Commissioner wilson that motion carries. Theres no further business. [gavel] i will note commissioner pating is here joyce singer and sanchez. Yes there are four. Commissioner pating just walk in. Item 2 is the approval of the minutes of the Health Commission meeting of october 18, 2016. Commissioners i apologize. Is a common missing from item 2 on the minutes between the four and 26 injured i apologize for that. Any is there a motion to approve the minutes . Moved and seconded. Any comments or questions . No . Second all those in favor say, aye [chorus of ayes] thank you. Item 3 is the directors report i will left the directors report in front of you get a visit any questions for the directors report all try to insert the staff is also available for any answering. I just want to note we do have all of our news items media items attached to the directors report. So if theres any questions about any items, please try to answer them. Any questions, commissioners . No. I just had one and just curious about it a little more color on the easy to update yes our Health Officer [inaudible]. From my perspective, the report is actually very up to date up to now weve had 25 cases identified in San Francisco. They have all been travelers could all the cases in california theres been 353 cases good all of them have been travelers. The only area theres been transmission in the us has been in miami. The only other thing that is news is that there has been longer ongoing transmission in southeast asia. That is been known about but they the cdc has added Health Advisories to people traveling there. The last thing i want to mention is just something that can out recently that sort of interesting from a scientific perspective and that is that it looks like they micro [inaudible] seems to be more associated with a secret cases in brazil and we had seen less typepad defect in latin america. So its perplexing as to why that is. The scientist or try to figure out whats going on in brazil thats causing the virus there to to cause the [inaudible] in newborns you may not be ready to comment on it but on that point, there have been several news stories about what might be the reason for that that had to do less with the etiology of the disease and more with Standard Public Health practices yes. I just learned about this last week did i dont know the details yet cured thats really it. Thank you. No further questions . Next agenda item item 4 is general Public Comment. I dont request any request for general public on we can move on to item 5 urges report from the financing Planning Committee commissioner singer okay. Let me get the agenda here. We did a number of things probably the most relevant here are the month it was a very thin agenda but the month contacts report we got and we got a request for approval of the new contact and both those items i like to go through in some detail with the commissioners. So and mark, jumping if i do this wrong, but there were two contracts. One with university of Pacific School of dentistry and the other with health right 360 which included no additional money from the general fund. It was either additional funds or reallocation of funds and id like to recommendsorrythe finance Committee Recommended that we refer to the commission for approval of those two items. Then also the new contracts. Can i do that all at once . Usds he was there is a new contact, which i like to describe an point out why this is sounds mundane but is actually important. It is a contract with guttural Healthcare Laundry and Linen Services for pounds of laundry i learned today that5. 4 we generate at the Zuckerberg San FranciscoGeneral Hospital in laguna honda hospital in a year. It should take care that in the finance Committee Also recommended to the full commission that we approve this. The thing that is interesting about this and very encouraging, is an example of a consolidation of vendors could be of vendors for each of the hospitals separate contracts and through doing is theres a number of ways which it looks like we will be able to reduce what would have been the projected cost of laundry. So congratulations to the staff on that and hopefully its the first of many contract consolidations that will come before us. So do we move approval for these . First asked if theres any questions offers as if theres any questions from the committee any Public Comment any questions from the committee to that change the rules on how we do [inaudible] its an example of how they took through the normal process and decided to use one vendor instead of two. But it went through the normal procedural hoops that contract has to go through. Thank you. A good question. Question through the chair. I just was looking at this this afternoon and just wondered these are significant dollars that as you said, evidently theres been integration consolidation which is about a threeyear grant. I guess the question i have because i cant understand how, in fact, this operates because number one, before laguna honda and general both have their own laundry facilities. This quote was not effective, quote unquote to costly quote unquote etc. Etc. Then the con department contracted out and some of the Hotel Industries got the contractor so they were literally getting the laundry from general and tracking them down to monterey, monterey peninsula and getting it done and when they came back they really had problems with the quality of the work. Then there were other things being done. At the same time there were a number of small laundries in the city there were trying to consolidate especially minority communities that small laundry succumbing forbids and so one effort would always be why can we build hospitals which run higher local contractors and local workers etc. Etc. Do you know, then it seems like as i read through this, this is a large collaboration based in wayne pennsylvania and its part of an International Worldwide contract. Wow. Have we gone from our small neighborhood communities to try and encourage Job Opportunities and Small Businesses, etc. In order to provide jobs and keep families here for, what is this. Its what are my . Number of contacts [inaudible] the went to saudi arabia and china so forth and so on. I guess my question is, if in fact you look at the board of directors and it can go up to 30. I dont are these people all pleased here or are they based out of the home port in wayne pennsylvania . Or are they part of the international corp. In who really is the international corp. . Thats what i want to know and i assume our staff has reviewed it. We can certainly give you understand i understand your point of view we can surly give you more information about this particular project or you can also recognize that we also do have [inaudible] required to minority owned businesses as part are confident this just happens to not be one but is really born for us in terms of bulk costs and how do weand we had very sizable purchasing power going on throughout the department in fact that does not give his i think the end result of what we need to do is really try to use our purchasing power to build lower our cost. This is one of the ways we can try to do that. But i do understand a position but we are still required to follow lb fuels which we do for many of our services have minority owned contractors or providers. But this in particular one is one in which i really support to ensure we try to reduce our cost overall by using our purchasing power for large processes like we have to have. As you know, weve gone in out, in out in terms of the services. So this is also a nationwide for all Public Hospitals in which we are trying to purchase together and trying to reduce our overall cost. Then, i understand i understand your position. Its a different protocol as we dont look at your diligence and i mean its the [inaudible] when we look at the building of the hospital were always so proud are hiring rate was above 20 even 2829, 30 and look at the contractors should i mean laguna honda the same. Something the department of Public Health was so proud of and whatever they could take a look at we are doing some great things but i guess as i said, normally long before we used everything on ethnic eight bracco and dont sometimes the directors came in from germany to tell us why theyre bidding here when its a german based company. We have special interviews on that. So i just wondered [inaudible] can also address this doctor sanchez thank you for asking that question in terms of our local Business Enterprises, one of the things as we are beginning to utilize these Group Purchasing contracts that director garcia mentioned as a component where we can actually have our local Business Enterprises become members of that gpl. As we are bringing on these new larger were guys asians we are also working with her obe to give it got him on the same list we get the same pricing for those service. We are doing both at the same time. Thats very helpful. Thank you for clearing that. Thank you. So opening up. Okay. Good thank you. We can move on to item 6 which is the consent calendar which you all can vote on. To approve good should we vote on the consent calendar . All those in favor say, aye [chorus of ayes] any objections . Did i do that right . Yes, thanks next agenda item item 7 is the healthcare accountability vinton this item was introduced at the last meeting and today you will be voting on this. Good afternoon to visit my name is patrick jane and secretary [inaudible] said we presented on this on Alaska Missions on happy to take any comments or questions you may have about its. Mister chang, can you review the changes made so even though the commissioners of the package not necessarily everyone but maybe scuttled i apologize. Thank you. Whether any changes since the last meeting . There were no changes. No substantive changes. Since the last meeting the draft resolution is just expanded to include include all 16 resolutions. The previous one had only the 14 number subject to change given that the full consensus of the workgroup. So this draft resolution includes all 16. As a rule is a resolution would thank you. There are several Public Comment request for this item. So our questions as commissioner, after those yes, sir. Albright. The first person is greg brown. Thank you for taking the time to come talk to us. Everyone is making public on. Ive 3 min. On the egg timer. When the buzzer buzzes that means your time is up the was thank you for letting me come talk today about this. Its my first time serving on this group and it was probably of all the things ive ever done before the most interesting. It was a lot of different viewpoints and we went through every single point. Ive never seen a more thorough review of anything before in my life. All viewpoints were discussed and we turned around and came to recommendations based on the needs of the Business Community as well as i represent labor could labor community, and nonprofit do we all just kind of sit here are our needs and we can up with our own proposal based on those needs. The proposal basically we do not go to a basic sewer plan in order discovering that a lot of of our members are going through their own doctors for healthcare preventative but not for when they get sick. Because that costs money. So they did not go. That defeats the purpose of having healthcare. Now we are paying premiums in employer are paying premiums for deductibles and its not being getting their moneys worth out of it because people were not going to the doctor. We discovered this through our own workers. Ive my own people tell me that. So yet, we can up with a solution of raising the deductible to 2000, raising the insurance 27030 and raising the top eighttop outofpocket 26853 at having the hra hsa cover the first 2000 basically deductible. That weight should solve most of our members concerns, lower to keep the cost down for the employer and was kind of a winwin for everybody. We all discussed it and we all happy we came up with something bounced everything up. Met all of our needs could so actually was a very good consensus. We were able to find a winwin women all the way around for everybody and that was our recommendation based on meeting everybodys needs. I represent a group of women predominately women group several hundred members at the airport that are predominately85 female. Predominately minority. Even though we are in a more progressive liberal city in the state most of the work still falls on the women, the wife, the mother and these women are working there as a fulltime job. I got an education that have by working with them and helping with her problems in im just amazed with these women can do. The working fulltime and they go home and they take care of their kids make sure they go to school they take have some other inlaws with him there taken on their almost superwoman and they dont give up. Just every day do what they have to do. And they carry one massive work load to that quite a few single moms carrying the load all by themselves. Theyre paying rent 2600 month for a onebedroom apartment that is green but not in the best neighborhood. So this helps them tremendously. Thank you for pathos and keeps double they can stay healthy and ask for your support on this one. I think needs a lot of peoples needs will help a lawful lot of people. Thank you. And the gerald. The microphone is all yours. Good afternoon commissioners. My name is emma gerald and im with seiu 1021 we represent city workers but we also represented by the thousand nonprofit workers in the city. I spoke here last week regarding our priorities around reducing the burden of the deductible and how that affects our members. It really is a barrier to health care and thats why we work so hard to have the hra or the hsa cover that amount because we feel like that will have our members utilize the healthcare. I would like to read a statement from the labor council. All right. This is a statement from the executive director from the San Francisco labor council. I want to be in rate fellow Committee Members recommendations to accept and implement the workgroups plan in updates the workgroups spend much time three multihour meetings in allies in data plans prices and trends in this everchanging world of healthcare plans and premiums. We feel with consensus that we came up with changes that reflects the intent of this historic legislation to provide the best healthcare for employees of vendors and contractors do business with the city and county of San Francisco. In the era of obama care we need to be thoughtful about the values of our city and not just make decisions that appear to be simple bureaucratic fixes. That is what this workgroup accomplish. It should be noted that whoever is elected president next week is pledged to address healthcare in one way or another and we expect that our group under the guidance and facilitation of the great team that are dph will be meeting again with the adjustments that might be needed. On behalf of the 150 units 100,000 workers representing in San Francisco i highly urge your adoption of the recommendations. Thank you. Karl cramer. Karl cramer is San Francisco living wage coalition. The San FranciscoHealth Department did a study this year that found that deductibles were one of the chief concerns of employees. Also the metlife 14th annual us employees benefits trends study 2016 found that 55 of the employees reported that there were worse Financial Fears and worries included not having enough money to cover outofpocket medical costs that were not covered by their Health Insurance. The Health Departments study found that recent surveys indicate that nearly a quarter of adults with insurance are still unable to cover their deductible. The Commonwealth Fund provides a useful measure for underinsurance is having a planned the dockable that is higher than the 5 of income. Insured persons would plan deductibles greater than 5 of income are considered underinsured. Which may lead to forgoing needed care. The current minimum wage under the minimum compensation ordinance which is a ordinance that we organize workers back in the late 90s to pass as well as a companion measure the healthcare accountability ordinance, under the minimum compensation ordinance which covers many of the same workers at the airport and on city Service Contracts, is currently 13. 34 per hour. Many of the workers at the airport are at that wage. The 1500 deductible that is currently in the minimum standards is 5. 4 of their annual income. So according to the health determine study 40 of adults with these kinds of deductibles that amount to 5 or more of income reported that because of their deductible they had not gone to the doctor when sick but did not get Preventative Care test, skipped a recommended followup test or did not get heated special scare. We heard reports that the meetings of workers on city funded Service Contracts not opting for insurance. Instead using indigent care at the general. We know first our organization knows firsthand of workers who have healthwho have Health Insurance instead of going to the emergency room at general and saying that they are unemployed. This shifts the cost burden of healthcare to the city while the city is also providing tax dollars to pay for the Insurance Company