and if you don't vote early vote >> we want to thank the following members of sfgtv staff for covering the meeting today. jessy larson and jonathan, thank you for your service.

>> if we can have a motion to excusing supervisor mar, by spurpt sperp yee, and we can take that without objection. >> and if we can please call the one item that we have, item one. >> and it is an ordinance, revising the healthcare security ordinance to require all healthcare expenditures to be made to establish a city, public benefit program known as the healthcare, access assistance program.ordinance revising the health care security ordinance to require all health care expenditures to be made

irrevocably; to establish a city public benefit program known as the health care access assistance program (hcaap); to describe the public benefits available under each of hcaap's three component programs, healthy san francisco, covered san francisco, and health care access accounts; to set certain eligibility requirements for program participants; and to set an operative date of october 1, 2014. >> >> thank you, very much. and this is an item that i have included in the agenda, and i want to thank my co-sponsors supervisors avalos, kim and mar and this is a long time come and before i go into the key points that i would like to make, i once again want to thank, the office, and particularly sherry, for the amazing work, that she has done. and tapping into the very complicated issue. and it is greatly appreciate ated and we will not be okay today without the excellent work that they have provided. and once, again, to thank my chief of staff, hillary, who has been working for a very long time. and over the last two weeks, i have been working with the department of public health, and with the objective of

developing the amendments to this legislation that address another concerns that we have heard. and as we discuss at the hearing, there may be items included in this ordinance, but the two main points that the legislation deals with, are one the closing of a loophole that has been in existence for a number of years. and that has left hundreds of millions of dollars unavailable to workers in san francisco. and we know that at least 26,000 workers that have been impacted by the assistance of that loophole and then the second piece of that legislation is what happens as san francisco moves forward in the implementation of the affordable care act and the legislation tried to do, what

we believe needs to be done to make sure that we devise the access that every san franciscan has to healthcare and quite frankly codify some of the very same policies that the department of public health have indicated that they will follow, like the idea that people who qualify for the aca, who are currently in san francisco but may not be able to afford the aca, are not going to be kicked out of healthy san francisco and the intent of this legislation was to do precisely what the department of public health has said that they were going to do. and i believe that when the specifics of what the department of public health proposes to do in terms of compliance with the affordable care act and maximizing access to san franciscans, i believe that when those specifics are finalized that the specifics will look very much like what we have proposed and while we believe that the coverage san

francisco portion of the program is a workable program, that as soon as it lays out a way for san francisco to insure that every worker and every resident is insured and i understand that there is always a need for flexibility by city agencies and so we are open and prepared to work with the department of public health to give them the flexibility. we have distributed to the committee and they are available to the members of the public, a set of amendments that i will be making today. and address the specific issue of what happens with the aca i am mri thentation and coverage san francisco piece of the ordinance and the amendments that i will make today direct the department of public health to develop its own plan that the employers made to the city, are used in a manner to get as many workers insured as

possible. and the amendments and the set of amendments require that the department of public health develop this plan by august first, 2015. and that the department of public health seek approval of whatever plan they develop not only from the health commission, but also from the san francisco board of supervisors, and that all of this happens in a timely fashion, so that we can implement that plan for the 2016 coverage california plan year. and in the interim that the department of public health would continue to operate the city option, and in a manner that is consistent with what the guiding principles and the key findings of the 2013 universal healthcare council in the final report that they issued. i believe that these amendments will accomplish the objective of closing the loophole while at the same time giving the department of public health the

flexibility that it desires to develop a plan that it feels comfortable administering. and so the main thrust of what we are doing and the important key and the important component when we have been working on for years is that we finally closed the loophole in the ordinance so that the workers are no longer denied between 80 to 90 million dollars, in money that would help them and their families, including the children, to have basic healthcare. and i call upon the colleagues to join me in supporting to send this to the full board and i also want to take the opportunity and i know that we are going to hear from some folks during the public comment and i want to take the opportunity to thank both sides of this issue who have taken the time to meet with me. and i especially wants to thank the workers who have had the

courage to come forward and to speak about what this loophole has created for them and their families, and this is truly a long time coming. and it could not happen at a more important time. san francisco is in an affordability crisis and as we speak, san francisco arguably the wealthiest city in the country has the fastest growing inequality in the country as well and the gap between the have and the have-nots keeps growing and it is only fair, consistent with the values of the city of saint francis that we finally insure that the tens of thousands of workers that have been denied access to healthcare with money that was fully intended for them to use to provide healthcare for themselves and their families that they finally have what the law always intended to provide them. and so with that, i thank my colleagues, for the consideration and seek their

support. and unless there are any comments, or questions, that we would like to ask the director of public health who is in the audience to director garcia, to please come forward and we appreciate your presence here today. and wanted to make sure that i do give you the floor to provide any comments that you would like at this point. >> first of all, thank you, chair, campos, and supervisor yee. particularly to you, supervisor campos and to your chief of staff, hillary and we want to thank you with the flexibility that you have provided us and i think that we all have the same goal and no matter what the program may look like, the ultimate goal is to get the people insurance and i think that is both you and i, have that same goal in mind and we may have to have the different roads to get there and this flexibility will give us that opportunity to insure that the people as many people as we can get covered by insurance. to strengthen the healthy san francisco is another area that we would really like to look at as well and as you know the

more people that we can get on the insurance, the stronger healthy san francisco will be for those who cannot afford and also do not qualify for the aca. so, we are going to work very diligently and we will be working with the local health plans and i also have the san francisco health plans, full commitment to us to work with us as a potential third party administrator for this program. and any administrative role that they can help us with insuring that we understand how health plans work. and there is a lot of complications in their own it systems but we feel like we can get through that and insure that those who need this assistance for out of pocket, support, as well as in this assurance and that will be all of our goals. and we are also going forward to the health commission in the near future, to talk about the fact that we are going to continue the effort to provide for those until this program is implemented, for those who cannot afford it. and also, we will see in the

future that that may be continued for those individuals who may not qualify for the particular program that we are working on, but we still need to have people have medical homes, and healthy san francisco will be there for them. and we also look at the request and i have and i think very positive support for the health commission and moving forward on expanding healthy san francisco for those over 64 who do not qualify. and moving forward on that and i like to thank the deputy director who was here at the last meeting who was able to represent me well in terms of this program and also helped with your staff to insure that we have the flexibility to make this commitment that we can get more people on insurance, and that everyone in san francisco will have health access or health insurance. and so for supervisor, campos, thank you for the flexibility. thank you, and if i could ask you a quick question, ma'am? and i just want to make sure

that with respect to the dates, that on the time line that i have provided in the amended ordinance, which would be that the department developed the plan by august first, 2015. and is that something that you are comfortable and does that give you enough time. >> that is very comfortable. and we are working as fast as we can on this and we believe that that date is a reasonable date. >> great. >> thank you, very much. >> i know that we also have someone from the office of assembly member tom and nadia conrad and i want to make sure that she or that we give her an opportunity and again, you know, we would not be here today, in terms of having a universal healthcare in san francisco, without the amazing work of tom, and we know that he has been fighting this for a long time to make sure that we

have access for everyone in san francisco. and this is a top priority for him and so we are grateful for his leadership. and with that, i will turn it over to you. >> thank you. >> it is great to be here this morning and thank you to the committee, for hearing us. again, i am here, and i am here on behalf of assembly member tom to read his statement in support, supervisor campos's ordinance. my goal when i introduce the healthcare security ordinance of the supervisor, was to insure that every san franciscan had access to healthcare. and i wanted to remove as many barriers as i could. and we have seen the city become a model for making care available. however, there are still improvements needed. i'm glad supervisor campos is here to carry on the vision, that i had when drafting the

healthcare security ordinance, and supervisor campos has been working diligently with the department of public health on compromised language for amending the healthcare security ordinance. and these amendments will help close the loophole in the ordinance, and maximize the up take of san franciscans with health insurance. and the amendments will also direct the department of public health to develop a plan for using the employer contributions for medical reimbursement accounts for the workers so that they are able to access health insurance. this will make sure that those employer dollars will be used in the right way, to help people get healthcare. when coverage california took effect, we also found people were falling through the cracks. still unable to afford insurance. the campos ordinance will take care of that, creating a safety net and allowing more san franciscans to access the coverage they need. the city has a great

opportunity here. we can amend the healthcare security ordinance so that it works with the affordable care act to make healthcare truly affordable for all san franciscans. we need to make sure that everyone's health needs are met, because it benefits all of us. thank you. >> thank you, very much. and again, we thank him for his leadership and unless we have any comments, do you have any comments? i would like to open it up to public comment, if that is okay? thank you. supervisor. and if i could actually call upon i see here the president of the san francisco labor council, mike casey to have an opportunity to please come up. and i think that we have a manageable size in the terms of the audience and so we are going to do three minutes, which is the regular time that is usually allotted. thank you for being here. >> okay, thank you. supervisor, campos. my name is mike casey and

president of the local two and the president of the san francisco labor council and i just wanted to note that eight years ago when this legislation was initially passed, i think that it passed unanimously. it was determined that there would be two tiers. one being for larger employers, and second, for the smaller employers and i was involved in those discussions and those needs and i remember, the discussions that they have, and actually have occurred, within the mayor's office when mayor nusome, pulled supervisor amiano at the time, and other leaders together to talk about what this legislation, would look like. and it was determined, that there would be two tiers not three tiers. in fact, what has occurred, as a result of this loophole is that there has been the creation of a third trao*er, a third tier, which is exempt, and there are no exempts. and there were none at the

time, and that third tier of employers who have been able to get away with taking back the money, under false pretences for many of the employers who have actually restaurant employers who actually put a amount on the check that should be deducted for healthcare that often goes back into the pocket of those employers. and so, that is fraud. and i remember at the time that there was a clear understanding that this was just a start. and nobody even imagined at the time that it would not cover everybody. in the meantime, hundreds of millions, hundreds of millions of dollars, that should have gone to healthcare of poor and working families, has been kept away from those workers. it has gone back into the pockets of the employers. and i find it amazing, that an unbelievable that we are here today in 2014, 8 years later,

not able to clearly understand that this is fixing something that should have been fixed a long, long time ago. and i come mend you supervisor campos for trying to do this two years ago. and i think that it was a very dark day, when the board of supervisors compromised two years ago. and i can only hope that we can fix this once and for all. and it was never intended to have a third tier, workers, excluded, or exempted from this legislation. and at the time, that legislation was passed, unanimously, i would like to believe that there has been progress made over the last eight years. that san francisco is an even better city, when it comes to taking care of its poor, and working class, who do not have the advantage of healthcare. and to think that we are yet, again, facing the possibility that this could be compromised once again, or possibly,

possibly, deferred, for an extended period is unbelievable and i really hope that we can close this loophole, once and for all. >> thank you, mr. casey. >> i am going to read a few more name, michael pulsano, meril beul. dana viacof. dina lamb. and steve sarver and borden. come up and if you could line up on our left, what would are your right, the aisle. thank you very much. >> go ahead. >> hello, my name is michael lusano and i am a recently on the board of san francisco, organizing project and inner faith action and more importantly i am a 62-year-old native san franciscan who is back where i grew up on tenth avenue and supervisor eric

mar's district. and i was compelled to come today because attending the meeting last week at the board of public health, i was discouraged is the polite word after the meeting because it was basically roughly, 15, in favor and one gentleman against. and i just want to fully support and afopm or pr and i want to support closing this loophole. thank you. >> thank you very much. i appreciate that. >> next speaker. >> good morning, supervisors i'm meril, director of healthcare and coverage and access, it is eleven non-profit

community healthcare, and more than 10 percent of the city's population, and i am here today to support this legislation and illustrate why it is needed because coverage california is not affordable for the many san franciscans who currently enrolled in the healthy san francisco coverage but eligible for coverage california. last fall i had the pleasure to train, 115 staff from the department of public health on how to enroll people in the coverage california, many have been working with the clinics and the population since the program began in 2007 and they know these patients very well, they were so excited to learn about the program and the prospect of helping people enroll. and well, when we got to the part of the training about the cost of the premiums, the cost of the co-pays and the cost of the deductibles their eyes got very wide. and mouths dropped open, and coverage california is significantly more expensive than the healthy san francisco program. and these staff knew that the first time they saw the sticker price that it was going to be

unaffordable for their patients. staff who were very upset and even angry. they so wanted to be the bearer of the good news, and now they tell them that their coverage was going to be out of reach. this was not a job they wanted. their fears were realized i have countless stories directly from people that i have worked with that the coverage california costs are not affordable, and he told me that his wife could not sleep at night, knowing that they could not afford the least expensive plan and that they could scrape together and borrow enough to coverage the premiums for a few months and they could not afford the co-pays. and what good is the insurance? we are asking the board to make the full scope coverage more affordable for more as soon as possible. >> thank you. >> i am going to read a few more names. >> caroline and amber bauer and

caroln, and scott hage, and brenda, beros and i apologize if i miss pronounce any of your names. >> good morning. my name is dana and i am a leader also at the san francisco organizing product inner faith action. and we represent tens of thousands of familis in san francisco, and as part of the pico network, we held the healthcare security ordinance and the affordable care act into law and we want to see them work together for bring healthcare to the most possible people. and the universal healthcare council agreed on a few principles, one of which was that healthcare should be paid for by the coalition of the community of employers, of the employees, and of the government. and for this reason, the loophole has got to go.

it is unfair to other employers, who have been paying what the law requires, and with the golden gate restaurant association thought all the way up to the supreme court that said no, this law is the law. and it is valid and constitutional and binding, and then they figured a way to get around it. and unfair to the employees, who don't get their healthcare paid for by employers who are using loop holes. and it is particularly unfair to the restaurant patrons who for so long paid an extra portion for their meals in a good cause, and happy to be supported for the employees, and they did not realize that three quarters of that money was not going to the healthcare. and that that is entirely unfair and just really fraud lent and so thank you supervisors for your support of this ordinance and please bring it to the full board, and get it into law.

thank you. >> next speaker, please? >> hello, supervisors i'm dina and i am the vice president for policy and advocacy at the san francisco clinic, and i am just here to say that we are proud to be san franciscans today because there was a problem the supervisor and the department of public health worked hard and hillary has made huge efforts and we have all worked together to bring a modified version of this ordinance. so i think that i just want to say on behalf of us and all of the patients that we serve, 90,000 in san francisco and mostly low income and we are particularly going to be glad to say that the seniors that they don't any more age out of healthy san francisco. or for some reason they are not eligible for medicare and we are just proud that we have been able to bring this and get this and get it passed and we hope to get it passed and be

able to tell our patients some good naoutds and so thank you for your work. >> thank you for your hard work too. next speaker, please? >> thank you, supervisor campos, for your leadership on this topic and i am steve, the owner of san francisco soup company. and while i think that we definitely want good healthcare coverage for workers in san francisco, and residents in san francisco, and i think that we will disagree on how we accomplish that. and i am afraid that the biggest problem that we have in the city is affordability and it is affordability for everything and while healthcare is a high priority, i think that healthcare is a higher one, and i am concerned and the version of it what will do to affordability in the city and the problem with the law is that it is the law of unintended consequences and when we try to metal with the free markers and we are not careful we can have the

unintended consequences as we have seen over the last few years. and the problem is that some businesses can easily afford this and other businesses just simply can't. and we talked a lot about the restaurant industry. and how is the restaurant industry dealing with this and we are dealing with the back actors and the people have been collecting the money with the serious charges that are not applying it to healthcare and however, over all, a concern amount of money has been collected and businesses have been able to survive, over the last five years. but i think that everyone understands and agrees that only whatever the number is, 25 percent of the money has actually been spent. and if the businesses have to

actually spend 100 percent of that money, that four percent surcharge that you are seeing now has to become 14, or 16 percent surcharge. and that is what i am concerned about. and i am concerned that the only way that businesses can manage this increase, and these increased real costs is going to be through the price increases which will make the city of san francisco even more unaffordable to those who can at least afford it. and this is going to have a ripple effect through the entire economy. and on top of the increases in the minimum wage that we all know are coming and the very dramatic increases in minimum wage. and personally, i prefer a single payer healthcare system. i think that everyone in our country and city should have good healthcare. and i think that there must be another way and other ways of solving this problem, rather than forcing the employers like myself who hire the people who

have the low skills, and have to pay 20 percent more for healthcare and employing these people and ver we are and i am proud of hiring the people that i hire and the problem is that... >> thank you. >> when you hire people at the lower end... >> thank you. >> you have to pay more. it effects them even more. >> thank you. >> that is the problem. >> supervisor campos? borden the golden gate restaurant association and i am going to focus the comments on the inner portion of the legislation and we agree that we would like to see more people covered under coverage california and if there is a subsidy model that works, that makes a lot of sense, but one of the issues if you are pulling the funds and they are going anywhere other than an mra account it is a tax and it should be dealt with differently and i think that we have always said that we would be interested in talking about a tax if our goal is to make sure that we can provide

insurance to the broader space of people across all segments. and the issue is that the city is 54 percent and i think that there is a misconception that money is sitting around that we are recaptured after 24 months because the employees did not spend it was because the employers were being mean and cruel. the city's own mra, and only 54 percent utilization and that says that there are people who have these accounts, who don't need them. some of those people are people who have insurance already because under the employee spending requirement of the city if your insurance cost less than the hourly spending requirements you still have to meet that requirement in another way, and the health reimbursement were birthed out the fact that the employers needed to reach a dollar amount. and we always contended with the implementation of the affordable care act that this law should be amended to allow the employers that provide