health service system. funding with blue shield. we completely retoo old the plans new networks. the shop is now in california. we have really looked over the last 4 years of every aspect of the administration of benefits with the health service system. i think towards our goal of stainable affordable benefits, we have to look for every aspect of financial waste. in 2011 we did a lot to get our co-pays in line. with 3.1 percent in 2011, this race is unprecedented and not only help us pay for our employee benefits and our retiree benefits but also mitigated our long-term liability which is a significant concern do this city. with 50 percent of our members in kaiser, we know we could not obtain our goal of sustainable and affordable benefits without dealing with the financial waste in kaiser. we do have a plan and we are going to talk about that because it is an issue with 50 percent of our members in there. we have to draes that and we plan to. i wanted to spend just one more slide on good news. greg, did you have a question? so slide 8 again is reviewing the compressive cost conta

so, presentation so far has focused on how the plan identifies the current and projected need for health care services in san francisco. the next part of the presentation will focus on the remaining portion of the plan, which is a set of recommendations on how to achieve and maintain the appropriate distribution of and access to such services. the recommendations came from the work of the task force and community input as well as the data that was collected as part of generating this plan. these recommendations include the policy and more tangible recommendations. the more tangible recommendations that could be [affectedeffected]} through development projects will be implemented once the plan is adopted through what is being called a consistency determination which i will discuss in a moment. again, the plan's recommendations have been developed to help guide land use decisions, inform the siting and scope of health care facilities and services, and guide our city's policy makers. these recommendations acknowledge that health and wellness involve much more than just the siting of brick a

they also appreciated infusion of the health lens in all policies as a very important outcome of this plan. in particular, when developing -- when evaluating development projects that we consider the impacts of health and the impacts on the population. there was a small comment in making sure that the role of [speaker not understood] play in the health care safety net. they are mentioned in the plan, but somebody wanted to make sure that we say a little bit more about how they are important, especially those that provide language access and cultural competent services. and like you heard from collene earlier, there are many services, there are many more -- we have a better ratio of bed per population. there is a good amount of services and, so -- but availability does not equal access. and we heard from the community that transportation and language access were kind of the key issues for them, especially for those folks -- folks who live in the southeast part of the city, the transportation was key. and then lastly, we also heard that ensuring that the roads of the planning department and

plan. and this health care services master plan and dph being the experts on health, soey [speaker not understood] on maternity leave and couldn't be here with us today as well as collene having been the primary city staff leading the preparation of the plan with the support of our director barbara garcia. also like to acknowledge members of the task force or of the public who may be here today who participated in the community engagement pro shes. [speaker not understood] truly informed the plan on where the key gaps and needs are. so, before i turn it over to collene, i just want to give you an overview of what you'll be hearing today, if i may have the slides. so, again, like i said, collene will give you an overview of the plan. and then we're going to talk to you about the key findings by assessment, the legislation required certain number of assessments and that was in your memos. and then [speaker not understood] will talk about the recommendations and the determination process and it will be kind of less [speaker not understood] for the planning commission and how planning department staf

and i would add that our boil so not only to do the work ourselves we can engage the health plans in addition to bring support to us in the wellness activity like kaiser and blue shield. we're ideally positions to do that. our focus to date with our one person has been focused on weight management and diabetes education and resiliency training. so certainly behavior health and our employee assistance programs work. some statistics to be aware have to report to the department of labor on a workplace wellness they have 2 hundred armor employees report some kind of wellness programming so this is very widespread and it's something that needs to happen. and just have a healthier workplace. this is a sum of two slides there's no new information on here. it gives the overall information. and finally to move away from the budget and it up on the competency issue. we're not required because the city employees are expected to have an english competencecy we're not required to have a foreign language program we have people who speak russian and cantonese and other foreign language skills we do

the unions say, wait a second, he can't keep our health plans. this case, they have it right. >> jonas, do youink so,. >> trying to pay these health care bills, why companies are being run into a lot of trouble because -- so these plans are cadillac plans. they had to get caught. i was looking at the white paper by the union about what their griefs are, and they don't like that lower employees are going to have to basically go into crumbier health care. we need a race to the botm from the high end of health care. this is one of the good effects. i'm ooanti-union and pro-obama. >> unions used to support obama care. now many of them don't, steve. what does that tell you about the health care law? >> it doesn't tell me anything about the health care law because there's one good thing about the health care law, and that is that it provides everybody with access to affordable health insurance. but no supporters of it -- >> we're never going back to something else. but let me say this, it does say our health care system is totally wacky and the health

. >> item number 1 is a hearing on how the department of public health is planning to implement the affordable care act with implications there are for healthy san francisco and the health care security ordinance and how the affordable care act's implementation will affect various communities in san francisco including undocumented san franciscans. >> the main objective here today is to hear from all the members of the pun lick and the community and the business community included who are here. let me say that i'm very grateful that because of the amazing work of president obama and our incredible and amazing leader congresswoman nancy pa loes si, in march of 2010, president obama signed the comprehensive health reform that we probably have heard a lot in the last couple of years. it is the patient protection and affordable care act which many people referred to as the aca or obama care which is something that we have affectionately appropriated because the term was use ined a derogatory way, we think it's a positive way, this law does many things but perhaps most importantly, it makes prevent

administrative code health service system plans and contradiction rates calendar year 2014. >> item 27. establishing monthly contradiction contribution amount health service trust fund. >> these are the approval of the health systems 2014, health and dental plans. we have a number of speakers here, acting director of the health service system and greg who is out of retirement or still in retirement, but with this thank goodness with the city and also specifically want to thank kathleen for putting this together. with that i'm sure there will be good discussion. why don't you start off with your presentation and we can take it from there. >> good afternoon, supervise, lisa, acting director, i'm joined by our cfo and joined by the vice-president for actuarial services for an hoout. we have asked jerry rap port to speak on this so he will follow my presentation. i would like to start first with what we believe is the most important story of 2014 raise some benefits process and that's precedent 4th year. this has never happened. it's unprecedented for the city of san francisco and somethin

.: cleshg cleshg health service system plans and contribution rates calendar year 2014. health service trust fund. >> madam clerk please call item 71. >> urging chaosing to immediately begin negotiating a fair and pricing model that provides fee and transparency to report back to the board of supervisors on progress of the negotiations. >> supervisor ferrel? >> thank you president chiu. colleagues we are here to discuss the contribution health plan for city employees and retirees. i know this has garnered some controversy in the past few weeks and something i have been involved in for a number of months now and thanks for raising issues and pushing the dialogue forward. i hope we are at a place to fight for greater transparency from the city's health care providers that we are doing collectively as a board and i will continue to lead a fight on and also to move this item forward so we don't jeopardize the vital services for 10s of thousands for our employees. i think it's important to note that specifically health care plan blue shield has been voted on a full package. th

the health service board was covering a commercial health plan for expansion and profit to put some facts on the table to support this demand. as a purchasing agent, the health services board had every reason to say no to the proposals that were not complete, not persuasive and disrespectful of the health evaluations board for cost and services that we buy and receive. those have not changed. only health plan would prefor multilocal government that would refuse to support it. as a taxpayer and retiree, i ask you don't let them get away with it. rejection is still the right thing to do. bring kaiser back to a serious table to renegotiate realistic rates. thank you. >> thank you supervisors. chris bailey. aclu. kaiser is the outlier. they were asked to justify their rate increase, despite declining utilization rates. kaiser's response, "we consider the detail response and analysis to be proprietary." in other words we are not giving you a justification for these rates. i railed against multimillion dollar packages. in this case, our neighbor up in salas salas -- lito, the lack of informatio

the health plan has been impressive and they've done a lot with the city plan and generating some significant savings to the city and really keeping the cost of the members thank you minimum. the second observation is that really it's how significant the staffing constraints have been. that every year the workload increases and as we're making changes in the blue shield contracts the increases in workload have been dramatic and the department manages to get the work done. the material you'll be looking at on the slides really we'll see there's a significant staffing increase in the budget with respect to that i do want to express the mayor's office and the controllers office have been supportive to help us going get to the - greg let's move to the next slide. oh, you have it over here? i don't think i have control here >> okay. we're going to be talking about over the next few minutes to talk about the mission statements. i want to split the budget into the administrators budget and then i want to take a separate look at the e pa program and finally we do have a response on the competency iss

bronze, silver, gold and platinum, the difference is their percentage of annual cost that is the health plan covers, bronze covers 60% of cost, silver, 70, gold, 80 and platinum, 90, there's a catastrophic plan that also will be available. there are sliding scale subsidies available to low-income individuals on covered california up to 400 % of poverty which is about 46 thousand dollars a year for a single adult. half of the individuals expected to get health insurance through covered california [inaudible] currently five health plans are approved for offering in san francisco under undercover california, they are anthem blue cross, blue shield, the chinese community health plan, health net and kaiser. technically, there is no mandate on employers to provide health insurance under the affordable care act, instead there are incentives and penalties for employers to offer coverage. they can offer for affordable coverage on the exchange, and for more full time employers, there is a financial penalty structure if employers offer no coverage or unaffordable coverage, no coverage is defineesed as

for the draft report of the health care master plan. so, our survey show that one in five residents rely on healthy san francisco for health care. one of the recommendation ins the health care services master plan is about preserving healthy san francisco, we're here today to talk about why healthy san francisco and the health care security ordinance is still really important even with obama care, so locally under the health care security ordinance, the minimum workers is 20 but if the ordinance was replaced by the affordable care act, the minimum would be raised to 50. this is important because lez people would be covered or get health care and businesses and instead businesses should also share the profits by helping the workers get health care. 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). n

the report expresses concern including no process to monitor health plans and no way to enroll applicantsday is a perfect example. i got healthcare for my back but the prescription i couldn't afford them and they didn't have a co-payment for them. >> california's program is expected to offer more qualified health plans and the goal is to begin operating by october. >>> tonight more reason for residents to protect themselves from mosquitos. this after more tested positive for west nile. a crow was found dead and a group of mosquitos was trapped. >>> warmer out there today. numbers that got into the low 90s. antioch, 94 degrees today. that is the hot spot. these numbers inland are coming up. antioch and fairfield, mid-90s tomorrow and your bay area weekend. fog is along the coast. it is going to stay there. not going to have a lot of push inland. tonight it will have some push. for the weekend, next three days it will live along the coastal sections. there will be some breaks in the afternoon. but a lot of fog. high pressure builds in from the southwest. parks the fog at the coast. heats us

plan premium. >> we did also want to mention on page 10, that there is a rates and benefit packet. a flat premium incentive subsidy. this was at the meeting on the health service board. the board approved a rate card for the blue shield and city plan and this card will provide a subsidy from the trust fund to bring the 2014 only contribution to be the same contribution of the kaiser contribution for our members. this rate would apply to any member whose union agree to the contribution strategy. this was to ensure that a member didn't have to jump out of a plan 1 year and be able to jump back into a plan next year because the out of pocket to blue shield going up $60 for the employees only, feeling they had to move to kaiser and the next year it would be corrected. this would allow the continuity of care that is important to our members. >> moving on to slide 6. this is a review for the kaiser negotiation project. we just wanted to share with you that there is a substantial effort made to engage kaiser into negotiations over the last 6 months. we had six meetings between health and service executives since january, numerous phone call conferences. two h

>> if you like your health care plan, you'll be able to keep your health care plan, period. >> what just happened that might just change that. the ones getting involved and staying engaged. they're not afraid to question the path they're on. because the one question they never want to ask is "how did i end up here?" i started schwab for those people. people who want to take ownership of their investments, like they do in every other aspect of their lives. >>> hi, everybody. at this hour, growing concerns over new violence breaking out in egypt. 30 are dead in the last 24 hours. hundreds more injured and new reports now that a christian priest has been shot dead. a live look now for you at cairo. demonstrators furious over the military's overthrow of president morsi. the army removing him wednesday following protests by millions in the square. morsi now in detention along with some senior members of his muslim brotherhood movement. >>> and an entire town in canada evacuated after a freight train carrying crude oil derailed. and you can see it caught fire. the flames spilling the sky with

health mandate. the obama administration, rolling back part of their enforcement plan for the federal health care law. what was supposed to happen in 2014? what has been changed? guest: we still have the situation for most individuals will be required to purchase whorance, but employers, were also supposed to have a requirement beginning then as well, they will no longer be required to have that mandate on january 1. lawyers were supposed to, on january 1, here again we are talking about employers over 50. for was not a requirement smaller employers, it was a requirement for larger employers, offering their employees some kind of coverage with a minimum set of benefits or pay a penalty. somewhere between 2000 and $3,000 per worker after the first 30 years. talking about $2,000 to $3,000 per worker. you mention that people generally still need to have insurance in 2014, that has not changed? guest: correct. host: but the element has changed. why did the obama administration will this back? guest: there were a couple of blog posts that came out from the administration last week, explaining why they had

and marketplaces and requires the provision of the essential health benefits for the qualified health plans that pertains to private health insurance. the other piece reforms to the health insurance system and that is focusing its target on the health plans that have to comply with the same rules that health plans follow on the employer sponsored insurance. as a private health insurance is a chief focus of the reforms in the affordable care at. >> if i can pick up a couple of questions on the cards that follow in the same general area. one for john and probably one for linda. one questioner asked coming into this part is for john, what's taken the administration so long to write the rules for mental illness and substance abuse. the act, and what has been the consequences of that long delay? i know some of the california newspapers have an account of a hearing and the legislature yesterday in which the insurance commissioner was lamenting his lack of tools for trying to enforce the parity restrictions or requirements with some of the private insurance firms. and then for linda, john mentione

because those have separate overhead costs that could be eliminated. >> we could come up with the health plan we could tell the members this is the house planned he will get your matching funds from the post office for maybe i think there is an opportunity to negotiate that now having said that i think the real savings for the postal service is to not pay the full freight. >> we're working on that but if you do that and then it puts the additional cost that to the courage to employ a but now let's get to universal type plan to give the membership what they wanted we could come up with a lower cost to save the post office money to prevent the cost from going up. >> data when to take more time today but i want to invite your representatives to work with our staff because we control that question for the entire federal work force is currently working on the reform with the postmaster leaving the system intended to achieve those areas the postmaster put forward but if it is a willingness to give us the additional opportunities specifically at of changes how we deal with coastal to the benefit of

health !insurance premium, a 2012 survey of planned parenthood clients showed that 60% of our patients had no health insurance because they couldn't afford any monthly premium whatsoever, 28% more couldn't afford more than 50 hours a month, accessabilities, we heard it here, three of four million californians will fall through the crack, our undocumented and immigrant families will not be eligible and have been shut out of the family, these folks are important people to our community and it is important that we ensure they have health care access to them at all times. again, planned parenthood supports healthy san francisco and we're doing a tremendous amount of outreach getting people enrolled in expanded medi cal and covered california. >> thank you very much. next speaker. >> hi, my name is brenda, i'm a seiu 1021 member and i work at san francisco general and i've been there over 30 years, so i remember the days when we were going around when the union rep was dragging me to synagogues everywhere else talking to the public to making sure healthy san francisco happened, i see every day the

and health committee and last week at the presentation for the draft report of the health care master plan. so, our survey show that one in five residents rely on healthy san francisco for health care. one of the recommendation ins the health care services master plan is about preserving healthy san francisco, we're here today to talk about why healthy san francisco and the health care security ordinance is still really important even with obama care, so locally under the

plan one. we are in the business of delivering health care. the only plan that we can guarantee to our members is the city plan. the cost for that because it's an indemnity plan, it's not just the premiums that would blow our members out of the water especially our family members and the retirees, but it's the percentage of cost of care that they would have to meet and continue to pay throughout the year. it would be devastating for our members. that is the only plan we can legally continue. kaiser has been our partner for over 66 years. we have worked closely with them and we will continue to work with them. they remain despite this increase, they still remain the lowest cost plan and i think it's important to know. dental, vision, mental health are all part of this package. we are not just bifurcating one group he

plan. there was no health care plan. there was just an insurance plan. at 30 million people to abroken system and this is what you get. the feds are going to have to d those. what you're going do see with all of this is that just like when they got to the banking industry and they put all this regulation on it, $2 trillion of credit lines went out of a 5 trillion credit market. you're going to see etna, you're going to see united, surprise, surprise. a politician overpromised and underdelivered. >> gary b., you got 30 seconds. >> we, look what happens when the government gets involved in industry. they eventually crowd out all the private insurers and people. it happened with flood insurance, it happened with nornlgs. so you're going to see the government come in there and they're going to want to attract people to those nash exchanges, crowding out the private insurance and eventually enabling us to have horrle health care. >> i'm sorry. our commercial is coming. thanks, guys. >>> fireworks and fighting in egypt starting a firestorm over here. time to s

inaudible] we know first hand the importance of the healthy san francisco plays and health being in our community, while planned parenthood supports the affordable health act and its access that health insurance provides, two key problems continue to exist, health insurance will not be affordable to many people and many people will not be eligible for any sort of health coverage under the nca, affordability, more low-income people will be eligible for expanded medi cal, health insurance covered will still not be affordable for many, especially in a high cost city like san francisco, people will not be able