care. >> supervisor cohen: okay. >> okay, good afternoon supervisors, my name is cindy comerford and i manage the policy and planning at the department of public health and today i'm going to give a very brief presentation on issues that impact health care reform. these are not all specifically around the a.c.a. but somehow impact our ability to provide health care in san francisco. so i'm going to talk about six issues that are on the slide in front of you. i'm going to give a very brief update on each one and some of the funding mechanisms, they're very complex so i'm happy to answer any questions at the end. so the first item michelle already talked about at length which is tax reform and tax reform could potentially impact the health care landscape very significantly. as michelle said, one of the biggest issues is the repeal of the individual mandate. this is a component of the a.c.a. that requires most individuals to have health insurance or face a tax penalty. this is in the senate bill. there are also a couple other items within tax reform specifically, the elimination of the

and also cindy comerford is here to discuss the updates on the affordable care act in particular as yourecall that federal funding, a vast majority of the funding that the city receives is for health programs, particulary medicare and medicaid to san francisco residents so it's a large piece of the federal picture. by far the largest dollar value component of the proposals that are in front of the congress at this point, in terms of their effect both individuals and state and local governments, is the state and local tax reductions and also just to mention very briefly that you're aware that the house and the senate have separately passed versions of tax reform legislation and currently are reconciling those two versions to bring a final piece of legislation to the president to sign by the time congress leaves for holiday break which is christmas, so they're in a very short timeline. and so some of this information in here -- this is very dynamic and probably amendments are being proposed and reviewed and discussed, even as we're speaking here. but by far the largest impact item to both