Transcripts For SFGTV Government Access Programming 20171214

To see what the changes might be because everything is in flux but just looking at this i think that it could really hit a lot of San Francisco, but what were trying to do to get people middleclass folks in sa San Francisco to invest in a small piece of real estate here, its going to be detrimental to that effort. Supervisor cohen definitely. Any other tax wisdom that you want to share with us . Not at this moment. Ill turn it over to cindy comerford from the department of Public Health with an update on affordable 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 im 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 im going to talk about six issues that are on the slide in front of you. Im going to give a very brief update on each one and some of the funding mechanisms, theyre very complex so im 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 medical expense deduction and the elimination of the Student Interest deduction, and also the orphan drug industry deduction is eliminated. Or capped within the senate bill. And these bills are in Conference Committee right now and were not entirely clear whether the house will adopt the senates bill. It kind of goes back and forth each day. This morning it seemed more likely that they would include the individual mandate but a couple days ago that didnt seem feasible. So its still pretty fluid on whats going to happen. The potential impact of repealing the individual mandate would mean 13 Million People would have would not have insurance. And it also impacts premiums by causing them to increase. So that 13 million translates if you do a straight statistical calculation about 35,000 residents in San Francisco. In addition, since the tax cuts are so large it could potentially trigger an acrosstheboard spending cuts and this would impact medicare. And in order for it not to have impact on medicare, there would have to be federal legislation passed that would protect these Additional Health care programs. So the next item that ill talk about is the childrens Health Insurance program and also known as chip. And chip is a federal and state partnership that is designed to provide lowincome children with Health Insurance coverage. This Program Provides Health Insurance to about 1. 3 Million People in california under the age of 19. So the funding for this program expired in the end of september. And traditionally this program has enjoyed bipartisan support but, unfortunately, its kind of become a political tool. In october, the house did pass a bill that would extend this funding for another five years. It was passed primarily along party lines and mostly rejected by the democrats because of two reasons. One, it took funding from the prevention and Public Health care fund which is the only federal dedicated fund to Public Health. And it also changed the window in which people could be late on their Health Insurance premiums and so it would increase the amount of people that would get kicked off their Health Care Plan for nonpayment. And so the Senate Negotiations in the senate have stalled, right now potentially we could see a bill passed by the end of the year, although right now i think that Congress Main priority is around tax reform. So its unsure whats going to happen and the a. C. A. Has i maintenance of effort clause which requires the states to continue this program through the year 2019. So california would have to pass legislation to determine how it would move forward with funding this program in the absence of a bill being passed by the end of this year. And theres approximately 15,000 children in San Francisco that benefit from this program. So the next item is the disproportional hospital payments and its known as dish payments this makes payments to hospitals that serve large number of medicaid and underinsured individuals. So based on the assumption that with the aeca that there would be more increased coverage and less individuals uncompensated it called for a reduction in these payments. So these payments have been scheduled within d. P. H. s budget and they were to start in the year 2014 and they were delayed to 2017, but in the chip bill that we just talked about that the house passed it has a delay of another two years, but then having a really steep reduction after that. So right now we have a scheduled 11 million reduction for this fiscal year that would increase to about 39 million by the year 2024. And these payment schedules may change depending on what happened at the federal level. The next item is Community Health center funding. And Community Health centers are communitybased and patientdirected organizations that typically serve communities that have limited access to health care. So federal grants are a key component of the funding for these Health Care Centers through the Health Center trust fund which includes both discretionary and mandatory funding. So as are the chip bill, this funding the mandatory portion of this funding sunsetted in september. And the house bill did include funding for Community Health centers for another two years. So california could potentially lose over 300 million in funds if congress does not extend this funding for over 1,200 Community Health centers in california. The San Francisco Community Clinic consortium which is a collective of the San Francisco Community Health centers, estimates that the funding loss to San Francisco would be between 5 million to 10 million with about a Million Dollar impact to d. P. H. And the next federal item that i want to talk about is the Opioid Crisis funding. This is not directly tied to the a. C. A. But there are some potential avenues to increase funding to d. P. H. So i wanted to mention it and i know that everyone here is already aware of the Opioid Crisis. In 2016, we had more than 64,000 people nationwide die of overdoses to opioids. And drug overdoses are now the leading caused of injury and death within the united states. So it was expected that our Current Administration would act on this issue and in october our current president declared the Opioid Crisis a Public Health emergency. And in november, trumps commission on the Opioid Crisis released its final report with the recommendations on how to handle this and so it had 56 different recommendations. Last week the House Committee started having hearings on this report and then the white house appointed Kellyanne Conway to lead this effort. So the Public Health Emergency Declaration doesnt provide any direct funding to d. P. H. But it does open up some avenues to increase addiction treatments and this is specifically around eliminating the i. M. D. Exclusion so that we would be able to get reimbursement for hospital stays through medicare and also it would increase the access for medical assisted treatment. And the last item that ill present on is our 340b drug discount program. This is a federal program that requires drug manufacturers to provide outpatient drugs to Eligible Health Care Organizations at reduced prices. So its a safety net hospitals such as s. F. General buy these drugs at a discount from pharmaceutical companies and then theyll reimbus for those services from medicare and extend those savings through patient care. In november, it was announced, a final rule that cut the 340b payments, a lawsuit has been filed by hospital groups to prevent this from happening and two house of representatives have introduced a bill that would also prevent this cut. This final rule would impact would reduce the programs revenue by about 28 so its 1. 6 billion nationwide and the impact to d. P. H. Would have been about half a Million Dollars. So those are some of the federal policies that are potentially impacting d. P. H. And im happy to answer any questions at this time. Supervisor cohen thank you, cynthia, i appreciate the very thorough and important update. Colleagues, any questions at this time . No . Seeing no questions. One question. Supervisor fewer seeing that this could really supervisor fewer seeing that this could effect a lot of people in San Francisco, what are our plans do we have any plans if these were to go through . And how do we intend to backfill some of these services or do we . So a lot of the federal policy changes would then impact the state so i think that our first line of defense is really working with the state legislation to see how we can mitigate the local impact. So i think that a lot of these issues are really fluid and theyre changing daybyday and so we dont have a formalized plan, but a lot of these programs go through medica well other thal, sowell see legislad on a state level to combat these issues at a federal level. Supervisor fewer thank you very much. Supervisor cohen thank yo you. Heavy subject matter. Thank you. Colleagues any other questions and we can go to Public Comments on items one and two. Ladies and gentlemen, if theres anyone that like to speak on items one por or two, come on u. Hello, im dina lawn, the Vice President of internal affairs for the San Francisco clinic consortium. As cynthia mentioned were a coalition of the nonprofit coalitions and the northeast medical services, etc. I made an error in supplying information to d. P. H. And i want to correct that and to talk briefly about the impact of the Health Centers fund not being renewed. I had originally given an estimate of 5 million to 10 million and in doing that i made an error because i didnt realize that the same fund had contained funding for our health care for the Homeless Program. So the San Francisco Community Clinic consortium is the recipient for San Francisco of the health care for the homeless funds and we then subgrant those funds to several of our clinics and to several of the d. P. H. Clinics, and we also run a very effective outreach van that goes around the city to certain places and provides kind of urgent care but more importantly a connection to primary care for any Homeless People that we can convince that they want to be welcomed into one of our clinics or the d. P. H. Clinics and enroll in whatever they are eligible for and get health care. We dont usually come before you very much and the reason for that is that of all of the nonprofit Community Clinics only 4 of our funding comes from the county and the majority is from the state and the federal government. This money is critically important for our clinics and especially for our health care for the Homeless Program and it will have an impact on the entire city so we want to make sure, a, that we corrected the number which should be 14. 4 million and make it clear that this is absolutely crucial and we have communicated with nancy plohse and harris and finestein are all onboard and were hoping that the res liewgdz to we hope for a res liewgdz inresolution on this. Supervisor cohen thank you, i appreciate your perspective and thank you for sharing it. Any other member of the public that would like to share . Seeing none, Public Comment is closed and i want to comment on a couple things, we voted recently on the release of a 9 million reserve to backfill the federal and state impacts so i thought that it was important to have this hearing to get a timely update on the overall federal budget. Specifically the proposed federal tax plan and how its going to relate and impact our local budget so thank you for your presentation, both from the Controllers Office and now from the budget Directors Office on more doom and gloom, i hope not, i dont know. Alyssa . So what were going to do now is were going to not take a vote on items one and two but were going to take a motion to hear and file items one and two and we will probably call them up again in the new year once we have a final idea of where the federal tax cuts will come. So melissa, are you just for clarification i thought that you were presenting on item 22, is that right . Okay, so let me get my motion and we will call your item, okay . So id like to make a motion that we have heard and like to file items 1 and 2. So moved. Supervisor cohen thank you, we can take that madam clerk. Clerk the motion must be made by a member of the federal select committee. Supervisor cohen thank you. So i believe that i am a member and supervisor fewer is here, perhaps you can make a motion acknowledging that we have heard this hearing. Supervisor fewer thank you, chair cohen so, yes, we have heard these two items and id make a motion to file them. Thank you. Supervisor cohen i appreciate that. Thank you, well take that without objection. So now well pivot and go back to our regular Budget Committee meeting and we still have a quorum and i want to recognize item were going to call item 22. Clerk item 22, ordinance appropriating 9. 6 million from state and federal contingency reserve to backfill the loss of state Inhome Supportive Services and revenue at 4. 5 million and fund the anticipated payment liability to the state for the ihss maintenance and the effort due to the anticipated change it is at the state level of approximately 4. 8 million. Supervisor cohen i would like to adjourn the federal select committee at this time. That meeting is adjourned and thank you, supervisor fewer, for standing in and so we called item 22 and i want to give adam cray from the Mayors Office of housing, well hear from you next. Thank you. Melissa, youre next. Item 22 is up. Great, thank you, chair cohen and im Melissa Whitehouse and the mayors director. And we released budget instructions to the departments and we talked a lot about the risks and the issues that you all just addressed and i think that similarly relate sid relate supplemental that ill talk about today and so the board and the mayor were very smart and thinking ahead to budget a 10 million state and federal unknown impacts reserve in the 20172018 and 20182019 budget and i appreciate the willingness to do that and today i will talk about a 9. 6 million appropriation of that amount, so almost the entire amount. We have representatives from the citys administrators office, and d. P. H. , tracy packer and from h. S. A. , dan caplin, so if you have additional questions on any of the uses in the supplemental let me know and ill do a walkthrough at a high level right now. So as i just stated we had 10 million reserve in the budget and at the time that we proposed the budget, the board of supervisors on june 1st we did not know if this reserve would be needed or not needed and as you can see today we are asking you to appropriate almost the entire amount right now. And so what is that going to be used for . The largest portion by far will be on the inhome support Services Program and the funding for grants and daka support. So heres a dollar value, so as you can see 8. 8 million to the inhome support Services Program, about 700,000 for the department of Public Health for h. I. V. aids cuts and about 70,000 for dhaka support through the office through the City Administrators Office for immigrant affairs. And so im going