next speaker. >> [inaudible], national union of health care workers, we strongly support the health care ordinance and strongly encourages everyone to leave alone the employer mandate to pay for health care, but that aside, i just want to issue some concerns that i had about -- that it was the business community talking about this universal health care committee and i want to strongly encourage, if that train has left the station, in her statement saying people should be paid -- naoubl as this committee is going forward, i just want to make sure if it does go forward, i want to make sure there are users involved as well as community organizations and labor involved with na because i don't want the [inaudible] in charge of the hen house at all. thank you. >> thank you very much. is there any other member of the public who would like to speak who has not spoken whether you signed up or not, if so, come forward. seeing none, public comment is closed. and i just want to take this opportunity to thank all of the members of the public who have taken time out of their busy schedules to be here

care abing. we know that healthy san francisco has served as a model for health care reform nationally, as this transition happens, we know hou,backer thousands of workers will receive limited or no action under obama care, now that health care is a mandate, it's important that employers contribute to helping their workers in paying health insurance. when healthy san francisco is drafted, the employer spending requirement in san francisco's health care security ordinance was always meant to help workers access what would otherwise be unaffordable health care and nothing about obama care changes this reality. we can't allow healthy -- health care security ordinance to be undermined by a few businesses that are trying to avoid their responsibilities, to workers, the patrons and the workers of san francisco, our office looks forward to working alongside of all of those to benefit from the ordinance and that it serves our community, thank you. >> thank you very much, next speaker. >> supervisors, tha

on their health care reform. it was encouraging to hear from legal council that there's a way in which the current health care ordinance will be able to support our low-income families to be able to afford health care reform. lastly, i will say you already heard that we got some funds for our enrollment and we want to express to educate our community around all the options, people have to remain in health care and we will do our part to ensure that those 35 thousand uninsured individuals have a place where they can call their medical home, so thank you. >> thank you very much, ms. story. next speaker, please. >> good afternoon, supervisors, my name is shanell williams and i'm a student trustee at city college of san francisco representing 90 thousand students, so also some history, in 2004, i served on the youth commission, at that time we wrote legislation to expand the healthy kids program to help to pave the way on what we have now in healthy san francisco, so the affordable health care act, we cannot allow it

health care system, the bottom line really is that it is superb in both access and quality of care. >> what about cost? >> cost is an issue. it is well-documented, and i concur with the documentation. the u.s. is the most expensing system for health care in the world, that is per-capita or any other metric. in this israeli the major problem with the system that should be at where their forms are direct. green down costs. >> dr. alice, some of the reforms have been directed toward bringing down costs. and then not work to your view? >> well, if you are talking about the basic affordability care act or what is now called obamacare b yum, actually when you look at the numbers the projections under obamacare are actually not that costs will come down. it will put forth as one of the reasons why reform is so essential. yet when you look get even the government alone estimates and all the other agencies come in and of them really predict, projected decrease in health care expenditures compared to a pre obamacare. so this is really one of the ironies of this whole discussion about health car

the health care policy. >> the health care law rules out. and our guests are mary agnes carey, a longtime reporter who has covered the health care law, health care reform, she watched as it became law on capitol hill. she worked for congressional quarterly fire and also has worked at pyrogens newswires. casein is a senior correspondent for kaiser health news, a longtime reporter for the baltimore sun and he worked for a newspaper in virginia. we are joined by sarah varney. she comes to us from california visiting washington for this very special show we're doing today. she worked for a long time kqed public broadcasting in san francisco and a lot of health care coverage as part of the california report and has also filed for the monthly magazine help dialogue. we are taking your calls. is that health care. it is insurance. >> certainly. the primary goal of the affordable care act. >> a whole bunch of other things . >> so we're talking about the mechanics of security and by far the largest filing for bankruptcy in recent years and recent deca

to make health care and health insurance truly accessible to as many san franciscans as possible.ou know, the thing about the health care security ordinance, it was really an example of how san franciscans can come together, you had labor, community activist and is the business community coming forward and passing an ordinance that set an example for how you can have universal health care for the rest of the country. in september of this year, i plan to hold a hearing on how to enroll for health insurance in california's exchange which is called the covered california. right now, i know that san franciscans are getting ready for enrolling in the aca which the enrollment begins on october 1 of this year for coverage that would then begin january 1, 2014. later on this year, and we're thinking around october, we plan to have a hearing that will focus on women's health and how women's health will be impacted by the implementation of the affordable care act. in the coming months, i look forward to a lot of lively discussion about the exciting moment in history in the history of this c

what impact on access of pry care care do you believe the policy will have? and what other steps can we take to improve access to these important services for our most vulnerable? >>? >> well, higher payment is certainly a positive, although it's temporary nature, i think is going to limit the behavioral response on the part of physicians. it's unlikely they are going to fundamentally change where they practice or how they practice for an incentive that will last a short period. i think it's important to think of it as a step, an imperfect step in broader efforts to reorient system spending toward primary care, and in of i.t. is not going achieve. >> it's two years, probably, because we have reduce the cost of the bill. we have to reduce the cost of the bill because we could not score the me venges, the savings prevention, which is something we still need to do. thank you, mr. chairman. >> the chair thank the gent the lady. and recognizes the gentlelady from north carolina. >> thank you, mr. chairman, thank you to the panelists today. i want to talk about the

guest: first of all the affordable care act is not government-run health care. i know people talk about the canadian system. this is not the canadian system. this is not the great britain system or even most of the places in the world. this is a system where the free market insurance companies will join these exchanges and they will have rules they have to go by, federal rules nationwide, to sell insurance policies. in the 1970's, lynndale is similar to what it was back then, it's an area not a wealthy area, a lot of hardworking folks who work hard for what they have, again in the district like i represent in houston harris county, they shouldn't have to work hard and still have to not have some type of insurance product. and this will give them their opportunity. they'll have to pay for some of it. if they are low-income they'll be able to get subsidies. they will have some type of insurance product in our contry. host: this is otis from livermoore, california. democrats' line, good morning. caller: good morning. good morning, representative. i wanted to call a

the health care system needs us to do this. a prime example is what we will be doing with our outcome. it is very dissolving of the silos around patient care. >> is a something they may not have done before? i know the ama recently classified obesity as a disease. you are recognizing it as a disease. does that make the insurance company more open to covering more treatments for obesity? >> i would think so. the ama has said this is something we want to deal with. we want to escalate this to a significant level. we're going to look at the things we must change to make things better around hypertension are whatever we choose to study. i do believe they will be a part of this. they want to see what is best for the patient as well. they want to help us eliminate so much suffering and reduce the cost. >> a couple of minutes left. >> some people have disagreed with the decision to classify obesity with a disease. what is the debate that led to the decision? was there some disagreement about going forward with this? >> this is a discu

very difficult to tell this point, but the elements of care of cost for care.here's a lot of unconfident care in this country right now so people uninsured or have difficulty in paying create a lot of costs on the system. in addition, in the past pricing is typically based on quantity of care, not quality of care. lots of defensive medicine practice. it is very much going to be like universal insurance. it will take care of the uncompensated care. but doesn't address the cost equation. gerri: does not address the cost equation at all. your health care rulebook i blue of the great resources. tell us about your offerings, is it countrywide, what can i see online? >> it is countrywide for every zip code. we started this, i started this just to help patients find affordable health care because there is a large cost variation. finding a fair price provider you can afford care much more easily. you can go to the website for free and to consumer health care bluebook.com and download it on your phone. ask your employer or health care theto have a customized versiond on

the health killer -- care law is still in a good position. goinge saying we're not to participate after some congressional inquiries. it is a tight rope they are walking. i am guessing they do not want to be seen here. they want to be the trusting family position. >> how clout -- hard is that tightrope? have been very concerned about other groups like the nfl getting involved in education. how will they be able to thread the needle? >> i imagine it will vary from practice to this. you will see some doctors who are very enthusiastic and some who aren't. i would be interested to see what they can do to talk to their entire membership you're all working in different areas. >> i wonder for example would they go as far to have the computer set up in their waiting room? here is where you drop down to see the exchange, whether they are operating here are on their own. would they have people on site? some will say we cannot afford this. people reallys trust their doctors. we have both seen numerous reports that people can have data and do not do this

that this is a, the affordable care act, bhaum caobama care, i comprehensive packe. you can't have an individual mandate without the employer mandate, without the, you know, all this stuff is supposed to work together because how are we going to know if someone is, in fact, eligible for an individual mandate subsidy if you don't have an employer mandate in place, for example? and there's no clause, to my knowledge, in this very large bill, comprehensive bill, dealing with 12% of our nation's economy and growing at a rapid rate. there's no clause that allows you to separate out particular pieces. so i think that in the interest of comity, in the interest of transparency, and in the interest of better law making, this would have been better handled here in a public forum, which is why i think it's important we as a congress, we as a body sanction the delay of the employer mandate. >> you actually made me anticipate, actually, my next question, which, again, i put to both of you. because i have to tell you, if i accepted that this was constitutional and wise, i would st

under obama care it's 30 hours a week.be 40 or business owners will be forced to cut hours and split workers between different franchises. >> i have seen them start to prepare for job sharing and job share something bad. managing around a 30-hour workweek is ridiculous. >> we will end up cutting back hours, increasing prices. $5.49 now for a full stack of pancakes and probably look at $7. >> reporter: only 3% of america's small businesses are affected by this part of obama care. the other 97% have fewer than 50 workers, but with 150 employees, george says the costs for him are steep. >> i don't believe i would be able to get away with less than $200,000 in health care costs. >> reporter: what would that mean for your profits? >> there wouldn't be profits. >> reporter: he said the health care law delayed or not has put his expansion plans on hold and layoffs are possible. >> who do you tell to go home, who do you tell not to be here. what do i tell my employees when i have to lock the front door when i can't afford to buy t

the health care security ordinance would secure that more workers would get health care and health care is the human right and everyone should have the right to access health care regardless of their income. thank you. >> thank you. i'm going to call a few more names. (calling speaker names). next speaker. >> hi, supervisors, my name is judy and i'm a resident of the easier neighborhood and i'm part of the chinese progressive association, i parent panted in klektsing surveys and presenting our recommendations to the health care services master plan task force. as was said earlier, a lot of companies are cutting their employees' hours because they don't want to pay for health care, that's not fair and i don't want that to happen in san francisco, our local law limits employers to do this because they have to put aside for their workers' health care based on each hour the employer has worked and my family can't afford private insurance, this is a lot of the case of other health care workers in san francisco who work in restaurants or retail, they need health care security ordinance so eve

child care really doesn't pencil out and it takes a lot of strategies to make child care work on the capital side and the operating side. this is really one strategy in our toolbox to make sure that we have affordable care options for families in their neighborhoods and we still have a number of unmet needs in the city rehated to child care and we plan to incorporate this along with the other strategies to make sure that we're meeting families' needs. >> it's really important to know that in particular, with development in the pipelines and discussion of the development, that we have the right expertise to look at this. i'm thinking in terms of whether or not the stadium will be built in san francisco. whether or not that can house a child care center. we're looking at issues at pier 70 that's going to be a humongous development and also the property -- some other development that's going to be happening along the shorelines. it's going to create some opportunities for us and we need some experts to lock at those issues. even [inaudible] development when this takes off we'll be devel

anthe convenience to care.se facilities work. we offer an option to the public that a forears has been at the hospital room level. we've decided to fix what's been a longstanding problem. gerri: here's what i don't understand. so hospitals have emergency rooms, why do we need emergency rooms with no hospitals? what market niche are you filling? >> we're filling the niche that -- first of all, our freestanding emergency rooms are no different than a hospital-based emergency room. other than we're not physically attached to a hospital. we see all of the same patients that come to an emergency room whether it be a nonemergent, an urgent or an emergent patie seeking treatment. the problem that we're fing is hospital-based emergency rooms have long standing been on 2, 4, of, 8, 10-hour waits. with the freestanding emergency room, we are taking the wait out of emergency care and giving the patient direct access to the physician in a more timely and effective manner. gerri: so you're not going walk into the emergency

first is about dph's own health care delivery system. we are looking to ready our system to be the provider of choice for our patients, our uninsured parents have not had a wide choice of health care providers but health insurance provides them with that choice, we want them to choose us. a recent survey indicated that 60% of low-income individuals who are uninsured would change their provider if they were given the choice to do so so we are responding to that challenge and integrating the service we offer throughout our delivery system so we do a better job to coordinate the care our patients need, we're working to improve quality and capacity to increase access to care, we're enhancing our patient's experience by shortening waiting times and increasing our efficiency in customer service and these are exactly the items that barbara is at the health department working on today. our second role is more citywide in nature and related to our mission to protect and promote the health of all san franciscans, we're maximizing enrollment into t

my husband acts as care through the health care security order who was involved in a serious bike accident, would not have been covered throughout the aca, it included serious rehabilitation, because he had care through health care security ordinance, we were able to keep our family afloat and stay here in san francisco, we would not have been able to do that without that fund and in our continual quest to keep young families here, we need to consider that as part of the problem, so here we are yet again fighting for an equitable and just economy that respects the contributions of the people that make this city work, and i really appreciate your hearing on this issue and your leadership on this issue, we need to keep this fiekt going and the san francisco labor council will be there every step of the way. thank you very much. >> next speak e please. >> good afternoon, my name is maureen dugan, i work in a medical surgical department, i'm speaking here today because i want the mayor and board of supervisors to understand that keeping healthy san francisco in tact is critical to the san fran

this is about health care, the quality of health care and about preserving jobs in this country. i rise in support of the fairness for american families act, that would suspend enforcement of the individual mandate. this bill would provide hardworking individuals and families with the same relief that the obama administration recently gave to american employers. as i traveled throughout our district i consistently hear about the law's devastating effect it has our families, work force. whether it's the community college in danville that's cutting employee hours because it simply cannot afford to comply with the law or the family in charlottesville that's dealing with skyrocketing insurance premy yums -- premiums, we are dealing with this law. the american people are left with nothing but broken promises. at a time when too many people across this country are out of work, it only makes sense that we reduce the burden by suspending this mandate while continuing our efforts to repeal this flawed law and replace it with market-oriented policies. i yield back. the speaker pro tempore:

let's take care of you, you'll get sick, tremendous health care costs, we'll all take care of you, but what is it going to cost? >> we have everybody in this. >> major social legislation, bipartisan support where there's no child left behind. medicare part d. president obama came into office with the kind of rhetoric that he was a uniter, but he ran partisan legislation through congress. >> health care was rammed down our throat? >> right. >> stay right there, we're going to turn to utah senator mike lee, he's threatening to -- not really shut down the federal government. but unless president obama is defunded -- you say we're going to defund obama care? >> the american people are overwhelmingly in support of it. congress never read the law before it was passed. the supreme court amended it, not once but twice, and now president obama has done the same thing. amending it twice without any constitutional authority to do that. he exempted out his big corporate cronies. meanwhile, he told hardworking individual americans, they have to comply with the laws exacting commands or else they'll

specifically in response to the question about child care and the school site, for child care in missionwe've been proactive, recognizing it is an important issue for the community. the first affordable housing project, the [speaker not understood] which is a family affordable housing project, first one we did in mission bay. it includes a head start child care program on-site. affordable housing is under construction currently, 150 units again of affordable housing for families. it's going to be targeting the older age group, so, teens would be on-site teen activity room. there is also two units which are being set aside for in-house child care. ucsf also has a child care center on-site and then also we've been working actively -- one of the big issues with child care and making sure we have adequate outside space. and, so, we've been -- as the new larger projects come in, for example, block 40 has a map actually, if we can do the overhead. block 40, here's block 40 is down south. you have the ballpark to the north, first street, 16th street. so, block 40 is one of the newest -- it's th

care security ordinance as it is. thank you. >> thank you, next speaker, please. >> good afternoon, my name is rosa, i'm here on behalf of health access california, our mission is for everyone here in california to have access of quality affordable ho*elt care, i would like the supervisor's commitment in providing health care services for everyone who lives and works here in san francisco. the affordable care act, i wanted to say a few things related to the affordable health care act, the affordable health care act is a historic opportunity to expand meaningful health coverage, some key achievements include 640 thousand californians to got mep throughout the health program, there's been 4 thousand young adults who are between the age of 18 to 26 who have been able to stay under their parents coverage because of the affordable care act and there's 21 thousand californians who were denied health coverage because they have a preexisting condition who are able to get health insurance through california's aca funded preexi

duties tomorrow or take care of my mother. there are real challenges around that and so we have placed provisions to require some level of predictbility. >> i think that what he is pointed out is that what we have proposed may not be the perfect fix but i am open and i would like to think of ideas and how to address that. >> we don't want this ordinance to supercede what has been bargained for as those two parties. but the intent again was to honor the agreements reached between labor and management as part of collective bargaining agreements and the last point that i want to make is the suggestion that there is an unusual degree of ajudicatory power in olc. when it comes to the paid sick leave and the leaving wage and the healthcare has similar powers and so what we did here is we simply adopted a similar approach and if there are creative ideas in that area, we are happy to consider that. i want to make it clear that these so-called potential negative economic impacts, one, don't necessarily suggest that there is going to be

of reproductive care that women seek. when they're desperate for help, and we're already seeing the results of restricted access. right? there was another study, 7% of women have such restrictive access, they're trying to get abortions, they're trying to self-aboard first. >> i want to hammer this home. this is a really jaw-dropping statistic. a study out saying 7% of women in the state of texas already before the bill passed were trying first to self-abort before seeking medical attention. and we could only imagine that if the number of clinics in that state go down, then you are going to see more of them. >> absolutely. i mean, i think, you know, we're going to see women die. we're going to see more kermit gosnells cropping up all over. i think people really understand and they're starting to understand that when we outlawed alcohol, it just meant violent gangs, controlled liquor. when we try to teach abstinence, sex ed, kids just get pregnant. every single study shows when you outlaw abortion, you don't stop women from

premiums in the health care marketplace required by obama care are turning out to be nearly 20% lower than projected for 2014. >> stephen: maybe so. but you're not going to live any longer because let's face it, most americans are going to blow those savings on cronuts. and the death sentence, and obama-care is being implemented despite the best efforts of house republicans who have voted to symbolically repeal it 39 times. i don't know why it's not working. maybe they need to load more emptiness into their gestures. i don't know now the key to implementing obama-care is the so-called individual mandate because to keep premium costs down officials say they must register 2.7 million healthy people between the ages of 18 and 35 in order to counteract the costs of ensuring seniors and people with health problems. don't fall for it, young people. you don't need insurance. you're going to be young and healthy forever. i mean, just look at me. i'm 19 look at this awesome skateboard move. that is called popping a yolo. now fortunately, the godfather of the tea party movement freedomworks rec

care.- let us take a listen to senator leahy on fox news sunday. [video clip] >> americans, by a margin of two to one, believe this will make their situation worse, not better. it,nesses do not like individuals hated, union beater say it will be bad for workers. even state laws and the principal author in the senate described as a train wreck. the law certainly is not ready to be implemented and we should not fund it. news senator lee on fox sunday. independent caller, hello. caller: i am under obamacare. i have a very good heart doctor. it took me two years to find him. two years to find this dr.. he apologized. he called me into his office and sorry, but i am going to close my office ergo -- my office." he could not practice medicine under obamacare. that is the effect obamacare has had on me. i no longer have my cardiac special test. was talking about the joys under obamacare, i do not know where he is. it is not working for me. i think we should pay attention to what is going to happen

burdens associated with the care. my testimony is a report from the field where i observe a medicaid program that is dynamic, continually evolving to meet the changing needs needs of vulnerable populationses, leading how care is structured, and delivered and participating in transformations of care delivery that are occurring around the country. for example, medicaid led the we to identify children who benefit from early enter intervention services. the number has grown from under 20 to more than 30% inch north carolina it's 75%. nationwide children with public health insurance are actually more likely to receive critical developmental screening than children with private health insurance. in 2000 the surgeon general called poor oral health america's silent epidemic. medicaid programs are active will you pursuing efforts to ameliorate this situation. washington state and maryland among others have innovative programs designed to increase access to dental care for vulnerable children. medicaid is the nation's primary p

>>> the group charged with enforcing obama care objects to being forced into obama care. this is "special report." good evening, i'm bret baier. we are repeatedly told by the administration that the affordable care act is now the law of the land, and it is, but groups that traditionally support the president and his policies are now lining up to try to get out of obama care. tonight another bump in what has been a rocky road for implementation of the law. and this one involves the irs, responsible for enforcing that law. chief white house correspondent ed henry has our lead story tonight. >> reporter: to hear president obama's top advisers tell it, everything is going just fine, thank you very much, with signing new people up for his controversial health care law. >> for millions of americans they will have access to affordable care that they don't have at their place of work or that they haven't been able to afford in the past. >> reporter: what secretary kathleen sebelius didn't mention, some of his allies in organized labor don't seem to share excitement, with national

care. >> gary b., do you need a survey to tell you that hiring will go down with obama care? what tracy was basically talking about is a tax, isn't it? >> exactly. tracy makes a great point. the logic of which that obama care tax, if you will, will not affect hiring is baffling to me. look, when the government wants you to drink less alcohol, what do they do? they put a tax on it. when they want you to drive the highways slower, what do they do, put a tax on it via speeding tickets. when they want you to use less gasoline, what dthey put a tax that works, and that's fine. so now they are putting a taxes on businesses and saying, oh, wait a second, it's not going to affect behavior, it's baffling to me the logic there. it has to affect behavior. in that sim survey 70% of those small businesses via the chamber of commerce says it was going to negatively impact their hiring. i think it's going to be 100%. >> okay. jonas, i'll get to you in a minute but i want to let stefan respond. >> gary b.,

>> it's a global health care services company.s to market, make sure they're safe and effective. this is a natural extension. our communities and where we operate and showing that we care and we're passionate about getting medicine to the people that need it. >> you and i have been passionate about health care, about why america would not have this as a priority. and being here on the ground. talking to people saying i have no other way to do this. hardworking people every day, it's heart wrenching. lady with her baby saying i could not have afforded it if you guys hadn't come here today. >> i think i cried a million times. people give you a part of their heart when they tell you these stories. >> absolutely. >> it shouldn't be like this. health care should be a right, not a privilege. we shouldn't be coming to a convention center to get health care, no matter who you are, what you believe, this is not how health care should be delivered in this country. >> we were talking to some of the people and then i would come back with the

, a type of care and reliability of care. health care we fail to take advantage of the fundamental changes in care, technology, communication, and information to make health care better, cheaper, and ubiquitous, which was the real opportunity of the last five decades. >> thanks. i am not going to argue anything. the notion dispute that the smartphone or a game the months that you carry on your hip is more complex than medical care. save that for another time. i also will argue that if you look at the various players and compare them, there are all kinds of easy comparisons. it cost the typical private health care insurance company $28 to practice it -- to process a claim. -- by every comparison medicare is more efficient. the place i would like to start is how i got into this in the first place. contrary to your flattering introduction, i am hardly the four most analysts of health- care policy. my experience extends to this article. it with nod preconception, certainly no, preconceptions of the kind that i came out with. conf