The employees the city programs focused on peace of mind which isnt easy to describe did you incredibly important which is why i listed it first as well as the Preventive Care as the Health Service youre not addressing health unless i address wellbeing to Work Together through dpw and wellness thank you. Thank you. Next please. Good afternoon, commissioners abby here representing the health in both of our hospitals st. Marys and st. Francis Memorial Hospital our president was cochair of the Health Council and sends his regards and happy to see the Program Continues to modernize were pleased to have been supported this all along and it is great to see the creativity and the innovation and research that is going gone into open about this post ac a world were living in from the hospital operation we have seen a significance in the demand for services through h sf we see as a success and many patients have shifted into medicare and the systems are continued to enhance the medical population but putting in this little very creative i think fix for dilemma we experienced in San Francisco is really great thinking on the part of department and i commend their support for the research that went into this and lastly i want to comment the Wellness Program we heard a nice prengs presentations is very much in line with the hospitals theyre working with the San FranciscoHealth Improvement in with the Wellness Program a manifestation how to Work Together is a terrific assess of this modernization act thank you. Thank you following calling names those are the only slips i have if anyone else wishes to speak turn in a form. Commissioner chow Hospital Council of northern and Central California were here to lend our voice and support of the staffs efforts to bring this ordinance to modernize is and to capture more in this program during the presentation he couldnt help by wonder what a great job this city and department does in making this sort of adjustment that need to be ma made as we live in this ac a world that hospital contributes with your directors were here to lend our support and hope you adopt this at your next meeting. You. Im emily from the Pacific Medical center im happy to be here to lend our support for this modernization plan and say how thoughtful he think that is and impressive we are supportive both of the problems of the expanding insurance through the bridge to coverage medical reimbursement account by promoting insurance through offering that extended benefit and modernizing healthy be San Francisco to make sure it is the Safety Net Program we intend it to be and also to say were looking forward to continuing to work with dpw and the staff to make healthy San Francisco a success were supportive of the modernization plan and hope youll approve it on august 4th. Thank you. I have to adjust this good afternoon, commissioners im rosa i work with the acts or the statewide were an Advocacy Organization also in support of the proposal that is before you we in the past i was not on board but in 2007 we were very active in support of the Health Care Security ordinance as well as healthy San FranciscoSan Francisco continues to lead in so many ways by definitely in terms of how it performs were aware two other states vermont and massachusetts have taken additional steps to improve their program with the package of the Affordable Health care act were protest of what the staff did in providing an updated proposal we have our own recommendations of things wed like for you to consider are example the premium assistance should be available for San Francisco residents as well as residents that dont live in San Francisco our executive Board Director anthony was not able to make it because of a previously schedule Board Meeting no los angeles i have a statement ill leave with you were in strong support thank you. Thank you. So dhs. Deanna from the San Francisco clinic consortium were here in strongly strong support of the city option i want to say you hear a lot of thing about the things happening in San Francisco not great for the average san franciscan this is really supportive of the san franciscans were proud of that im sure youre aware of san franciscans need clinic consortium we represented many clinics and serve about 10 percent of San Franciscos population primarily the low income and moderate income population weve played a big role and as colleen talked about the healthy San Francisco enrollment has gone down most of the patients moved over to medical or some covered california we are heard a lot of the same people in healthy San Francisco also added on the ac a they wanted covered california but couldnt afford it are picked the brogues plan and not afford the services those are people that wanted to do the right thing they understood the goals and gooldz for in their own health, i want to applaud everyone in having a resolution i have a statement the Womens Community clinic want to say the vast majority of our clients are under 40 the clients over 2 hundred and 50 percent of Poverty Level repeat theyre unable to afford the fund 24 will support those women and therefore having the access to care thank you for your support and we strongly support the modernization there are a lot of political rhetoric that pits fwroipz against each other one of the things were doing in San Francisco were helping people that are eligible through 9 ac a and maintaining the programs so i think we are once again a model how this should be done. Thank you very much. If i may commissioner, i said to acknowledge the work on this project shes made a difficult process into an Important Program so i want to acknowledge her shes acknowledged everyone but i wanted to be the one to acknowledge here shes fantastic clapping. thank you director garcia. I was going to express the thanks for the commission to making a complicated proposal as simple as i think you could because even i can understand it laughter no thats correct its clear the amount of work thats been done the background material this has been provide and the accomodation for creating and indeed able to support a program i think weve heard from public testimony will be helping more people commissioners were prepared for comments or discussion at this point or additional suggestions commissioner taylormcghee you i want to recognize stephanies work on this. How many people today anticipate will enroll in healthy San Francisco as a result of the extension it is my understanding it is subject to fines because healthy San Francisco is not insurance and thats correct so when the Health Commission approved the extension in 2014 and at the end of 2015 we look at how many people were in healthy San Francisco under that temporary waiver and there were 4 thousand people at the beginning of 2014 who were otherwise eligible for covered california insurance that number is 7 hundred today with declined and those who have Health Insurance have not come back to reenroll it will continue to go down to 12 hundred individuals in 2016 the federal penalty for not having Health Insurance we the the maximum in 2015 individuals might not know the impact nail their tax return in 2017 but the maximum penalty of 2. 5 percent in 2016 as that cost of the penalty blue healthy San Francisco participation fees gets closer to the cost Health Insurance it might make that cost easier to move in favor of the Health Insurance. Shirley. Whats the reaction of employers and is there additional costs to employers under the new modernization. We had meetings on this with employers and labor representatives of labor organizations and from the employee prospective i think that what we heard was this looks like a fine program it doesnt make any changes to what businesses are obligated to do in the Health Care Security and the Employee Wellness fund theyre interested in participating in a process that would create the Wellness Fund but they up were neutral they thought it looked like a good idea but didnt change anything. Theyre not opposing it. Not to my knowledge were making a similar presentation to the Small BusinessCommission Next monday. Commissioner singer. Thats correct deputy City Attorney and thank you for answering my questions in preparation for this i have a comment then a couple of questions comment is that were living in a time roadway where sort of everything goes up and to the right the level of employment goes up and even though wealthy in the city and unemployment goes down and therefore we can do things like that but especially with complicated programs it is reasonable to ask of it is a when we present those analyze the projected costs and membership there is so sort of scenario stressing so what happens and i know that greg wagner worries about this he present you it us frequently what happens when it changes but with you our eyes wide open whats the obligations were taking on this is especially important with complex programs because the law of urban intended convinces will take over my two questions are as follows i completely understand and support the thesis to plug the holes as we see them developing what i dont really understand is why were not using this an, an opportunity to drive more people into the San Francisco network it will become healthier and more vibrant at the same time, we have people in the competitive environmentalist triumphantly environment were paying their insurance into their niblth or networks my concern a long term that the quality care in the city will suffer wool be out exceeded and this is a great opportunity to think about that. We certainly looked at that as a proposal we wanted to putter before you it requires many things to be in place first, it requires us to have a contract with covered california if were going to maximize all the subsidies and currently no pathway for covered california to choose the did you want as its provider so right now there notice ability to do that we look at it with the eye towards a contract in the future what we looked at we are several options they were detailed in the report that h m a put together if you want them to comment they can after im done several things that raised concerns for different stakeholders in the process first was covered california ability to allow a plan on covered california to contract with this kind of a program to offer something that is as federal eligible for federal subsidies to offer it to consumers in San Francisco this creates an unlevel Playing Field and for the federal in terms of the ability to for us to contract with one qualified health plan in cost california in addition, we met with the h m a they have discussions and the plans had very little incentive to change any of their processes or procedures for the relatively small Patient Population were talking about were talking about 3 thousand combreerlz and 4 of the plans are invading plans so we focused our communication on the r without objection one local when you the ability to make changes to account for a special program for the 30 thousand san franciscans were talking about was not doable for them certainly in the near future but potentially not in the distant future looking at the timeline and those regulatory and legal barriers we didnt know that was feasible to do that at this time. This make sense id love to see a plan an outline how we will do it and when as we talk about you know as the city spends moroni health care we have to think about the other spend were doing if f there is a way to e rattle and get Higher Health care it is worst exploring the second question around the Wellness Program partially what kind of employers are we targeting. Well likely targeting of this is a special initiative not connected while likely target employers who contribute to the city option to comply with the Health Security ordinance those bike sharing tend to be sizeable businesses that choose a size limit or some certain features of that business to target the benefit towards. So the thing that strikes me not and weve talked about this the validity of those programs the question is really it doesnt make sense to me why it is part of this it seems like another different thing so if i had the mask 10 it wouldnt be in the modernization it selfspeak to the modernization apparently that the department so thoughtful fully prepared is trying to do it is trying to do something that is important maybe the employer should pay for it or the city im not sure it doesnt seem like it should be part of the ordinance. Youre right the city modernization is specific to how we implement the Health Security ordinance and the wellness is a separate program what pulls it together with the alignment of the aeblth Affordable Health care act it had a investments in the Wellness Programs the report that i cite in the memo is actually commissioned by h ms and others by the randy cooperation corporations to support the Affordable Health care act on preservation so it really incorporate our overall goals around Population Health and our Citywide Mission to protect and promote the health of all san franciscans in the framework of the Affordable Health care act so thats why. I was on the board when randy did that study youre right advertised compelling work i personally dont think that belongs in this program that needs to be evaluated in the context of what it costs us is it our obligation for the city or their obligation to do that and so this would be something id like the commission to consider. Commissioners he raised a good question about the wellness and the Wellness Fund im reading maybe i need a clarification how this is funded so i thought it was connected with the aco the security collection of dollars from the employers and this was. When would be a general fund budget. Thats correct and it clarifies and what youre speaking to this was the thing i was worried about and so i think there were two questions other questions from the commissioners, i was trying to photocopy on commissioner singer on the thought of what would happen in the future and whether or not even though right now it is infeasible to find the alternatives that are so well documented by the h m a report for the extensive report were intending to have this available for 2016 and not create our covered california what is future in terms of what were looking at for as this now films in how would we or considering to we consider maybe another city option i mean what are your thoughts. Weve discussed that part of the reason that the Health Care Foundation was interested the we were looking at ways to leverage our own Health Care System to provide health care to those and well absolutely do that. Commissioners this program is worth a review after so many years by the commission to ask that question we will we cant predict what the future we can predict what ac a was happened but it is well porth or worth it to look at it and we dont know what the economy will look like we can fill that into the review. Right it could go into the resolution. To be i think this is a reasonable idea that was not the thing i was a proposing i was proposing when we approve things like that or evaluate them we dont see one analysis look if unemployment goes to one percent it is going to cost a lot less or 11 what is this is going to cost not that we wouldnt do it or understand and be responsible to the Mayors Office and say hey heres what were signing up for so noted. Thats what i wanted to say and. I still like high idea and i think youre quite correct in terms of the analysis it is nice to understand and where are the limits of the dark side in a year if now all of a sudden something happens is that the type of scenario youre asking for the future. I just fell off maybe im not communicating as i listen to the presentation and look at the charter six or eight years ago and you sort of see you know today in california were ranked almost 50 accounting for the children and consecut