at the population. if the folks choosing brown and toll an are 10 percent healthier, then the employee cost. if the premium is 10 percent less, then the employee cost is less. if it's 10 percent the other way, it goes the other way. if we only look at the premium price and say one is more and less expensive without understanding the expected cost of that population, you are only looking at, you come to one set of answers and if you look at the divided risk score you come up with a different set of answers versus what was the value and what is more or less expensive. >> i think we understand the concept of risk judgement. are there other methodologies that you are using? >> we do with medicare. they use what they call hcc category by diagnosis. the exchange is uses a retro spective looking back. we do a light underwriting. we are not as sophisticated within our group but we have a team that looks at the cost, expected cost of the population and we do price premium for that. >> to be specific, do you have

population is it's now even further than that you heard if the self-employed police department with the drop in the jail population we're not seeing the increases in crimes or public safety where one says that's the untint consequent o those not incarcerated the purifying and our department and community and city hall can appreciate that we are seeing also significant improvements in anti recidivism and lowering the repeat offender rates that's the population staying out of jail. there's something that role went very undetected in san francisco and that's kind of a of a should've thing to do i shut down the entire jail county jail number 3 the sixth floor in its existence that had been shut down. in the parlance of what it means to proceed over our incarceration system building a jail is a big discussion and a you shutting down a jail shouldn't go unnoticed. that leeltd for us the ability to have flexibility in our staffing to redistribute some of our staff one of the main richlz in the condition in that jail was to bad it was the paralleled of the discussion but because of overcame

there's a lot of new data on sugary drinks we're also learning that it affects different populations differently and the doctor has presented data on asian population for example, they might have the same body index as the caucasian but they're likely to get diabetes as a lower mp i that's new information so this impacts every population and it might impact them different but the lower asian body weights are impacted more. diabetes is a very expensive disease to treat. hospitalized costs are very, very expensive on average. they cost you know the costs about 29 percent more to care for a diabetes patient. so that's a bottom line not to mention the fact that diabetes is a very chronic condition to manage. there's a significant human impact but there's significant costs associated. our budget and elective analysis did a report and the costs attributable for sugary drinks at a low end of $48 million and at a high-end $60 million plus. they look at those city and county of san francisco with a low estimate of $10 million arranging to a high he estimate of $28 million per year. those are

as such, we have to focus more on population, targeting population health.here's several types of things specific in different ethnic populations and of course medical needs vary depending on age groups. we watch these things in the communities and notice that there's an increased inmigrated population, newly immigrated population. we're watching the latino population and focusing more on how to make services more cultural relevant. we know with economic changes there's a need to be more flexible with the types we provide services and days of week. so tri-city is up for the challenge. the aca has brought a challenge to the safety net of our country and we're no different in tri-city, we're trying to find the right care to the right people at the right times and often times it's not a 9 to 5 approach. >> what kind of ailments are folks coming in with mostly immigrant population, basic primary care? what are you looking at? >> often times we think that folks who have conditions that would cause you to go to the doctor would be something critical and major. if

it was just that over 5% of population cared about it. more recently the explosion in tax breaks since the end of world war ii has been more by way of credits and deductions so there's a thousand dollar per child tax credit which came in the last couple of decades. there's the earned income tax credit which is tremendously important. it was introduced in 1975. to oversimplify most of the things that you think of as the deductions that you might take when you returned have been around pretty much forever. the credits for the most part have. >> host: when you talk about two cheers for the return-based mass income tax what is returned based? >> guest: well there are a lot of countries that have income tax systems that don't require people or at least don't require a lot of people to file a return. they work on the basis of what is called exact withholding. if you think about it payroll tax works that way. you pay a payroll tax but don't file a return because the employer takes out the exact amount you own -- zero. the income tax is too compl

called beach county the jewish population has exploded in recent years. in addition to a sizeable all the population the number of younger families has also expanded and an owl calling places like boynton beach and boca raton of. the population of palm beach county just north of miami stands at about one hundred million people. the u s census bureau says the population rose to eighty four percent between two thousand and ten in two thousand thirteen. despite having a significant jewish population as recently as the nineteen seventies in some parts of this area now over fifty percent of households are jewish traditionally this part of the us has been a haven for retirees of march a jewish communities. much of the recent growth can be attributed to younger jewish families. mac lab and is president and ceo of the jewish federation of south palm beach county starting to see especially in our own community here in south beach county the indigenous community candidates living here working here raising their families. of building a life here really beginning to

general population gets. showed,ers you just they are a drop in the bucket compared to what you need when you look at what the prevalence is right now. we're going to continue fighting very hard. just for more research funding, but for a very coordinated strategy to identify what we want to fund, what needs to be done, and to make sure there's enough accountability for it. right now we are just not making enough progress and we are not making it fast enough. are: back to the research, we any closer to finding out causes? guest: pedro, evidence points to a combination of genetic factors and environmental triggers. that is really what we know. read, whether it is effects of air pollution or toxins or certain gene mutations that indicate that perhaps paternal age. again, nothing conclusive, but we know a little more. what we're really know is there are treatments available that can help someone who is diagnosed with autism. we are very focused on making sure that they are available to those who need them right a

the population health has to stand the population of your employees. that is a different set. the first set is high intensity in their actions. that's the infrastructure required to truly individually help each patient with that level of a need. on the population side we use the same robust analytics to identify the sick population to understand what preventative measures haven't they gotten that they should get trying to get early detection. that's the long-term strategy of trying to keep health care cost while you are still managing. it's making it an interesting concept. i appreciate the question. >> thank you very much, doctor. >> paul brown. i'm area vice-president for premier accounts at blue shield. i want to answer commissioner fraser about other customers. we have other customers that do risk adjust. it's increasingly more common to recognize the risk that richard fish talked about. in particular those that have a self funded plan that they feel like is being selected. that is their risk. they will set that contribution on their level. i would be happy to identify the

all the jewish population. i won't. isn't that nice to see her in pursuing a ph growth. it's not the easement that day. we should be taught that the state. being bald is one of the jewish people. place dough into two isn't that difficult for a shadow cabinet to use the uk. gah living dead. i doubt if many jewish federation in illinois called an open center though the united states. it cannot be too little ditty by the government buildings in any society that the god to give the american cheese increasingly especially among younger cheaper to make two of religion to eat it at that cute institute alan cooper man who has led the study talks about numbers that should worry every june and lo there a lot of different rhythms of life one that thinks it's gained a lot of attention. it is that there's a growing percentage of american who identifies tuition. don't identify with the jewish religion. that is to see the gospel with their religion is they will not tell you jewish they will say atheist or nonstick or nothing in particular among younger jewish adults those under the age

the city and county population is open to all of our population but the volumes continue to go up through awareness. we've also contracted through awareness care and from our verbiage through urgent care, there is a higher level of licensing required for you urgent care than after hours. most of the volume is for extended hours that truly needed urgent care but not needing er. i would close by saying that we've learned a lot about this population. i know i have spoken here before but i can't give up my moment in the pulpit without mentioning it. >> we didn't mean anything by that. >> would you believe that we appreciate the studies that have been done to look at the risk of the populations that select each delivery system and make sure that we are all setting the expected cost structure and the rates commensurate to the risk of the population that's being served. medicare was out first with this risk adjustment on the medicare program. now all the exchange products are using a different methodology. we believe that's the future for all the programs in overall populations of the patients.

this is mostly people who were eligible under the aca expansion, and so those are the two maji populations that you see and expansion and sf path and there are traditional people who are also elible and by traditional, we mean the people who were eligible for medical before the aca, but may not have enrolled for whatever reason. >> so, as a point of reverence. we went over these a little bit last time, but our city wide estimate for people who would be nearly eligible for medical, were 81 to 95,000 people. and this included people who were uninsured and who currently buy their own insurance and to have employers sponsored insurance and obviously not all of those people who are going to take up at the same rates and so we estimate that about half of those people would enroll in insurance. and so, it is not a bar, but it looks like we are doing pretty well. so, coverage california, we have a total of 27,809 people enrolled and most of these people well over 80 percent are in subsidized coverage. and which is again, what was expected. so, in our city wide projections we estimated that 44,000

those estimates with our city enrollment projections and the fact that 100 percent of the path population has transitioned and that we have granted an extension to the healthy san francisco participants to be able to stay in the program through the end of this year. and we updated these numbers. and so in this in this respect we have 87,000 uninsured and 18 to 64 and of those, most of them are in our healthy san francisco or in the sf path programs and whereas there are almost 28,000 who are unknown for our systems and so, when we tried to determine who was eligible and in those groups we find that in both groups, most of the people are eligible for medical or for subsidized on coverage california. but, combined, we have about 18,000 people who are not eligible for coverage. and first we are due to the undocument status that it was also included and because of this case, we classified eligibility as subsidy and so that some people who are not eligible for subsidies or they are not eligible by age. >> and so, we know that everyone who is eligible did not enroll, and so at the end by applyi

and we have so many facets influencing this population. they're aging -- well, we're all aging, but the population as a whole is skewed, over 50% of people with aids and hiv in san francisco are over the age of 50. many of them have been on disability, fixed incomes for like 20 or 30 years and we're coming up to a point where two thing are happening. because rents are sky rocketing so fast, when people go off the hopa funding, for whatever reason, they move away or whatever, the money is eaten up by higher rents of our existing hopa recipients. so, no new subdifficulties are coming out of that. very few, if any. ~ subsidies so, you're seeing a declining pool of people being served. and the other thing is that seniors, when they reach 64, if they have a private disability insurance, it's canceled and they must rely solely upon their own resources and social security. we're going to see a cohort of people who are very likely going to be ripe for eviction relocation and displacement. so, if you could keep that on your radar, that would be gre

it was just only 10% of the population cared about it.ore recently, the explosion in the tax breaks since the end of world war ii has been by the way of credits vin deductions so there is that thousand dollar per credit. there's the earned income tax credit which is tremendously important and was introduced in 1975. so, to oversimplify, most of the things that you think of as the deductions that you might take on your return have been around pretty much forever. the credit for the most part are newer. >> when you talk about the two cheers for the return of income tax bas base that is the return? >> well, there's a lot of countries that have income tax systems that don't require people or at least don't require a lot of people to file a return. threturn. they work on the basis of what is called an exact withholding. if you think about the payroll tax it works that way.

. >> you said that there is about 26 percent of these sites have a population of the seniors and the people over 55 percent, 58 percent. >> let me clarify that. and so let me find that, and this smaller number, of 26 percent, is used for the ear marked for the seniors it has to be 62 and over, depending on what the mechanism what and what kind of grants we get, however, we house 58 percent of all of the people at 55 years and older. >> and then, you also made a reference to the homeless population, because of the lack of healthcare over many years and probably ages a lot and more quickly and as a senior population grows, with the baby boom generation, and it is not only the growth of the number of babies, but, also, that they age faster so there might even more more of a need for the homeless, senior, support, and it sounds like. >> that is right. and so, three of the buildings that we are involved with, and that we will be opening over the next two fiscal years and there are 15 years and over 65 housing for seniors over 62 and then, we have set aside in each building, around 20 unit

and that is how do we make sure that we are addressing the needs of our growing lgbt senior population and supervisor campos and i immediately agreed to work on that, with bill and the others. and then supervisor alagi joined us and we sponsored the legislation that created this task force and i have to say that i have been to so impressed by the work that the task force did, people have been, and we really, i think that empaneled a very diverse set of task force members and people from a lot of different backgrounds. and different subject matter and expertise, and the different political views. and the different demographics and a very diverse task force and sometimes in san francisco, we, you know, you wonder, with so much diversity are people going to be able to work together effectively and this task force, really, i just think worked beautifully, together and the people i think engage in very respectful and thoughtful dialogue, and i have to say that the report is incredibly impressive, and i think that it is going to be helpful for all of us, as we move forward, and we know, that

slightly under the total population. they have the same over 65 population. i can't speak to the adults with disabilities breakdown. they receive about 100 reports a month. by comparison, we have a lot of reports we receive here in san francisco. i an attribute that to a number of factors. one is that we have a very responsive aps program. the more that an aps program can do, the greater the need and the more calls that you are going to be getting. we also have a very services rich community and we have a lot of mandated reporter's here and they are very thoughtful and conscientious about calling in and we have a program with a centralized intake unit and not many have that and you really can lose reports that way. we have a thriving aps program. i would like to think we could be starting to work on prevention and working ourselves so to speak but given the graphics and the issues like here in san francisco. >> thank you so much for coming today. >> thank you so much and i'm happy to come back if there is a need. >> we'll now have some public comment on this

our population grows over time.ally, meaning that we will be spending more on agricultural as well as other products. so the demand curve will also shift out. but how much? if you get more income, how much more bread are you going to want to buy? not that much more really. so demand does shift out, but only modestly. and the result is plain. farm prices go down. here, and then here. and with them, farmers' incomes also plummet downward. why did a million or more farmers abandon their farms in the 1920s? why have millions more left farming since then? ultimately because of this message from the market -- a message of abundance for a well-fed nation, a message of despair for many farmers whose plans and hopes were shattered. schoumacher: by 1932, president herbert hoover declared the nation to be in a "great deession." fully 1/4 of the american labor force was out of work. but farmers were worse off than most. i've lived here 25 years on this land. up to four years ago, we always made a living and had plenty. these ho

in recent years, we have also seen mountain lion populations, grizzly bear populations, but your populationsalso on the rise -- black bear up regulations also on the rise. so the wolves have made some decreases in numbers of certain animals, which makes it a little bit harder to bring meat to the table. is certainly frustration as part of that reintroduction. it did feel as if we had to go along for the ride for a while, willingly or not. but now, since the hunts have started it, now we have regained that sense .f empowerment self-sufficiency, involvement in the process. that is really important for us as a state that has the hunting traditions that we have. i get thousands of e-mails per year castigating me as a terrible human being because we allow hunting of wolves in montana. remember, we have in montana some of the healthiest wildlife species on the planet and somehow our wildlife managers are able to manage those species in a way that maintains the numbers and keeps them completely healthy and we have for generations. yet, the will folks in washington, d.c. said, you are good at energy

because they are from the communities in which they are fighting - they rely on the local population to give them shelter to give them food, they rely on them for funds sometimes in terms of raising local taxes and so they need to win the hearts and minds of locals to be able to fight nato or the afghan forces. >> over the several days that i spent in charkh, it was obvious that the taliban here control the area. while i was allowed to film openly, most of the time there was a taliban minder with me, so it was impossible to know how honest the people felt they could be. >> villagers in places like logar are really in a tough spot. they're not likely one to offer i think very honest opinions when they are on camera and there is a great deal of intimidation on either side, if you had nato forces standing there next to them, i think they would also happily say that we're very pleased to have the westerners here as well. >> my impression was that most people just wanted to get on with their lives, whoever was in control of charkh as long as it wasn't foreign forces. despite a member of t

oftentimes this population we're talking about a population >> so colleagues what he continue this to the call of the chair. >> we'll take that without objection. >> ms. wong any other business before this committee. >> no mr. chairman. >> thank you. the meeting is >> we came to seven straight about 10 years ago. -- 7th street about 10 years ago. the environment is huge. it is stronger than willpower. surrounding yourself with artists, being in a culture where artists are driving, and where a huge amount of them is a healthy environment. >> you are making it safer. push, push. that is better. when i start thinking, i see it actually -- sometimes, i do not see it, but when i do, it is usually from the inside out. it is like watching something being spawned. you go in, and you begin to work, excavate, play with the dancers, and then things began to emerge. you may have a plan that this is what i want to create. here are the ideas i want to play with, but then, you go into the room, and there maybe some fertile ideas that are becoming manifest that are more interesting than the idea you