we will review that and you will see that recommendation and then we would structure the two hearings around september when you would normally see the contract. >> i would also like to point out, this is not unprecedented. many other cities have it. >> i think is a great idea. idea. i was just looking at the process. >> i'm support improve of this and think it's a positive change to the programme and seem like it would incentivize more landmark designations so i'm in support. >> the millsap is such a superb tool and i'm all for this, in that it streamlines the process and it saves a lot of time and

gives much more of an incentive and it's positive all the way around. it would work nicely and i support this, as well. >> i have one question and we had talked previously about the requirement of the restoration work and when it would be permitted or when it was actually accomplished and therefore eligible for the mill's act. could you update on that or remind us where we're at with that? >> sure. so last year, shannon brought to you some proposed changes for the mill's act.

among those were a more robust look at the rehabilitation and maintenance plan. with that, we are asking applicants to receive all of their approvals for any proposed work for the first three years of their rehabilitation plan. puwe are asking applicants this year to follow through with that. and we are adopting the recommendations that this commission made last year. >> so specifically, if an applicant has previously done work at whatever time prior to being eligible or approved for the mills act, is that still possible? we were talking about adding a check box in the permit or something. >> well, commissio commissionerf all of the recommended modifications, the one michelle

is presenting is the one with an amendment to the code. all others were policy changes. now we have a better understanding of when that work will or will not occur and then we can present that information to you at the hearing. >> i the motion it says we're approving it but that's not right. but i make a motion recommending the motion. >> second. >> very good to adopt a recommendation for approval and commissioner black? (roll call).

>> so moved, commissioners and the motion passes unanimously, placing us on item 10. for the landmark designation and cultural heritage work programme quarterly report and this is an informational presentation.

>> hello again. the item before you today is the quarterly update on the status of the landmark designation programme from january 1 to march 31, 2019. in addition to summarizing what happened in the last quarter, will tell show you the quarterly report. with these changes we have to offer you and the public with the comprehensive related report all of the document-related activities. during the last reporting quarter, four designations were approved and these included the they're door rose vest middle school, the sunshine school, balinlick and quarterly business. this included a landmark initiation of the galleria and

kingman building. through the remainder of the 2018-'19 fiscal year, staff will work on the following items, the imagnum building landmark designation, along with bringing to you the lgbtq plus cultural heritage strategy to the commission next month. additionally staff received seven applications for the programme that we will keep you updated on. we plan to bring the website to the hpc for potential adoption in the fall. into the next fiscal yeah, which begins july 1, 2019, we'll continue to provide support for five additional hpfc-funded project, including new deal era,

historical context statement, the park statement, north beach historic context statement and the ashbury landmark report. we will continue to work with the department-lead and grand-funded chinese context statement. and that concludes this last quarter. at this point, i would like to review several of the changes that staff is recommending for the content of the quarterly report. can i have the -- thank you. staff is recommending to update the content and format of the lan m designation work programme quarterly report. in your packages today, you received a proposed draft outline for the proposed preservation activity's report for your review and comment. in the fourth quarter report, we'll continue a draft of the report for your review. since 2010, staff has provided

regular status reports for activities associated with the landmark designation work programme to inform and guide this commission priorization of the work programme. we supplemented this quarterly up about the cultural heritage work programmes. on occasion staff has updated you on other preservation topics, including enforcement activities seqa projects. in an effort to streamline all preservation-related activities, the staff proposes consolidating all reports into a single document to be presented to the commission every six months. the proposed new report will not only cover the cultural heritage and work programme reports but provide you with regular updates on all preservation-related activities. these will include the landmark designation work programme, cultural heritage districts,

city-wide cultural resource's survey, the business registry, the historic resource assessment pilot programme, the land measure's programme, california equality act and incentives historical property's contracts and public information center. this new report will have additional information presented in a metric-focused format with the intent of providing this commission and public ans-to-read document. it will offer graphic format with brief descriptions.

this will track disbursement of preservation programmes aamong a range of communities in san francisco. these are landmark designations, cultural districts, and public outreach. the graphics will include maps illustrating distribution of permits and other activities. we will also use mapping to show distribution of activities. one important mapping overlay we would like use is the risk map which refers to a san francisco city-wide map created by the mayor's office of housing and community development and used by the planning department and based on mapped created by uc berkley displacement project. we will use charts and graphs to

measure property types and others. along with numerical representations to provide snapshot views of important general information, such as number of hours dedicated to preservation related enforcement cases. we also intend to retain successful visual tools up such as those we're using in the landmark report. we hope with these graphics, in addition to a more comprehensive documentation that we can present to you and the public with a reporting document that better reflects the breadth of the city's programmes. this concludes my presentation and i'm available to answer my questions you have and we would like to hear from you, any feedback about the proposal, content and outline. >> let's take public comment. anyone from the public wish to comment? seeing none, we bring it back to the commissioner.

>> thank you for that presentation, miss taylor. i think this report seems like a great idea having all of this information as opposed to the piece-meal approach where we've had great reports where they're coming at different times and it's hard to keep track. the outline seems great and i'm supportive of this and seems to really identify the major issues and graph and charts would be helpful. i thought in our last hearing, we talked about trying to move up the russell house, kind of move that forward and i don't see that reflected anywhere in the landmark programme. >> i'll make note of that, thank you.

>> commissioner? >> i think that's a terrific idea, yeah, thank you. [ laughter ] >> thanks, everyone. >> i have a couple of questions. shelly will now summarize progress made to our cultural heritage programme. >> i do have a couple of questions. one is, i understand that because of the length of this report, doing it every six months is probably why or choose doing it every six months is because of the length of the report. >> that's right. >> i'm curious if there might be items, one of these items or self-of thseveral items that mao come before us more frequently. like the city-wide survey and legacy business. i'm just curious. >> point well-taken. i think we're happy to present that information to you whenever you would like to see it and naturally, office, small businesses providing their reports more frequently than

every six months and we're happy to share that information with you and certainly we want you to keep a close watch on the survey efforts. i think this was more of a way for us to automate some of the data collection we're doing around your request. but yeah, i mean, if you want us to sort of memorialize coming to you on a more regular basis, we're happy to do that. i wanted to reiterate, we're happy to do that whenever you make that request to us. >> you want to respond on this? >> no, totally separate comment. >> so on the landmark report, these will be a part of the presentation, right? these nice little bars. and then -- >> we find them very effective. >> we would not want to lose those. it's really, really helpful. lastly and then maybe we can

come back, i was curious on the risk map. i would like more information on the risk map. if we can bring that back up and you can share more of what that is and where it came from. it's really compelling. >> i might ask shelly to speak to that a little bit more, if you don't mind. >> is that supposed to be on the screen now? >> yes, could we have the screen projected? >> thank you.

one of the things we're aware of is there's more displacement which has an impact on cultural aspects and landmarks and we thought that it may be interesting to start overlaying this map which shows level of risk with maps of where we're currently doing work or for instance, or maps of where we have -- where we're doing survey work, maps where there are security designations and we can see if there's an area we don't have any area designation and there is a high level of risk and maybe wanting to shift our attention to that area. so i meant to be a planning tool for us and it's yet to be seen exactly how much information we'll be able to derive from that, but we thought it might be an interesting combination of data. if you have other ideas for other types of data that would be interesting to overlay with

our work plan, we're very open to ideas. >> and are other communities using a similar tool? >> the displacement map was developed for the bay area the original maandthe original map e complicated and they worked to simplify that to make it easier to some of the data we were trying to highlight and we're using a simpler version of the data set. we can look into if others -- how other cities are using it,

though, specifically if they're using it with a focus on cultural assets. >> great. >> maybe if i could follow up with my very first question and if we could give you feedback now for things that i think might be important to bring back to us more often than every six months. definitely the city-wide survey. hopefully we'll be done in three years, but we'll see. the legacy business -- >> i'm sorry, do you have -- do you want it to come quarterly. >> yeah, i think quarterly is fine but the city-wide survey, the legacy business and we're doing the la landmark designatis and i would think if there is a question on priorities that we need to revisit, that maybe that should come back to us. >> focused. >> yes, and other than that, any others? i think that would be fine.

commissioner? >> i have two comments. one was about the risk map and i'm wondering whether there's another map related to risks in seismic or flooding hazard sea level right. it seems like it's useful for the designation piece, as well. >> that is a thought we were thinking because city-wide surveys put together wonderful maps, looking at various risks. i think putting together a sea-level rise and seismic activity could be done. >> so that's the comment on that and then the other comment i just had was looking over the number of landmark designations we've done recently. i thought i would congratulation staff and this commission because i think this might be the most projects that have come forward and have been approved in the ten years i've been on the commission, so it's impressive, the amount of work

that's done is impressive and it's fantastic. to. >> i second that. >> i will be brief. i just wanted to highlight a couple of items in the cultural heritage quarterly report will be combined in the future for the comprehensive work plan report. so we did process 19 legacy applications in the third quarter which is relatively high. i was not able to report on the legacy business programme statistics of this quarter. we're not quite aligned with the office of small businesses reporting yet, which is where i derrive most of the data. however, in the future, going to

a six-month structure scheduled for that reporting will align us with the reporting. they also moved from quarterly to biannual reporting in the last half year or so. so in the future, hopefully all our steps will be aligned. put i wantei wanted to give youk overview of what's happening in the cultural overview district programme. since this data is reported from the third quarter, it's a little bit out of date. there wasn't much activity in the third quarter and that's primarily because the programme was getting off its feet. the programme coordinator and mohcd came on board in january anand the primary focus was reay to get the city family team to be able to sit down with each of the cultural districts and just

take a pulse to see where everybody stands in terms of their needs and work for the future. and then, outside of the last third quarter but just outside of the last third quarter, in april, they were able to issue their first rsp in order to issue funds to the cultural districts. so i will be reporting on that when we come back in june or july. and i wanted to also note again that the lgbtq plus cultural heritage strategy is expected to be published in june and we will be presented informational hearing at the june 19t june 19th meeting. and other than that -- i also wanted to know that we, again, partnered with the university of san francisco to assist some of

the legacy business applicants in the preparation of their applications. this last round, rick crelo, took on that mentorship role and in the future, we may start trading back and forth on that duty. it is somewhat staff-time intensive, but it has been productive and we continue that as long as professors are happy to have us. then last, that brings us to the performance americans in terms of staff time, towards the legacy business registry applications, no big changes. we're still averages four to five hours a case. we did not spend time on the philippino's district strategy. as i noted earlier, we were taking a pause in the programme, but we will be ramping up this summer now that the grants have been issued. part of the rsp -- grant

proposal is meant go toward preparation of the chess reports for each of the cultural district and we expect staff time will be ramping up in the next couple of months and still consistently high for the next few years. we also have getting closer and closer to starting work on the survey methodology for documenting and evaluating intangible cultural resources and we expect that project to begin this summer and that conchilds my report. if you have any question, please let me know. >> talking about the cultural heritage district grants, could you give us a summary -- i know each of the six cultural

districts had to submit a specific area of focus and if we could get kind of a summary of that particular area focus where each the districts, because i want to make sure that all of them are encouraged to included to legacy business and landmark designations as part of the overall scope. >> the proposals that we have reviewed -- >> for the cultural district. >> -- for the cultural districts, yes. the proposals we reviewed in response to the rfp did not get so specific in how they would scope the chess report, which is where we would start to build an amylosis ananalysis and recommer the business legacy programme. so i might not be able to report specifically on that, but i can definitely provide more information about where funds will be going. >> that would be great. >> and how we intend to partner

and specifically on the chess development. >> i know people are coming in at different levels of the process and if they can kind of start to think about that from the beginning, i think that would help them. >> yes. >> thank you. >> if there's nothing further, item 11, case 2019-006507-crv, an administrative certificate of appropriateness to minor delegation. >> good afternoon, normally the delegation is seen by this commission or considered every other year, you approved an october of 2018, a revised delegation. however, the amendments that were made recently to the accessory dwelling unit programme that you had discussed and we had discussed about

creating objective criteria for landmark districts, that information to align ourselves with state law needs to be included in the delegation and so at that time, we saw an opportunity to make a few other refinements that i wanted just to quickly walk you through to see if you have any question and if you're supportive of this work, avoiding a noticed public hearing and just adhering to the department and your administrative review process. and all of the the changes were highlighted in your packet. starting on page 7, there's been confusion about when roof replacement is considered ordinary replacement and repair and it's generally -- our interpretation is when the roofing material is character fining, like copper and this clarifies then the ordinary

maintenance and repair that doesn't trigger or remove character-defining features, can be approved over the counter but this clarifies that scope. the second is on page 9, this is similar to your delegation to milzac approved work. you're doing the same thing for planning code amendments and flexibility for just 80 3.9 allowing for zoning uses such as an office conversion.

there's been a number of murals on your consent calendar and as the mayor's office in particular starts to look for other ways to revitalize the central market area which has a number of article 10 and 11 properties and generally, there's not a concern over murals on secondary areas providing their reversible and certain requirements are met according to most preservation practice, we thought this made sense tsenseto include this as s well. so that concludesmy short comments. if you have any comments, happy to ands them an answer them. if you're readopting this, instead of coming back to you in 2020, now we're coming back to you in the spring or early summer of 2021. thank you.

>> any member of the public wish to comment? anything further? >> i move to adopt or approve this delegation. >> second. >> thank you, commissioners. on that motion, then, to approve the delegation amendment? (roll call). so moved and the motion passes unanimously 6-0. >> best of luck, victim. >> we're adjourned.

>> hi, everybody. welcome to laguna honda. [cheering] >> and before we get started, my grandmother spent almost 14 years here at laguna honda, and so many of you took incredible care of miss camelia brown. i want to give a special shout out to denise and so many people here who day in and day out take care of some of our most vulnerable folks that rely on us to care for them every day. we are so grateful to be here with our governor, gavin newsom. [cheers and applause] >> he has already hit the ground

running, and we know from experience of being a former mayor of san francisco, he understands intimately all the challenges that we as a city face, which really is going to be so incredible for our city and cities across the state of california for all the things we know we need to do to change california for the better. laguna honda is a key part of san francisco's health network, which cares for one in eight san franciscans. primarily people who are uninsured, low income, or for -- from our immigrant communities. and includes not only laguna honda, but san francisco general , and smaller clinics across our city, and health services in our county jail. here at laguna honda, more than 1,000 patients each year receive care for complex conditions like

h.i.v. and alzheimer's and dementia, and other mental illnesses and disorders, and we have, for patients who are suffering from strokes or brain injuries, or spinal injuries, or other trauma. these treatments require long-term and specialized care, as so many of you here know, and they commonly include medications as part of the treatment plan. however, it is a well-known fact that these medications are expensive, and can drive up the cost of healthcare for millions of people who need these drugs to survive. the san francisco health network is constantly working to find ways to save money on drug costs for uninsured patients. we work with federal programs like the 340 b. program that provides drugs at a discounted rate for some of our facilities, but facilities like laguna honda , or our county jail, our behavioral health clinic, they

don't qualify for those federal discounts. not to mention the medications used in treatment plans at these facilities are some of the most expensive medications. the health network purchases more than 3,000 drugs for patients who don't qualify for 340 b. discounts, and just the 25 most expensive drugs, of those costs, it because our city more than $17 million each year. when we have people struggling on the streets of san francisco, with mental health challenges and substance use disorders, or people spending thousands of dollars on life-saving medication for h.i.v. and aids, or people fighting a battle with cancer, we need to be focused on helping them recover and heal, not whether or not they can afford to pay for the medication

this is the same case at many healthcare facilities, not only in san francisco, but across the entire state of california and the nation, and this is why i am so thrilled to be joining governor gavin newsom here today to announce a san francisco will be joining the efforts to bring down medication costs in our city. [applause] >> we will work hard to bring down the cost of those medications. we have worked hard over the years, but we know there is so much more that we can do, and by joining forces with other counties across the state, we know that we can make a difference in the lives of millions of patients. we are joined here today by two other bay area counties in making this commitment, alameda

and santa clara county, and please join me in acknowledging our new department of public health director, dr. grant koufax who is here with us today [applause] >> at this time, i would like to call to the podium colleen who has spent about 13 years working for the department of public health in san francisco. she is an incredible health care advocate, now heading up alameda county department of public health. [applause] >> good morning, everyone. it makes me so happy to see so many familiar faces here, and to be able to bring my new county in partnership with my old city and county in this really exciting endeavor. alameda county is pleased to stand with governor newsom to leverage the collective garb -- bargaining power as a state in its counties to lower the cost

of prescription drugs for all californians. i would like to thank the governor for his leadership on this important issue. alameda county's vision 2026 is in alignment with the health forward agenda. vision 2026 is our comprehensive effort to set a course for a decade that anticipates community challenges and maximizes our ability to meet residents's needs in this rapidly changing world. vision 2026 foresees a thriving and resilient population where individuals and communities are empowered to overcome adversity and be supported so they can grow, flourish and be self-sufficient. essential to achieving this vision is our ten goal of healthcare for all, which seeks to ensure that every person in alameda county has access to the care and services they need to live their healthiest lives. governor newsom's collaborative approach to obtaining

prescription drug costs will put us closer to a comprehensive solution for affordable and accessible healthcare for all. collectively, public healthcare providers and other safety net providers in alameda county, spends tens of millions of dollars each year on prescription drugs for our county's most vulnerable residents. while many of these drugs are acquired through the federal 343 b. program which may or breed referenced, drugs purchased for individuals accessing our behavioral health services or our inmates and our jails do not this means that we are surely paying more than we need to for these medications, diverting valuable resources from other safety net programs and services this presents an important opportunity for our county and others to partner with the governor's healthcare team to explore how we can make drugs more affordable in our safety net healthcare system. additionally, this approach will foster regional collaboration through the sharing of

information and protocols and best practices. alameda county is looking forward to partnering with the governor's office, and our county colleagues to explore the promise of this timely endeavor. at this point, i would like to welcome miguel marques, marquez, the chief operating officer for the county of santa clara. [applause] >> thank you, colleen, and thank you governor newsom for inviting slight -- santa clara county to participate in this event and in this work, and thank you mayor breed for hosting this event today. over the years, santa clara county has implement it programs to expand coverage and affordable options that move us closer to providing healthcare for all. indeed, our board of supervisors has officially supported a single payer healthcare system. and santa clara county, we are proud to operate three hospitals , and a dozen clinics located throughout the county. each of which provides high-quality, integrated healthcare to the 2 million

members of our community. like the governor, we know that innovation through the healthcare system, including a path to single payer systems will help us reach our shared vision of better health for all. that is why we are excited by the opportunity to work with the governor and with so many other partners throughout the state to take on the high cost of prescription drugs. year after year, pharmaceutical companies continue to increase the price of brand-name drugs. we all need to ask the question, do prescription drugs really have to be that expensive? wild drug purchasing practices are complex, we must look for and implement innovative solutions to reduce these costs. federal policies have not done enough to control drug prices. in the absence of federal leadership, local and state government need to partner and

need to think creatively about how to leverage our collective buying power to negotiate better prices for our residents. last year, santa clara county valley medical center spent more than $120 million on pharmaceuticals. giving the extrude nearly high cost of prescription drugs, we have been looking for opportunities for savings. we welcome the chance to work with the state and with other partners to explore options to reduce these costs. as you know, public helps it -- health systems play an especially important and unique role in delivering care, services, and treatment to the patient's in the communities we serve, especially the uninsured and the underinsured. we are a safety net healthcare system that is proud to offer top-notch care to all who need it, but to do that, we need to explore all opportunities to reduce costs whenever possible so that our limited resources can better be spent to help the

homeless, the mentally ill, and other vulnerable members of our community. a number of years ago, the county of santa clara was the first county in the nation to ensure that every child, regardless of immigration status , could get healthcare services. we are especially proud to support the governor's efforts to become the first state in the country to provide coverage to young, undocumented adults. thank you, governor for leading the way for these young adults. santa clara county and the state of california have aggressively implemented the affordable care act. it has been a huge success. just a couple of numbers. in santa clara county alone, more than 100,000 -- 140,000 residents gained coverage through this expansion. another 45,000 plus have subsidized coverage through coverage california, that is just in santa clara county.

and most important, the bottom line number, the uninsured rate in santa clara county has dropped by 50 3%. so the time is now to take the next step. we are fortunate to have a governor who is a champion for these important issues. we look forward to working with the governor to make better health for all, california's highest priority. thank you very much. [applause] >> thank you, miguel. i also would like to take this opportunity to introduce someone who has been a champion for laguna honda, our supervisor for district two, catherine stefani is joining us here today. thank you so much. [applause] >> and now i would like to introduce our governor, who we all know was a former mayor of san francisco, someone who led innovative programs, pushed to really change san francisco and

california for the better, same-sex marriage, he was the one who put forth the idea and opened the doors for so many people to get married at city hall, when so many people attacked them on this issue, and now it is gone global and has been recognized throughout the united states, 311 was just his brainchild, this innovative resource that we use to call to deal with a number of challenges in the city, so many incredible resources that we use today, and now, is a governor in his budget , he will continue to provide the support and the resources that we need to address many of the challenges that exist in san francisco. we also should know that he really led the charge on the rebuild on the hospital to the new facility that we see today. the governor of the state of california, gavin newsom. [applause]

>> thank you, thank you. this is fun coming back. the couple of you were showing me photos ten years ago, pregrey hair, and this is remarkable that this place opened. i remember standing here during the ribbon-cutting, and i think i used a line, which i am now reminded of, at the time we were doing something with a skilled nursing facility. also ten years ago, that was novel and no one was investing in this place. people so the county couldn't afford it and we had to move in a different direction. we get it when it comes to skilled nursing facilities and keeping people in place. we are on the leading and cutting edge and doing something no one else is willing to do. i remember saying that the mayor of athens said, he says, we do

not imitate, for we are a model to others. i say that then, nine plus years ago, i will say it again today in the context in the spirit that brings us here together around the issue of prescription drugs. we do not imitate because we are a model to others what we are advancing here today is new, what we are advancing here today matters what we're doing today is what i expect others to be doing tomorrow, not just other counties joining california's purchasing pole, but other states joining california's purchasing pool. leveraging our resources, big buyers mean lower costs. the fact is, in the state of california, 13 plus billion dollars a year, your tax dollars are currently being spent on prescription drugs.

i will repeat that, 13 plus billion dollars a year. the problem is, we were isolating the purchasing. we had jails doing their purchasing, we had the state hospitals doing their purchasing , we had our retirement system doing their purchasing, we had the va doing their purchasing, we had our medi-cal system, which is 13 million strong, we were only leveraging 2 million of those 13 million in our purchasing pool. just combining the medi-cal system alone, taking the 2 billion and leveraging the purchasing now with 13 billion is going to drive hundreds of millions of dollars of savings on an annual basis. we project in our budget that we just submitted a few weeks back, or a week or so ago, that we will save conservatively $393 million because of this purchasing effort.

that's just on an annual basis, $400 million of money that we otherwise would spend that would allow us to provide discounts, to provide additional subsidies to reduce those costs each to each and every one of you. if we are not curious about these drugs, we are not curious about addressing the cost as it relates to the issue of healthcare inflation. this is one of the principal drivers. we have seen close to doubling of our costs in the state, doubling of our cost in the state, just in the last nine years. this cannot continue. with all due respect to big pharma, i have no problem, no gripe with people being successful, i don't begrudge success, i appreciate competition, i appreciate research, i appreciate the kind of innovation that we pride ourselves on, but i don't like people taking advantage of other people. i don't like gouging, i don't

like windfalls, i don't like folks, you know, getting massive bonuses and, you know, at the expense of folks that are struggling on the streets and the sidewalks. this is a foundational principle , it is a value i know laguna honda community shares. it is a value that san franciscans share, it is of value the mayor shares, it is shared broadly throughout this state and substantial of lee, around this region in santa clara, in alameda, that value now is being brought to the forward in terms of counties joining the state purchasing pool. we had hoped this would happen in a year or two, maybe three, but here we are, just weeks after announcing l.a. county joining our purchasing pool, no three additional counties are joining the purchasing pool. this is remarkable. the momentum is real, and this is exciting because we are actually making progress in

realtime. this is not just platitudes, this is not just a tweet, this is not just a promotion, it is not just a promise, we are seeing things happen in realtime , so i just want to thank the enlightened leadership that you heard from today. they didn't need to do this, it was wise to do it, but they didn't need to do it, but the fact that they are doing it, and they are doing it on the front end, is an extraordinary testament to mayor breed's commitment not passing interest to bring down the cost of prescription drugs and the cost of healthcare in this county. colleen's commitment and miguel 's commitment to do the same is a big deal, so i don't want to undersell this moment. i want to appropriately sell it. i want to overhyped -- i don't want to overhyped it, but this is significant. we have governors calling this state wanting to join our efforts. we believe this is the beginning

of a different frame of momentum not top-down, god bless watching congress, pretzels trying to deal with big pharma, this is bottom up. it is a new frame. i will tell you, a california, we just reached at $3 trillion year mar. we punch above our rate, and there are only four nations on planet earth that carry more wait then the state of california. we are truly a nationstate, the fifth largest economy in the world, the united states is one of those economies ahead of us, only a few others that have the capacity to do what we are doing as a state. now the second largest purchaser outside the v.a. and the united states itself in the country. this is important. i want to express and acknowledge the hard work of our team in sacramento that is working overtime to get this right, to make sure we do it right. i want to thank the counties for

building that momentum, and i want you all to know that we are inviting the private sector to join our purchasing pools. we want to see companies large and small also join in and take advantage of our ability to leverage and to sit at that table as one purchaser, not just aggregated as thousands of purchasers. we are formed -- where pharma has the power, now we are taking back that power and we are leveraging that power over the table. hugh merrow costs 96% more in the united states than it does in the u.k. some medications are 100% more then the folks in the u.k. give me a break. with all due respect, it is not just about well, we do the research on the development, we have to pay for that, the people who do the most research and the development are people like you. through our grants, through our tax dollars. they leverage those, they supplement those, and we are

proud of that research. but give me a break. they do it because they can. they do it because no one is pushing back. they do it because they leverage influence of the people like me. they come in with a lot of money and they come into leverage their point of view and they usually scare folks instead of doing the right thing, but they can't scare the leaders assembled behind me, and the cannot change the trajectory of a state that says, we have had enough. we are better than this. we will do more and we are going to leverage our voice in a way that respects the people of this state that we represent, so thank you all for coming out. thank you for being part of this announcement and all this extraordinary momentum and know this, in closing, this is just one of many things the state of california is doing to expand healthcare in this state. our budget, briefly, is going to

expand coverage regardless of your immigration status. our budget will double substantially and increase by doubling our annual contribution and our medi-cal system through proposition 56. forgive me for boring you on that, but we will increase our reimbursement rates, more trauma screenings, more early screenings to address issues before they manifest, we are going to deepen subsidies for low income families on the health exchange, and expand subsidies into the middle class. the only state in america that is expanding subsidies for families earning up to $150,000 a year. we are very proud of these efforts. our goal is universal. our goal is to get this done through a single parent financing system, but until we advance those ideals, we will build pragmatic steps, make progress each and every week until we ultimately get to those goals. thank you, san francisco, thank

you to mother nature for adding a little energy, thank you mayor breed for hosting us here today. [applause]. >> thank you. >> i don't know if there are questions, how do you want to do this? i will let the electives go, and supervisor, very wonderful you are here as well. any questions, we will do it out here. we will let you all go. thank you, guys, very much. >> good evening.

please turn off your cell phones. the signals tend to interfere with the recording equipment in the room. if we can stand for the pledge

of allegiance. [ pledge of allegiance ] >> good evening, commissioner hirsch. i would like to take roll. >> thank you. [ roll ] >> also present is department director eric balances sar and the chief of police. you do have a quorum. >> thank you. good evening, everybody. welcome to the meeting of may 15th, 2019. we have a moderate agenda tonight. so public comment will be limited to three minutes per person. we're ready for the first