costs the chief concern of affording whether or not their insured or uninsured employers said they want to be able to over health insurance to their part time employees but not possible because of the cost or because the insures don't allow the employee employers plan to address those concerns the department of public health through a generous grant from the health affirmation engaged the university berkley center to present the proposal before you today the berkley was the created of the cal model a model that is relied on by covered california and other state and policymakers that impacts the elements of the ac a we asked uc berkley to

advise us on the numbers when is affordability exactly what are the tax up rates of models with the assistance we could offer how many people need assistance and how much revenue to support the program they were able to custom nays their model to have estimates for this report for h m a we asked for air perimeters we need help how much that will cost and how much revenue how to get the assistance and h m a helped us with this analysis they the a operational analysis and made information for the benefit designs. so together they had a few major frntd from their works that informed our work for the

proposal first, the high cost of living in san francisco it is estimated to the cost of living in san francisco is 49 percent than the national average second is that post ata that relies on cost schaffer those people from 2 hundred and 50 to 5 percent of passport are financially vulnerable the chart on the right shows the various income levels the household income that goes tarts premiums for an average 40-year-old person between 2 hundred and 50 percent of poverty and 5 hundred percent of poverty individuals are paying more than 8 percent of their money on premiums this coupled with the higher cost of living in san francisco puts san franciscans at risk of being uninsured or under insured that

was determined pie most viable for the proposal that will insure that all low and moderate san franciscans have access to affordable health care act now a a little bit of 101 on the health security ordinances impacted in 2007 it requires employers to make expenditures for health care on behalf of their employees so for for profit with 20 or more or nonprofit with 50 or more employees they make quarterly expenditures for employees they have many options those are the months popular option by far the most is health insurance 85 percent of the employers according to the 2013 which enforces this ordinance about 85

percent of employers provide health insurance which is great about 20 percent provide reimbursement bktd i an employer reimburse employees and 20 percent provide the city option employers can choice one or any inspiration of those or other options to comply with the heartache ordinance about 20 percent as i said contribute to the city option who happened when a employer contribute the city once the contribution is made the funding is used to provide a benefit public benefit to the individual open who's on behalf of the contribution was made if the person is an uninsured they are provide with the training and experience that supports their participation in healthy san francisco if they're not an uninsured san franciscan

perhaps they reside outside of san francisco their contribution goes into a medical reimbursement account in the amount that the employers contribution in 2018 some changes lows people to transfer their money in order to save up enough in their accounted to afford health insurance when open enrollment became available so, now to the detail of the city option modernization proposal today again here the gray represents the city option program medical reimbursement accounts this remains unchained for a person in an unbridged count and healthy san francisco in the gray remains unchanged for healthy san francisco on the

next few slides i'll talk about the blue and the reimbursement account and the healthy affordability extension so first bridge to coverage who is global for bridge to coverage and what is it >> bridge to coverage is available for any san franciscan reside who employer contribute on their on behalf of 20 percent and their global to purchase health insurance on covered california and their protection is less than $59,000 in 2015 so this population what will they be eligible for for premium assistance and cost sharing assistance to make health insurance more affordable so premium insurance a 60 percent of the cost of the lowest so premium costs will be covered by

the program and cost sharing assistance would be insuring that people avoid under hungers that is denied as 5 percent of our income going towards the deductible so without premium assistance 60 percent of subsidies reflects the higher cost of living in san francisco than other places that is meant to address san francisco's higher cost of living cost sharing assistance is intended to addressed issue that the people between 2 hundred and 50 and 5 hundred are at risk because the deduct is more than 5 percent of the heartache plan 9 deduct is the first amount to pay towards the health care when that monuments to more than 5 percent of the income are at risk without health care

so this graft shows an example of bridge to cover one of the development is we wanted to maximum all federal assistance before putting forward a local program so as you know the cost of health insurance varies by age and the federal subsidies by in case this is an example of a 40-year-old san franciscan hundred percent of poverty at the left all the way to poverty and a thank you right the full cost of health insurance is 6 thousand plus it is the same at every income level the difference the subsidies available at each income level so at hundred 50 percent is 17 thousand plus a year 82 percent of the cost of the plan

represented it in blue will be subsidized by the federal government the vast majority bridge to coverage feature for the medical reimbursement account subsidized 14 percent of the premium 4 percent left for the individual to cover those costs assume the individual uses the full deduct the cost of the premium bus the 5 percent deductible when you look at the 4 hundred percent and 5 hundred percent the last two bars on the right the federal government covers none the bridge covers 41 percent braus plus the deductible and the individual discovers the rest the 59 percent the earlier graft between 2 hundred and 50 poverty the health care costs are the highest percentage this is

lateral due to the significant incline to federal government subsidies that occur as income increases thus with the high cost of living in san francisco this is the population that most likely to be at risk without our bridge to coverage program so the brick to coverage benefit was designed to have a meaningful benefit to have the resources for the participants we estimate it the 3 hundred san franciscans that are likely to use this program 67 percentage will be less than 40-year-old and 73 percent work less than thirty hours per week and 85 percent earn less than 17 thousand and the rest eligible for the subsidies it is entirely

support by the contribution of the employers by the 3 thousand individuals each projection the 2016 and 18 projections are the projection in berkley studies and 3 thousand participant are estimate to participate in the program they will be associated with revenue of $8.8 million and the cost of the program would be $08 million total this is a $7 million benefits to individual plus one million dollar in administration so as you can see for all the program years the entire cost is speeded to be covered by the employers when we designed this benefit we designed it so it will provide a meaningful benefit to the employees that made a defensive in the

affordability of the health care and limited to the cost of the expenditures made on their on behalf of by the employers. >> so, now i'll move to the healthy affordability extension there are two key components as i mentioned none is eligible will be ineligible for san francisco after the implementation of the proposal there are two major changes we proposed here in the element of the proposal the first to increase the offer threshold of 5 percent of poverty i'm sure you're aware of we wanted to align with the affordable health care subsidy structure but when we do the fundamental analysis up to 4 hundred people are issues with affordability we wanted to return there this back to the eligibility of every poverty

second component to include the eligible san franciscans not able to afford the ac a option the state of california has approved that in 2014 and 2015 they called it the waiver we proposed to you and you approved that for a couple of reasons one people previously uninsured might not be awarded or aware of how to get the insurance we didn't want anyone to fall out of care and affordability concerns were raised from the out setting we didn't want to destable care with affordability concerns that passed by the health commission and to expire at the end of 2015 our proposal to extend that indefinite as the affordability along with at components that include robust education and financial counseling for people trying to enroll in healthy san francisco

but have another health insurance options available to them 0 overall it is largely the same still available for san franciscans age 18 and over the health commission recently the upper age limit was eliminated it is blow 5 percent of poverty and they've been urban insured for 90 days we don't tim displace people out of health insurance they can't be eligible for other programs like medi-cal or medicare that is one of the elements of healthy san francisco medi-cal is certainly no cost health insurance with the extension is more health insurance to more people they also cannot be eligible for the bridge to coverage program i described and maybe they can self-attest their unable to have

health care coverage or exempt from the ac a so what we want to do as part of the enrollment is really focus even more on the education enrollment assistance we provide already our enrollment assistance are able to enroll individuals in health insurance they're eligible for but we can include a more robust evaluation of their benefits of health insurance over uninsurance or the affordable health care what over and over those be eligibilities in terms of finances and weighing the benefit of paying a penalty other than healthy san franciscan fees versus paying health insurance perimeter and the coverage you get for that we wanted to infuse that into our education and enrollment assistance and after all that will if an individual is still buildings they're unable to

afford health insurance we'll allow them to maintain their eligibility in healthy san francisco we believe that this program addresses the potential coverage gaps by far the laerlth those not eligible ac a for the vast majority of healthy san franciscans and the mandate due to harding park or religion or other factors an exception for people that have offered employers supported shiners but that officer is too high and qualifies for an exemption under the law and the last one the no option of the employers coverage still not able to afford purchasing coverage so financially looking forward what this means for the healthy san francisco the first column the

2013-2014 for healthy san francisco at the end of the year we had approximately thirty fussing thousand combreerlz and participation fees of individuals that participated in the program together that revenue totaled almost $29 million the experiences to be the program were hundred and $12 million leaving a general fund of 83 point plus million dollars this is represents the cost to the department of public health to the recommended by the the nonprofit hospitals or the clinics that pandered in this program so in 2014-2015 we estimate to the are combreerlz will go down and stabilize lists by 15 thousand we believe that the revenues will go down and we'll

reach a plateau in 2015-2016 and decline slightly by then and conversely they'll reach they're low in 2015-2016 and increase by the rate of medical inflation after that so the general fund contribution similarly has it's low in 2015-2016 and then increases by essentially the rate of medical inflation so the second component of our proposal is the creation of a new employee wellness fund the employee wellness in our proposal will recurs or reinforce for qualified expenditures made and used by the employees in their businesses we are scheduling this one to commence later there are previous elements of the proposal the modernization we're

proposing to roll aisle identity in 2016 that one roles out in 2017 creating a stakeholder progress that helps us design the projecting program elsewhere engage the employees and employees in a process to plan for the program eligibility for the 2017 launch as part of progress stakeholders will review the wellness examine health status and review the workplace interference in san francisco through this process we will determine employer eligibility and benefit design what is a qualified expenditures under the program and make sure that are provisions for tracking and utilization and also make sure this is in alignment with the city community health improvement plan research has already shown there

are clinton medical improvements that support the health of the employees that participate in the wellness and for employers that participate they have recorded dollars in health care costs and absenteeism and prosperity it contribute to the healthy san francisco overall the benefits will be designed to support the interventions for the health risks by san franciscans by reaching the population that might not be exposed to the efforts are overall population can be supported by the workplace healthy work style so what are the expected benefits of the proposal certainly affordable health care act for all middle-income san franciscans this benefits san franciscans it benefits employer

it benefits everyone to have everyone healthier but specifically for san franciscans we prioritized hundreds of dollars and little more we can do this makes health care affordable for many more san franciscans those who don't have the option and can't afford health insurance we'll be there with the healthy safety network and promote the healthy within if their with the bridge to cover increases the health insurance for they're low wage or part time workers as i said the focused group the employers want to over the health insurance but had barriers because of the cost or the ability to obtain insurance for the part time employees 24 provides them with the opportunity this employee

wellness is - by over and over the wellness program to their employees and to the city the bridge to kochlg is funded entirely through the employer contributions it is a way of reworking a benefit that the employees receive to make health insurance affordable the affordability extension and healthy san francisco enrollment trends that have been accounted for in the budget make sure we avoid the uninsured health care costs there was a significant reduction in the hospitalization by the participate without access to preventive and early prevention care they use it at a higher rate when their unhealthy the employee wellness helps to improve the population health

for all san franciscans. >> so finally i thought i'd show you a graphic of health care coverage and how to changed over time so on the vertical and assess the percentage of poverty and the horizon assess various categories of adults and how they're covered the portion shows 2018 so at the bottom you have adults the disabled and the blind adults on the far left the second column are the single adults that happy 80 happen to be low income and next the seniors and city option employees next and those ingibld the undocumented and those unable to assess affordable health care act so the health insurance options were limited

in 2006 age blinded and disabled were ineligible for this and seniors were eligible for health care everyone else in the light for a fee per service or charity or a fee clinic program in 2007 the health care security ordinance was passed it made san fran health care it served 60 thousand individuals so for the first time adults who were single and what did you do children adults over hundred percent of poverty up to 5 hundred percent of poverty a have access to the health insurance and this implemented the employees so the city option was created for employees who's employers contributed to the city option for low income that meant you had the city option

you have medical reimbursement plus medi-cal and you have a reimbursement bltd for healthy san francisco so, now 2014 that's the implementation of the affordable health care act this provided actual health insurance not just healthy san francisco but for many, many individuals across the board at the bottom for all populations medi-cal is a available up to hundred and 38 percent of poverty and those disseminated are not eligible for healthy san francisco but the subsidies are available for people are incomes hundred and 39 to above 5 percent of powerful and covered california is available for all adults and seniors if they wanted to they have medicare available to them nothing has

changed for the city option for employees they have their opening statements available to them and those unable to access alice griffith affordable health care act they were able to stay on healthy san francisco during the transition period and finally twhaepz as a result of this proposalas a result employees are effected so it's that fourth column to the left those individuals have medi-cal in the city reimbursement accounted and above that they'll have covered california with a bridge to coverage reimbursement nthsd making health insurance more affordable for them that concludes my presentation. i want to say this work really represents the work of many,

many people and primary in that is the senior planner alisha chavez i couldn't have done that without here her and thank you to the director barbara garcia and the commission many of the heartache participates are here and may have comments our consultant cc berkley as well as health management society and many of the healthy san francisco providers were part of the universal consultants on this project our focus group and the san francisco health plan is here and the average office of labor and enrollment endorses the program is here as well i don't know if i think the mayor's office is represented here as well and as i heard from director garcia they've embraced this program we're excited about as well you have before you process wise a resolution that we need to

make a couple of small edits minor combroits for you later but for your k and action as you're following meeting on august 4th i'll be happy to answer any questions that you might have. >> prior to questions we have public comment if anyone was not turned in their slip please do so otherwise i'll call the following in groups of 3 each will have 3 minutes. >> first is stephanie (calling names). >> i'll have the timer when the buzzer buzzes your time is up. >> i'm stephanie fishing the manageable that administrators the benefits for the employees

so for the city and county of san francisco employees spend 50 percent of what we get health related choices what to eat for lunch or if i'm going to smoke or walk this brings full time and satisfaction or a cause of unmanaged stress the wellness makes the healthy choice the easy choice if their make them at work that's 50 percent of the time if they form healthy choices at work they'll take them home though help the quality of life for the employees and their family members at both home and work and they're overall work satisfaction but the employee wellness program don't just benefit the employees we rely heavy on the gallop research

that effects people across the country large employers that research demonstrates the wellness is associated with lower health care costs and fire scheduled days of time off and rates by the supervisors and combransz pursuit /* product. >> several years ago the mayor's office and department of human resources and the heartache services came together to sponsor the program the goals of the plan to improve the employee winging walgreens and handle the high cost of hedge funds it is a concept that addresses our choices and relationships and environment it included not only our physical but mental well-being it needs to take a comprehensive look at