merchant groups together and like commissioner dwight says, none of these other cities have seen this yet. i think people may copy us to see what we do. i do believe in what you said too, in smaller towns, where you don't have this type of access, i can see this working and in san francisco, i see the opposite. for a while there, i was seeing a lot of this em and all of a sudden a lot of them went away too. i can't thank you enough for taking this on because i know you are hearing it from both ends. good and bad and sometimes people are really passionate about their feelings on this issue. i want to thank you for heading this up and taking this on because it was something that needed to be discussed. you are doing a great job with this, thank you. >> do we have any public

comment at this moment on item no. 5. c'mon up and please state your name my name is danny miles an -- mire. i own a store. i'm a vice-president for the north association and a member on the board. i had a very open mind in the beginning, but it's tough out there and we don't need anymore competition. we'll fight it like we fought mobile retail and probably win. just over there is certain where

commissioner right dwight has your arms wrapped around it. >> are there any scenarios where your merchants, are there services where they would welcome? for example, i'm in a dog patch, and we don't have any atm aechlz --'s. for the most part we have to get in our cars. >> i would see that work but from the merchants association they would not entertain any. >> okay. thank you. good to know. thanks for coming out to rep your people.

>> do we have any other members of the public who would like to speak on this issue? seeing none, public comment is closed. commissioner white? >> all right. yes, just going to comment on the merchants feeling opposing the mobile retail. i know that there are certain things that do work. i recently was at the urban market that was somewhat of mobile retail that was recently held in bay view or what they have in hayes valley. are you saying the merchants would oppose something of that sort, or is this just coming in district corridors? so i guess

in some mobile retail, if it is an event driven merchant corridors would be okay with that or no? >> [inaudible] because it seems to me that those bring traffic to the corridor. >> you might want to get to the microphone. it's probably what they are calling about. >> your question was if there are mobile retail events such as the hayes valley urban market or the bay view urban market that happens to have a mobile retail driven, is that something that you see the

measure chapters -- merchants being against. >> i'm not in power to represent the whole county district. most of them were opposed. >> even if they would drive traffic? >> they didn't see that as driving traffic as a brick and mortar. the scenario was that small businesses who wanted to try their business before they got into a brick and mortar store but we don't feel that's tliel -- actually going to be the end user. we see others competing with us and it's not going to be a good fit. >> unless you have a neighborhood annual fair like on union street or out in north

beach. those are events that attract attention aengs to those merchant communities. >> in valencia street, a lot of the brick and mortar birsz -- businesses are not exactly what you want. >> we'll get back to commissioner cartagena. that's definitely got to come into that. >> if you compare to the south bay view, they are developing their commercial corridors as well. it's kind of -- and there is a large concern over what

type. i know from christians office and virginia's office they have done a lot of floozeyness of what kind of mobile retail they can have. the scary is the fact that you couldn't control that. you would have pretty much any ugliness that you can have. while i was open to it, at the end of the day, i'm opposed. >> okay. thank you. any other comments on item no. 5? seeing none, next item please. >> that takes us to item no. 6. presentation and discussion on moebl affordable care act, covered california and small business health insurance options program shop market

plates. we have mr. larry loo. chinese community health plan. >> welcome. >> did you figure this all out? >> i think if someone figured it all out they were lying to you. you the commissioners for an allowing me a brief period of your time. i'm here to call about covered california about what is going to be impacting small businesses. i will talk a little bit about it and then i will go through my powerpoint slides. i have about 20 slides. i'm not sure about the format. so i want to start a little bit about who we are and which

explains why we are in covered california. chinese community health plan is parta of an integrated system that goes back when chinese hospital and the association was created. out of chinese hospital association came the chinese hospital. then in the 80s the medical group performed chinese community health care association which is a non-profit independent physicians organization servicing managed care patients. it's really a delivery system that came out that arose from the mission and e is involving with the needs of the community. i will talk about the xhiens community health plan. one of the questions in the back of people's minds, i will give you the answer is that no, to continue have to be chinese to join. we are very good in serving the community, but we are open to everyone. we are

open to everyone in san francisco and san mateo county. we are very active in the medicare space. we earned a four star rating from the medicare services. we are the highest in terms of quality rating. this year we were announced to be offering covered california. so we are pleased to hear that. i'm going to talk about some of the biggest changes in the affordable care that are going to impact small businesses and small business owners. first is why these laws were put into place. really the goal was to provide more people with more access to health carement it's creating the exchanges, the state of california was the first in the union to create

our own exchange and we know how we are going to do this and got that passed as soon as the law was enacted. the individual for 2014, the individual market is moving from the current style of market where there is preexisting inclusion, underwriting. when you go for conversation, the first plan that offers coverage will take you. the other change is that $0.80 on the dollar collected on premium must be spent on medical cost. if you have a $500 dollar$500 premium, that must go to all small group plans. the other thing about

coverage plans that need to confront to metallic tiers is to get a quick gauge on how much coverage they will get by buying these plans. these are platinum, gold, silver plans and and bronze where people pay less but pay more. i will explain some of the numbers around that. the rational is that there is so many different plans out this. it's hard to see whether there is a $25 co-pay represents another $25 co-pay and it pays your exposure. this is in theory a shortcut way for plans to

determine how much it will be. it covers 90 percent of cost of care. go all the way back down to bronze, it's about 6 percent which covers that cost of care and 40 percent would be born by the consumer depending on the cost per year. that's how the level is going to facilitate this choice. this next slide is all about the essential health benefits that qualified health plans must be covered in 2014. in california we have a lot of mandates and categories of coverage that were already into most health plans. in 2014 going forward, all health plans must cover these categories. you can see from these 10. ambulatory services, that's one

already covered, emergency services. the tricky one is for example no. 10, pediatric and dental. someone had to buy separate plan for vision dental. these are going to be one big plan. so, small group changes. in 2014 small group in california moves from 2-50 eligible employees to 1-50 employees. that law has changed. there is no more rate adjustment factors applied to small groups in the past. small groups, your book rate was not your book rate. you can have a variation of 10 percent down

the factor of each group. in this case, all plans that are offered small group plans are doing way with that methodology and there is one set of rates for that plan. where the rates are going to be, that is based on the residents of the employees. you can have different rates for different areas. one tricky part to this is that definition for employees now includes that you must have them on a w 2. that maybe tricky for some small businesses. the large group expands to small group employees or less. that follows the federal law. there are tax credits that encourage small groups to pick up coverage if

they don't currently offer them. for the years 2010-2013, this were some premium tax credits given to small businesses if they paid half the premiums of their cost. starting in 2014, however, those credits which increase only if you buy your small group plan includes small group option plans. that's the significant change in 2014. if you want your tax credits and you are a small business owner, that's where you have to buy your coverage and how you get your tax credit. so, that's what's happening to small groups. the most important thing for you to know is that there two exchanges. for your constituents, in the individual change, that might fall in the

options program or the exchange. i will talk about what it is and what it suspect because -- isn't because there is misunderstanding about it. california coverage, is not obamacare, it's really a separate entity that was formed in california. there is a separate governance and non-profit. what they have done is two changes one for individual and one for small employer groups. there is two separate exchanges, not one. what they have done that was a key decision point in my mind was that they standardized the health plans and the health plan benefit design that are in the exchange. the reason why this is important as i

mentioned on the metallic here, if you standardized the metallic tiers, they are still confusing to the consumer as to how do you compare one plan to the other plan a because of the co-pays out of pocket. the covered california leadership said we are going to standardize plans and lead in this business and for this plan design and therefore the only thing that changes is your premium, negotiated rates and your model whether it's a p po or some other plan design. the >> important thing to know is that standardized designs are two different exchanges. back in may of this year, covered california, about a year ago covered california wentd to see

if there is interest. 33 health plans expressed an interest in entering the exchange and made the selected 13 health plans. cchp was one of them. in this area, i will highlight the plans that serves san francisco county. the ones in bold serve san francisco county and the italicized serve the county. there is one that serves the individual and only four plans that serve the shop exchange. we are one out of the four obviously. that's why i'm standing here. i will give you an example of what happens in the shop exchange. small employer groups can pick up the

metallic tier. if an employer picks a silver tier for their employees what rates might show up. the rates vary by age and geographic area. in this case what we show the bottom lean -- line there, is region 4, for 40-year-old, the $4, for 40-year-old, the rate is $223. kaiser is $328. the average of three low price is $417. the average comparable benefits for 2013 according to covered california is $403. so you can see the covered california likes to see that by competing, they are able to see some

savings by market rates. that is a monthly rate for an individual. each individual, just for clarity, each individual has a separate rate. if there is a group between 40-45, there is a single rate. here that spouse gets one rate. the other spouse might be 59 and might get a different rate, the children get a different rates and they pull together and get a family rate. that's the federal law to make sure that each person gets charged that rate for their age bracket. that is going to be confusing for small businesses just so you know. it goes from budgeted family rates and age spans to each person gets their own rates and it gets added

together. that's on small businesses. there is news here for mechanisms for employers to put their employees in different plans in the exchange for all of their employees. each employee can pick a different health plan. so how does a small employer buy on the shop exchange? they can really buy direct during their open enrollment period. the factor is important. if they current offer coverage and every year they renewed in april of every year, then that's their open enrollment period, if no. the general market enrollment period. they can renew he is the plans during the open enrollment

period. they can consult their agents and brokers. right now thousands of brokers have signed up for training. keep in mind in the enrollment and training is in progress. a lot is not quite done yet other than though for a lot of folks, technically the open enrollment starts october 1.st. let me

talk about standardized plans for the individual. keep in mind where this platinum plan was the most robust plan. the platinum plan has no deductible. preventative care has no cost. the primary care visits is $20 co-pay. the specialist visit is $40 co-pay. that at a very high level is the richest plan design. you will notice there is an out of pocket maximum of $4,000 for an individual and $8,000 for a family. by rule, whenever you have a limit like a deductible or an out of pocket maximum,

it's per individual. that's the richest plan. $20 co-pay, maximum out of pocket is $4,000 for an individual. if you go to the right, there is deductibles and higher co-pay for a physician. if you look on the third row down, primary visits are $70 and the physician visit is at $120. the out of pocket maximum is $6350. the family out of pocket maximum is $12, 500. >> is this the same for all providers? >> these are all plans for the

exchange whether it's kaiser, health net, or us, we follow these plans. our networks are going to be different and our premiums are going to be different. i want to call out the blue shading areas are the areas that service our deductibles. for the bronze there is a deductible on the $5,000. on the silver plan there is a deductible. so, i'm going to talk a little bit more about the silver because that is the plan bylaw that if people qualify because of their income level they can qualify for lower cost sharing. who benefits from most individuals? those who don't qualify for any government programs and don't have any employer group

coverage. there are two ways that people can benefit from the individual exchange. first is the premium tax credit. they are the ones with cautionary reductions. it means they can reduce for cost sharing. for example, the pcp co-pay. they can be reduced. there is individuals that qualify for both and some that qualify for advanced premium tax credit. they can qualify for these programs only by enrolling in covered california. if they want to stay outside of the exchange, they want to benefit from these programs. it's estimated that 42 percent who have individual coverage can benefit from these programs. in

the city and county of san francisco, it's estimated that 28,000 people would benefit from this program. in order to be eligible you must be a citizen. you cannot be incarcerated and if you have and this is a little perk. if you have services through your employer but cost more than 95 percent of your adjusted growth income, you can leave this plan. that's a quirky thing here. how that came about, remember how i mentioned that each person based on their age gets rated a certain threshold? what we've seen is the higher age bracket could out pace the

income of those higher aged employees and therefore be higher than 9.5 percent of their adjusted growth income and benefit from the individual exchange because of the tax credit and it would be better to enroll because of the individual exchange. and i think everyone's heard about the individual mandate penalties. and there is a lot of talk about that. there is an individual mandate for 2014 if you can't prove that you had credible health care or an individual policy you are subject to a 1 percent or 95 which is greater. that goes up to 2.5 or $695 which is greater on 2016. on the face of it, it

doesn't look like a severe of a penalty. what we tell people that while $95 is not that much much, it's better to have insurance than not. you can't predict what your drug cost are going to be or whether or not you need to see a specialist. get with these plans especially if you have two of these programs to help you out. i think i spoke about the tax credit, i talked about the cost share redeductions. roughly for the tax credits, there are credits for people who earn income up to 400 percent poverty. we caution counselor and people who work with covered california pros -- prospects to not think of people as poor, but the program is to determine qualifications for these programs. for example an individual who makes up to 45,000 or a