandate, full-time employees got health insurance, dental, paid time off as a benefit. we spend about $250,000 for our crew. then the city passed its own minimum-wage and paid time off. that added $30,000 to our cost. most of that money went to the

part-time employees, the tipped employees. full-time employees were already making more and had benefits. then the city passed health care benefits. without the hra option, it will cost another $25,000. with the hra, which i use for part-time employees, we were able to manage that at a considerably lower number. now the city wants to change that. the benefit will go to the part- time employees who have used much less than is available so far. the cost would go up with all of the ordinances from the city, paid time off, minimum-wage, $50,000. we just cannot do it. it is a high wage, low profit business. the odds are, if the amendment passes, a store will have to close. instead of giving a benefit, 30

people will lose jobs, i will not pay a business tax, license fee, i will not pay property tax, there will tax, or registration fee. supervisor campos: thank you. i have a few more names. >> good afternoon. i have worked in san francisco for over a year. i was hired at a restaurant in the embarcadero. i worked there for over 11 years. it was mentioned that we would have health insurance after three months of employment. after three months, it never happened. i know the restaurant charges a

percentage for healthy san francisco to their customers. i know people are very happy to pay that because there are good intentions with the program. i am here to support the loophole about healthy san francisco. i also need to mention, at this time, the restaurant charging 4% to customers, that money, i think, went to the owner's pockets. instead, that money is going to the pockets of one person instead of the everyone. i have documents to prove that the rest from made over $2

million. just do the math. supervisor campos: thank you. next speaker please. >> director of the office of small business. at the small business commission, you have the commission's response in your packet. we are not recommending -- the commission is not recommending approval, but does recommend the fact that the needs to be strengthening in notifications. we checked with our city attorney. the city can require employers to provide some regular noticing of these hra accounts. a particular note i want to draw to your attention, on paragraph 4 of the commission's response, many of these businesses are using the hra account to deal with their part-time employers. the unused funds are actually helping to supplement their

ability to pay their full time worker's health care costs. two weeks ago, in the paper, there was an article with kaiser, who is raising their rates to 300,000 policies which are administered through small businesses. i think we need to keep in consideration the fact that as our small businesses -- ideally, they would like to provide health care. insurance companies are not making it easy. the health care reimbursement accounts is allowing them to balance that out. healthy san francisco and the san francisco health plan, they actively inform the employees who have the medical reimbursement accounts. they are averaging a 55% response rate. this is with active notification.

for employees whose policies have gone dormant, left their jobs, the health plan does extensive outreach. they have seen their employers have not responded, have not collected on their medical reimbursement account. as tendering noted in the commission meeting, there has been approximately $3 million that employees did not ask for reimbursement, that have gone into healthy san francisco. the commission's question is, if we use the san francisco health plan as an example of a percentage, that 45% -- if these medical of reimbursement accounts, if employers are not able to use it -- that money is going to sit somewhere. through the san francisco health plan, it has been demonstrated that not all employees access that medical reimbursement

account, even though they are actively informed of the money and policy. the commission supports stronger enforcement requirements for notification. the other amendment, that this 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