million. that's kaiser's choice. if we don't do this, there is going to be 40,000 people without health care. that's the decision kaiser made. that's going to be how they act as they want. as someone from formally a non-profit worker, to be in a situation where in the last month 1/2 non-profit workers have been here providing data, charts, spreadsheets and evidence, to get a cost-of-living adjustment and that got knocked down from 4 percent to 1.5 percent. we have done everything kaiser won't do. and we are supposed to be

thankful and lucky that we got 1.5 percent without any explanation as to why kaiser is going to hold a gun to our head and say give us $15 million or no health care. i consider that to be an act of violence. >> my name is aheadey johnson. we work in psychiatric emergency services. we help people with case management. as you know workers got 1.5 percent raise. we appreciate it but it's not enough. we find it

insulting that kaiser is gouging this money. it's a cut for us and cost more to work and live and buy food in this city. so we are demanding that you block the kaiser rate increase and give at least the 4.5 increase to the workers to do valuable work in the city. >> hello. thank you for looking into this situation. just an example of some of the work we do and why it's important to get funded. one of our clients, he's in our program for a year with bipolar disorder and working at sf general. before he went there, he would not speak. because he started working there, they offer services to people with mental health issues, he started learning how to initiate conversations to become more

functioning person. but recently sf general had to cut that program and he had to quit, they had to quit paying him and he wakes up at 5:30 a.m. and comes back at 3:00 p.m.. that's something we can't refer our clients to anymore. along with ramps that we used to always refer to people to vocational services. it's very important that we continue these services because we do want to keep our clients and the city moving forward in mental health. we know what happens when we cut mental health, they will be out on the streets. that's what we are asking for, thank you. >> thank you, next speaker. i apologize, i see members here from the health board as well.

so i want to call you up next and sharon johnson as well in terms of next speakers. >> good afternoon, i'm a resident of san francisco as well as aclu vice-president of organizing. i'm here to support my brothers and sisters from my unions and co-workers as well as members of the public who want to see some accountability and transparentcy. i have referred folks to primary care and medical and mental health services over the years and understand the complexities of the system and subsidies and you know how things get paid and coverage. i think this is a

very important issue, but i also think that we must definitely look into how we as a city practice giving out the money. what i'm sensing here and i'm fully convinced by folks earlier that we are giving out a blank check here. we are giving out too much money and no real scrutiny or analysis of why this money is coming out. at the same time we have a lot of services in the community that are just as valuable that this payment goes out to kaiser. i would like to see in money go back and get renegotiated to the health services board so we as a city do the right thing and make the best decisions. i feel like it's too much money. i'm not convinced that kaiser should be getting this money. this money should go to better services in the community to services that non-profits do for the city workers and county workers and some that are here today and we

need to stop the practice of giving money to large companies. if they are concerned about putting people out of health care services, they ought to know better. >> my name is david. acting field director aclu. at the last two meetings, kaiser was asked to provide the data to justify just like you are trying to do today. kaiser absolutely refused. they said almost every answer was that's proprietary. in the meantime kaiser has made $87 million, they billed this extra. they

have made a profit for $2 billion. kaiser is doing perfectly well financially. with no data, we don't understand what you are being asked to approve, why kaiser should be given the check without providing the data. they fail to provide the data to hhf and hhf expressed their dissatisfaction with their answers. we are asking you to do the same. we are asking you to stand up now. it is time to draw the line today, folks. because if you don't stand up, then who will? if we don't do it now, then when? so don't give it to them. don't give them the increase. they do not deserve it. >> thank you, next speaker, please. >> my name is karen, president

of the health service board. pretty much everything has been said here but i do want to point out that a similar incident happened years ago where our board did not approve the rates. we were told clearly that everyone would go into plan one and we would be vulnerable to litigation and that was quite a few years ago regarding another issue. i do also want to say that kaiser is still the lowest priced plan. and there is a reason for that, because years and years blue shield came up with double digits and kaiser with single digits. this is why, for years kaiser was really quite a good

partner and it was expressed many times in the board. now they are the able person at this particular time and i agree there are problems. i'm not saying there are. until we had transparentcy with blue shield. hhf is the lowest staff. what happens here with low enrollment is a problem. they are in a problem here already because of all the turmoil that's going on. >> thank you. next speaker, please. >> good afternoon, supervisor sharon johnson former health

services board. don't we all wish we had single pay r? we do. but we don't. kaiser is a corporation that makes money and there is blue shield. we have to still keep our eye on the ball and the eye on the ball today is those members. because they need the continuity of their insurance coverage. retirees especially need to know that the doctors that they have been seeing for 40 years plus, they will be able to continue to see. so i ask you please to go with the transparency. don't hold up the rates and benefits package. work with the board for that transparent -- for the cost attributed to health care. i

nor that you can do it. please don't play with our health care. thank you. >> thank you, next speaker, please. >> good afternoon supervisors. i sat with the health services board and i sat on a number of those negotiations over the years. i want to reiterate what my colleagues have stated that this really is about members. all of us on the health service board, all of us individually support very strongly transparentcy legislation.

those that are still on the board, that we can understand that methodology so that we can work with them in a much better way. historically, kaiser has been a good partner. we have had ups and downs over the years and always managed to work it out. they paid us several million in the past because we had issues that we continued and when we resolved them they agreed that their rates and issues needed some reimbursements. please remember it is truly about the members. we also have the unified school district, community college and the court members as well. if this package doesn't go through, it is true because i was on the board and i remember specifically, we own city plan one. we are in the business of delivering health care. the only plan that we can guarantee 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