to our members is the city plan. the cost for that because it's an indemnity plan, it's not just the premiums that would blow our members out of the water especially our family members and the retirees, but it's the percentage of cost of care that they would have to meet and continue to pay throughout the year. it would be devastating for our members. that is the only plan we can legally continue. kaiser has been our partner for over 66 years. we have worked closely with them and we will continue to work with them. they remain despite this increase, they still remain the lowest cost plan and i think it's important to know. dental, vision, mental health are all part of this package. we are not just bifurcating one group here or a portion of our

benefits. it's a full package and we have a legal obligation. the board did it's due diligence and i think the rate package you have is unbelievable rates. we have kept rates stable for the last 4 years. there have not been any significant increases. i think that that's significant to understand and that's still true even with this rate package. we need to keep the pressure on kaiser, no question, and we need to go for the transparentcy. this package affected thousands of lives. the extended bay area is not capable of absorbing 109,000 individuals who will need medical care if we can't continue to provide it. they can't even absorb the 40

thousand. the affordable care act is coming in and going to force them to try to absorb many more. why should we put our employees in jeopardy for their health care and there is the retirees as well. i would urge you to consider the consequences, the full package, the members of the health services board and incredible staff as we worked very hard going forward to mitigate this in the future. today is not the day to do this. i hope when it comes before the full board that you will support this in the same spirit that we are here today. >> i want to ask you, i know sharon johnson the former health service board member acknowledged kaiser's profit making and as a corporate entity, your brothers and

sisters have made some comments on lack of transparentcy and that huge profit and besides the other efforts that i'm going to guess that we all support what else could be done given that profit margin when blue shield is going down and the city plan is going down as well. >> as stated by commissioner brez lynn, we have had very high rates from blue shield in the last year. they took millions from us and our members in their language, "because they could". we ending up the accountable care organizations in order to help bring down cost and then we ultimately went to a flex funding or shared risk plan that's actually our risk in

order to bring those cost down. so what you are seeing in blue shield rates really have to do with administrative cost and the cost for them to pay our claims. we bear the responsibilities of the claims. so those rates, it's apples and oranges. kaiser remains the fully insured plan. they take the full risk. not our health trust fund. in that vein, their rates are not outside of keeping with the rates that they have offered when both blue shields rates have been as high as 20 percent. they are mostly double digits. kaiser's rates have always stayed up 5 percent. i will add this. kaiser's rates have consistently been below the 10

county amount which is the minimum that the city pays for the health benefits and technically members are responsible for all cost for health beyond that 10 county a -- amount and you will see what they have to pay if they don't have a bargained contract. this is prior to -- we made money from the rates because the city pays the board that amount and the board shops health benefits. so if some are higher and some are lower t board can adjust those rates. we have done that consistently and taken money out of that trust to supplement rates in the past to keep affordable rates. in this regard, while we may think and i think there is some validity to the fact that kaiser

riders are rating us higher and that to make sure it's below that rate. in this case kaiser remains close to that 10 county amount. they are really not costing us very much. we no longer have to make money than that. i see this as a continuing of kaiser's consistent rating which has been around anywhere from 4-5 percent consistently over the number of years. >> i think from the health services board. i'm not sure if you were still there. >> i was. that was my last meeting. >> there was ideal prices the lower levels of the actual pricing. it doesn't seem like an a little bit. it's quite a

bit. i'm wondering how without adequate information and the hiding of information being called proprietary information how you can make decisions like the board did? >> you have a good question. i know those figures because kaiser has done what they call community rating. in that respect we are put in a pool of employees and we get a portion of that rating. i don't believe those numbers in terms of that rate of $80 million that it's that high. it's not my experience of the board to see that. we get a number of reports from kaiser on a regular basis that demonstrate to us what our utilization is and how our membership is doing. so i believe that those are exaggerated. i have asked

and i can't find out where that kind of information comes from. i have no doubt that these rates are a bit high, but i also think that with the addition of the aca charges and fees and taxes that have been added on for everyone and the fact that we are self insuring out of our three plans. if we weren't self insuring blue shield we would see a very high increase rate and some would be blamed on the aca and kaiser is positioning itself with regard to that future aca absorption so they don't know what the experience is going to be and that's what all the major health plans are doing. they get the rates from the federal government and they building in their own community rating as a cushion. that's why we need their methodology and that's

why transparency is so important. we want to pay for what we use. we have an older population, a good 46-48 percent of our members belong to kaiser. their service is great. i think we can go forward on this but we have to understand the unintended consequences of trying to bifurcate this issue or trying to not pass the rate. >> thank you. i definitely acknowledge the consequences but unless we draw the line with kaiser and send a strong statement, you come out of local 97 as well as i do, only with challenging with kaiser can we have fairness transparent sea for our members. >> thank you. next speaker. >> good afternoon supervisors.

my name is karen joe bear. the vice-president for the aciu local 10-1, from the hospital in san francisco. i stand here today to ask that you deny this $15 million rate increase. as being a member of kaiser for over 49 years, what the members and workers of san francisco have faced and struggles and sacrificed for the last 4 years and kaiser can have increases and increases. the workers have done what kaiser said in their model of thrive, they thrive with less and made it work. that's what san francisco does. we thrive with less because we believe in being healthy, we

believe in helping others. kaiser doesn't even want to let us know how they come up with this rate increase. transparentcy is what we are talking about. thank you for asking the key question. the key question is if we don't approve this, will you stop taking care of our members? it seems the representative from kaiser said they would continue. so that let's me know that my 49 years of being with kaiser will continue. i ask you to think of the members of san francisco, think of the workers from san francisco. put this money into the community for the services that are needed. help us thrive, help us thrive with transparency. >> thank you. next speaker.

>> i was going to say good morning, but now i will say good afternoon. i'm with founder for quality care. a local non-profit charity and working with local 21 and with the labor council on whose behalf i'm speaking today. some of this will be repetitive but then again some of it bears repeating. for months they have been negotiating a premium with kaiser for services utilization over a 7-year period and also to negotiate a premium based on transparent utilization of cost data. the premium before you today does neither. it charges the city more when

beneficiaries are using fewer services, that is disputed. it includes an $81 million, you are reported unverifiable rate services that kaiser has consistently refused to disclose as a basis for projecting it's cost. if kaiser is demanding a premium on projecting cost then they must disclose the data and assumptions to project those cost. kaiser has refused to disclose that as proprietary. this is unacceptable. city officials cannot and should not accept year to year increases that are unjustified and under reported. as has been noted $87

million has been collected by kaiser over and above the services that has been provided to city workers. what we are asking for is for the the board and this committee to do something other than simply approve the rate. see if the country contract can be extended. hold something back. do something. >> thank you. >> good afternoon. my name is james thomas. i'm a member of the 10-1 and also a city employee for 30 years and a member of kaiser. over the past 4 years, folks in san francisco have furloughs and wage decreases. yet, kaiser with 40

percent of the large group market continues to want in a market for goods and services that none of us can do without. as one of hhf commissioners, kaiser is simply refusing to negotiate based on an hhf analyst showing the response to our utilization to increase rates and raise fees. the city should turn the tables by approaching a 2014 equal with the board approve and take back to kaiser, take it or leave it. >> thank you very much. next speaker, bobby, you are here already. we do have rebecca

king and emma and joe bear, and thomas and ed and suzanna blang. >> hi. my name is brenda and i'm a city employee. i'm here because i'm the angry employee, i'm representing the angry employee because we keep making concession after concession and we see the city an allowing others to take take take and you don't stop it. i think this is the time where we have paid more money than kaiser has to take care of the people of kaiser. we are the people who belong to kaiser. the otherwise don't. we don't want to pay for

kaiser's increase. i don't think the city should pay. i think they have gotten enough. $800 million is more than enough. i think that you guys are standing strong. i was at another meeting where they were standing strong and it didn't happen. i'm hoping the board of supervisors will stand strong for the working people of san francisco and stand strong for even the citizens of san francisco because kaiser is not the only gouger to the city. so you have to start somewhere. so i'm saying start with kaiser. >> thank you very much. next speaker, please. >> good afternoon supervisor mar and avalos. i have been working in mental health for the last 15 years. one of the things i want to stress today

is accountability. what it seems to me is you know, these billion dollar corporations continue to bill the hardworking people of america that are just scraping by and they don't want to have any accountability for raising their rates. that's just unacceptable. you got to wonder why they are not doing that. it's pretty shady, don't you think. so what i'm here to testify is to block this increase and stand strong against this corporation because what happens time and again with these super billion dollar entities. people fold, people get scared, people freak and run away. we can't do that. so you are talking about people's lives here. you are talking about already folks that are hardworking that

aren't getting the raises they deserve, having to put out more money? it's not okay. please supervisors stand strong with this. we are here. we ain't going anywhere. thank you. >> next speaker. >> good afternoon, supervisors, my name is rebecca king, i'm the public health nurse with the city and county. i have been a kaiser member for 50 years. i very disappointed with kaiser at this time. when henry kaiser made an agreement to take care of workers, they knew what they were doing and they valid them. kaiser's lack of transparency is disgusting right now. the fact that you call it an integrated care management bill, and that it's not a necessary physician's visit. this is not right. i'm

very suspicious of kaiser's add campaigns and i'm a member and a taxpayer. how much do we have to pay for this ad. board members, stand strong. kaiser knows how to sit down at a table. stand strong. meet with them. make them accountable. don't sign a blank check to them. >> good afternoon. my name is ed. i worked for the health department. as a retiree and taxpayer here in san francisco i want to say that i think it's scandalous that kaiser would come to this city and expect this rate increase to be approved without justification. it would be scandalous for the

city to approve that rate without more information. as you know, the health service board rejected the rate increase back in may. they did the right thing. the health service board was covering a commercial health plan for expansion and profit to put some facts on the table to support this demand. as a purchasing agent, the health services board had every reason to say no to the proposals that were not complete, not persuasive and disrespectful of the health evaluations board for cost and services that we buy and receive. those have not changed. only health plan would prefor multilocal government that would refuse to support it. as a taxpayer and retiree,

i ask you don't let them get away with it. rejection is still the right thing to do. bring kaiser back to a serious table to renegotiate realistic rates. thank you. >> thank you supervisors. chris bailey. aclu. kaiser is the outlier. they were asked to justify their rate increase, despite declining utilization rates. kaiser's response, "we consider the detail response and analysis to be proprietary." in other words we are not giving you a justification for these rates.

i railed against multimillion dollar packages. in this case, our neighbor up in salas salas -- lito, the lack of information. $15 million of the people of the city and county of san francisco's money an additional profit for kaiser, unjustified. the man is earned his $8 million. this city works day and night to find in the budget and you move $125 million to fund the community services that were left unfunded. today you are discussing this $15 million that is 60 percent of this committee's work over a month.

aclu in the strongest possible term ask this committee to hold this. staff and the city attorney's office and the system that have been working hard are saying that procedurally you can't do it. the people in the city and county have said this otherwise that it requires 3 fourths vote to pass these items that the people of san francisco compel you to analyze this and scrutinize this and that's why they ask for a three fourths vote. don't ask them. get a fair deal for san francisco, get a fair deal for the taxpayers and bring kaiser to the table. thank you. >> thank you. next speaker, please. >> bob, chairman of the puc and

representative of local 21. i wanted to take a step back for a second and tell you that all of us within the puc and various labor unions are impressed with the work that the hhf staff have done over the last few years ascribed yes, -- described earlier to you. they have come with the interest of the city and with representative of the mayor's office, and unions and hr to form this citywide committee to take a look at this. now we have moved to the area of accountability and transparency. we have all realized that more than a half a billion dollars on expenditure, this is really a subject area that needs more attention than some of the rest

of us have been giving it and there is a way to support hhf going forward. it's not like pension or retiree health that we saw with a couple of ballot measures with the hope of the possibility of no extraordinary events that they will long into future solve pension problems. the health care problems is very different. it's going to require us in this change of environment to continue to monitor the work on health care to try to come up on strategies on a continuing basis. there is not a one time fix on health care. as lisa mentioned earlier there is these units that open collective bargaining agreements for pricing in those contracts because we all now realize there are unintended

consequences that can result to what we agree on in terms of health care. there is an intelligent strategy that we have to take. in the middle of these group discussions that we've been having at city hall in comes this story about kaiser and the rate increase and with hhf as leadership and all the unions in that committee have joined forces and stepped forward and went before the hhf and went to them and asked them to reject the increase. hhf has done a turn around and for all the reasons that they have cited this morning that you accept it instead of reject it. when most

of us are in the rejection mode that having felt the more information we receive, more felt more strongly that this was a give away and something that really shouldn't be accepted by either hhf or board of supervisors. i was happy when the kaiser representative were called to the podium. unfortunately i don't think they were asked the right questions. it seems to me that hhf is satisfied going forward and they have a plan in play. >> what would have been those correct questions? >> i think the question to kaiser is what have they learned from this and what can they do? >> what are those correct questions? >> what have they learned from all that has transpired from the last couple of months and what are they willing to do differently going forward. are they willing to put the new

rate increase intoes escrow and allow us to continue the discussions in terms of what we might do to improve the health of all the members. >> anything else you would have asked them? >> i think what was the reluctance to share the information that would explain the rate increase to us in greater detail, detail enough for us to understand what kind of value are we getting for our health care dollars from them. i would appreciate if you can call them to ask if there is anything they can do differently after all we have gone through in the last couple of months. thank you. >> thank you, next speaker. good afternoon. i would like to address some of the comments made in the previous presentation by the city and by

kaiser. i want to point out that some of what the city has been saying is that they are concerned about loss of service for our kaiser members. well, i heard kaiser up here say that their goal was to not have any break in service and that the real question is what are the actual rates are going to be. that's what we are saying. the rates should not increase to $15 million. that's what we want to happen. we want kaiser to come to their senses and understand that they can't just have a blank check from san francisco. first they have to give us information but second of all this is unconscionable. i also want to point out that the person that talked about with the charter amendment says that you have to continue to provide th