some of the uncertainty about where we're going to be coming into the coming year and refine our projections, but we're in a much better place than we were in the past, especially on our expenditure. i just realized one thing that i do want to point out that i skipped over on the san francisco general hospital slide. i skipped one of the slides on the expenditures there. we have -- on the expenditure side we are living within budget. you'll see that we have a projected $16.6 million favorable variance in salary and fringe benefits so we're coming in below budget by $16.6 millions. that is due to a couple of things. we have a couple units that are under their budgeted agent

census so we've incurred some savings there and we also have some savings from our delays in hiring. i wanted to point this out because this is something that's come up at a couple of the last commissioner meetings and it's also come up extensively in our meetings with our nursing union as we've talked about their contract. we have -- despite the salary savings, that is not coming from our inability to fill our clinical positions, although that is a very serious issue for us. we have about 80 nursing positions at san francisco general that are unfilled and we are working overtime to fill those positions, however, from a financial perspective we are back filling those shifts with per diem and registry, so that's not what's driving these savings. it's the units below census and

the other positions we are having trouble back filling, which are things like our information technology, we've had a hard time hiring there, clerical positions, interpreters, etc. i want to point that out in particular because we know it's an issue. repeatedly every chance we get we've expressed our commitment and desire to get that hiring pipeline moving so we can staff up the hospital particularly in our nursing area. so that, i think is the story as we are within budget on our expenditures and we have a little bit of good news on our revenues which we've been able to turn around and turn over to the mayor's office and it's translated to some positive things in our budget so i'm happy to answer any questions if you have them. >> i'd just like to say we're

very appreciative of the mayor's office supporting us and this may be one of the first non years which means we use today have hearings for any reduction in services and we sit for three to four hours listening to community about why we are reducing it and the consequence of that so this is a good year for us in terms of getting back any of the reductions, particularly for our community based organizations. it's not that they did something wrong, it's the fact we did not have enough money to meet the needs of the budget so we're very appreciative and i think it shows in terms of our bottom-line. >> is there any public comment on this item? >> i receive no public comment requests for this item. >> okay. commissioners, any comments? >> yes. >> commissioner singer. >> i have one quick one. many people have expected that

with the aca the problem of bad debt would shrink, but in this last quarter or your projection for the year, your bad debt at the general hospital goes up 11%, i think. 11.7% to $98 million and i was wondering is that because we expected it to get so much better and it didn't get quite that much better or -- and we can probably take this offline because it's probably not something on the -- >> i -- that's a good question. what i would like to do is kind of dive into the details, but really or bad debt projection is a function of multiple things on our actual, so if we have higher billing, our bad debt will go up because it's a percentage of our billings so what we'd need to do is take a look at the fee for service, analysis and where we're

withholding dollars in terms of what the billing is that's out there. further questions? >> i just wanted to comment that i wabted to thank you for you continued clarity, the clarity has been made even more clear by the fact that we don't have to juggle this, you know, invisible set of words with the mayor's fix and i think it's also amazing and another reflection of this city's commitment to healthcare that the cbos were being able to be given their raises, they didn't take back, but were actually resfoered. stored. we're putting forth as part of

two year budget and funding most of our initiatives which we need to try to remain on top of all the needs that aca has given us to be able to develop the integrated system. and we can see it more clearly because the numbers no longer are being, you know, confused with this problem of -- yes, the expenditures are [inaudible] because we didn't fund it or it wasn't funded from the city adequately. i think the unintended consequences are we're much more able to manage this budget and i think again, that's a commitment that the administration has made towards the improvement of our healthcare system here. so thank you again for bringing that -- >> one of the things i wanted to note was the fact that the community based organization

has a 1.5% increase as you said, but they received a several million dollars to help them with their increase cost of rents prices in the city. >> on top of that. >> on top of that. >> i didn't understand that part. that's even more of a commitment for health here in the city and so our thanks then to the mayor's office and we're hope tg board of supervisors will see that that is the road to take. next item please. >> yes, we move to item 11, which is the update on the proposed amendments of the healthcare security ordinance. >> thank you. >> when i was here at your last meeting we talked about

supervisor campos' new program that would provide subsidies to individuals purchasing health insurance on the exchange. we indicated to you at that time that while we agree with the intention of the program, that there were some concerns about locking us into a specific pathway forward at this early date while so many things are still in flux. so since your last meeting, we met with supervisor campos' staff and have come to an agreement on language that's included on the revised resolution and have provided in the key paragraph of the cover letter to you, which is intent language that requires the department of public health to develop a plan that will bring to the health commission of 2015 that will address the affordability of health insurance and in the interim we

would continue to operate the current programs, the medical reimbursement accounts and healthy san francisco in a manner that's consistent with the principals of the universal healthcare council which are affordability, prioritizing health insurance and such. we're pleased to say we were able to come to agreement. the revised legislation passed out of the neighborhood services and safety committee last thursday and will be headed to the board of supervisors next week for its first of two readings. and additionally, we haven't stopped since we got a little relief on the october 1, 2014 initial timeline for implementation. we have not moved forward with planning on what to do about affordability. we have arranged a meeting this coming week that is between the cover california plans in san francisco, the five cover

california plans, plus san francisco health plan, plus foundations that are interested in healthcare will also be there and cover california will also participate. we want to get their best thinking about how to address the affordability issue. we're moving forward on that front also. >> thank you. commissioners any questions or -- so it does sound like the cover san francisco is not really in the legislation anymore and that we're talking about what is the best way to take the existing programs and make them affordable to our public and how to encourage getting into real insurance bill. >> that's right.

or the plan could be a different program that doesn't look like the cover san francisco program that was prescribed in the previous version. >> that's possible too. >> that's possible too. >> director garcia, any comments on the work you've been doing with the campus legislation? >> well, i want to thank supervisor campos, who was flexible with us, particularly as we move into exchanges. as you know, president chow, there are a lot of issues in terms of how do we do these subsidies, but i think they're not unsurmountable. cover california isn't quite ready for us yet so in the meantime we'll look at local health plans. we need to think about how to make this simple because of the node to get these funds to people as quickly as possible

and i know nothing's simple in our health area so we'll try our best to do that. on next week after the health plan meeting we'll have much better understanding of how the health plans can help us in the program. >> very good. commissioners, you recall from our previous resolution had said that we were asking the department to continue to update us and bring at the appropriate time, resolutions as needed in order to be sure that our residents have affordable insurance programs, so are we looking at maybe a month from now having a report or -- >> yeah, i think monthly would be sufficient for us and we'll have enough to be able to report to you. >> commissioners, is that acceptable at this point? >> if there's a significant encounter that we find that we'll need to bring to you we'll bring it sooner than a month. >> monthly reports and earlier if needed. >> absolutely. >> thank you. >> thank you.

>> any further comments? if not, thank you again colleen and we'll go on to our next item. >> item 12 is other business. >> commissioners, any other -- any comments or any comments from the public. >> no public comment. >> i wanted to ask about just as a follow up item, we had in our packets two meetings ago i think a letter addressed to uz from us from cpmc about bed allocation between facilities and at some point i feel responsible -- >> that was the [inaudible] and it's a prop q hearing. you want to tell us -- i think we have it on the calendar. >> right. that's going to address the prop q setsing up a meeting with -- -- >> you don't need to cover this now, i just want to make sure we -- >> yes, we want -- >> you're scheduled to have a

prop q hearing at your next meeting. it's on the reduction in skilled nursing facility beds from 99 to 74. >> and we are currently working with director garcia on the response that cpmc gave us regarding the diabetes clinic and we'll see and report back to commission what their response will be after we get further clarification of nurse services. any further questions, i will move on to -- >> item 13 is report back from the joint conference committee with [inaudible] during this past meeting period. >> it's the law gu that honda jcc met on may 17. at that time we reviewed the hospital report and the third quarter financials. we also heard a presentation on

efforts related to patient flow in and out of laguna honda and in the open session the committee [inaudible] in closed session we approved the may credential report. >> any questions? if not, we'll go on to the next item please. >> item 14 is the committee agenda setting. >> any -- just to remind you that our planning committee meeting is -- >> august 19. >> -- august 19. okay. and we've been able to obtain the same facilitators so pleased with what will be a continuity from our last meeting. >> and since our last meeting, the commission must ask the women and health commission are worked on a date and it's a date of december 16 for a joint meeting, which would focus on women's issues, both from policy and department public health perspective. >> okay.

and we're working on an agenda for that too? >> oh, it's all very preliminary. i just wanted the announce it. yeah. >> i think if anybody has any items they think the joint commission should take up, then we should give those over to the director now so that we can see if those are of mutual interest to the commission -- the other commission. >> all right, you are now at item 15, which is voting on closed session. >> any public comment on closed segsz? >> i've received no public comment. >> first a motion for closed session? >> i move we go into closed session. >> is there a second? all in favor, i. opposed? we'll then go into closed session. thank you

>> the information from the closed session. >> second. >> i.

>> welcome everyone. my name is ann chronicallying burger (clapping) thank you. this is such a very exciting day

for all of us i see lots of friends in the audience who worked with heather harvey and loved him as people part of the legacy to think we're honoring this man with a u.s. postage stamp is phenomenal thank you so much for coming. last week stewart and are were at the white house for the stamp dedication it was a inspiring dedication but to both which us it's more important to do it here this was harvey's home and city hall he loved the most. (clapping.) i wanted to introduce our mayor,

mayor ed lee who is going to speak to you and give some opening remarks we're lucky to have mayor ed lee represent us here in the city of san francisco we really understands obviously civil rights issues by understands the kinds of principles that harvey also talked about we as individuals don't have the same kind of superdelegate or power when we collaborate together and minority groups and disables individuals and lesbian or gay straight whatever with we come pathotote with w we have become the majority so mayor ed lee thank you very much >> (clapping) thank you, ann

well to the people's palaces another wonderful occasion to see all i have you but also a unique one. i want to begin by tang ann and stuart for your wonderful leaders when i saw the pictures from d.c. and i've been there before on anothers cargos this was pretty unique for san francisco. well deserves phenomenal nor harvey milk but your city has been about and what harvey milk attempted to do in his short life but look at who we are today and if harvey were here he'd be proud of the diversity not only in the elected officials but also in our department heads and our lgbt caucus at the board of supervisors i would actually know that attorney general

pamela harris would join me in a unique opportunity for our city and to see the national and international stage of a step named after supervisor mimic not only a stamp but a forever stamp a forever stamp (clapping) rose marie thank you for being part of the postage service because this is pretty unique it also means that we confidentially ourselves inform being a city of quality and making sure we do everything we can to do what harry taught us he saw the significance of changed and he had that door open and all he asks us to do was to keep the door open when

we come walking through it that's our commitment we've seen the millstones just a year ago we were here celebrating the instruments decision an dermoand prop 8 and a if i months ago we celebrated 10 years of w45er7 doing here to lay the foundation for change across the country lovd 18 its in the united states of america have seen it there's more to be done (clapping) today, this forever stamp puts us and harvey milk stamp autonomy face and name in history but your culture of of tolerance and acceptance for the world to understand we have to

educate more people and bring more people along and keep the doors of opportunity open and it's centered right here in this wonderful, wonderful city of san francisco so thank you, again. and ann and stuart to the positively services and all of who you who are here you'll see a stamp that you'll have to reproduce more of those stamps i'm in line because i want to be part of this exhibition of history but the reminder let's keep working together and making sure that everybody experiences this wonderful celebration and feels the power of equality this is an and congratulations for being here. thank you (clapping) i'm stewart imagine i've been

going on known a envelope of harvey milk (clapping) and my friend ann and i are could hosting we're splitting back and forth on introductions. two years ago we were invited by the post office there would be a harvey milk stamp and the team is are volunteers they've been living and breathing the post office we had to keep it secretary no one can know you can't tell anyone anything but we had an amazing group even if people leads lift ev'ry voice and sing by miriam working with an incredibly talented team of people so if someone asked me what quasi governmental intermits that have amazing talented and highly engaged and

prospective modern be prospective folks i wouldn't have immediately thought of the post office by those folks have been trembles most people are proud and the design was by the post office folks we were honored to have the post office general in d.c. and equally happy to have rose marie he recorded to the chief of human resources in her roll she's responsible for the united states post office talent and training and development and diversity and personnel services and medical everything h.r. we have folks in training to get

jobs so for you guys from the treasure island center the woman i'm about to introduce is who you want to know please join me in welcoming someone i've only spent a few moments with please welcome rose marie (clapping.) thank you stewart and ann and mayor ed lee thank you and the post office is proud to pay tribute to one person of change harvey milk. i have to say thank you harry we really are to bring cool back to the post office he think with the stamp we're going to do that there's a lot of reasons to admire him its unique ability to bring folks together look at the cr