between a health reimbursement account, a health savings account, etc. what i learned during the study is that typically sell for reimbursement accounts have been used -- health reimbursement accounts are high-deductible health plans offered in tandem with spending accounts for the most part used as incentives to recruit employees or keep employees, given that health care premiums are very high. they try to incentivize employees to pay for a high deductible plan but put money in their account. in a lot of cases, this money is rolled over. although hra's have been offered with high deductible plans, they can be offered alone. that means that at this point there are accounts like that for catastrophic illness. the stray away from the consumer-directed model there were designed for. they are designed to be controlled by the employer. they can decide what they want to cover. they can decide whether the plans will roll over to the next year or whether they want to take it back. one of the interesting things is trying to understand hra's. i've reached out to a

the department of public health was supposed to particularly protect the public's health near the to the limit. nearby residents began complaining of high levels of dust and resulting health problems. there are numerous hearings due to the residents' concerns, yet the department of public health always diminished complaints and reassured the residents that their concerns were overblown. as a resident, i was concerned about the monitoring process and the apparent dismissal of the request for tests for toxins, particularly the most vulnerable young children. the presence of airborne asbestos is particularly prevalent. eventually, the plan was approved by the san francisco board of supervisors. now we have evidence that the very agency, the department of public health, that is supposed to be protecting, was collaborating with the the developer, lennar. this was -- all responsible parties must be held accountable immediately. the city must recognize its role in affecting the public health and safety. the many small children in bayview-hunters point are having held a protest. we must be a

the regulation and environmental health assessment, the health department is not the final decision maker about land use regulation and it is not the only factor taken into account. the planning department both making land use decisions as well as making an environmental review. and we are advisory to the planning department in that capacity. would you have certain laws and regulations san francisco has some very unique regulations that are not found in other cities. i will discuss three of them in this presentation. so analysis for contaminated sites. and air quality assessment. the department and a consulting and advisory role supports environmental review. we review the environmental impact reports when asked for by members of the community or the planning department or when it is a major project that we feel we need to proactively review. we will provide those comments and additional analysis to the planning department for their consideration. we will discuss them and work with the planning department on strategies if there are identified health effects. we have developed several inno

that we are talking about health, major health conditions that they may be mental health, they may be emotional health. and as a matter of fact... language is important, emotional health transcends to all of what we are talking about today under behavioral health. because if you are emotionally healthy you have a strong character, you have confidence in yourself, your family is emotionally healthy. we're looking at lowering risk for behavioral health problems across the board. and of course our audience needs to realize that under the parity law small businesses of more than 50 people that are already covering certain conditions need to also cover mental health conditions as well, correct? correct, and some of your listeners may not realize that that has not been done before. and that is one of the reasons why parents struggle and why they may not talk to their young people at a younger age simply because they can't afford it. so what would you do as a parent? you have something you can't really talk to anybody about, you don't quite understand it yourself, and your doctor is saying t

of health. meaning, and in a much simpler way, bringing substance abuse and mental health issues to the world of physical health. dr. greene, final thoughts? i would like to just say that promoting the community think tanks such as dc rock and other such initiatives that are there to help and provide additional services, they address needs... are a way for us to combine the health care professionals to outside community organizations so we aren't out there alone. there are other people who are working on these initiatives, and we need to combine our efforts. jane, final thoughts? one final thought: i think it's really helpful when communities have people like jordan and wendy, our doctor, involved in these kinds of efforts. it's so essential to have young people become good community problem solvers and its really, really important to have our professionals in the community working on these problems, not only from a programmatic aspect but from a systems change and policy aspect because we all k

in mental health, mental health services are delivered by many different realms. we have medical homes that deliver services, we have community centers that deliver services. you don't see traditional structures like in the substance abuse world for treatment. dr. greene, what is the magnitude of mental, emotional, and behavioral health problems in our society? if you look at the national averages of mental health disorders, they may vary by regions, but there... if you look at some of the underlying day-to-day anxieties, you can imagine that it can go upwards of 70 percent if you include a number of the less diagnosed or less appreciated disease processes. in our trauma population, we often see upwards of 60 to 70 percent of our patients may have some sort of mental health. we feel that the patient who actually has a traumatic event and has some sort of substance abuse associated with it, be it alcohol or some drugs, because they usually have a polysubstance abuse patient. we often find that they aren't just drugging because they want to, but they are usually dru

i want to applaud the health department of the city. we have an outstanding health department. amy brownell was outstanding. in the face of public insult, public attacks, she still did her job. on one occasion, they went out to do some research on nosebleeds. it was intimidating. they had to stop their research because of the attacks and all of that. one of the things i'm concerned about, supervisors, is last summer, the shipyard's project was approved. the board of supervisors, six other city boards, and the two community advisory groups with jurisdiction over the site, and the citizen committee, the same old, and become a dead rhetoric is what we have been hearing all this time. [tone] supervisor campos: if there is any other member of the public would like to speak, please come forward. good afternoon. >> mr. campos, supervisors, real briefly, the health department may have employee issues. i don't know. i am not in the health department. but certainly, we should absolutely not allow that to be a backdoor way of undoing what the citizens of this city overwhelmingly supported

c'mon, this is very good for your health. this is garlic, for your health.. 1, 2, 3, 4, 5, 6. one more. oh, money. this is for wealth. those people who are wealthy, they have a lot of this. yes. there are many more but i forgot to bring them. i came in a hurry. this is kind of crushed now. this is the greenery. we love this. i don't know for what. there is a big one, you can go and eat it. [laughter] ok, that is an asset. and, we put the book, usually hafiz or other books. i will read a few verses. but, i have to put my glasses because i am very old. [speaking foreign language] morning breeze, and the old world will once again sale [speaking foreign language] to libs will bring a red cup to the meadows -=- tulips will bring a red cup haifz -- hafiz will tell the tale [laughter] we will celebrate the rest of new year's in that room. this new year is for friendship and to put your sorrows away and to walk in love in the garden of your heart, that not the rows of love. let's celebrate new year for justice, peace, and everyone in the world'. [applause] please fo

most folks do not have health care and greater -- health care. we are asking that the money be made available by these workers and not pocketed by employers. >> good evening. we had a large group of people ready to speak, but our wanted to share that we know that times are tough. small businesses are struggling. workers are struggling. you are looking at the interest of small and businesses, and i want to let you know how workers are affected. you want to support the high road. you recognize that taking care of your workforce is a central part of taking care of your business. 90% of the businesses in santa cisco are complying with this law, and they are not talking about a -- of stanford cisco are complying with this law. we know that -- of sanford cisco sent -- san francisco are complying with this law. the fact is san francisco has led the wayne establishing protections for workers. we are a city that has taken great leadership in pioneering. we have pioneered environmental awareness and health the idea that employers should help protect not --

health-care costs continue per person on health care benefits. for that you could hire a computer programmer in india. controlling health-care costs is key to keeping jobs here in san francisco. we have to control those costs can be sure that the doctors are on the same page with us. >> the last question that i have pertains to one of the items pulled out by the budget analyst. the plan analysis of the city planned, currently we have blue shield, kaiser, and an option for city plant. can you speak about the expectation for when that process will begin? >> completely funding the professional service line, the analysis needs to be done tomorrow. only 8% of the membership are enrolled in the plan. the primary payer is medicare. early retirees and active employees. what you have is a group of employees staying in a plan where they can go to any doctor that they want within the health-care network but it is still a much broader network. there is no management of their care. what are our options in terms of that? i am hoping that there are many. probab

the health related provision of the development agreement follows the framework the health commission recommended. the key policy issues that the health commission want to look at where the charity care patients, the long-term viability of st. luke's, and the community benefits to afford services to low-income san francisco residents. as i mentioned, through the work with health commission, cpmc has agreed to some of the provisions included in the development agreement. i want to share this with you. these include the creation of 62 new skilled nursing beds for medi-cal patients. subacute care, concurrent construction at the two campuses, implementation of the blue ribbon panel recommendation, and the center of excellence and senior and community health. charity care. charity care is the provision of health care to low-income individuals, without the expectation of reimbursement. cpmc has made improvements to the provision of charity care the past few years and we like to see that trend continue. according to the resolution passed by the commission, it should provide charity care at a

supervisor campos alluded to this. 90% of all the health care data -- health care dollars are allocated to group health insurance plans. 3% son was allocated to the city option, the health the san francisco program, and at 7% was allocated to reimbursement plans. we can answer follow up questions. andres powers -- president o'brien: sorry to interrupt you. 90% were spent on insurance programs? >> 90% were spent on health insurance plans, exactly. >> that table is on page 7 of the draft report in your packet. >> exactly. table six gives you the full dollar amount. table 7 is the percentage allocations. 90% health insurance. 3% to help the san francisco. 7% to reimbursement plans. >> just to clarify -- of the money that -- the business is that this was targeted toward, to sign up and become participants in the program, so to speak -- only 3% are paying in to help the san francisco? -- healthy san francisco? >> the piece of the law we are talking about, putting aside the creation of the program, which was a landmark step in its own right -- we are speaking specifically to this employer spe

health facility entrance would be located at the far north id of the building for qualified health care patients to make it clear there's no access from the cafe to the m.c.d. and vice versa. the entire property would be designated as a nonsmoking building to not disturb other neighbors. other issued were safety concerns. we will be hiring a company to provide us unarmed presence at the door, along with a vehicle controlling the premise and surrounding block on a bee ottic basis. enforcing rules and monstering access of the property. we will be installing security alarm system and high tech dith day and night security cameras. we will also provide added lighting on the building for people to feel safe walking it around the area at night. i plan to undergo construction to completely renovate the entire building, upgrading the facade to be more visually appealing, create an active store front for the neighborhood to enjoy and revitalizing this stretch of mission street by creating more job and safe environment for people to utilize the cafe and m.c.d. and most important, provide the best

health care conditions. the clock is running out we can and we will do this much better and we have to. thank you. [applause] >> tom does not disappoint. our final co-author and speaker is bob moffit who is the current fellow in health policy with the heritage foundation, the center for policy innovation. he was director of heritage health policies center for many years. before that he served in the reagan administration both in the department of health and human services and also at the office of personnel management what he would have a good close look at a program that we all have thought actually a model to give people actually consumer choice. in purchasing their health insurance. bob moffit, i welcome you, one of our again valued co-authors. the fact that we are also speaking to each other shares that we start out very much in the same place and have worked for equality. >> thank you very much, grace-marie. i, too, would like to thank my colleagues for this wonderful collaboration and the wonderful sta

johnson is here representing the board of health. if you can go over the guidelines and conduct the swearing-in process. >> the board requests you turn off all funds, beepers, and pages of that will not disturb the proceedings. please carry on conversations in the hallway. the rules of presentations are as follows. each have seven minutes to present their cases and three minutes for a bottle. people affiliated with these parties must include their comments within the seven - oare-minute period. to assist the board in the accurate preparation of minutes, members of the public who wish to speak are asked but not required to submit a speaker card or business card to board staff when you come up to the lectern. speaker cards and pans are available on the left side of the podium. the board welcomes your comments and suggestions. there are customer satisfaction survey forms on the left side of the podium as well. if you have questions or requesting a rehearing or rules or hearing schedules, please speak to board staff after the break or af

we can see the mental health issues. the number of people on the streets these days, mental health issues that escalated on our streets are very visible right now. so to tell us you cut your psych beds because they're not profitable, we know they're not profitable. but we still have the priority for the city we have to figure out how to deal with. so we have to seriously look at mental health. i'm personally very passionate about this. my first job in department of health and mental hygiene. i worked at a mental institution and i saw the transformtive ability when you work at a facility that provides care for people. i was not in the high secure facility but more of a campus site facility were people were able to move freely about the campus and there was a canteen and reward system and people lived semiindependently within a campus and saw the way people were able to rebuild their lives and rejoin society. and it's a shame generally in california we don't have those things. that's been long gone. but the fact we don't h

the south of market health center in addition to many other health centers throughout california. region 9, which includes arizona and nevada, hawaii, specific jurisdictions, and throughout the united states. i had the opportunity -- actually, i work just a few blocks away at the modern federal building towards market street. i must confess that my first visit to the south of market health center was in december when the administrator was in san francisco, and we had the opportunity to visit the old space or the current space, and the new space as it was being billed out. i must say, we were all just so impressed. i had a little bit of envy. reconsidering where i should seek my primary care. such a beautiful, impressive space. and though the recovery act has been helpful in making these expansions possible, and the affordable care act as well, throughout the united states, is contributing to expansion of the health center program, such that by 2015, the program which serve nearly 20 million people in 2010 will serve as many as 40 million persons by 2015. i am just so excited and p

we are spending a lot of money using our criminal justice system to manage public health issues, a mental-health issues, and substance used. [applause] i did not realize that was going to be the applause line. ok. and we need to ensure we have sufficient resources in our public health system so people do not have to go through the criminal justice system in order to access mental health services and criminal justice, and more importantly, they do not end up with a criminal record which serves as such a barrier to housing employment and many other things down the road because of what is a health problem. that is a plea to enter the we are using our resources wisely. we are not using them to arrest and incarcerate people with health problems and to insure that we have sufficient resources in the public health system to take care of their concerns. thank you. [applause] >> alright. [reading names] big evening. in the tenden

there are flexible spending accounts, health savings accounts, health reimbursement accounts, and medical savings accounts. that provides a veneer of confusion here. but the percentage of these dollars are toward health and savings accounts. supervisor campos's legislation would not have an impact on that subset that goes to health and savings accounts. by law in definition, they have precisely the features that the legislation is imposing upon or requiring with respect to the health reimbursement accounts. in some respects, that is a way to look at defining the expenditures in a way of changing these accounts that are already in place. flexible spending is another variation. in our enforcement experience, there are no employers who use those to meet the requirement of the ordinance. many of us have these accounts to our employers. while the irs permits an employer to contribute to them, 99% are employee contributions only. there are essentially a health care reimbursements and accounts. supervisor campos: i wanted to add something, through the chair. one of the points i think is really i

i also want to talk about health reimbursement accounts and health savings accounts. it is a very confusing part of the law. the same language has been used interchangeably, and they are not interchangeable terms. when you have a high deductible insurance plan, you compare that with the health savings account. an hsa can only be used with a high deductible insurance plans. there are then separate flexible spending accounts that provide for various -- i had one at my last employer that i used for health care reimbursement. this was a flexible spending account. family costs -- my child's day care, i can get reimbursed, but i have to use it every year. ssa's are required to be use it or lose it. there is then an hra, which in many ways mirrors the hsa, but is a more flexible approach that does not have to be prepared with a high deductible plan. i just want to clarify that because the distinction got lost when people were talking about how to use hra's. an hra is more flexible than an hsa. an employee can take advantage of this money and it is not reflected as income. if

the person's health insurance as a mechanism as paying for health care. >> is all about financing. >> it is the purchase of health insurance in order to pay for health care that the government says you are considering right now or certainly will in the future. does that frame the government? >> i would add one more thing. every person cannot guarantee that they will not need help for -- health care of some point in the future. just like maxwell, there is the potential that any of us, even if we think we will not into the market, we will into the market. >> is it fair to say this is an economic mandate? you brought up economic activity and this is an economic mandate. >> i am not sure what those words mean. i will prefer to use the words that congress used. in the minimum coverage provision, and the reason -- it may be similar to your economic mandate. it is thoroughly about financing. it is about regulating whether someone will pay cash or credit. and in that sense, it is not unusual at all. >> all that is true, but i like to go back where chief judge dubina began. is there any case o

funding for health care providers and non-profit health organizations. the important question is what does this mean for our city? according to blue shield, these funds will appear in the form of a 30% credit in one month's premium. we understand this will likely occur in october of this year. these funds will be credited back to the health services system employee trust fund which includes the city, the school district, city college, and the superior court. because the health services series -- because the health services system trust fund includes these entities and not just the city and county, the approximate $7 million credit, approximately $5 million of that will come to the county of san francisco. please note these numbers are just estimates, approximately is a prop -- approximately values supplied by blue shield. we do not know the exact value of the credit until the health services system gets further information from blue shield. the answer to the question of can this be allocated to the retirement health-care trust fund -- in short, i cannot

especially dealing with people in the health field. dealing with people in housing. dealing with those that cannot reach out and do the things they need to do and need that additional help. so there is a representative from her office, and i am so proud that she is here. so i would like to bring her up to the podium. would you please come up, nicole rivera? [applause] >> thank you, charles. i know it is hot, so i'm going to make this break. the leader would have loved to be here. she is currently traveling, but she did send a letter greeting she asked for me to read to all of you today. "dear friends, congratulations on the ribbon cutting and grand opening of the new west park plaza, which includes the new south of market hulbert -- the new west block plaza, which includes the new south of market health center. i had the pleasure of touring this beautiful new facility and meeting so many of you. san francisco is fortunate to have a new state-of-the-art medical facility that is fully equipped to respond to the increasing an urgent health care needs of the south of mar

either they want a public health system or they want a destroy the public health system where people get half care, unsatisfied workers because they're not being paid properly, and all these other things. all these services that people have been talking about, we at primary care, we need these people to do our job. so you can't cut them and then expect to have the same system. it's not going to work. [applause] >> excuse me, before the next speaker, i need to ask folks to please respect the rules of the board chamber, no applause, no expressions of opposition. i don't want to have to recess this temporarily until folks understand that, ok. i please ask you to respect that. next speaker. >> thank you. thank you, brenda. my name is gary kuch, a psych tech at san francisco general. and i'm here today to voice my opinion about the sheriff's department possibly losing the security detail on the hospital. i've worked with those guys shoulder to shoulder for about 10 years now. and they have a real tough job to do. they're asked to do a thankless job, controlling people that are temporarily

low-wage workers need health care. everyone needs health care. when it is too late, people died. they are invisible, and that is why we need health care. we want to close this health care lupo, because we want to even the playing field. -- this health care loophole, because we want to even the playing field. thank you. >> two months in a row we have been here after 8:00. thank you. a couple of words were used by the speaker's earlier. good thank you for your own legislation. gooone word you used was unintended consequences. there are some unintended consequences. small businesses as far as we know we're not even contacted to discuss this prior to the legislation. we do have some meetings scheduled going forward. i would like to paraphrase a little section 14.3 of this legislation, which indicates this carries over not only to the employees but to anyone else related for future health-care expenses. i am paraphrasing. i do not get the. i think it is difficult. we need to do some long-term planning of how the legislation has been done. if you currently have 21 employees, what if ti

long-range effects are in health care delivery and equitable health care delivery for the city as a whole including all of us sitting in this room. i with an to commend the staff for an extremely good job today. for the first time i'm sitting here and all the questions to which i wanted like statistics, illustrations, comparisons, the way it is, the way it could be and what's in between, these questions are clearly and actually quite clearly answered. some of the things, until you see them explained as today, you don't fully understand because words can be interpreted a number of ways. the facts are here. and that is what we ultimately need to look at page by page relative to what we're asking for and what we're willing to give. and at this moment based on whatever today, and i was going to take a broad version of hostile comment, i think we haven't even asked for enough, because some of these statistics and some of what's explained in here seems to be somewhat unresolveable to me. . there are big, big questions for me. i had a discussion earlier and was talking about mr. rich and p