>> it worked earlier today, it might be the connection.

>> can he checked this out of ahead time and it seems like this is not going to work, i apologize. >> thanks. >> too bad. >> and i have not received any other requests. for public comment? >> okay, there are no other requests and he is coming back and we are going to try to solve this for him? >> i am concerned about time and so i am not sure what, and i am not tech savvy and everything worked earlier today on the same computer. >> and so, he has one chance here. okay, there you go. we are rolling.

>> okay. >>[video] >> i am a mother and i am tired of debating about the rubber and the black pellets that get everywhere and everywhere and contain, lead and benzene and carbon and a whole host of carbon and now flame retardant, what is good for a fire is not good for a child. >> all right. >> repeat after me, there is no such thing as an acceptable level of lead for children. [ applause ] >> and i am so tired of reading scientific studies that say that a product is safe, only to find that the study was funded by the industry that is just exonerated. we know that you have the talent pool to do better and yet, right in front of us, and things that we may exposed to

every day synthetic playing field and the toxics have gone untested on human health and certainly one tested in aggregate and for me and many of us here today this is not acceptable and there is nothing more important than protecting the health of our children and generations to come. and no one's profit margins can justify that to our children and the future generations. thank you. >> reporters are pushing to make the legislation stricter and to put safety ahead of profit. >> jennifer, really meeting with members of congress. there is you know the rates of autism and asthma and adhd and all kind of hazard illnesses have gone off and can't be explained. there was a synthetic field that was put in in chicago and

30,000 resurfaced tires which carry... in california, and somehow, you know, people think that it is safe for my kids to play on and i want to see, again, pregnant women and vulnerable communities protected. >> you mentioned system wide that law because the united states has never filed a precautionary principal. >> there are a lot of parents out there and a bipartisan group that deeply care about their children and the future generations and you know, no one's profit margin can justify. >> okay, thanks again for it, we appreciate it. >> okay. >> so we can go on to the next item? >> i was just going to ask that perhaps our community of public health and the committee, and could just also get a report

from the department on the specific issues. >> okay. >> yes. >> and the next item on the agenda is the finance and planning committee report back. >> good. >> good afternoon commissioners. >> and the finance and planning committee met at 2:00 p.m. this afternoon prior to this meeting and we have voted and approved to add the following items to the following consent calendar and the april contract reports. and the approval relocation of the lutheran south services and the mini, management program and it is currently on 8th street and it is going to move back to its old home. on golden gate avenue.

and we also heard and voted to approve a new contract with health right 360 in the amount of $154,086 to provide physical intermediatary and if he can cal assistance to support the department of psychiatric inpatient unit project and in addition to that, we have also agreed that the aca updates that was originally schedule to be heard in front of the finance and planning committee because of the nature of it and also we want to make sure that all commissioners have a chance to participate in their discussions that we are

suggesting that carline, and come and do the presentation. and during the commission meeting. and in addition to all of that, we have also heard from kim oka, and that the pd director of managed care and the director of herpes san francisco on the outline of the herpes san francisco and a new report for 2012 and 2013. and we are expecting to see a draft in our next meeting and the finance and planning committee. >> and lastly we have also explore some of the agenda setting mechanisms currently in place for the committees, and want to make sure that we in the spirit of transparency look at how to redirect some of these agenda items back to the

full commission. and so that all commissioners can participate. and you know, and without like having the staff like provide you know like every single presentation two times. and that is our report. >> so, we believe that at this time, we will get the ac a, enrollment update as part of the finance committee request that it be presented here. so kol lean? >> thank you. good afternoon, commissioners i am happy to be here and very timely that we are here with the enrollment report and as you know, march 31st was the end of open enrollment for coverage california and we will go over a little bit about that here today. but, over all 7.1 million americans have enrolled in health insurance through the federal or the state exchanges in california we had 1.2 million who have enrolled thus far and you will hear a little

bit about the extension of the enrollment time line to allow people to complete the applications that have been started in coverage california. and 1.5 million californians have accessed medical this far and so these have all exceeded projections for enrollment and we will continue to provide you information then with the information that you will hear today is enrollment information through the end of february which is the latest information that we have available for our specific county and we will can't to provide you updates as we know more and i would like to turn it over to anika and tala who work with me on implementation. >> good afternoon, commissioners. okay. so, as claire mentioned the aca enrollment numbers that we have are for through the end of february and these are actually cumulative numbers that i am

going to be showing you from october to february. and so first up would be medical and as of right now we have over 33,000 people enrolled in medical and in the city. and this is mostly people who were eligible under the aca expansion, and so those are the two maji populations that you see and expansion and sf path and there are traditional people who are also elible and by traditional, we mean the people who were eligible for medical before the aca, but may not have enrolled for whatever reason. >> so, as a point of reverence. we went over these a little bit last time, but our city wide estimate for people who would be nearly eligible for medical, were 81 to 95,000 people. and this included people who were uninsured and who currently buy their own

insurance and to have employers sponsored insurance and obviously not all of those people who are going to take up at the same rates and so we estimate that about half of those people would enroll in insurance. and so, it is not a bar, but it looks like we are doing pretty well. so, coverage california, we have a total of 27,809 people enrolled and most of these people well over 80 percent are in subsidized coverage. and which is again, what was expected. so, in our city wide projections we estimated that 44,000 to 71,000 san franciscans will be eligible just for subsidized only coverage. and so and of that, we estimate that 29 to 44,000 will enroll and again it looks like we are on par for meeting those projections. and so, healthy san francisco has provided as a reference and this is enrollment at the end

of february. and this at the end of january, we reported about 46,000 people, and so, this is another reduction, just a caviot that any of the enrollment that you see in medical does not mean that it came from healthy san francisco and we actually don't know if the aca coverage previously had insurance or not and our healthy san francisco people are obviously uninsured. so, these are a little bit of the trends that we have from people who are purchasing plans on coverage california. and so on the left you see that the subsidized group that is a large group of 22,000 people, most of them are purchasing silver level plans, and that is where the plan covers about 70 percent of your costs and this is probably also reflecting the fact that a lot of people up to 250 percent of poverty also get

the assistance for purchasing the silver plan and within the subsidized group, the chinese community health plan is the most popular plan, and because their premiums are actually quite low. and in the unsubsidized group we will see a reflection of the state wide trend where the bronze plan that is the lowest and where it covers 60 percent of the costs and at the lowest premiums that is the most popular among the unsubsidized group. and so something of note in the unsubsidized group is that this black piece of the pie here, represents the minimum coverage. and which is available only to the people who are under 30, and people who qualify for some sort of a hardship exemption from the aca, so in san francisco we see the second highest percentage of people enrolling in minimum coverage throughout the state. and the other two regions are in the central valley, where

presumably more people might be eligible for exemptions and as more data becomes available from coverage california, we are hoping to see what might be going on here. and most of the other regions have right around 5:00 percent. and the unsubsidized group and the commercial insurancers take a bigger piece of the pie than the chinese health plan. so we previously presented an estimate of the residually uninsured and we needed people who will stay uninsured after the first year of the aca implementation and in order to to better align those estimates with our city enrollment projections and the fact that 100 percent of the path population has transitioned and that we have granted an extension to the healthy san francisco participants to be able to stay in the program through the end of this year. and we updated these numbers.

and so in this in this respect we have 87,000 uninsured and 18 to 64 and of those, most of them are in our healthy san francisco or in the sf path programs and whereas there are almost 28,000 who are unknown for our systems and so, when we tried to determine who was eligible and in those groups we find that in both groups, most of the people are eligible for medical or for subsidized on coverage california. but, combined, we have about 18,000 people who are not eligible for coverage. and first we are due to the undocument status that it was also included and because of this case, we classified eligibility as subsidy and so that some people who are not eligible for subsidies or they are not eligible by age. >> and so, we know that everyone who is eligible did not enroll, and so at the end by applying estimate and different scenarios who is

likely to enroll and not, we come up with on the left, among the unknown population that more than half of them are not going to enroll. and this would likely be because this population did not really take an initiative to enroll in the coverage when they had, or to enroll in healthy san francisco when they had the option or so they might not know about it. and on the right, we have we have more than half of the hsf and the sf path association likely to enroll and over all when you combine them for the gray boxes and so that the people who are not eligible for the aca and those who are eligible and may not enroll for whatever reason, and will come up with 43,000 to 52,000 people. and it will stay uninsured at the end of this year and we expect to update these numbers for 2015 as we get more trend data coming through this following year.

>> so, to out reach to all of those people who are not signing up, i will turn this over. >> hi, as she mentioned last night ended the coverage california open enrollment period. yesterday by two p.m., there were about 324,000 unique visits to the fight along. and so individuals who are unable to start an on-line application or complete an on-line application, due to technical difficulties, and will be given until april 15th to actually select a plan for coverage on may first, and provided the payment is made. >> the next open enrollment period will start in november of this year. and for coverage beginning in 2015. and there are some

opportunities for enrolling outside of the open enrollment period which are qualifying life events, for example if you are married or get married, or divorced or have a child, if you permanently move from one area to a different area, that has other health plan options, if you lose other healthcare coverage such as medical or other coverage or if you experience a change in income that will effect your eligibility for a financial assistance. >> and then, just a couple of updates on out reach activities related to dph. and dph and have to say that they had the first meeting with the sheriff in march. and the sheriff is planning on potentially partnering with the community based organizations, to assist with the enrollment with the enrollment of inmates prior to their release. and he is also considering training more than 20 of his staff, and in the local on-line enrollment systems for medical

and healthy san francisco. and since january, approximately 325 applications have been submitted from medical. and on march 22nd, healthy san francisco had their enrollment event that san francisco city college to assist individuals with the enrollment and to health insurance. and 200, to 300 people were expected to attend and more than 223 individuals attended. and 72 applications were completed and 41 of those were for coverage california and 31 of those were for medical and 31 were initiated but not completed. this was made possible due to the partnerships with many organizations who provided the volunteers and staff time to support this event. and now that the coverage california enrollment period has come to an end, this city will be looking at ways to target medical population as a

medical enrollment is year round. >> so, we are happy to answer any questions that you may have and i thought that it was probably worth mentioning the article that was in the paper today, about healthy san francisco, it is important to note that healthy san francisco eligibility has not changed since we started the program, healthy san francisco has always been available for the people who are not eligible for other publicly subsidized health insurance and uninsured folks who are not eligible for those programs and that includes medical, medicare and subsidies on the exchange. and we did as the commission know and extend the eligible for healthy san francisco through 2014 just for those people eligible for subsidized health insurance on coverage california and the actual program requirements remain the same, supervisor campos is

introducing legislation today to make the changes to the healthcare security ordinance that will propose the changes to healthy san francisco and the city option under the current healthcare security ordinance and we have yet to do an indepth analysis of the ordinance to determine what the impact would be on our budget and on our programming and our policies and on our operationalization of the programs that are envisioned. so we will be doing that and bringing that back to you. >> okay. >> and i just want to pull up and let commissioners know that this will be continued item and that we are planning to have this as a continuing agenda item, on the finance and planning committee and we will probably come back to the full commission to give updates you know like on the more periodic

basis when we have more aggregates and more concrete data, perhaps, three months to six months and depends on how this continues to evolve. and with that i actually have a couple of questions. and first question that i have is would we be able to track the data on how many young adults enrolled in the systems and i think that is also one of the priorities, you know, like for the affordable care act, is to really look at the populations that have historically under uninsured, and but would have the ability, you know, to get covered. >> and so i suspect that coverage california will provide some break down at some point of the population that enrolled during this open enrollment period. and i don't know if data is available by age now, is it by age now? >> occasionally they report the

data broken down by age, so they have a group for 18 to 34. and so, we anticipate that they will make that available when they are a little less busy. >> okay. >> and the second question that i have is pretty much like a follow up question, from the commission meeting last time because we just got information that when i might part d would be eliminated and that the budget would float into the part c, and because at the same time we have medical, expansion here, and under sf path and also under affordable care act, and under our california jurisdiction, i am curious, like how that transition takes place. because it is effect different part of our budget. >> i am not personally familiar

with the part c and part d of ryan white but i will tell you that the extension of healthy san francisco to the end of december actually first began with the people living with hiv. and there was concern that the individuals who were on healthy san francisco who have to transition to health insurance would have to change providers, and if particularly if they were eligible for coverage california. and the department of public health not being a provider on coverage california, they were not able to keep the provider with the department of public health and other healthy san francisco providers and so at least for 2014, and people eligible for healthy san francisco, or i am sorry, people elible for coverage california in healthy san francisco including hiv will not have to change providers and that will give us time to look at the impact of the transition of d into c to see how that will impact them before we make the changes to that population. >> i just want to note that

there was any public comment at this point and we will go on to the commission comments. >> i have not received any at this time. >> commissioner karshmer? >> so i have a question about the jail, when you leave the jail is that one of those life qualifying events? >> yes. >> open enrollment any time. >> yes. >> have you said that... >> true, i believe that is true. >> that is an ongoing opportunity to enroll people when they leave the jail. and you mentioned the sheriff said that he was considering doing this and considering, are we going to have an update on when that might be decided n >> the legislation is at the board to give the sheriff the authority to enroll the inmates on their behave within the jails, the health department through the jail health is the entity that has been doing the inrollment and the applications that have been accepted have been through the jail health staff and so they are working closely with the sheriff in order to figure out the best model and as they mentioned is what they are anticipating is that they will bring in an

expert who has maybe, health right rkts 360 or some other one who has experience working with the inmate population and also, who has experience doing enrollment to help expedite that. also because, there is only so much information that you can take while the person is in the jail, and there is usually follow up that is required outside of the jail and the sheriff's ability to do that outside of the jail is more limited. and so the partnership with the cbo will be a great remedy for that situation so we can definitely report back to you. >> thank you, i appreciate that. >> commissioner sanchez? >> yes. >> and yeah, i would just like to ask if given the fact that there is any immediate focus on the period now and between april 15th. and it has, or it has completed part of the computer, or are

getting additional information that they have been required to get. and others who have had the navigation problems, and just spending many hours either on the phone and or waiting for some contact to complete. and i guess what i am saying, is that i know that in some counties, they are saying that here are the areas that you could contact to make sure that you complete the application, by the deadline, which is an extension period for california. and you know, i wondered in fact if we have those types of links let's say go to the nine supervisor districts in the city saying that here are two or three areas where there could be human technical assistance and not just a phone, and or a computer. the senior seniors and no. and we could if we could disseminate this and i really think that it might improve the

completing process especially given the multiculture and languages in the city, and so this way, that it could help them finish this particular complex protocol that has been for many of them and it is so important that they are lining up and concerned about it. i would hope that we could have some excellent desemination. and they will be able to help them to complete the process where they will be getting the additional tax information or updating this or making sure that everything is correct. and you understand that, because some are a little threatened saying that well, suppose that i put something down, and i will be guilty of something. >> and suppose that i didn't have, but now i am working part

time, does that mean and all of these questions, and i think that are brewing and we want to make sure that they complete the process to insure that they have adequate healthcare and so i would hope that we might have this in the radar and we could help our non-profit and those involved who really complete this process, which we feel is very important. >> and that is a very good point and there are many dph partners and all of the healthy san francisco sign up sites are also doing enrollment and we can get the word out that way, and there are many in san francisco that are focusing on this that we could work through. >> thank you. >> also, this is an educational experience. because this is the first time that that we have to do this kind of city wide enrollment and just a little bit cautious that maybe you know, the next two weeks should not be our final target that really looked

at the lessons learned and because the next enrollment period that is only like 8 months away and that might be actually and it might be a time line to look at what the gaps are and start preparing for that. >> very good point, thank you. >> i was just going to follow up on dr. sanchez's issue. and well we have a lot of cbos helping with the enrollment and all i thought that part of the message was that we have the two weeks to actually follow up to make sure that was done, and that is, so, is that actually part of the program? that we have asked our cbos is our enenrollment to work with that public that had complete applications. >> it has not been done to date and that news just came out and so it is not something that we have acted