would work for the department. >> thank you very much. i really appreciate this because that gives us that perspective and opportunities that you're describing which we hope the department will take advantage of. commissioner singer. >> i had a few questions. co-lien, it's great to have you here because you make complicated stuff retractable for me. i don't know if you have the sense, but when you think about each of the buckets that everyone flows to and proposed legislation, how many people are in those? speaker: it's two ways to think about that. thinking backwards with the remaining uninsured, we think they'll be between 43 to 52,000 who

will remain uninsured and that's for many reasons. it's because they're not eligible for expansions under health reform because they choose not to end roll because they don't enroll because they can't afford to end roll and they don't know the options available to them. any number of reasons. what will happen with those uninsured. many will rely on healthy san francisco and some will rs be eligible if this ordinance would to pass for the san francisco program, and there are about 26,000 employees of businesses now whose employer relies on that stand alone health reimbursement account whose employer would have to find another mechanism to make their health care expenditure. so those employees, if their employer contributes, the department of public health will determine

where to route them under their eligibility and many can be eligibility for subsidy. working backwards when we were looking at the ordinance commissioner garcia referred to the on and off switch. we looked at the whole population because the need will be beyond the people who have employment who was contributing employers. so that could be up to 37 to 40,000 people who would be eligible for covered san francisco. that's a long answer to your short question. >> there's so many moving pieces. >> okay. i had one more question for you and a question for the chair. there was a statement

earlier that made logical sense to me but i'm wondering can you react to it? we subsidized a lot of health care out of the general fund here in san francisco, and if we get people on insurance covered, the sub set that we're talking about, that it in fact will be beneficial financially for the city because it will slow down into everything else being constant, less money invested from the general fund. is that you're comfortable with or you're trying to figure it out. >> i might refer to our cfo on this issue?

>> mr. wagner. >> good afternoon commissioners, greg wagner, chief financial officer. that's like everything else in this discussion, a complicated question, of course. in many ways, that is a line that we're comfortable with. we have people who are uninsured and using our services, there's a general fund share of the cost for the those services. to the extent that we can continue to serve those people, but add revenue into the pot, that is revenue that wasn't there before this offsetting general fund. on the flip side, there are other circumstances, if somebody is insured and then goes outside of our network, so that they're insured, that's a good thing for that person, but that's not a general benefit to the general

fund necessarily. overtime if we did lose enrollment, our network would have to shrink but on the margin you wouldn't experience a big savings because you only have a reduction in your marginal cost, not in the base fixed cost. it's a mixed bag depending on what happens to that person. overall our goal is to get everybody we can into insurance. >> and my last question dr. chou, what is our action that's being asked of us right now as a commission? >> currently we had asked under our resolution in february that we have a continued update. we're very appreciative that the -- a

member of the board certainly supervisor campos who has been a champion of moving forward in health planning and all as we know, also has taken on the continue -- continues to take on the subject of access and that this was before the board of supervisor so we have logically then asked that we have a hearing on this and the commissioners actually ask for that. to have input into the process, so that is whereas it's titled here, the review of these amendments and commons we would make -- and the comments we would make and it's up to the commissioners to decide where they want to take us. much of what is being done follows our solution trying to look for affordability, continuing to work for solutions. the novelity also and i'm happy to hear that --

if we can't do a direct covered california because of the problems they feel they have as capacity in administration, maybe it is something and that's why i think that director garcia has spoken to that we might then be working directly with plans or via some sort of foundation for which funding can be given because we can't do it directly. and so i think all those are innovative ways of looking and i believe that this follows as a progress report and the commission can proceed to do what it would like to do as we are so inclined. there was a draft resolution that had been put out prior to our editing, and we think that similar to how we dealt with the care resolution felt that this

really needed some more input especially from the commission, in terms of how we might want to frame that and have it recognized, what we have as a moving target and what we should be as a commission, then looking at taking a position on, so this was the first step of understanding this and that's why i certainly and we are certainly very appreciative of marone and responding as she has in terms of the five points that you've helped us also put. we're at a discussion period. we certainly can move forward, however the commission wishes but i would recognize that the resolution, the ones that were floated for most of us did not see because it was put out and the department did not have an opportunity to

finish bidding -- therefore it's clearer to options available to us. if we're going have a meaningful resolution, piggy back on where we are and not proceed to have affordable care. >> so i mean, that's my opinion at this point. >> obviously the commission can do what it wishes. >> i would tend to support that process because i think that there is a lot of unanswered questions here and i like to have some clarity as to how are we going onto pay for this if we don't have the money? implementing something like this is important, but we need to know where the money is coming from and as far as i'm concerned, we're very supportive of the spirit

of the ordinance in providing health care to the insured but the rest is for me so i need to know that. i know that healthy san francisco is costing us money and be need to make sure that we don't leave a legacy of debt in the future. so i'm really -- i'm willing to look into it. i'm willing to really study this. but i'm not really certain that i want to support this or do anything at this particular point. >> i'd ask director garcia in which way because we are very supportive of moving forward in responding to the needs of our people here and supervisor campos has come up with one of the solutions, how do we work together with this

and work with the supervisor and work with business, work with our partners. i think we had an offer from mr. salar to continue to be apart of that dialogue. i think the university of council or at least the chamber was. >> we'll continue to work with supervisor campos's office and get - you've heard today from hillary and her looking at time and flexibility. that's what we're asking for, but i want to do the work that's necessary to get this done, so we'll work with them and at the same time as i said, the next steps are going to be to meet with healthy -- meet with the health plans and work with the foundation and start the structure of a plan to how we're going to attempt to do this and we'll see how often we can do this and i'm more than willing to put the effort to make sure

to do this quickly as possible. i just want to get -- i need some time and that's why i'm saying 12 months to 18 months because i don't want to put myself in a situation where i can't meet that need as quickly as three months. i can't do that. i know supervisor campos is willing to look at that. i think there's more agreement and i've heard more agreement tonight. it may not look like, but we're more in agreement and i'm will to go go through that process to make sure we get as many people and this is my position is we need to get as many people insured as possible and workers have a right to use their dollars for this and we need to help them with the mechanism to do that. >> commissioners, i'm thinking the that the issue is quite important and also fast moving and urgent and while the board is also considering its own resolutions

and ordinances, it would be appropriate to get a progress report at our next meeting in terms of our successes about the prongs you're talking about, not expecting you'll be able to, but saying these people are interested. this is what we found. these are areas we've been able to work with the board of supervise -- with supervisor campos. we start making that legislation make sense. does that make sense that we would have a progress report? >> absolutely. this is a big project, then you'll get continuous updates as we get progress on it. it's important to do and i'm sure the health plans would be supportive of this kind of a program. it helps them in their business line and so it's just the complications of getting individuals and dr. chou you work in this area. it's complicated to make sure people get the right level of their subsidies and that's a changing

target too because people's insurance plans change accord to go what their needs are. we'll get through this and we've done complicated things like this and we will get it done. >> commissioners, are there any other -- at least a progress report within the next two weeks and maybe better in terms of what you were able to accomplish and i think we're extremely appreciative of the public's interest again. healthy satisfy did not occur in one hearing. it also went through a number ofity iteration and we can tell you about the mechanisms it took to get it passed. we won't have anything perfect and we like it better than the aca. i think itself is a good example where

legislation was hastedly crafted. let's hope we don't create the same in san francisco with the best intent and i would hope our department would -- i know our department will working collaborations with all the parties to make sure as much as possible we can do that. i want to thank mrs. baron for representing the supervisor well. thank you for understanding that we like to get the points out that we need and your very strong and we always appreciate it. and to the rest of the public for being here. any questions or further comment. >> chair, i wanted to just add one thing and i don't know if it should be apart of the resolution as it now stands or how we would do this, but what i'd like is since this is a moving target giving the complicated issues that's going on as i try to negotiate

covered california, i would like to make sure that at every meeting, we have an update of where we are? >> we're going to begin with the next commission meeting and we'll see how it's moving, if it looks like a resolution would be helpful, then we will ask that that be brought for a hearing. that were true then. we also would -- [inaudible] to get further comments and since this is extremely important topic. we'll begin with an update at the next meeting and depending what that sounds like and we want to have regular updates and we'll try to create it so it can be showing progress and asking for our input as we go along. is that fair director garcia? >> absolutely. >> is that going to meet your needs? okay. thank you.

>> this unique dialogue, we're all really focused on the outcomes, but i was thinking that we have some new people now in some of these foundations. fred is come being back from oakland to san francisco as the san francisco foundation and we have dr. hernandez which is our ex director. and there are others who are -- have always been committed to the uniqueness of the commitment of the city. i know that barbara garcia and her staff and others, we would be glad to contact and work with them, so it's not a question of any five million, it's a question of how do we sustain and make sure we get everything needed because this is -- this could be the flagship of the nation pertain to go what we do here and we're all in harmony. the only reservation was the

time variable given how we're coming back and we're still moving ahead forward and we'll continue to move forward. as our chair said, there's been a lot of credit and should be to supervisor campos and others who have been working on this and they'll continue to work on this and we will continue to dialogue and to insure that we do have a former model that could make a significant difference overtime. hopefully san francisco can have access to health care to everyone in this city and county. >> thank you. the commissioners are thank you for the work that the supervisor has done, the public who has also brought their concerns to us, and we will continue to encourage that department of public health work on this legislation and work on rigs and work with all parties so that we can bring together a new healthy san

francisco and new covered san francisco also. thank you very much for your participation this evening. can we go onto the next item. >> yes, we may. >> the next item is an e-cigarette update. >> good evening, president chou and commissioners. can you hear me? thanks mark. thank you for inviting us. i'm derrick smith and i'm with the tobacco free committee and it's apart of your promotion branch. i'm here with the health department itself, but i'm here

with our colleagues who are the community partners. can we ask the public that is in conversation to try to vacate the room so we can hear the next presentation, thank you. >> thank you. so we're here with partners. here's jessica and nguyen who has been leading projects and ali who is a staffer in san francisco. speaker: we're here today just to give you a little brief update. particularly about local legislation related to e-cigarettes. have you been on this since introducing a legislation. e-cigarettes matter and they fit into a

fixture on smoking and health. i would like to tell you about projected. we partnered these people. they're local leaders and they're the people who move the city forward as far as making services a health a place. we provide resources and data and that sort of thing. our paradigm has been to address tobacco use so it's changing the world and changing san francisco one item at a time. i'm sure you've seen that over the last 25 years in san francisco particularly around the matter of tobacco use -- what we do is gather data and do education on an issue like e-cigarettes and we work on policy solutions and partnerships with the board of supervisors and department of public health and health care provide

-- providers and we to educate the community about this policy and get the word out about a new health harm. we solve problems and that's why you see youth involved in this effort and the staff here are going to speak about that. also just to let you know, this is apart -- it fits in this e-cigarette issue with the strategic plan . we're trying to reduce this in adult youth. we're going to talk about why e-cigarettes are linked to youth and the product and people who have been using cigarettes for a long time not quitting through the use of this product. so we did a pre-view with a couple of commissions that were glad to be at the public health committee and you asked to be real clear about what article n and health code does.

we always say the bottom line is in san francisco now with the adoption of this ordinance, e-cigarettes are cigarettes. they're to be treated the same. for 25 years, there's been ordinances on where you can smoke and licenses to sell cigarettes. it's the most simple way to two about it and to explain that issue. so for one point, e-cigarette sells require tobacco retail licenses. at first you didn't need a license so they were popping up all over the place. they can only be sold where cigarettes are sold. they have the pre-amazing 2008 ordinance that states if you have a pharmacy in your store, you can't sell cigarettes. stores like

walgreens, cvs, they can't sell e-cigarette. they can be used for cigarettes where cigarettes are used. it's best to use them at the curb. that's where it's safe to use them. they cannot be used in work places and restaurants and bars and public transit like our muni stations and they can't be used in parks and schools and play grounds. this is as of april 26 when this took place because of our partners and moving it forward. a brief outline, you can look at this. the first e-cigarettes came into this city only five years ago. really and 2010, the tobacco coalition was activating on this issue. and we developed the first e-cigarette fact sheet and in 2011, you adopt this in regulation of

e-cigarette. we worked with the city attorney to draft an ordinance. general hospital adopted their own policies. and then in 2013, that is when the department of public health adopted a department wide policy which relates to san francisco general, honda hospital and all the clinics and then in late 2013 like wild fire, many cities started looking at these cities, particularly new york, los angeles, and chicago. we jumped in there with the lead of supervisor mar and moving this issue forward. in 2014, san francisco enact the ordinance the same month as all these other cities that you see. let me hand it over. >> so i'm going to talk to you

all about the next few slides. 2014 was the year that san francisco led on this issue, the e-cigarette issue and like derrick said, with the support of mayor erik mar, the ordinance is introduced in december of 2013 and the tobacco coalition which derrick talked about, supported this and it was adopted and signed in march of this year. the department of public health and the tobacco free coalition had roles in this process. we engaged in educated new partners. i say "we" because the institute was apart of this. and the youth was involved with this as well. we delivered research and an outreach plan to insure this ordinance was adopted. how do i do the next slide? so what exactly are e-cigarettes. it can be confusing. you have

seen them being used around so they're electronic nicotine devices and they come in different shapes and flavors. here are a few examples. some of our youth were able to purchase e-cigarettes with radical flavors such as skittles or blue berry and that kind of thing, so it's getting to young people. you see a break down of what an e-cigarette looks like. there's an led light at the front. a battery, the cartridge where the filter is and the nicotine container. so the health harm of e-cigarettes, for a few years, we've been working on these, but there's no long

term study so we can't determine if it's harmful. it contains nick tames and heavy metals and carcinogens. it creates a false hope for smokers of creating. it doesn't actually help with quitting cigarettes. the public is misinformed about harmless water vapor. that's not necessarily true. there are new air pollutions created indoors because people are able to use or were able to use them indoors and it's being sold to kids as you can see from the flavors. let me turn it over to jessica. >> hi, i'm elf from the soccer free program. and i wanted to talk about how youth is aware of this product. some of my group

members in the tobacco free program, they two to high school and they two to college and we use people using them. but e-cigarettes under mine this. on the picture on the left, you can see photos from instagram which is a photo application that those my age use and on the photo on the top left, it's an e-cigarette in the shape of bunny and it's marketed towards a younger audience and the photo on the right shows a girl about our age too who uses e-cigarettes and tags such as e-sig are popular and hash tag on instagrams. we work with the school district which conducts a survey and these are 12 to 14 years old and

they seemed knowledgeable about this subject as well. everyone is doing it. it has the fuel a real cigarette, but safer and you can hide it easily and i smoked them for three months and i know a lot. you can tell how these are marketed and concentrated towards youth markets and because of how easily accessible and how widely seem they are. my group decided to advocate for this legislation. >> that was amazing. speaker: i'm jessica. i'm her coordinate at the vietnamese center and i want to reiterate what she was saying. in our group i work with ten amazing and they're seeing it all over instagram and there's millions of post. i have an instagram account, but i'm not as savvy