Body. Is there a motion . I make a motion to pass on committee with positive recommendation. Well take that motion without objection. Thank you, next item. Agenda item number seven is a resolution authorize the recreation and Parks Department to apply for a grant of 245,000 from the california state dment of forestry and Fire Protection for state Greenhouse Gas reduction funding to carry out an urban forestry project. Good morning. Im [inaudible] with the recreation park capital division. Im here today to request your recommendation to the board of supervisors to support excuse me to adopt a resolution to apply for an urban forestry grant from the department of forestry and Fire Protection. In the amount of 245,000. The urban Forestry Program grant is funneledded by cap and trade funds which are designed to Fund Projects that reduce Greenhouse Gas emissions. The program that the Grant Program were applying for will provide funding for the department to develop in an urban forestry plan for open space and parks in cord nation with the Planning Department. The Planning Department has completed an urban forestry plan for street trees adopted by the board of visors in 2015. The granted granth will funneled Public Outreach and Tree Planting in disadvantaged communities. If awarded the grant, the department will come back with ako an accept resolution. The staff are here if you have any questions. Thank you. I you making yourself and staff available to answer questions. Well go to Public Comment. And see what the public has to say. Not much. Thank you. Public comment is closed. All right, colleagues. What say you . Ill mac a motion to send forth this item with positive recommendation as a Committee Report to the april 18th full board meeting. Well take that without objection. Thank you. Thank you for your presentation. All right, what is next . I think thats the end. Thank you, this meeting is adjourned. And finance committee and the budget federal committee i am supervisor melia cohen supervisor of this committee. In the chamber today weve got supervisor sheehy kim, and fewer. Were going to be joined shortly with supervisor yee and supervisor tang. The clerk of the board is linda wong and john carroll today. I want to thank phil jackson an injury in stark from sfgov tv for assisting us with todays broadcast. Mr. Clerk any announcements . Yes. Please, sounds all cell phones and electronic devices. Completed speaker cards and copies of any documents been included as part of the file may be submitted to the clerk. Items acted upon today will peer on the april 25 board of supervisors agenda unless otherwise stated. Thank you very much. Could you please call item one on the budget and finance select committee agenda. Item number one a hearing to receive an update on the federal budget and any related impact to the city and request a Controllers Office and maters budget office. All right. Thank you for hearing this item. Several weeks ago we received an overview of federal fundingof federal funding to San Francisco as well as any anticipated impacts or risks to our cities department. These are the risk theyre going to be facing. Its difficult to anticipate the pace of how quickly things can change at a federal level, but i believe its incredibly important that this Committee Stay abreast and up to speed on the changes that do occur. That may have impact on our citys budget and financial health. This week will hear from the department of Public Health regarding the status of the Affordable Care act. What impacts and what impact the failed attempt to repeal the aca will have. With that i like to bring up pauline chawla, good afternoon pauline from the department of Public Health. Good afternoon supervisors. Thank you for having me. Arlene joplin for the department of Public Health. I have just a brief overview for you on what is occurred since i was last here just about two weeks ago related to the Affordable Care act. So primarily what i want to say is that the Affordable Care act remains in place. There have been no changes. I think the most Significant Development took place the day after i was here last week, last month. On march 24, the majority leaders in the house of representatives canceled a key vote on the Affordable Care act on American Healthcare act, that is, and this is really a win for the 133,000 san franciscans whove been benefited from the aca sponsored Health Insurance. When i was here last i talked about the American Healthcare act which would repeal and replace the Affordable Care act. As i described to you previously, the American Healthcare act wouldve repealed the individual employer mandate, would have repealed subsidies on the healthcare exchanges like cover california. Would have reduced federal medicaid funding to states like california and would have really restructured fundamentally the medicaid program. Though the cancellation of this vote on the house floor is a reprieve the white house and congressional leadership have indicated their desire to continue with the repeal effort. In fact, i was in washington dc just last week with our Community Clinic consortium and we had the privilege of meeting with leader pelosi. The leader had indicated to us that the reason that the American Healthcare act was so important to the leadership is because they needed the savings from the repeal and replacement to fund the tax reform package that there are intending to take up next. So that is among the reasons why its still important for leadership and congress and in the white house to look at some changes to the Affordable Care act. So it is unclear now what will happen exactly, whether the American Healthcare act will pass, or, if it does pass it may look different than the current version looks now. In many details would be also up to the administration when she implements the legislation if it were pass. Finally, whatever california does in response to federal action, will also be as important as federal action in terms of the impact on San Francisco. So its also important to note is a significant amount of Administrative Authority that can occur in the absence of legislation to rollback provisions of the Affordable Care act. So to highlight a few areas where the administration already has within its authority some power to change the Affordable Care act significantly. First would be around the subsidies that make insurance affordable for low income and middle income individuals. These subsidies areone of the subsidies is a subject of a federal lawsuit Congressional Republicans sue the Obama Administration and were successful in a lower court. The Trump Administration couldthe Obama Administration appeal. The Trump Administration could take up the appeal or drop the appeal. If they drop the appeal, that means the subsidies could be eliminated for the lowest income individuals purchasing Health Insurance on the exchange. It could also allow state administration could also allow states impose restrictions on medicaid beneficiaries. Whats being talked about at the federal level are things like work requirements. Making sure that people on medicaid are working. This would be an allowance for states to opt into. The federal government could also without legislation we can the individual mandate. They could choose not to enforce portions of the individual mandate. This could result in destabilizing the marketplace because individuals who rely more heavily on Health Insurance would be those more likely to enroll in those who dont rely heavily on Health Insurance would which would be more cost costly for Health Insurance and likely drive up prices on the marketplace. Finally, within their Current Power redefine essential Health Benefits. Right now, theres 10 categories of essential Health Benefits. They include hospital care, primary care, maternity care, prevention and things like that. While those 10 essential Health Benefits would have to remain there significant latitude within the admin stations power to change what comprises those essential Health Benefits. Changing what comprises prevention or Mental Health or Substance Abuse care. So shifting a little bit to the president s budget, i dont have any new information for you today. Updating from a was last available. The president had introduce whats called a skinny budget. A skinny budget means it pertains only to Discretionary Spending not entitlement spending like medicaid. In the discretionary budget the proposal was to reduce the budget by 18 for health and Human Services. The comment that most directly affects the department of Public Health. But specifically, specifics were not provided. The whole of health and Human Services area with two pages of narrative so i dont have more details than i did before. I will say, too, just as whatever changes to the Affordable Care act are taking up under the American Healthcare act were administratively by the Trump Administration, how california response will be as important as the changes made at the federal level. So what does that mean . Generally, funding at the federal level pass to the states not in all cases but in many cases medicaid is certainly one of those largest cases. But, how to fundif the federal government reduces medicaid funding, or changes requirements for medicaid, how california adopts those and whether california adopts those would be a significant question. How to fund and Structure Medical in the event of changes at the federal level or, whether to take up certain federal options that the federal government gives to states to make the programs more affordable for them also would be of significant importance to the department of Public Health and the city. Its also important to know the california legislator is already considering other options. So there are legislative proposals afloat that would create a single payer in the state of california also, universal Healthcare System not unlike our own healthy San Francisco system. We are keeping an eye on those things, too. Just an overview on what we are doing about all of this advocacy is our number one goal right now. I mention id been in washington dc and met with elected officials there. Despite the proposals that are pending at the state level, it still important we feel to protect the gains we have achieved under the Affordable Care act. So we are meeting with our delegation. Meeting with the citys lobbyists and we are conferring regularly with her statewide and nationwide association. In the meantime we are tying to maximize all of the programming that we havethat were also in a lesson the impact of the proposals that are part of the Public Health. With that in mind, we are keeping at the forefront of course the care to the individuals we serve and making sure that we keep those principles high. That we want to make sure that Healthcare Access for our residents is of the utmost importance. So just to leave you with a few key takeaways. A summary of my presentation. To say that nothing had changed despite all the conversation and everything in the news, everything is still the same as it was before. Health Insurance Benefits remain in place and people should continue to use them. That federal changes still possible but the details and the impact remain unclear and we are continuing to monitor so that we know what the impact of the is as it is clear proposals come forward. Even a clear proposals come forward, california has to act and how california acts will be of significant importance to the department of Public Health in the city and whats really at risk here is coverage for the 133,000 san franciscans who gain acas sponsored insurance. For those individuals Health Insurance could be reduced or lost. We want to preserve the gains that were made under the Affordable Care act and the addition of new insured san franciscans and we want to make sure that we maintain continuity of care, not just access, the continuity of care in the very Health Systems across San Francisco that serve these individuals. Its also important for you to know healthy San Francisco remains in place. We continue to have a healthy San Francisco program that will assist those who have no other options for Health Insurance. That is the conclusion of my presentation. Happy to answer questions you may have. Thank you very much. Supervisor kim has a few questions thank you i want to ask about congresses passage in regards to title funding and trump p signing into law states ability to withhold federal funding from clinics that perform abortions and family care. I know that is a state choice, but i want to know a little bit more about what the department of health is thinking about that. Title x funding right. I am not familiar. I should be formatted. Im not summa with the actual executive order my investing around some of those decisions were in the American Healthcare act and other places. But we certainly support reproductive rights and offer a continuum of Reproductive Health services at the department of Public Health. Yes. I know that but february actually not sure its an executive order. I think Congress Actually passed that. I know trump is signing that into law today or couldve been executive you know. Signing into law today so its a legislation that would allow states to withhold federal funding title x funding, from organizations like planned parenthood that perform abortions. That was a lot obama had put into place. It would be great to get more information about that. I think it something we need to prepare for seeing thats decision is out of our hands. I doubt california would take that option up but im very interested. Will be very sure to try to get like the out other california rules i highlight i think were fortunate to be in a state where many the things are not likely to be adopted by our state likely being one of them. Its only something we need to Pay Attention to because the state has zero resources they need to make difficult decisions. Thank you. Thank you super visor kim. Question for you. You mention in your report california roll and you [inaudible] California Legislature is hearing a couple options one being singlepayer and the other being universal healthcare. Do you know where these piece of legislation are in the process . The single payer bill has been amended. I think just last week to include much more detail on what its proposing. Has yet to make it through the legislature. The universal healthcare proposal is one that has been talked about by the lieut. Gov. But to my knowledge has not yet been put into legislation. So okay its being discussed. It has not been drafted or submitted . Correct. Thank you. Any other questions . Seeing none, thank you for your presentation i think we will go to Public Comment at this time. Ladies and gentlemen you have Public Comments. You will have two minutes. Your soft chime indicating 30 seconds on your time. If you would like to come up, please do so. Good evening ladies