Transcripts For SFGTV BOS Full Board Of Supervisors 20240712

That is our intention . And i just want to close with your questions. It feels like a half a dozen topics, but it could be a few more. But these are items that are being discussed, and i really appreciate you raising them and starting that dialogue here. Supervisor preston and thank you for your willingness to have the conversation, and thank you to all the frontline workers who have really formed both the questions and stood in the ontheground reality with folks that are living this crisis. I appreciate everyones work on this, and thanks again. Thank you. President breslin any other comments or questions . Vice president follansbee yeah, this is commissioner follansbee. I think [inaudible] Vice President follansbee regarding potential usefulness which is, of course, not firmed. So the bottom line is if a patient did not get their medications because of some complicating thing, we shouldnt be rewarding the rates based on the unavailability of medications because of overutilization elsewhere. One other thing i want to make very clear is we as a board have a very Important Role to make sure that people can manage their health care as appropriate. Theres been a National Trend of underutilization of Emergency Rooms for things like strokes and heart attacks and progress with incredibly body outcomes. As we talk about rate doe rate to make sure that our members, regardless of this effect on future rates is critical to a healthy population. So i dont want anyone to walk away from the board feeling today that we are urging them for some future rate discussion to not utilize the health care that they are entitled to in any way, sense, or form including mental health. And then, the last thing i want to mention is c. D. C. Guidelines around personal protective equipment and issues. I think were all aware of the issues that happened in some of these agencies that are novel or enhanced. And im hoping that these policies that are prevalent in all of the medical centers and clinics are being reviewed by the expertise that exists within kaiser itself, and as an Infectious Disease physician, now retire, i will applaud my colleagues and hope that theyre having discussions into personal protective equipment, used and not used and not simply relying on some federal guidelines, which, when i read them, to some extent, theyre appended by when appropriate or when possible, and that is not really in the interest of employee safety or protection. So im assuming that not only kaiser but all of our Health Care Partners are listening to their own expertise as they develop programs and plans for issues such as this. I dont have any questions, i just wanted to talk. Thank you. President breslin any other questions. Yes, commissioner. This is clare zvanski, and i want to get to utilization because i do Pay Attention to marinas demographics and the reports that she puts forward. And when i was listening to some of what lorena was talking about in regards to setting of rates and utilization, i noticed that no one mentioned age, and while im looking at and i appreciate all of the kaiser staff that was here and appreciate the comments by supervisor preston and totally appreciate dr. Follansbees comments, im thinking overall. One, is this demographic that were working with here with early and active retirees, do we have some kind of skewing of the average age that were looking at, and does that have an impact on utilization [inaudible] really are impacted by the age of the population that eve were looking at here. And the last thing that i want to add a comment on, it doesnt impact currently. But while the utilization may below right now in 2020, its still a fact that people are afraid to go out. And the message to our retiree members is you need to get your health care, and youre not walking into a contaminated area at kaiser. The people that are hospitalized with covid infections, its one thing to say okay, youre symptomatic and you have the virus, but if youre hospitalized, and you need that treatment, and people are staying anywhere from two to four to six weeks being hospitalized and under incredible treatment, that the cost of those kinds of treatments will probably offset the utilization of any other kind of utilization that most of us are used to, and i wonder if you have any speculation with regard to that. Something im really interested in is how age may or may not have influenced rating. Thank you. Thank you for your question, commissioner zvanski, and welcome back to the Health Services board. I very much look forward to working with you as youre welcomed back to the Health Service board today. Thank you. Let me address the first part of your question, and then, id like the kaiser representative to address the specific covid19 treatment impacts. This particular segment of the sfhss membership in the Kaiser Permanente plan is approximately 90 of the members or roughly 50,000 total members and their dependents and approximately 5,000 total lives are early retirees and their dependents. And as part of our overall review, when we periodically work with kaiser to evaluate costs and utilization information and also produce the renewal, we do look at employee utilization cost and utilization. I fully recognize today that as we have this discussion, we routinely present to the board every year our experience on Blue Shield Health plans and united city plans, and we do not on Kaiser Permanente. So we will be working to present Kaiser Permanente on an ongoing experience in a similar formality. Recognizing that that was not part of this years cycle and i dont think its been a part of prior years, so clearly, something we need to bring to the board Going Forward is the same type of information on kais Kaiser Permanente cost and utilization overall every year. One statistic that we reviewed this year is 92 or 93 of total covered lives in the kaiser plans between active employees and retirees is the difference between the 2018 and 2019 experience. We call that persistency. Its a basic word, but it basically means one percentage of the total population was covered last year because we would like to see patterns of change not only on the entire population but also whats happening on a constant enroll population on an aggregated basis between one year and the next. In that instance, we having observed certain demographic changes. You will recall reetas report from two weeks ago, there was a risk of about 2 to 3 in this kaiser population, so were keeping a close eye on that as well as the overall utilization pa patterns and the data. With that, i will turn it over to kaiser to answer your second question. Hi, commissioner zvanski. You were breaking up a little bit on the second part of the question, and i think it had to do with the overall utilization during covid and covid related treatment and others, so maybe if you could clarify what youre asking, and ill make sure that we answer that. Well, i was just wondering that it seems to me that there are extremely high costs in treating covid19 in the hospital, given the nature of how it needs to be treated, isolated, the intense staffing, and also the extremely lengthy actual hospitalization. And if the costs of those treatments and i dont know how many patients kaiser has with covid19 and if any of those are from our population, our membership. But the extreme cost of those treatments, that would really supersede utilization rates that would be set by what we normally look at as the everyday treatments of going to kaiser, whether its the colonoscopy or taking the kids in or whatever it is. Seeing that, in my brain, it says the costs to those hospitals are going to exceed anything that people are talking about with current utilization of low regular health care benefits. Does that cover it . Yes. Thank you for that. Were all watching this very closely. Youre correct. Were all watching the severe covid19 cases, and they could be very costly. Whats key is reviewing information regularly and reviewing your actuary and the board on whats happening with the utilization. So there is the covid19 costs and there is the possible pentup demands that can be very real, and then, the possibility of a second wave of this. So a lot of unknowns, but youre right. Those are the types of costs that were watching very closely as we go forward. And as it relates to how your rates will be impacted, we will be looking at this years utilization when developing the 2022 rates, and that will play out in that rate discussion. Yeah. Just to add one small additional item as part of what kay was saying around the pentup demand, etc. , as kay said earlier, we have been partnering with test city San Francisco, but also in our own facilities, theres the covid19 testing, the expectations and desires of Many Employers to figure out that dynamic before they return to work, as well as the Antibody Testing that were really just starting to get our arms around in terms of the Antibody Testing and if were fortunate enough seeing, if its produced before the end of the year, the costs associated with delivering vaccines, etc. So theres a lot of nuances that will happen, not just for those that end up in i. C. U. Care in the hospital and in those dire straits. I appreciate that. And because we represent a lot of the folks that are first line workers we have police, fire, paramedics and im also hearing from a lot of my colleagues working at sfgh who are meeting people every day who are coming in for services through our facilities, as well. And so all of those employees and we are disaster workers the concern is, youre right is youre right about testing. I think a lot of employees feel that if were on the frontline, we need testing, and possibly periodic testing, multiple testing. Its not like i test today, and oh, im covid free, and hooray, i go off. Its going to be more than that, so i appreciate your comments. Thank you so much. President breslin okay. If there arent any other Board Members questions, ill ask for a motion supervisor breslin, if i could go back, supervisor preston asked a question that i was able to get an answer back on. If any of our care providers test positive for covid19, they are put on a paid furlough for two weeks until they test negative, so they are not asked to work. Whether they have symptoms or not, if they have a positive test, they are on a paid furlough for two weeks until they test negative. Thank you. President breslin okay. Does anybody commissioner breslin, this is randy scott. I would move that we accept the presentation as presented on page 21 of the presentation. Number 1, that 5. 8 insured plan increase from 2020 to 2021, and the resulting rate cards that are identified in the presentation. President breslin is there a second . Sorry. This is commissioner hao. I second that. President breslin okay. Now well have Public Comment. Remember, this is item number 4, kaiser. Clerk thank you, president breslin. Were going to take a 30second pause to allow for members at home who are watching us on sfgovtv to hear this advisement. I want to remind everyone calling in, you must press onezero to be added to the queue. Otherwise, you will be just living to the listening to the commentary and questions by the commissioners and mr. Clarke, so were going to wait 30 seconds for the callers. Thank you. Clerk all right. Well now begin the Public Comment for item number 4, Kaiser Permanente nonmedicare rates and premium contributions. Moderator, will you please open up the lines for the first caller. Operator you have two questions remaining. Clerk hello. Good morning. Hi. This is [inaudible] from the San Francisco labor council. I understand these rates need to be approved for the upcoming fiscal year and but it does not excuse kaisers poor performance regarding p. P. E. S. It does not excuse kaisers attempt to silence and gag workers that work for it. City employees need to go somewhere where they can go and know that theose workers have the absolute right to speak out against kaiser in a concerted and collective way, and that i think that the board of supervisors needs to have a hearing on this and change these timelines so the community can, if need be, look for someone else clerk miss, thank you so much, but your time is up. And take care of the workers. Clerk thank you so much. We appreciate the comment. Thank you. Moderator, can we have the next comment, please. Operator you have two questions remaining. Hello. My name is sylvia alvarez. I respectfully urge the commissioners to vote no on the increases to the people of the city and county of San Francisco. Kaiser has millions that they can spend more wisely to address the Health Issues of its members. Thank you. Clerk thank you very much. Moderator, can we have the next caller, please. Operator you have one question remaining. Clerk hello. You are on the Public Comment line. Hello . If you are here to give Public Comment, your line is open. Okay. Moderator, can you please see if any other callers are left on the line, please. Operator you have zero questions remaining. Clerk okay. Thank you very much. President breslin, that concludes Public Comment on this item. President breslin okay. So the motion has been moved and seconded to approve the staff recommendation for Kaiser Permanente nonmedicare rates and premium contributions california members. All those in favor, signify by saying aye. Any opposed . All right. Then, this is unanimous with the ayes. Okay. The motion passes. All right. Now, i suggest that we have a tenminute break at this time since weve all been sitting here for almost two hours, so we will be back at 1 10. Is done by mike clarke from aon. Mike clarke, aon. Next slide, please. This will review a quick preface on rate setting methodology. Ill focus specifically on blue shield of california plan elements. A 2021 plan rating summary of the blue shield renewal, present the monthly rate cards for the access plus and trio monthly plans for early retirement employees, close with a recommendation for Health Service board action, and information in the appendix is information that i will not be reviewing in todays presentation but is available in the deck. Next slide. Next slide, please. So in the last presentation, i reviewed this page in detail. I want to just remind on only the flex funded column as that pertains to the Blue Cross Blue Shield of california h. M. O. Fund. Flex funded means theres an insurance approach where there are claim dollars based on services by members. These dollars are paid by the trust but with fixed costs for services and health care. For example, this covers physician services, laboratory costs, radiation costs, and other services that are typically part of a physician element of delivered care. As well as Plan Administration fees and large claim reinsuran reinsurance mechanism whats calling pooling. I as the aon actuary set the recommended plan rates for the access plus and trio plans using cost determined trend plan assumptions that i validate as the actuary with required pooling fees and legislative fees that we also provide scrutiny over as the actuary. In the last row, you will see that this flex funded plan does have application of the Health Service board Rate Stabilization policy, and to the extent that there are claim variations from original forecasts in a given year to address the concepts that supervisor preston asked about in the earlier presentation, any change in experience will flow to the Rate Stabilization reserve for future reuse in rating of the flex funded plan. Next slide. Same fivestep process that we used before, accounting for any design and head count changes, which again, no plan design changes are proposed for 2021 for this plan. For blue shield specifically, before Rate Stabilization adjustment, access plus would be recommended increase of 4. 4 , and trio, 7. 1 . I will speak shortly as to the difference in rating recommendations for these two plans. After Rate Stabilization adjustments, the increases are less than before Rate Stabilization adjustment because we have a surplus in Rate Stabilization that was approved by the Health Service board earlier in this rates and benefits cycle, and so the blue shield access, its 4. 5 , and trio, its 6. 3 . You can see the placement of the plans on this page that we reviewed earlier in the kaiser presentation. For the monthly total cost rates that are recommended for each plan, comparing 2021 recommended rates to 2020 actual total cost rates and showing the dollar difference and percentage difference in those rating forecasts for 2021. Next slide. And this is a reminder of the two contribution approaches that are displayed on rate cards for the active employees in the city and county of San Francisco. Next slide. And a reminder of the three contribution components from the employer from the city charter for early retirees. Next slide. And with that, i will start with a recommendation to the Health Service board and then explain the rationale for these recommendations. The staff recommends that the Health Service board approve the blue shield access plus plan renewal proposal for a 3. 6 rate increase from 2020 to 2021, the blue cross trio increase of 6. 3 from 2020 to 2021, and the rate cards presented in the Materials Today for these plans. Next slide. As with the prior commentary on kaiser, we present the rate cards for the two employer contribution strategies for the city and county of San Francisco, recognizing that the total cost rates that would be approved today would also apply to active employees and the other employers with their employer contribution sharing strategies, and the early retiree rate cards shown in this presentation apply to the early retirees who earn the full city contribution contribution levels based on dates of hire and Contribution Service with those determined by the city charter formulas. Next slide. So ill present the summary. Blue shield renewals for the two proposed plans. If you weight average the access plus recommended increase of 3. 6 and trio at 6. 3 , that results in an overall combined increase for the blue shield plans in total of 4. 4 . You can see the elements of the rate plans that ill go through shortly. They include 2021 pharmacy and medical claim costs that are net of pharmacy rebates, certainly medical services, including physicians. The fees charged by blue shield that include the Administrative Services only or a. S. O. Only fees, the Affordable Care act fee that i will discuss shortly, the Rate Stabilization surplus buydown that i talked about earlier, where in prior years, we had a buyup of the blue shield plans, but there is a buydown to the Rate Stabilization applied to the rates this year. In march, we reviewed with the Health Service board the overall blue shield plan expenses on a per employee, per retiree, per month basis. And in that discussion, we reviewed how the plan experience increased about 7 per member from 2018 to 2019, and this is slightly higher than our forecast Health Care Cost trend of 6 . Trio has a higher recommended increase than access plus because the trio plan has substantially higher large claim experience in 2019 than access plus, and ill review that shortly on the next slide. The stabilization adjustment in rates, as i mentioned, changed from a buyup in 2020 rates to a buydown in 2021. So all else, that creates a favorable change by 4. 4 . And that 4. 4 aggregate increase, it was 8. 8 going into the 2019 plan here. So this falls in between the recommended increases for each of the two path renewal cycles. These are the administrative fees on a per employee, per retiree, per month basis. This is increasing by 2 in the upcoming here, which is consistent with the National Trend for administrative fees. The large claim pooling fee is increasing by a high percentage, 18 into 2021 plan year, but it reflects a significant increase in the claims that were reimbursed back into the trust for us in the plan that for individuals who exceeded 1 million. In 2019, there was 9. 3 million in large claims exceeding 1 million per person that were reimbursed back into the trust versus 3. 7 million in 2018. And so that large increase in the large claim pooling payments back from blue shield resulted in a high increase in the large claim pooling fee. And then, the Affordable Care act has a Patient Centered Outcomes Research Institution Fee that had been scheduled to expire after 2019, but it was now extended another ten years, through 2029, as part of the federal secure act that was passed in december 2019. So that fee is 45 cents per retiree and per employee. So overall fixed fees for blue shield are increasing 7. 4 on a per employee per retiree per month basis. Next slide. So the rate cards follow, where again, ill present on the active employees for the two employer contribution models and city and county of San Francisco and the early retirees. Next slide. We start with access plus. This shows the monthly rate and contribution changes proposed for 2020 to 2021 for the early retirees and the 939383 contributions. The early contributions are the top set of rows, followed by the employer contributions in the middle, and the total cost rates at the bottom of the page. For access plus active employees, all rates are increasing 3. 6 as the contribution strategy is a proportional sharing. For the early retirees, the anchor for the employee contribution is the 729. 19 per month in 2021, which was derived based on the tencounty survey and presented and approved by the Health Service board in march. And so the monthly employer contributions increased by 3. 5 . Next slide, please. This and i apologize for the technical glitch. I understand i could not be seen for a brief moment, but hopefully, everything is working now. So for access plus, this shows the change in contributions for the early retirees, and the 1009683 contribution strategy. Next slide, please. This is the access monthly rate card for 2021 as proposed today. You can see the components and the total rate are the medical costs, the vision core plan, the 3 sustainability fee, and the reduction for the buydown for claim stabilization, followed by the application of the tencounty amount, the actuarial difference in the employee contribution based on the city charter employee contribution formula, and then, the application of the cost sharing, and finally, too, the member cost sharing premiums at the bottom of the chart, along with a comparison to 2020. Next slide shows the same information but for the active employees, 1009683. Next slide. And then the same set of charts but for the trio plan. The 6. 3 is for the active employees that you can see is proportionately shared. And for the early retirees, there is the the the employer contributions are determined by the city charter formulas, and so the difference becomes the contribution that the retiree pays. Next slide. And this is for the 1009683 employees, along with early retirees. Next slide. And the rate card for trio for the 939383 employees. Next slide is the same information but for the 1009683 early activeretiree employees. So staff recommends that the Health Service board approve the blue shield access plus plan renewal for a 3. 6 rate increase, theably shield trio plan for a 6. 3 increase, and the resulting 2021 monthly rate cards that i just presented. And if you could go to the next slide, i will ask a blue shield representative for a statement. Good afternoon, everybody. My name is paul brown. I am area Vice President for account management at Blue Cross Blue Shield california. Thank you for allowing me to speak on the 2020 renewal. 96 of our rates go to medical and pharmacy claims for sfhss members. Health care inflation is a reality both locally and nationally, and we are continuously fighting to control health care inflation. For example, the cost of specialty drugs for various medical conditions have escalated far above general inflation. In fact just recently, last week, the f. D. A. Approved the most expensive drug ever, a 2 million drug for an infant muscle disease that didnt exist before. Locally, we continue to work with our provider partners, including brown and tolen, hill positions, ucsf, dignity, and others, to find innovative ways to manage Health Care Costs for members. The average rate change over the last eight years since weve had those provider partnerships in place has been approximately 4 . We will continue to work to control overall costs. A recent example is the announcement that alteas, a Company Launched by blue shield in 2019, merged with brown and tolen in order to provide their 2700 doctors with next generation tools and technology that will allow them to spend more time with patients in order to improve the quality of care and reduce provide burnout. Blue shield, our mission is to provide high quality, Affordable Care for all of our members, and we will continue to drive that for sfhss members, as well. Thank you very much. Now, thank you. And with that, would you please go to the next slide. Please, commissioner breslin. President breslin i was just going to ask, are there any questions, but ill wait until you finish the slides. Yeah, so just restating the recommendation and happy to take commentary. This. Commissioner zvanski this is commissioner zvanski, page 22, the eaprocess for the earl retirement employee, mike, can you explain what thats all about . Yes, i can. So the base part of the city contribution employer contribution formula is the tencounty amount, and anthony, if you could actually flip back probably three slides three to four slides, but ill guide you, just so i can have the slide up as i address commissioner zvanskis question. Two more slides, please. And one more slide. So lets reference this slide because it also shows at the bottom of the slide that difference. So today, the retiree only, without medicare, in the trio plan, based on how the city rates and charter work, pays 11. 95 im sorry, pays 23. 87 per month for coverage. So that is in the first column of the early retirees. So the retiree without medicare column, the nexttolast number on the page, the 23. 87. Its now going to 35. 82, which commissioner zvanski identified as an approximately 50 increase, or an 11. 95 increase in member contribution. The basis of the city charter employer contribution formula starts with the tencounty amount, and that tencounty amount for 2021 is 729. 19. It is approximately 3 over the 2020 amount that is approximately 705, and with the actuarial adjustment, you see increases. The actuarial difference portion of the formula, its also shared proportionately in the retiree prop e portion of the formula. But with the tencounty amount only going up by 3 , that means the aggregate city contribution increase is going up by less than the 6. 3 that the total rates are going up. And so that creates a circumstance where the proportional increase for the retiree contribution is increasing more. And because of a relatively low figure and again, im saying that actuarially, not as a judgment on the figure, but just from an actuarial standpoint, 23. 87 going to 35. 82, you know, does create this 11. 95 increase, but does create a percentage increase environment where that specific contribution is increasing by 50 . So in the end, its all about the tencounty amount and how thats changed versus the 2020 amount, then guiding a city contribution increase thats less than the 6. 3 overall rate increase. Im certainly happy to take further questions, commissioner, if you have them, on this. Commissioner zvanski no, thats all i asked for. And my apologies to commissioner breslin. I should have said through the chair, so i apologize for that. Thank you, mike. Thats a good explanation. I appreciate it. President breslin any other commissioners comments . Vice president follansbee yeah, this is commissioner follansbee. I have a question. As i recall from our initial deliberations over the development of the trio option, one of the big components that let to essentially a significant rate reduction for that trio plan was that the Center Hospitals were not available as an option to trio members. Over time, that has changed. Finally, blue shield signed contracts with sutter, and so im just wondering if you can speculate a little bit about whether the marked increase in claims experience, was that because there was just more serious medical conditions, like we heard in the last presentation, heart transplant, or does it have to do with a new plan for the trio members that didnt exist. I bring it up because the difference between the trio contribution and the access plus contribution is being whittled away, its quite a bit of difference between last year, the two plans. Let me make another comment. This is paul brown, blue shield, and mike, feel free to add on. Specifically to the sutter comment, when sutter requested to join trio, if you may recall, they were not originally in the network. They joined. We were able to negotiate a contract that had no material impacted impacts on the rates at that time. They came in, and we could not afford to change their rates. The coming of sutter into the network really isnt material to the increase this year, and, in fact, im doing this from memory here, but in our utilization review meeting with staff, i believe a greater share of claims are at ucsf, not at cal Pacific Medical center. I think overall and mike can comment more specifically on this the gap well, let me go back a few years. The gap between access plus and trio originally was about 10 , and youre right. Its narrowing this year. Overall, trio operated as we intended it. Unfortunately, in this coming year, this appears to be a there appears to be a disproportionate number of claims between trio and access that are driving this. We are on the risk and liability for any amounts over 1 million, but sfhss is up to 1 million. So to the degree theres more of those, it does have an impact disproportionately on the trio renewal. Yeah, and ill make a comment a couple of additional comments, so thank you for that. So number one, there is a large plan underway for the plans presently, so Vice President follansbee, to address some of your questions, that is driving some of the audit activity that was spoken to by folks at the prior meeting from sfhss, so just to be aware of that. And specific to this year, there were eight total claimants that exceeded the 1 million stoploss point. But in particular, five were 2 million and above, including one 3 million claimant and one 4 million claimant. As i said, we only get the dollar amount, not the identifying information, so were reviewing the dollar amounts only. The large claim experience this year was magnified, and thats presented in the statistic i shared earlier about how much more in dollars was reimbursed in 2019 by blue shield for the large claim pooling than was in 2018. President breslin any further questions on that . Commissioner zvanski this is commissioner zvanski again. Through the chair, mike, what you just talked about or actually, i guess, mr. Brown, as well, if the point of having the difference between access and trio was the sutter was inclusion of sutter or exclusion of sutter, how could they have been allowed to join when that was the basis of having the two separate options . Im not sure i understand why now sutter is available in both options . It doesnt it seems to defeat the whole point of why we were really adamant about that and why our members were adamant about that, and especially our labor our labor folks were adamant about having sutter come onto keep costs much lower for members. Could you explain that, please. Let me take a stab at that, commissioner zvanski. Sutter was initially excluded, and we went for a period of time without sutter, and the care was successfully redirected to other facilities. We we, working with brown and toland, working with ucsf, successfully redirected care to nonsutter facilities, and it was at that point that they came to us, asking if they could please become part of the trio network. And our request of them was that it cant be it cannot impact our rates, so they had to come in at a price point that im not at liberty to disclose here, but they came in at a price point that made it cost neutral for trio in general. Our thought was if it means better access in particular for some lines of service like maternity, where that is a common referral pattern from brown and toland from ob gyn, and the care isnt affected, thats what we want. Its about actively working with providers to get to the right price point. Does that commissioner zvanski thank you very much. Thank you. President breslin any other commissioners questions . I have one. In these flex funded plans, mike, do you can you see the actual these claims are active with what the costs is . I dont know why im getting an echo here. President breslin, im happy to answer that. There is an online portal where we can access claim information, and were also being provided claim information as being separately reported by the blue shield account team to us. And then, on a semiannual basis, we work with blue shield as they prepare very detailed information to share with sfhss and aon as medical and pharmacy claim experience, again, on an aggregated deidentified basis. But it allows us to see greater detail on the claim experience thats been captured by blue shield. So we have access to that information for any experience that is directly claims that passes through to the trust. So those would include hospitalization costs, for instance, or other facility related costs. The cappitatiitation figures te related to blue shield, we review those per month, but those are aggregated figures that blue shield provides us. We do look at those capitation figures from one year to the next, the costs for physicians, laboratory radiology, othalong with some other elements of care, so that is the type of information that we gain access to within aonto support our review and the underwriting process that i described earlier in this presentation. President breslin okay. And so when you you start the new rates, looking at last years rates, and now that weve had flex funded, you can better see what theyre actually charging or what they actually cost. But you know, im always wondering about the starting point. I know for years, weve had blue shield, and for many years, i, for one, and other Board Members felt that they came in with very high rates, and we had a tough timekeeping rates down, so they had the one thing ill sorry. Go ahead. President breslin maybe you see that now. The other thing is the all claim database that, you know, Marina Coleridge spear heads from the sfhss side, and we work closely with marina to understand that and how that relates to the information thats reported to us by blue shield both directly through their account executive team and the portal. Well fully, going back to Marina Coleridges report from two weeks ago, there is a high risk in the membership of the blue shield plan compared to the Kaiser Permanente plan. The costs are higher in part because of the higher level of health risk that presents and ultimately reflected in the risk or data that marina produces for the board. President breslin okay. Thank you. I just wanted to point out that early retirees, it says and family, but that means a member with two dependents, maybe a spouse and a child, it results in 16,000 a year, which is a lot of money for a retiree to pay versus someone who was able to work a lot more years. And the trio, as commissioner zvanski pointed out, is going up a lot, too. But we have less choices, and less choices means less competition and higher prices. And were not going to change that here today, but im looking at this, and all we have is blue shield and kaiser. We really need more choices to keep these costs down somehow. I just find this is getting almost two expensive for an early retiree with two dependents. Sure. And if i could comment, with regard to how the employer contributions are set based on city charter formula, and this is illustrated by that earlier early retiree bar chart in this presentation. The city charter formula does provide for a higher level of employer contribution for covering that first dependent as a retiree, and so that alludes to the gold bar in my threecolor bar chart earlier. The light blue for the tencounty, the dark blue for the actuarial difference, and the gold bar for the employee contribution. However, there is no incremental for the employee or second higher dependents. The employer contribution for a given plan is the same between the retiree plus one and the retiree plus two or more tiers. President breslin right. Okay. Thank you, mike. Are there any other questions from commissioners . Vice president follansbee this is commissioner follansbee. I just want to make a comment in light of the questions and questions that you had, president breslin, and that is that we heard about the saltais contract, and the issue with blue shield is they deal with multiple medical groups. The oakland medicals database, and one of marinas favorite terms was efficiency. I suspect blue shield will be looking into efficiency and maybe be able to evaluate any added benefit of an outside agency sort of assisting providers in that regard and whether that could be generalized to other medical groups. Blue shield must have quite a task, looking at different medical groups. So theyve got competition within their own system to try to become, you know, maybe more efficient, and hopefully, that will end up with an adjustment of rates for us in the future. President breslin okay. Any other comments . If not, i would entertain a motion. Vice president follansbee this is commissioner follansbee. I recommend that we follow the recommendations for the blue shield 2021 plan rating as outlined on slide 10, including the monthly rate cards. Commissioner scott this is commissioner scott. I second the motion. President breslin okay. All right. Public comment on this item . Clerk excuse me. This is commissioner zvanski. Is it slide 10 or slide 27 . Clerk the recommendations slide is just repeated throughout the presentation, so it is slide 10. We just use the same recommendation card throughout the presentation. If that makes sense. We just duplicated the information. To be accurate, i can say slide 10 and slide 27. Clerk and now were going to move to Public Comment. Were going to give about 30 seconds for sfgovtv and live stream to catch up for Public Comment. So were going to be silent for 30 seconds, and then, well begin the Public Comment directly after. Clerk all right. Moderator, we will now begin the Public Comment section of this item. Please on the line, please remember to press onezero if you want to give Public Comment. Moderator, will you please open the line for the first caller. Operator you have two questions remaining. Clerk hello. Good afternoon. Youre on the Public Comment line. Hello . Good afternoon. If youre on the phone line, youre on Public Comment, and your time will begin when you give your name. Moderator, can we go to the next question, please . Operator you have one question remaining. I urge the commissioners to please vote no on any further copay increases and premium increases. Its a monetary hardship for the retirees. And due to the pandemic and economic depression, the fiscal burden is only going to increase. Thank you. Clerk thank you very much for your comment. Moderator, will you please move to the next caller, please. Operator you have one question remaining. Yes. My name is joseph newen, and i would like to say that with covid19 and the depression going on, that you should reconsider this whole thing. Thank you. Clerk thank you very much. Moderator, will you open up the line for the next caller, please. Operator you have zero questions remaining. Clerk thank you very much. President breslin, this concludes Public Comment. President breslin okay. We have a motion on the floor. The motion was to approve the staff recommendations, which was blue shield rates and premium contributions. All those in favor, signify by saying aye. Are there any opposed . All right. Its unanimous. Now we move onto item number 6. Commissioner zvanski commissioner breslin, this is commissioner zvanski. May i make a comment before we move onto the next item, please . President breslin sure, go ahead. Commissioner zvanski prior to this meeting, i did a lot of research with regard to what would happen if we did not pass these rates because were still getting the Public Comment of members who are very upset and dont want to see rate increases. And obviously, were painfully some of these are more painfully aware of these rates as the early retirees. As you pointed out, president breslin, the family rates for early retirees. But what i learned is if we didnt go forward with rates, because we have annual contracts, that there would be no Health Care Plans available in 2021. And i just want our members to understand that setting rates annually is a requirement and that there are various constraints we have to deal with and considerations that we have to make in Going Forward, and that our staff and actuaries worked very hard in negotiating these rates. And while some of us still think some of them are a little too high and whatever our opinions are, we actually are required to go through this process, and we are required to have, and the board of supervisors accept and confirm our rates so that everyone in the system can have health care given through the employer in 2021. And i just want us all to really understand that, that its not just a matter of our choice of sitting here and saying, you know, we think theyre too high, and were going to vote no. So i appreciate all of my colleagues on the board in supporting these rate increases. Theyve been hard theyve been negotiated very hardly . Toughly . Its been a difficult process, and we appreciate it, but i just want everybody to understand the perspective. Thank you. President breslin okay. Madam secretary, item number 6, please. Clerk yes. Item 6 is the review and approval of the United Health care preferred Provider Organization nonmedicare rates and premium contributions for active and early retiree members, plan year 2021. This presentation is done by mike clarke from aon. Mike clarke, aon. Next slide, where we will present the United Health care p. P. O. Plan nonmedicare rates and premium contributions for active and early retiree rates. Ill start with a brief process focusing on the u. H. C. Plan, the rates, the rate cards proposed for active and early retirees. And as with similar employees here today, there is appendix information that i will not review, but this information is listed here and contained in the document. Next slide. As we start the preface, we focus now on the selffunded column that represented the uhcppo city plan. Selffunding means the claim dollars that are based on services delivered to members are paid by the trust, along with plan administrative fees to manage the plans. This includes processing claims, providing call center for members and other aspects of what United Healthcare does to support the management of this selffunded plan of sfhss. I as the aon actuary, set the recommended plan rates for the uhsppo city plan using health plan trend assumptions and required fees as well as any administrative fees that may be included in the program. The rate policy of the Health Service board does apply to the uhcppo, and ill be discussing the inclusion of the stabilization policy in the adjustments from 2020 to 2021 in this plan today. Next slide. And we use the same steps that ive outlined earlier to determine the rate change factors that well be reviewing today. Next slide. Focusing on the city plan and city plan choice not available, the average overall increase for these plans before Rate Stabilization adjustment is 7. 5 . The plan does have a deficit position for Rate Stabilization, and as approved by the Health Service board earlier in this rates and benefits signi benefits cycle, there is a an element of rating for the Rate Stabilization cycle plan. This brings the increase to 9. 0 on an aggregated basis in the review of these plans, and well review that detail shortly. Here you see on the bottom two portions of this chart that we reviewed earlier the overall plan rates for the uhcppo city plan and city plan choice not available. The city plan does have the highest total cost rates for the active employees, and the city plan choice not available exists to support a lower framework for member contributions for those who do not have full access to every plan here on this page, and well discuss that shortly. Next slide. Just a reminder of the citycounty of San Francisco active employee primary contribution approaches, the 939383, and the 1009683. I alluded during the kaiser presentation to footnote two, and ire reinforced that here. Based on m. O. U. , the employer contribution dollar amounts are set to equal the employer contribution dollar amounts for the second highest cost plan, which is the blue shield access plus h. M. O. Plan that was just approved for 2021 rates. The exception is the employee only tier and the 1009683 contribution approach, where the member pays no contribution for any plan. Next slide. And you can see, on the lower left of this slide that weve referred to earlier, the uhcppo city Contribution Plan elements for the three city charter employer contributions. Next slide. So with that background, ill review our recommendations that ill be talking through staff recommends that the Health Service board approve this renewal presented in this document and the 2021 monthly rate cards presented in this material. The resulting aggregate overall rate increase for the combination of uhcppo city plan and city plan choice not available, including the stabilization adjustment that i spoke about earlier, is 9 , and i will talk about how thats distributed across city choice and city choice plan not available and active and early retiree employees during this presentation. The active rate cards are shown for the two most common employer contribution strategies. And again, i documented what i highlighted in the m. O. U. For ccsf employees. The contributions are set to the second highest plan. Next slide. Next slide, please. The recommended rate increases for the uhcppo are based on 2019 claim experience thats intended to 2021, as well as the previously approved uhc 2021 administrative fees from the march 20 h. S. B. Meeting, and these fees are also documented in the appendix to this material, as well as the previously approved changes and Rate Stabilization amortization applied to the rates between 2020 and 2021 approved at the february 20 h. S. B. Meeting. There are no rate plan changes for the 2021 plan year, and the rate cards include the following cost components. The projected 2021 medical and pharmacy cost plans, the 2021 fees for the Administrative Services only portion as well as the fees for the shared Savings Program that u. H. C. Has with sfhss. The buyup for Rate Stabilization and amort asedation. As well as the v. S. P. Basic vision plan premiums and the 3 Health Care Sustainability fund charge. Next slide. The overall plan experience for 2019 was similar to National Trend expectations with an approximate 5 increase as we reviewed earlier in this rates and benefits cycle. The plan claims forecast are based on 2019 claims intended to 2021, using annual trend factors of 5. 5 por medical and 6. 0 for prescription drugs. The amortization of the deficit results in a higher level of buyup in the rates. This adds 1. 6 to the overall rate increase, and now, were segmenting the overall rate increase into city choice plan and city choice plan not available. And it is [inaudible] for the uhcppo early retiree families by 2021 to the ratios for the blue shield plans. So you will see that final year of that adjustment that was approved to may 2018 when i present the rate cards today. For the active employees, the segment is an approximate 10 increase for the city plan rates, and for the city plan choice not available because the rating matches that for the blue shield access plus plan, the city plan choice not available increase for the aksia active employees is 3. 6 . Next slide. So ive spoken about city choice plan not available. Su just as a refresher for the board, this outlines the criteria for Rate Determination as approximately as the population distribution into regular city plan versus choice not available. Choice not available was created in 2019 to facilitate a lower level of member contribution for employees and retirees that live in a zip code where one of the following occurs either city plan is the only plan choice available, which is the case for the vast majority of city plan choice not available individuals, but then, there are also a few who may live in a zip code in california where city plan and Kaiser Permanente might be available but not blue shield access plus, or city plan and access plus might be available but not Kaiser Permanente. But again, of these three scenarios and these three dashes, city plan being the only choice available is the reason for qualification for city plan choice not available for the vast majority of these individuals. And youll see the distribution for active employees. Most of the city plan enrollees have full choice, but there are about 116 who do not, primarily in the hetch hetchy and moccasin employees. Next slide. And so the Rate Determination for city plan choice not available for active employees is the same rates including all card elements as the blue shield access plus plan, and for early retirees, the same premium rates, and for the city plan, which leads to lower retiree contributions relative to the city plan based on the application of the city charter employer contribution determination formulas. Next slide. So with that, well go into the rate cards. And again, just a reminder of the information that i presented earlier. Next slide. For city plan, the monthly rate and contribution change, 2021 versus 2020, is influenced by several factors, and again, you see top chart, monthly employee and retiree contributions, middle page, and total page. The total cost that i referred to for the employees of an approximate 10 increase, for the early retirees, we spread that 10 across all the tiers based on the final year of the three Year Adjustment for full families. However, this does not adjust the calculation of the retiree only monthly retiree contribution. Because of the actuarial difference, it absorbs that difference in the retiree premium only increase because the actuarial amount provides the increase of the retiree only rate portion minus the portion for active employees. But the rates do increase 18 for the retiree only column because of what i spoke about earlier. For the active employees, the monthly employer contribution amounts are the exact same what we reviewed earlier with access plus. So when you take a roughly 10 increase in total rates, less only a 3. 6 increase in employer contributions, because of the way that m. O. U. Works, it results in employee contribution increases that exceed 20 . Next slide. So this is the same information that i just presented, but for active employees. The 1009683 strategy, whereas the employee only pays no contribution. This is the rate cards done with the uhcppo city plan. You can see the various components, and then, again, the right side of the page and the middle of the page shows the city charter employee contribution elements that construct the city contributions for retirees. Next slide. And this is the 1009683 active employee version of the rate card. So that is the city plan information. The next slide starts the information on city plan choice not available where, again, these are individuals that do not have full plan choice across the entirety of the United Health care, blue shield, and Kaiser Health care plans. The active employee pricing mirrors that for the access plus. The monthly total cost rate mirrors that of the city plan, but the employer contributions are higher because the retiree contributions match those for the access plus plan, as well. Next page. And this is the 1009683 contribution. This is the 2021 rate plan for the 938383 early retiree employees, as well as active employees. And 1009683. Next page. So as we cascade to the recommendations page, staff recommends the Health Service board approve the uhcppo and city care not available approve the plan rate increase. The individual populations and tiers would have varying increases that would ultimately overall average to 9 , as well as the resulting 2021 monthly rate cards presented in this material. And as you move to the next slide, ill ask for a statement from a United Health care representative. Thank you, mike. Good afternoon, and thank you, Health Service commissioners. This is heather tear with United Health care plan. United health care has launched many initiatives to support clients in communities with the covid19 pandemic. In addition, we recently shared with sfhss that were going to be returning 10 of the monthly sfhsshso fees paid to help alleviate some of the financial pressures. As many of us know, many of our plans have members that are older or have Chronic Health care issues, so we continually work with our Health Care Providers and bestinmarket netwo bestinmarketnetwork pricing for our plans as well as Group Network plans for our city and county of San Francisco members. Thank you. Thank you. Im happy to answer any questions, president breslin. President breslin any questions from the Board Members . President breslin no questions from the Board Members . I will ask for a motion, then. Commissioner scott this is commissioner scott. I move the acceptance and staff recommendations contained in the presentation now on page 29 and ive forgotten the earlier page and the resulting rate cards that have been presented. President breslin do i have a second . Vice president follansbee this is commissioner follansbee. I second the motion. President breslin any other discussion . Commissioner zvanski commissioner breslin, im sorry. I was muted, but i do have a couple of questions, if i may. President breslin certainly. Go ahead. Commissioner zvanski ive noticed for some employees, the employee and family plus rate have been going down im sorry for the echo and im wondering why those rates or at least the outofpocket seems to be diminishing. I was curious about that, and i may have misunderstood something. I thought i saw somewhere there was a charge for a u. H. C. Dental h. M. O. , and im wondering what happened because i thought we had delta for employees. And the last thing, im still puzzled that after the stabilization is applied, we end up with a higher rate than 9 , because i thought the stabilization would help keep the proposed rate increase lower, and so i must have missed something, and i apologize, mike, but its, like, how do we get higher . So thank you for those. There is a dental offering through United Health care as an h. M. O. It is one of two dental h. M. O. S offered to active employees and early retirees. The dental h. M. O. Rates are not included in this presentation. Well be presenting those in two weeks, on june 11, but United Health care does offer a dental h. M. O. As a plan choice to go along with the delta dental p. P. O. And the delta dental care h. M. O. With regard to the rating, you asked about both the family adjustments for early retirees as well as the rate zabl Rate Stabilization. We were evaluating the rates hearing differences between the single tiers and the full family tiers between the united Health Care Plans and the other available Health Care Plans to early retirees and determined while there are not many early retirees in t taking the Family Health care plan spmp. We felt it was important to look for opportunities to help create a more consistent approach to rating for early retirees in the United Health care versus the other plans. And so thats created an environment thats allowed us to lower the rate for the early retirees, and the early retiree families. And for the Rate Stabilization, the Rate Stabilization policy does describe both for deficits and reserve surplus balances. It is meant to help stablize the impact of rating actions from one year to the next, where policy includes amortizing onethird of the Rate Stabilization balance over the course of a threeyear period, so onethird in each year. And then, with annual readjustments happening based on subsequent plan year experience. So for instance, i alluded to the february 2020 Health Service board presentation, where we evaluated the u. H. C. Plan experience for 2019 and adjusted the stabilization, in this case, stabilization deficit for the uhcppo plan, and unfortunately, that stabilization grew as a result of 2019 experience, so that resulted in a higher buyup adjustment rates in the plan for 2020. I hope that addresses each of your questions, but im happy to take further inquiries on your questions. Commissioner zvanski thank you. President breslin any other questions . If not, we have a motion on the floor. Yeah, and president breslin, could i jump in very quickly . The United Health care representative stated the a. S. O. Fee relief thats occurring, just to correct, it does not go to members, it becomes something that flows through the trust, so i just wanted to clarify that particular point. Very appreciative of United Health care for passing along that fee relief as the u. H. C. Representative described, but just to clarify, that will become a you know, something that flows through the trust. President breslin so as part of our trust. Sfhss, correct. President breslin so is it earmarked for anything . I cant speak to that. All i can speak to is just knowing that that will flow through to the trust. President breslin okay. I will have to defer to an sfhss representative potentially to speak to that, or perhaps that becomes a follow up. Commissioner scott this is commissioner scott. I would be interested in snowi knowing the amount of that fund coming back to the trust. As well, and i would ask to have a panel to report on that at the next meeting or as soon as its available. Yes, commissioner scott. We have a meeting in two weeks, so well be happy to report that to you then. President breslin okay. The motion on the floor it s t approve commissioner scott karen, we need to have Public Comment. I know weve been at this for so long. President breslin yeah. I just wanted to remind everyone there is a motion on the floor. Okay. So well have Public Comment. Clerk thank you, commissioners. Yes, were going to wait 30 seconds to allow for the catchup at home. People watching at home on sfgovtv are delayed by about 30 seconds, so were going to wait about 30 seconds, and then, well open up the phone lines. Clerk all right. We will begin Public Comment for this item. People on the conference line, please be reminded that you have to push onezero to be added to the queue. Moderator, will you please open up the phone line for the first caller. Operator you have zero questions remaining. Clerk president breslin, that concludes Public Comment. President breslin great, great. Okay. So we have a motion on the floor to approve United Health care nonmedicare rates and premium contributions. All those in favor, signify by saying aye. All those opposed . The ayes have it, and its unanimous. Thank you very much. No further business. I believe this meeting is adjourned. Commissioner scott thank you. I was going to move for adjournment. President breslin thank you. Hi, everybody. Im San Francisco mayor london breed and im joined here today by our county Health Officer, dr. Thomas aragon. He is a native san franciscan and has been with the department for over 10 years, has been responsible for all of the decisions that are being made to keep us all safe and healthy. Just yesterday, we made an announcement about a safe reopening plan and i want to talk a little bit with him today about the kinds of decisions, the very hard decisions as a Public Health officer that he has to make to keep us safe. I want to touch a bit on how are we going to reopen safely. Why the decisions around masks and locations that are opening at the time they are opening. I know so many of you have so many questions and also there is a lot of uncertainty. So today we want you to meet your county Health Officer and we want to dig deep and talk about why the decisions that are made are important for us to follow and what we can do to remain safe and healthy in San Francisco. At this time, i just want to welcome you, doctor. Thank you so much for your work. We know that that we have been working hand in hand with other county Health Officers throughout the bay area. A lot of hard decisions that weve had to make in every step of the way, i know you focused on Public Health. Lets start from the beginning. I know that initially we were having discussions about the need to start to reduce the number of people at events and then finally begot to this shutdown and it was necessary. So tell us a little bit about how the decision was made to really get to this point. Thats a really good question. If you remember in march, everything was moving incredibly fast around the world. We saw what was happening in italy. We saw the number of cases, the number of deaths and understanding the information that was coming out of [inaudible] so i think that [echoing] i think that that information that was coming out and seeing how other countries were responding, the United States has not been there yet. We did not have a surveillance system. And so as we moved and started shutting things down, i think that really set the mindset. We were incorrodably supported by yourself, elected officials in the bay area were very supportive of everything as we moved forward. I think that is what really set up the ability for us to collectively make a decision because we really felt we have the support of elected officials and also of the population. That was on march 16 that we got together and decided collectively to do the shelter in place. Yeah. And i remember those days because i remember as i was given arbitrary numbers of, you know, closures of events, i got to a point i know i ran out of. A little patience when i felt like, well, why sit 100 versus 50 or why is it 1,000 versus 500 . We got to a point where we knew that, in order to protect as many people as we can, we were going to get to that point so why continue to kick the can down the road . So, we appreciate the support and the guidance you proud on helping us to make that decision. Tell me the role of a county Health Officer. I am making decisions and leading the city, but im getting advice from from my county Health Officer. Thats you. Tell us about your role for Public Health in San Francisco. The way it works in california so, authority really exists at the state level. And in california, were fortunate what they do is that every Health Jurisdiction has a physician Health Officer, by law, to implement Legal Authority around Health Issues throughout california. And so thats existed for many, many years and so its a big state to have policies that are customized to the issues that people are facing. San franciscos very unique because were a city and a county. Whereas the county Health Officer in los angeles has to deal with 88 cities. I only have to deal with one city. So, it makes it a little bit it makes it easier for San Francisco to be much more agile in responding to Public Health threats and i think that is one of reasons why San Francisco has been a leader in Public Health is because were very agile and so that is basically how it works. So, yesterday we made an announcement. Working with the Economic Recovery Task force, the department of Public Health, we focused on and our assessor recorder who has been leading this effort, we talked about ways to reopen safely. And we announced this plan and, of course, it was really challenging. Because vefn though, from your perspective, you see the numbers are changing and the testing is going up, the p. P. E. And were in a better place. People really are frustrated. They feel like this is moving too slow. And they dont understand why one business over another is able to open or why museums are able to open. Or why did we pick the things we did to open. Again, people are this is not just about me wanting to go to the hair salon. This is about the fact is those folks who have hair salons in places with direct contact with people, they have no income coming in and they are struggling. So, can you talk a little bit about the decisions that youre making . I mean, i believe theyre too conservative. You believe that they are a little bit faster than what you would like them to be. Help us understand what goes into making a decision as to who is reopening and why, based on our s. F. Safe reopening plan. So, one thing to appreciate that we have never experienced this before. So, while it was in some ways straight forward to shut down the economy, opening it up is much more complex because theres so many stakeholders that are involved. And the city cannot act by itself so we work with a region and we work with the state. So weve been working with the state and really making sure that we have smart alignment with the state. The state has some challenges because theyre going to come out with recommendations thats almost a one size fits all for california. So, while it may be too slow for humboldt county, it may be too fast for San Francisco. We face some very unique vulnerabilities that other cities dont face. Were the second densest city in the country. We have, when commuters come in, we have a lot of folks and so while we have made incredible progress, we want to lock in those gains. We want to lock in those gains. And we want to move forward in a way that is going to be safe for everybody. Were really committed to not moving backwards and i think as we learn more about this virus and how it acts, we want to move forward and not backwards and safely in alignment with our region and the state. So, doctor, heres my pushback on that because, for example, in Grocery Stores where the system exists or even target is open because it has a component of a grocery store, you wait in line, youre wearing your mask. Only a limited number of people are able to go in. Youre still there. Theres no rules about what you can and cant touch, even though people are, for the most part, socially distancing themselves within those stores and those locations. And theyre not probably touching as much. They may have gloves. So, why is it that, like, for example, book stores and other retail businesses, you know, why why cant they do the same thing sooner rather than later . So, what happened was that we realised is that to open up the economy, we had to phase things in. So, that is really critical. And the state provided an overall framework and Economic Recovery Task force applied criteria to identify the areas that had the highest risk and the lowest risk. And what you do is you start with the lowest risk areas and you just slowly move through those phases. And one of the challenges is that some people in the later phases say i can do that safely and that may very well be true. Its just that we cant do everything at once and that is really the challenge. Even though some people some industries in later phases could, in theory, do things safely. We have to phase it out so that we dont move too fast. The next thing we do is we give it about two to four weeks to really understand the implications of what we just did. Because we dont want to do too much and then have to move backward. Just to give you an idea, theres already two counties and one is sonoma and the other is lassen where they felt they moved a little too fast. Sonoma is slowing down and lassen pulled back from one of their reopenings. It is critical for us to be mindful and make sure we have enough time to make sure that we dont get ourselves into trouble. Check the numbers. And then continue to move forward. And i think what we do know from the 1918 influenza pandemic, those areas that moved at a good pace did better economically because they did not have a large second wave of infections. Lets talk about that. While were averting one Public Health crisis, were unfortunately creating another. And so i know that depression is seting in with some people. Folks who had no income and no ability to take care of themselves and their families. We know that domestic violence, suicide, child abuse, all these things are a result of what we see happen and it is even worse for people in lowincome and poverty. On the one hand, we are lowering the curve and really been a leader in that effort but there is another Public Health crisis that is brewing as a result of the decisions that were making. How are we expected to sustain this . How are we expected to continue to live like this while, you know, there still are a lot of people suffering from something thats a different Public Health crisis. I agree. I agree with you completely. And i think thats really one of the challenges and, you know, when the Health Officers talk about the issues, we recognize that when you look at health in its complete way, the way youre describing, we absolutely have to take into account those tradeoffs. And that is for me. My personal commitment, i feel like im now on a mission. I feel like im on a mission to get us to open up as safely and as quickly as possible because we know that we have to have get back to work, people have to get back to seeing their doctors and people have to pay the bills, pay the rent, pay for schoolsment all of those things that all of us need are absolutely critical and that is one of the reasons why some people say to us why are we being so strict . Its because i want to keep moving forward and i completely appreciate everything that you are bringing up and that is what makes these decisions very difficult. And what about the seniors living in isolation and need to see their family members in what about the kids who are maybe, you know, only children who havent played with another kid for this long . Like this is not sustainable. Like emotional, its having an impact on peoples lives so i think it is going to be important that we give guidance. Like what kind of guide . The fact is, people for the most part r going to see their parents or their relatives or scheduling playdates and i know that we have said that is not a good idea. But people are probably going to do it anyway because they have probably had it. And i honestly dont blame them. So tell us a little bit about how people can do these things safely. I think human behaviour, we cant help ourselves. We want to be around one another. And we want to interact one another. I guess that we want to stop the virus, but we also have a you know, if my grandmother were still alive, she were at laguna honda, if she were still alive it would literally kill me not to go up and see her. So i just need you to help us understand, how are we going to see our relatives and other friends and folks safely. What is the solution to . To this . You are bringing up a really important issue and actually the Health Officers right now and actually the Health Department is going to design new strategies to bring people together, to bring households together for just the very reason that youre saying. And so in some ways we feel like can we dodge this bullet . And now we have time to do this right and youll be seeing over hopefully over the next week, well be coming out with recommendations for the region on how families, just the way youre describing, can really come together. But we want them to really think through and make sure that they do it safely so we want them to be a aware of the physical distancing, wearing the Face Covering and washing their hands. Its really important for social connections to stay strong and so we will were moving in that directionful and youll hear more about it in the next few days. Because we also know that, for example, there is going to be limitations to our summer quafrp and limited capacity for child care so what about those families whose kids dont make it into child care or summer camp . What are they going to do with, you know, their children. How how how are we going to make sure that they have access to other kids . And they have access to the abilities to be around one another and be around one another. I think i noticed that i see a lot of teenagers Walking Around together with one another. Some of them are wearing masks, some of them arent, but its really tough. I do think it is going to be important that, as we continue to try and push forward more Health Directives, if we expect people to follow them, you know, we gotta also think about human nature to provide them with safe guidelines to do so. So that, as you said, we dont see a surge and we dont go backwards. So, i know folks are going to be looking forward to those guidelines because this is going to be critical to our ability to meet the goals of waiting for things to open and get back to work and the other things that we need to do. And im expressing the frustration of the people of San Francisco because we know it is a fluid situation and i know people are tired. And it is really hard to sustain it and now there is another Face Covering requirement. Can you tell us about that requirement and why is it now 30 feet, why are the requirements a lot they seem stricker. Can you talk about what the new requirements are around Face Coverings . Yeah. Let me just really quickly just give a very quick background and why were very concerned. When you think of covid19 disease, we know that its more infectious than the flu. Its 10 times more deadly than the flu. And so were very concerned as we begin to open things up, how do we do it in a way that we continue to move forward . That is the first thing. Because there is no vaccine and no real effective treatment, we only have a few tools available to us. One of them was the hammer, which was shelter in place. We dont want to go there. We want to move away from that. We have only a few things left, which is physical distancing, Face Coverings and hand washing. And so now we want to make sure, as we lift shelter in place, that were doing the best we can in those areas. To give you an idea about Face Coverings. So, we know from the science thats emerging and from the mathematical models that have been developed that, if 80 of people wear face masks or Face Coverings consistently, we can prevent outbreaks. That is humongous. And so its really important for us to appreciate that. The countries that are being successful in keeping their economies open are the countries that have universal Face Coverings so we have to have we have for the next year, until we get a vaccine, this is only temporary, it is not going to be forever. Until we get to the place where we have a vaccine and we can safely have everybody most people immune, this is the bridge that is going to get us there. It turns out that the risk is very low, but the benefit is very high and it is going to allow us to have more movement and families to getting to and, over time, as the infection goes down and the risk goes down, were going to more and more people will be able to come together. So, it is going to have a big impact. So, why 30 feet, i guess. Compared to initially six feet. So, heres the way that i want you to think about it is that if every time you walk outside whenever you go outside the home, and there down, were going to more and more people will be able to come together. So, it is going to have a big impact. So, why 30 feet, i guess. Compared to initially six feet. So, heres the way that i want you to think about it is that if every time you walk outside whenever you go outside the home, and there is a good chance that youre going to have contact with people who are not part of your household, we want you to have a Face Covering. That is the first thing. Easy to remember. When im outside my home and there is a good chance that im going to have contact with people that are not part of my household, then i should have a Face Covering. And theres two basis scenarios that that ha. That that happens. Theres moving around, walking down a crowded street and hiking down a path. So the 30 feet is being hindful that as you approach 10 yards is to put your Face Covering on. Its about using common sense l. You have enough time to go ahead and put on your Face Covering. 30 feet, some people like to think of 10 yards if you like football or soccer or think of two average cars. So, when youre walking down the street. The other one is when youre stationary and this is really the more common one that you are talking about and that is six feet. So, if youre in the park with your family and youre away from everybody else and eating lunch or having a picnic, go ahead and put that down. This morning, when i got when i was leaving my house to work, across the street was a father and a daughter. He was holding her hand and they were walking the dog. Theyre totally outside and they didnt have to wear a mask and that is exactly how it should be. We give people plenty of opportunities to go ahead and pull it down so they can get fresh air. As long as youre not close to anybody, go ahead and pull it down so you feel comfortable. So, one of challenges weve had are runners. I noticed it, too. For some reason there are people who are running and i would say, you know, 50 of the time theyll get out of your way and move away from you. But sometimes they just run right past you and are so tell us why that people are saying im a runnerment im not going to run with a mask on. That is ridiculous, right . And im not a runner, but i know that it is hard enough to breathe in a mask sometimes. So, how do you expect people who are outdoors who want to exercise to wear a . Afk a mask . What are the guidelines . Basically follow the same common sense guidelines. Ill give you the example that i do. I like to run up to twin peaks and so what i do is actually just have my mask right here and most runners actually, this is some of the runner magazines that they recommend to folks. Run around when theres no people. When theres nobody around you you dont have to have it on. But when youre running by a family, lets say, go ahead and put it on. That is the 30foot rule, the 10yard rule. And when you pass them and no one else around, go ahead and pull it down. Were trying to make sure its really common sense so that people do it in a way that is respectful of other people as they come close to each other and come near each other for a short period of time. The 10yard rule is to remind them to slip it on and then when youre past them and alone again, slip it down. Were not expecting people to wear it the whole time. If im at the park and having a little picnic in one of my circles, then most likely i can leave mask off. Correct. Exactly. Yes. Ok. All right. I get that there is a lot of confusion there and sounds like were telling people be on your best behaviour. Use common sense. Dont police other peopleful just do the best you can. Were all in this together and we want to make sure that we keep people safe and keep ourselves safe and keep other people safe. Exactly. And the way you described it is perfect. Ok. Heres the other question. Say, for example, woe see the numbers blow us away and surprise us and go down considerably. Is there any chance that, based on the timeline of the dates of reopening, is there any chance that we could see that timeline moved up or things moved out of the timeline and up into the forefront . So, you mean moving the intervals closer . So, for example, if we see all of a sudden over the next week, we see a sharp decline, right, in the number of hospitalizations and we already see testing has gone up considerably. Were doing a great job with testing. So, we see a sharp decline and whatever you need to see a decline in. All of a sudden, you know, theres a strong desire for people to see more happening faster. Do you think there is a possibility that this safe reopening plan could be moved up so that is some of these things are available sooner rather than later . Ill give you a perfect example. Museum, right . Its not because i want to go to a museum, but i think about the people who work at the museum, the security who works at the museum and the fact is you dont need to touch anything at the museum and there is ways in which we can guide people in the restrooms and so on and so forth. The academy of sciences, theyre furloughing employees. But these are locations where theres a real possibility to limit capacity and theyre in phase three. Im using them as an example. Youre asking a really good question. And i think for us the way that weve been thinking about this is because its because San Francisco just we know that were we know that were just higher risk. That is the baseline. And so thats why weve been really anchoring to the state road map and the state road map is moving very fast and is very likely for some of the things that youre mentioning, is very likely to allow more and more of these things to happen. And so if the state allows that to happen, we will look at we will if the state starts moving faster, well look at our number and if it looks like we can do it, then were going to go ahead and implement it safely in San Francisco. That is what were allowing the state to really be that [inaudible] that they [echoing [ yeah. And i want to express my appreciation again for your leadership and also for the timeline and giving the people of San Francisco a lot more certainty about what to expect. It is not what we want, of course. We want more. And i will continue to push for more. But, you know, i appreciate the opportunity to have this open discussion. You know, i just want to say to the people of San Francisco, again, thank you for all that you are doing to help us through this. The better that you follow the guidelines around masking, around social distancing and hand washing, the safer we will be faster which will give us an opportunity to do more. And i know were asking a lot of the people of San Francisco and we appreciate that for the majority of you, you follow these protocols and were also well aware that some people are really suffering. And that is at the forefront of our minds when trying to push for changes faster. But we also want to make sure that we are safe and we dont roll back the gains that we made so far. Its difficult. It requires a lot of sacrifice. Its easier for us to ask you to do it than i know it is for you to actually do i. But we appreciate everything that all of you have done to take part in helping to keep San Francisco safe and healthy. You know, i know it is one thing to be a leader and another thing to be the person stressed out and whether or not they will be able to hold on to their shop or hold on to their apartment after this is over. So, we are keep, those things in mind and i appreciate the work that you are doing, doctor. Thank you for joining us here today. Please feel free to continue to submit your questions. These conversations are really about trying to get to the heart of the questions and concerns that people have. Rather than to do just a regular press conference. This is an opportunity for us to have a discussion about everyday questions that people have. You can definitely call 311 for testing or other questions and concerns or feel free to email me, mayor london breed sfgov. Org and thank you for joining us here today. Thank you announcer youre watching coping with covid19. Todays special guest is lindsey holmes. Hi, im chris manus and youre watching coping with covid19. Today my guest is founder and c. E. O. Of dispatch goods and former clinical profusionist at ucsf. She start add new initiative called project clean to provide alcoholbased cleaning products and Hand Sanitizers to atrisk bay area communities. Lindsey, welcome to the show. Thank you so much for having me. Its lovely to see you. Tell us a little about your background and how dispatched goods of San Franciscos restaurant community. Sure. We launched, in october, weve been working on this for a little over a year. And we partnered with restaurants to provide them with a free reusable container system that could replace singleuse products. We partnered with yelp headquarters in downtown San Francisco and 10 Restaurant Partners as of february before covid19 hit and employees at our Corporate Partners could request the reusable containers when they were getting their lunch for takeout or if they were getting it delivered to their office. We then handled the pickup and dish washing. So, obviously the virus pandemic has hit and now youve had to pivot your company and i understand you lunched a new initiative called project clean. Can you let us know what the program is all about . Sure. So we basically when this hit, we asked ok, what we do we have and how can we help . We also noticed there was a gap in the supply for Hand Sanitizers to Certain Community members and individuals and we talked to a distillery about making Hand Sanitizer and, in true form to our mission, we decided i bet we could collect enough containers from the community that we wouldnt have to supply more singleuse plastic containers and we launched project clean and with that, we collected over 200 containers. Theyre spray squeeze bottles and working on supplying the cleaning products. What has the response been from the community atlarge and how have peopled help . Were donationbased and selffunded right now. We are buying basically the products at cost and is not charging us much for that. Theyre also just trying to cover our expenses and we had a little bit of donations coming in. But if you go to our website, you can either donate containers that you have, well come do pickup. Were doing it twice a week now. Or if you yourself need any of the cleaning products, you can fill out the form and request those as well. And then there is also a place to make a donation. So, where are you handing out the Hand Sanitizer right now . Were doing it in the same route as the dropoff route. So, the Hand Sanitizer will be finished today. So, tomorrow well be doing our first round of dropoffs and weve been contacted by Health Care Professionals who after they come home have nothing on their hands there. We have been contacted by retirement communities and contacted by physicians in their offices that they dont have anything and a individuals that just werent able to get the supplies because they were sold out so quickly. Basically during our normal pickup routes now, we will be doing the dropoff as well. That is fantastic. You know, i think that is a Wonderful Service you are providing, lindsey. Thank you so much for coming on the show and keep up the good work. Thank you so much, chris i really appreciate it. And that is it for this episode. Well be back with more stories shortly. Youve been watching coping with covid19. Im chris manus, thank you for business. This is the special meeting of the Small Business submission on wednesday, may 27th. The meeting is called to order at 1 01 p. M. Phowe thank Media Services and sf gov tv which can be viewed on sf gov tv or livestream. Members of the public is 888 2733658 and the access code is 310745. inaudible . The members of the public will be calling in 888 2736538 and access code is 3103752. When prompted dial 120 be added to the speaker line and it will indicate that callers are entering the question and answer time but this is the Public Comment. If you call in before Public Comment is called, youll be added to the cue. Please mute the device youre listening to the meeting on. When its your time to speak, youll be prompted to do so. Its three minutes per speaker or otherwise established bit speaker. Please show the office of Small Business slide. Interest we will start with the reminder the Small Business commission can voice your concern about policies that affect the Small Businesses in San Francisco. And that the office of Small Business is the best place to get answers about doing business in San Francisco, particularly in this local emergency. If you need assistance with Small Business matters particularly at this time, find us online or via telephone. As always, our services are free of charge. Before item number one is called, i would like to thank Media Services and sfs gov tv for coordinating the livestream please call item number one. Youre muted. Call to order and role call, commissioner adams. role call 11. You have a quorum. Call item number 2. 200455, emergency ordinance, temporary right to reemployment following covid19 pandemic. And emergency ordinance temporarily creating a right to employment for certain employees laid off due to the covid19. If their employer seeks to fill the same position by a laidworker. The discussion and action item. The presenter is edward wright, legislative aid to gordon mar. Wonderful. Welcome edward. We are pleased to have you here and would you like to make your presentation . Im happy to. Supervisor mar is the author before you today. Thank you to the office of Small Business for your feedback and thank you to the Small Business commissioners for taking the time at this spent meeting to discuss the backtowork ordinance with us today. Im talk about a couple of Different Things and first, i want to share the background of why we introduced this ordinance and moving it forward. I want to share the details about what the ordinance currently written does and i want to talk about amendments that were preparing to change the scope of the ordinance in response to feedback from stakeholders, includes a number of the members of this commission and finally, any additional feedback on what the feedback has to share with us. This crisis is a state of emergency for laidoff workers and the pace is greaterrer than the Great Depression and 110 people in San Francisco have lost their jobs representing tens of thousands of livelihoods in economic uncertainty. Consequences of longterm employment included that the evidence of job loss is clear and that could lead to loss of next in the shortterm to lower wages in the longterm and result in physical health and mortality rates for workers who lost their jobs and further, it hampers childrens educational process and workers who lose their job involuntarily experience worse Health Outcomes and during severe downturns, it could lead to life reduction of 1. 2 years and that it might r pai. inaudible . We know this ordinance is bull because we feel we have to be bull to address the urgency of our unemployment crisis. This ordinance is a novel policy area and its so because the circumstances we face are novel. And this ordinance is an emergency ordinance because the crisis we face is urgent, too. Still, we make significant and substantive amendments to narrow the scope of the ordinance. In feedback, weve heard from the sector and specifically from Small Business owners. So first, i wanted to briefly talk about the ordinance as its written before talking through some of the amendments were preparing. I want to say we dont have the amendments drafted to share with the commission today and im happy to share the copy of the minutes as soon as we have the draft. In a current version of the emergency ordinance, workers have the right of first refusal for their jobs if and when their former employer are reopens and rehires. This would be prioritized by seniority in each job classification and it requires comparative wages, scheduling and benefits unless the employer is unable to maintain terms in which case they are affected. This requires employers to provide notice to the city of layoffs of the workers and provide them with information on available city resources as a part of the requirements. In terms who is covered, the emergency ordinance is currently written and applies this to any employer laying off ten or more employees starting on february 25th, 2020, the date of the emergency. And it does not cover employers of fewer than ten employees and does not cover employers who do not lay off ten or more employees in ten or more days or contractors and collective bargaining agreements. Theres a waiver included. Any questions and i will talk through amendments that were preparing, as well. Commissioners, any questions for edward . I say keep going. I have one quick question. But commissioner ukudio has a question, as well. Thank you, edward. In the bill, how do we prepare e an employer is not able to rehire folks back . Yes, that was most likely reset by regulations to the issue by the office of labor standards enforcements. It wasnt something in the ordinance. How did you come up with ten employees . We looked at the Healthcare Security ordinance and what those acts with the mass layoff, which was roughly half of the number of employees at a distance and, then, took the 20 employees as the threshold to help their security ordinance and took half of that. That was representing a mass layoff. I missed the last part. Did other people hear that . Can you repeat the last point, please . Yes. So, basically, taking half inaudible . Half by the Healthcare Security ordinance. I just have one more. Why seniority . Seniority is a common standard in righttorecall language for employees and so were taking the most frequent standard that exists and recalling what already exists and then expanding the application to additional workers. Ten employees is the right amount of people for this work . Im happy to talk about amendments to address that point. Are there any other commissioner questions . Seeing none, i have a question. Regarding the ten or more employees in the draft originally as its currently written, it says ten employees nationally, globally, in california or in San Francisco . Ten employees locally. Globally. And finally, ten people in nashville, where i have ten employees, i would have to notify San Francisco. You would not. They would not be ann titled to reemployment. If i laid off nine employees in nashville and one in San Francisco, i would have to notify the city with represent to the one employee . I dont think so. I think it would be triggered by ten layoffs in San Francisco. Thats definitely what you just said, so earlier you said ten globally, but now its ten only in San Francisco . So theres two definitions being referred to and one is the employer definition and thats defined as ten employees globally, but the layoff definition is ten or more employees, meaning San Francisco workers laid off within a 30day period. There ok, thank you for that clarification. Please proceed. Thank you. And so what we know that workers are facing a crisis right now, so a Small Businesses. We know Small Businesses need support now more than ever and ill be sharing some of the changes well be making to this ordinance to specifically address the concerns that we heard from Small Business owners. I did want to share with the commission that our office is actively working on legislation to waive Business Registration and business fees most impacted by the covid19 crisis and we hope to have a date on that that i can share with you soon. I did want to mention that we have spoken with more business stakeholders in this legislation, including dozens of Small Business owners, the San Francisco commerce, community on jobs, the San Francisco hospital hospital, among others. We know this is the life blood of our city and they are facing a central crisis and after i go through the amendments were proposing, if you have additional feedback, i would appreciate this opportunity. So for the amendment, we are intending to amend the definition of employer to exempt employers with fewer than 75 employees and this would be tying the definition back to the act of neglec flexibility with statewide employees and the definition of employer to exempt Healthcare Operations employers as defined in the april 29t april 29th order of the Public Health officer. And that would include most public hospitals. Further, we intend to amend the employee definition to exempt employees who are making more than 100 or 120 of the Median Income as defined by housing and community development. In addition, we intend to amend the reemployment revisions to provide exemption for making the reemployment offer based on the information of misconduct found for former employees. If an employee discovers a former worker committed misconduct, they would be exempt and that exemption would apply to the terms and after bringing back a worker facing misconduct, you are exempt from having to employ them. That would include severance agreements, so laid off workers entering so severance agreement and this right to employment is not apprized of that. And finally, we would be amending the notification requirements, removing section 5a4 and section 5a5 entirely. These, we understand, to be the most burdensome administrative requirements for the businesses applied to, as well as to the office of layer standards enforcements, so this is essentially the optimum requirements. And then, finally, to allow for notification by email or text before mail so that businesses only have to mail if thats an ox. Option. Im happy to answer my questions on this that i just talked through. Any questions . While we wait, we have two questions for you. With respect to employment being exempt if theres evidence of misconduct, how would an employer establish this misconduct . What the burden here that you te employer has to meet to establish that misconduct . We dont have the language forecastedrafted yet and im noi can answer that specifically. But the intention that would it would be some kind of evidence that would be demonstrating that everything is caught up that happened. And so that could be theft, it could be misrepresentation of facts and any number of examples of misconduct. But at this point, you cant give us any information that we could provide to employers about how they would satisfy the requirement, whatever evidence would be required . We dont have that amendment drafted yet. Another question, but i will defer to my colleagues first. Hi, edward and thank you for coming today. I am curious about your outreach. You had mentioned to get to this, you had spoken to more businesses or business organizations and stakeholders than you ever had and im kind of curious as to what their overall responses were and what type of interaction you had with them. Thank you for that question there was a range of responses to the ordinance all the way from support. We did speak with a number of Small Businesses in our district who support ordinances to outright opposition. And i think there were a diverse until of concernnumber of conce. We are hoping to address these concerns and we heard from a lot of Small Businesses, which is why we landed on Small Businesses and weve heard from quite a few Healthcare Providers with the Current Health circumstances that they felt that the healthcare sector should exempted, which is why weve included that exemption and to, then, weve heard concerns about not having the kind of misconduct exemption were working on to ensure that there is offramps for those job offers and a good reason to not issue employment offer. So can i ask, with all of these amendments or exemptions, who are you hoping to really be able to, like i dont know. Who is going to be compliant and who is going to be retain these jobs the way they want . So with these amendments, this ordinance will still apply to any San Francisco employer with more than 75 employees and laid off ten or more workers within 30 day, based on the applications we already have and the unemployment numbers that are trickling in, we expect that that will apply to thousands of San Francisco workers. And even with the ami narrowings, were focusing more on workers and expect there are thousands. And those businesses that would apply to, are they in favour of your legislation . Im not sure in their i in favor. We understand that that our Small Businesses would be the most burdened by this, which is why were purple this. Thank you. Thank you. Commissioner dooley. Hi. I wanted to ask about the seniority and how you would be asking people to determine that. I know that i work in restaurants as im a fluoresce d i see many people come is go for awhile and come back and then im just wondering whether theyre cumulative time in that business will count as where they would be in the seniority order or not. Its something ive seen a lot in restaurants. It would be determined by the date of hire for determining employment that was severed. So your most recent. Commissioner ozunis. New for being here, edward. Im representing the supervisors office. And i mean, yes, if anything is most important in this crisis, its class and the need for our workers to be supported and as Small Businesses are often one in the same as workers, i think its important to consider the good will piece and kind of the realities of Small Businesses are going to be calling people that they ed thi they had to le. It takes a lot of money and ti time. Sometimes the posts dont get hit and so, i think that Small Businesses are really going to comply wit intent of this either way and i just inaudible . A couple of questions i have, february 25th, when the order was in place, that was the next month and why the february 25th date of this start date . I do have some concerns with the oast background noise . Commissioner, wil while youe talking, if you could turn down the speaker, because your microphone is feeding back into your microphone and turn the speakerrer back up. The requirements to the city are waived and those are some of the questions that i have. Thank you for that question. Ill take that in turn. And so, first, as to why february 25th, was chosen as a start day for flexibility, that was the date Public Health emergency was declared and that is predated with the shelterinplace order. However, weve heard from workers, as well alzheimers ase employers prior to the shelterinplace being ordered in response to the Public Health emergency and so that is why that date was chosen. And in terms of the burden of proof of Small Businesses, Small Businesses would be exempt to hire. This ordinance after amended would not apply at all to any business with fewer than 75 employees. In terms of the details regulatory language or the language of a rule that is issued, those are kind of always issued after an ordinance takes effect and to give additional clarity for the implementing agency for the specific details and the law that may not be appropriate by code. And with that said, we have the specific amendment language and im happy to share that with you and talk through it. Great. So im going to ask my second question with respect to the amendment part of the presentation and you mentioned that severance agreements would be exempt. How is severance agreement being defined . For instance, i know Many Employers, myself included, when we had to lay folks off, i was very concerned about my employees having money for groceries and shortterm supplies. That period around march 20t 20th was very intense, as im sure you recall. I know Many Employers, lets leave myself out of this, Many Employers informally did thing for their employees and some continued health insurance, some did cash dispersals and many did a number of Different Things. With respect to a severance agreement, how are you defining that . Are you expecting a document that is signed by both parties or do some of these excessivseverance payments thate provided in excess of the employment agreement, would those also be severance agreements . It would probably be the narrower definition of severance agreements as it goes to the broader one as you just talked through it. With that said, this is to be heard at committee next thursday and we have between now and then to finalize any amendment language and, of course, it would be heard at committee. And so, im happy to talk with you on the specific definition that we would include there. And just checking in, is there more to your presentation or should we go into general questions . I noticed a couple of commissioners have asked questions, not specifically about your amendment. And i wanted to see where were at in terms of your presentation. Im happy to take general questions. Wonderful. Commissioner ukudio. Edward, thank you again an. I understand that both employers and employees are are undergoing a crisis right know and helping as many people as we can to navigate this and what we decide to do is going to be reflected back upon us in the future. This moment is important. I wanted to read a piece of Public Comment to you that we got because the seven of us have our own Small Businesses, but, of course, we represent of 100,000 individuals sole proprietors and the largest in the city and we received a lot of Public Comments about this and edward, this comes from a Small Business owner and i wont say who, but one that is beloved in this city saying if supervisor mar could guarantee my businesses income for 90 days, i can guarantee you his employment. If he can guarantee my expenses wont go up during that period, that the minimum wage wont increase from july 1st and it wont be more expensive upon renewal and sales in december, the only month we turned a profit would be the same as last year or better, that social distancing and Curbside Pickup and regulating how many customers are allowed in my store at once wont lower my sales, if the city can abundante that, we can guarantee employment. That gets to the point i want to make. Even with all of the cutouts and the amendments and cutting out this industry and that industry making it 75 , the government should not be right now in this particular moment trying to regulat regulate, whoe employ and at the same time, they are for good reasons deeply regulating however aspect of our business is being run in a way that is driving many of our Small Business owners to the brink, if not passed the point of closure. This is not a time, in my opinion, and in the partly opina lot of Small Businesser businesw people employ folks in the middle of this. And i wanted to read to you from the Small Business owners that we represent and we care a lot about. Thank you for sharing that. Weve heard a lot of stories from Small Business owners that are truly heart breaking and what businesses are going through right now. From our perspective pir inaudible . Our office is actively working on supports for Small Businesses. We want to make it easier for Small Businesses adapt. And i think weve also heard so many heartbreaking stories from workers. We met with one woman who was undocumented and worked at a Small Business for 20 years. That closed and had been able to reopen for Curbside Pickup and rather than hire back somebody who worked there for 20 years, they brought back new workers because they could pay them less. We everyone everyone is in a critical position here and it was a difficult decision for us to make. There are a lot of people in difficult circumstances right now is i think th and i think te is to ball the needs and ensure the work Going Forward represents that balance and represents a thoughtful targeted intervention to help the people who need it most but not to sort of step on the toes of the people who dont need their toes stepped on. We need a handup right now, too, and, specifically Small Business owners. Thank you for sharing that. So edward, i have a bunch of questions for you, but just a general point of information. Do you happen to know you said all of Small Businesses exempt, but then you said 75 employees or less. And i think california and the city of San Francisco define Small Business as 100 employees or less. And were you, perhaps, just misspeaking or generally characterizing or how would you define Small Business . So the way we define it through the employer definition and the amended version of this ordinance would be any employer with 75 or fewer than 75 employees would be exempt. Just to interrupt, would an employer with 80 employees be considered a Small Business . Not for purposes of this legislation, but is that a Small Business . There are various test defins under different ordinances. They dont define Small Business and im aware of one definition for Small Business and thats in california state law saying 100 employees or less. But if you could follow up and let me know later if theres if its true there are different definitions of Small Business, that seems relevant to our commissions work. And i will say that for our purposes, we have to represent all businesses with 100 employees or less. And so, for the purpose of your legislation, which still leaves employers with 76 to 100 employees, your legislation does not of course conclude them so its not accurate to say that all Small Businesses with respect to all work is exempt. So i just want to clarify that. Yes, a clarification. Probably i misspoke, its not the Small Business thats defined but the employer in different regulations or different ordinances using different definitions employer and many of which are based on different sort of policy intentions to exempt the needs of smaller businesses. And so i apologize for misspeaking. Thats totally fine. Theres a lot going on here. And hopefully, its understandable were about that and has an impact for the folks charged with representing. A couple of questions and one, you mentioned roughly 100,000 employed. How many of that 100,000 will this legislation help . How many do you think but for this legislation would be disadvantaged . We dont have specific data on that. Ok. I think theres a lack of data on specific aspects. Thats fine, thats fine. I have a bunch of questions, so i would ill be brief and hopefully, you can be brief, too. And if you need to explain more, just let me know. I may interrupt. I hope im not being rude but im trying to be respectful of everybodys time. How does this legislation impact workers outside of San Francisco . It wouldnt. How many businesses do you happy will be impacted by this legislation . We dont have i dont have an updated number based on the proposed amendment. That has not been made yet. Any initial numbers based on the original legislation . Not specifically, because the number has been changing and weve had a twoweek delay on getting those numbers. But i have a policy on that. What do you estimate is the cost of compliance for Business Owners to comply with the legislation for employees . Theres no direct cost tied to this. What is your basis for believing theres no cost. Were not requiring anyone to hire employees they cant afford to hire. You are requiring businesses to contact employees and you did mention that the section 5a4 and 5a5 had been removed and is there any notice requirement at all for employers whatsoever to any city Agency Authority . I believe the requirement to p notice on layoffs survived, correct . Yes. That would presumably be document for the issues that are still open regarding how the different aspects to be documented. Presumably theres labor in storing the documentation, would you agree . Very possibly could be yes. Well, what do you mean possibly could . Is there a scenario where there would not be a documentation being required to be stored . I mean, for instance, we are proposing using the same employer definition as the act of providing notices of layoffs to the city and to the state of california. So to the extent that this is building on top of that, there would be a certain number of additional layoffs that could be covered under the proposed amended version of our ordinance, but its tied to the definition of employer that is already provided under the act and those employers are required under state law to provide notices of mass layoffs. So is it your feeling that theres no additional cost or burden to employers to comply with this legislation . I mean, there would be the noticing requirement to the city for certain layoffs that would not be covered by the act but the layoff and more than ten workers and San Francisco, but dont quite meet the cal 1 act definition and that could be a labor burden on that business owner. Theres the burden of providing notice to the workers of the direct reemployment. So what was the Financial Impact on olse to develop this new program . Have you estimated what the cost to the city would be . We dont have a cost estimate from the bla yet. With that said im sorry, thats fine. Thats all i need to know for now. If the legislation passes, its anticipated that there will be litigation and response. Has your office estimated what the cost of what that Legal Defense might be . Were making amendments, partially for policy concerns, but also that we think will significantly increase the ordinance. If i had employees with performance issues like tardiness, behavioral issues, am i obligated to hire them back . If it false short of misconduct as to be defined through an amendment, im happy to talk with you about the exact language on, yes, you would. Im sorry. I have more questions, but im just noticing commissioner dooley has a question and im sorry, i didnt see that until just now. Please. What youre drawing on saying most employers wouldnt retire their staff because i have seen anecdotally of the opposite of what most businesses do, rehiring people that know their business and dont have to be trained a lot. And so im just curious has to why youre thinking that enough people would be bad actors as to need this legislation . Just to clarify. I dont think i cited those statistics. Im asking you for them. Yes, we dont have any localized statistics on that. I think part of what we view as our duty as policymaking body for the board of supervisors is to provide regulation that protect against that action. So we certainly hope that employers choose to bring back their workers regardless of a requirement and we certainly view that as a winwin scenario for the workers who would have certainty of future employment and for the employer who is able to bring back something they have a relationship with and who has been trained. So that this is behaviour beneficial to both parties, we think that is positive. I have a question. You mentioned earlier that you had extensive outreach from the Small Business community and you had received some support. I dont want you to single out individual Business Owners, but could you just let us know what Business Associations have expressed support to this legislation . We have not asked for Business Associations. But to your knowledge, none have expressed support . I donno. A couple of questions just about the legalities of this that im curious. One of the first things that popped up for me is california state labor code defining employment as atwill. It appears the proposed legislation would supercede employment and how d is that a correct statement or do you have a different understanding . I think theres a real veracity of the ordinance that is a question best addressed to the City Attorneys office. [ laughter ] well, respectfully, youre here to prevent the legislation. This is a pretty big change to how employment is defined for employers and its coming at a very sensitive time. We dont have the luxury of having the City Attorney here simultaneously with you to ask the City Attorney. I was hoping that, perhaps, the City Attorney had provided your office with guidance and advice on this issue because it seems germane and to the point. Has your office received any guidance or advice with respect to the atwill employment question . Weve had significant discussion with the City Attorneys office on the veracity of the emergency ordinance and it is our belief and our intention that where there is sufficient Public Interest in providing additional regulations on employment contracts, especially considering that this is an emergency ordinance, leveraging powers of the board of supervisors for the city and county of San Francisco, that we are certainly within our legal right to do that and thats a part of the reason why we are amending this ordinance to target specifically the policy intervention and the employers who may be most negatively impacted by it. But i guess did the City Attorney give you specific advice regarding atwill employment and that labor code . You give me a general answer and im asking a specific question. Respectfully, we have had quite a few discussions with the City Attorneys office on the legal veracity and ramifications this office and the specific discussions on those specific things are Attorney Client privilege discussions. And the City Attorney has approveapproved as to form. Any except shi exemption fors that employee writers, musicians, artists . Independent contractors are not covered by this ordinance. I did not say contracts with. I say employee. Is there any exemptions that employs musicians, actors or artists . There are not industryspecific exemptions, no. I dont want you to violate your privilege, but in your internal conversations did you have any conversations about the possible First Amendments in. Not specifically discussed, no. I wont continue that line because i think its selfevident that somebody who employs a writer or actor or a statement or cause or an emotion would have a First Amendment right to choose the manner in which they express that. Your legislation seems to supercede that. In your discussions with the City Attorney or internally, did you have a consideration of vehicle protection clause . We, we have. Was there a conclusion reached on that . Our duties is to provide regulations for the city and county of San Francisco and we can offer this impact to San Francisco workers and it would be outside of our jurisdiction to do otherwise. Commissioner gam adam. I have a quick question. I know the city has been laying off folks and are they covered by this . They would be covered by this, yes. Any other questions . Seeing none, can we move on to Public Comment . Well open this up to Public Comment. Is there anyone on the line for Public Comment . There are no callers. Hearing none, Public Comment is closed. And commissioners, further discussion. I just wanted to comment on the typical legislation that has left our Small Businesses in the city so vulnerable, so anemic, you cant get through this pandemic. Not only is this super burdensome on Small Businesses, but on city agencies that dont have the capacity right now or the budget to deal with this. I mean, to be honest, i dont want to make any recommendations or amendments. I just know this is not the time. And i love all of your supervisors, i really do. But after all is said is done, half of the restaurants you left go, they will no exist any more. Thats a fact. Come on, guys, like, no. We dont have time for stuff like this, thats it. Thank you. Commissioner adams, i believe you had a comment. Yes, i agree with commissioner ortiz. We have other problems right now and william, you said it the best. When this is all said and done, well be losing half of our Small Businesses in the town. Half of our restaurants. I had in the last week and a half since this got out, ive had so many Small Business owners call me saying, you know, what are they regulating us now for and saying if this goes into effect, theyre not even opening up their doors. So youre actually killing Small Businesses with this ordinance rather than helping them. So i agree, i cant add my amendments. This is just bad and you brought up the Healthcare Security ordinance and there are so many flaws in that, Small Businesses have been putting money into that for years and they cant access it now when they need it the most. Until we actually see the bad actors, theres no bad actors out there. This is a different time for a different place and just what it will cost the city when the city has no more money left and agencies with other issues to worry about, this is just i just think this is bad all around. And thats my two cents. Ok. I will have a couple of comments to say before we make any motions just for commissioners to notice. But commissioner dooley. I just wanted to add my agreement to what all of the commissioners have said so far. I mean, going back to what commissioner dooley said, the fact there are no statistic and data showing what youre actually proposing to save and who youre proposing to help, i think this is really alarming to me. There is so much data already in terms of how Small Businesses are been impacted. It feels so out of touch and this is why Small Businesses are having such a tough time and it also feels i dont know, maybe i shouldnt talk about how it feels. But i think to tell us that there are other pieces of legislation where youre deferring payments and getting rid of line items and fees, that in no way feels like a gift from the city, honestly. As a Small Business owner, and as somebody representing Small Businesses, those feel like not even a crumb. The thing that were really battling against i can assure you that everyone sitting on this commission, as well as all of the Small Business owners ive spoken with, which are probably hundreds at this point, we have been working around the clock to save our businesses and save our communities, quite frankly. And i think, you know, getting rid of a 200 fee and then putting on, maybe, 40, 50 hours of compliance that we have to then dig through and figure out how to navigate and then, perhaps, going into more litigation over justifying an action that at that point you had to make, i think that feels, again, out of touch is maybe very light, but its incredibly offensive, you know. I think thats really what i want to say. I cared so much for the city and all of its responsibilities and i thinresidents. Through this pae have come together and even creating a threshold of 75 and above, like, whatever threshold, to me, i feel like ive been asked to serve on the Economic Recovery Task force and thats a task forceful of all different sized businesses. To see everybody coming together to save the economy and thinking about ways we can bolster the economy together, i think that is a much better way to look at the situation right now. I just feel i am not supportive of any wedges in our communities and i think its our time to come together and to continue that thing we started early on in the pandemic. So that and i think thats pretty much it. I thank you for your time. Thank you, commissioner. Commissioner zazunis. Ok. Let me lower my volume. Can you hear me ok . Youre perfect. So i agree with some comments from my fellow commissioners, but i also want to speak to the fact that i am more supportive of this ordinance now that im seeing these amendments and that your office is being receptive to some of the feedback from Small Businesses. I like that theres a sense that they i think we do need to change our kind of mo on how we make policies in the city because were doing this preemptive punitive measure seeing nonstop on Small Businesses, hypothetically fining then for something they didnt do yet. Theres countless things on the books that are written like that, as opposed to incentivebased or helping people move into compliance. You didnt make this, you know, transgression yet, but were going to assume you are. And that mentality needs to end. Im really looking forward to some initiatives like the public bank which may give us kind of a way out to these types of laws that just rely on extorting people, you know, like we know based on how this Economic System works that it is about extorting people and it is about speculating on labor and, unfortunately, thats how our laws are, too. So that now were in a situation where economically is depressed, we need to get more creative instead of relying on extorting some other sector of the economy or low, middleclass businesses, whatnot, as a way to fund something. I was the only commissioner who voted in favor of the Healthcare Security ordinance when it came across our commission a couple of years back, but i agreed with all of our critiques which are in place today. The fact that we have not reassessed that program and the burden that it creates. So i really think that Something Like this is right to have a sunset date to, and i really encourage that our supervisors do their Due Diligence and doing the hard work of going back on the books and assessing the type of punitive laws that we have and really Start Building towards, as commissioner huey said, something that brings us closer together instead of pinning us against each other. Thats where i stand and thank you for presenting to us today. Commissioner ukudio. This is a short comment and i just want to echo that. Unless we come off in that conversation as a community that is not trying to do well by our employees, thats not i hope that is to the what were trying to communicate to you, edward, and to the board of supervisors and to anyone thats excited about this piece of legislation. I think in general, there are a lot of wellmeaning laws like commissioner ortiz has mentioned, that have done a lot of that have made running Small Businesses in San Francisco very, very difficult. And ultimately, that is the worst thing that we can do for our employees, is create an environment where Small Businesses cant operate at all because that means no one is employed. And so were just trying to do our best piece here in the middle of what is such a crisis for our community, to make sure that more laws are not put into place that dil affect them. Anyone proposing policies, the policies we shouldnt be proposing policies that we think might be really, really tough and bad for a whove sector of our city with the hope and examination that through the delivertive process its amended to a place where its better. That to me is not smart policymaking. Because if we had not found this and if the Small Business community had not latched on to this and said, oh, my gosh, this will be really, really hard for us and spent all of it time and efforts advocating and lobbying, by the way time we should have been spending to pick ourselves out of this mess, it is possible this may not have gotten amend. Then we would have had a law on the books that would not have been a great law. My ask is that in the future, moving forward, youre young and were all in this together and lets have a starting point with laws and policies in the Small Business community that will do more good than harm and lets not create laws or proposed policies that we think and we expect will require a lot of amendments to get to a place where it might do more good than harm. And that is my humble and respectful request to you to anyone making laws and policies that affect our community and workers and Small Businesses. Commissioner dooley. Yes, you know, i just think the timing is wrong on this because were anticipating bad behaviour and putting this in place and i think that i know all of our communities, were just struggling to get these places to a point where they can be open in my manner. And i just feel like its just not the right time to pile any additional legislation on our Small Businesses. Now, if after this moves on and we find out that a million Small Businesses are dumping their longterm employees and then we might want to come and address this again, but to do it in anticipation is just adding more more work and struggles for our Small Businesses that right now cannot afford anything more on their plates than what theyre already dealing with. Thank you. Edward, ill offer some closing comments here. First of all, i think you probably knew coming into this that there would be some pretty tough questions. Certainly i asked a few myself and i would like to thank you for taking the time to come in and represent the legislation that your office is proposed. You know, something that i think can sometimes get lost in these engines changes and i want to convey is i feel and i know many of my fellow commissioners feel that we want to help po policy makers make good policy and we want to support you and lift you up. We want you to be your best and we want to help make this city better. Everybody on this commission is a volunteer and most of us are struggling mightily right now. As you know, when you and i spoke on the phone and i conveyed some of the perm persol challenges im facing in the wake of covid and trying to take care of our staff. And so, this is a very difficult and challenging time for the Small Business community, probably the most difficult in anyones living memory. And i think its really critical in the moment when the community employ roughly half of all workers as a community. So many Business Owners are struggling and theyre looking at business bankruptcy. Theyre looking at personal bankruptcy and theyre looking at contemplating suicide. It is deeply challenging for so many of us. And i think the way that this particular legislation was promulgated, i kne know i reachd out to your office and sent an email and asked for somebody to get back to me and nobody did. Eventually, i was able to track down your number and speak to you. But i didnt feel like we had an opportunity to be a partner in this legislation prior to it being drafted. And i would encourage your office and i would encourage all to use this as a resource. Being here fowere here for a r. The voters put us in the charter for a reason, to help you do your best. We want the city to work great for workers and Business Owners and we want it to work great for everybody in the city. We are facing a complete loss of our business and a complete loss of our liv life savings and our homes and this commission, at our last meeting drafted 42 point memo to the Economic Task force. Over the past week and a half, two weeks, weve had to devote a lot of time to communicating with and about this legislation and hearing from the community who is very upset, generally speaking, about some of the requirements which have since been removed and some have been addressed by amendment. But others still remain. In 2019, my business employed 82 people and so, not any more. And not currently at the moment, but i can imagine a Small Business like mine, which is absolutely a Small Business, now looking at other requirement, another burden. And i think that the timing is wrong to be adding burden to Business Owners. If theres a harm that you want to address, then i think the proper route to address that is by not putting the onus on Business Owners to address the issue and if you are going to put the onus on Business Owners, then i think you have the duty to able to articulate how many people are being helped and what is the cost. We have to be able to balance cost is benefit and what i have heard from you is, we dont know how many people are negatively impacted by this. You have presented one an antidl report but we havent received any evidence that this is a citywide problem that all Business Owners in orbe order to address the citywide problem. Theres another question here, which is, were need to get back on our feet is concentrate getting back on our feet. Every time we start bickering about side issues, this is something, in my opinion, that should have been discussed as a community, as partners behind the scenes and not be put through this timeconsuming effort, all of these folks putting all of this energy and time into it. Its not t the best way to advae policy. Its inefficient. And in this crisis, we cant afford to have inefficiency. We have to Work Together and we have to be a team and we to communicate. As politely as i can, i would like to request that in the future when youre drafting legislation that could or may potentially impact Small Business, which we defined as 100 employees or less, that we be included that a conversation early in the process. You have my cell phone number and any supervisor that wants my cell phone number be, i, im ho help you and want you to succeed. I had to lay off a ton of people. I didnt have a championships. Choice. Our revenue dropped by 95 and i cried for days over having to lay off my staff. It was incredibly painful and remains incredibly painful. Every aspect of this is incredibly painful. And it is insulting to not be included. And we deserve better than that and i encourage your office to do better in the future. That concludes my remarks. Commissioners, do we have a motion . I motion we do not approve this ordinance. I second it. The motion by commissioner adams to not approve as membership and seconded by commissioner huey. I want to make sure that we have the director. I want that were very clear because edward did present the amendment, so can you just please make sure were accurately identifying, is it were not approving as written or not approving even with the proposed amendment . I just want to make sure. I will go ahead and change my motion to not approve this ordinance as written and with amendments. Do we have a second . And i second. Were. Dominica. Im trying to think about how to frame that motion because we havent actually done that in the past because we dont have the amendment drafted. So you cant really take a motion on something that doesnt exist. Could we say the amendment as presented today by representatives from supervisor mar . Youre taking a motion on a presentation and not the actual piece of legislation. So i think that the conversation can be summarized in the memo to the clerk, but the motion as it was first established by commissioner adams. So commissioners, the per what dominica, you have to take the motion and then the commission can provide clarifying comments. Comments, u want to ensure are in the final letter to the board of supervisors as it relates to the amendment. Ok to proceed our do you need further clarification . Im fine to proceed. First motion by commissioner adams. Rolrole call, please. Pai role call . Motion passes 61. Next item. Item 3, continue discussion on Small Business recovery. Before we continue, edward, thank you for taking your time to come and present and we do appreciate the office presenting the legislation. So thank you. This is or work and this is what we have to do. But we do appreciate your time. Thank you for the opportuni opportunity. Item 3, continued on rebuilding. So at the last hearing or meeting are they called meetings or hearings . Im never clear on that. I believe was it the last hearing we sent the memo to the Economic Recovery Task force . I believe it was two meetings ago. No, it was the may 11t may 11th meeting that the commission formalized its recommendation and im just confirm that. For your information, commissioners, i am able yes, we sent the memo to the Economic Recovery Task force on ma may 13th and i am able to share the screen 1 to bring up the list of recommendations in case you would need to refer to them. Ok, great. I have that in front of me, but i did want to provide a couple of observations on the impact of that memo with the task force and some of the ultimate policy changes that it had. And so im just making sure i got that. Here we go. So first of all, our memo was well received by the task force. The cochair thanked us for the information, chair fong specifically said the land use section was particularly helpful and many of the items that come up in subsequent conversations, i have attended meetings with cdma, spur and the memo has been referred to in those environments, as well. And i know that it leads there is pending legislation that it has had an impact on and this morning, i spoke with the Mayors Office and i want to convey that possibly one of the biggest changes to the city shared spaces which is opening up more space for the city, that our voice was an important one in helping to amplify that concept in getting it to the level that it has some support in the Mayors Office and thats a big, huge win. That is a very big and dramatic change in how the city has done business in the past and it is something that i think the community has largely had broad consensus and support for. So im pleased by that. But theres still a lot of work to do and, frankly, to have more work done today at this meeting that didnt happen. So with respect to the task force, weve had two Group Meetings with the entire group and one Small Group Meeting and my small Group Includes cd may and ben blineman and that was nice to see familiar faces. The task force, you know, i dont think is yet at a point where its making specific policy requests or proposals, but i think the work is happening behind the scenes and i have a quip, that i think the most important work will happen outside of the task fortune is the most important contributions will be made by people who arent on it at all. I view it as an informationsharing exchange. There are other Task Force Members and i want t wanted to e william and cynthia to offer any insight into the Task Force Work for the commissions benefit. If you so choose. Receiv[ laughter ] william, do you want to go first . I guess im unmuted and just volunteered myself. Thank you for giving us the opportunity to share. Ive been working really hard on a couple of things in regard to the task force. One that has been the most eyeopening for me has been trying to get dental offices, specifically, and other healthcare kind of private practises reopened. And i ivi realize that throughs work i dont know, should i provide a little overview of what happened in terms of whats been happen. Yes, anything you think the commissioners would benefit from learning about. I think dental offices were slated in the same category as personal services and that would be kind of, you know, the sector that would include probably nail salons, hair salons and personal services. The problem with that is that probably is not going to be reopening until a later phase in the reopening kind of timeline. Whereas, dental offices and different types of healthcare offices were not given the ok by the city and county to reopen for routine care and that type of deferral of treatment is oftentimes very impassable to the Public Health, when people are not able to get routine care. And in dentistry, self, we were in thing thainnoticing that thie starting out as maybe small fillings, after not receiving care, they were turning into root canals. And so for patients and for people, thats a huge deal when youre looking at the difference between a filling, a root canal or loss of tooth, like an extraction is so that type of thing, since we were deferring treatment and deferring care, we were starting to see more and more of that. And dental offices had come and talked to me about when are we going to be reopening. It was kind of hard to figure out exactly what was happening. Who do i talk to and where are the resources . So one is that having a more transparent path for industries that feel like they need clarity, especially when there are associations there. There is state guidance for dentists and the California Dental Association had given directives for all california dental offices, i think, may 7th. And we didnt hear anything until we started pushing for a response a week later. In that week, theres a big gap between the state guidance and what happens in our local municipality. And i think having a more proactive approach would be helpful in all of this. So what happened was, we inquire about this and figured out what was happening and we realized, oh, gosh, you dont realize that its important for patients to get care right now versus, like, other types of services that may be arent as impactful to someones overall health. And so once that was remedied, the department of Public Health issued a directive but it was not issued with the guidance from the dental association or the San Francisco dental society. So from california and the local level, there was no discussion. And then after the Health Directive came out, there were all sorts of things that kind of changed and one of the changes was that they required testing, covid testing for all air slide procedures. There was no discussion about that in terms of why they needed this because at this particular juncture, we dont have testing capabilities within offices to be able to ensure patients, nor dental practise safety. And so it was just a lot of, like, what do we do and implement this . And i think when we have this type of issue, it really creates a situation where people dont know how to become compliant. They want to, but you dont know why youre recommending a certain test that there were no recommendations for that test, also. There were no age guidelines for that test. So you could be looking at a 4yearold patient who would be also be required under the directive to get testing. And so theres still a lot of kind of, i dont know not misunderstanding but lack of guidance in terms of how to implement this. And i feel like if Going Forward, the department of Public Health could have a more proactive approach and reach out to local associations, as well as and then checking this with people and saying, ok, these are the things that were planning on doing. Because this directive for the dentists is the most restrictive weve even in the whole nation. Were the only county in the whole country that requires this for dentists which would kill our dental practise. Why would you go to a dentist in San Francisco and you could go to one in san m matteo where thy dont have this. There needs to be more transparent understanding of what the goals are, what types of goals, department of Public Health really wants to get in terms of testing. And, like, getting more input from people who are knowledgeable in our community. I think many stakeholders, we actually carry a lot of november knowledge where you could ask any of us to glean from. For the Recovery Task force, ive been pushing for more proactive involvement of stakeholders and more transparency in how they phase things out. I think dates are important for the reopening process as they put forth more Health Directives and people need to understand milestones and how long things are going to be taking place. Thank you. Sure. William . For me, its definitely making sure that throughout the process, that this is an equitable lense to everything going on, especially in the latino community. Small businesses that are latino or monolithic, residency in question, they have a greater impact because they dont have other access to resources than, say, some of the other Small Businesses and then beyond that is also a lot of the documenting a population that work this our Service Industry that are back in the house and they, too, dont have the resources to go on unemployment and its just a myriad of things. So were trying to focus on making sure that this crisis doesnt further the je gentrification in our city. So focusing into a cultural and equitable lense, thats the primary were working on or im proposing to work on. Any other commissioner comment on the update . Commissioner adams. The three of you have done an excellent job on that Economic Task force. Ive been hearing a lot of feedback from that and the three of us, you really need to be commended and you really are representing Small Businesses and i just think youre doing a fantastic job. It a battle out there and i wane best. One thing we do need is more guidance when we start to open up, because ive heard from a few people that the city says one day well open up on monday and, you know, with the popups, it actually took some people that i though, some businesses more than a few days. And so i really appreciated that comment, but the three of you, in my opinion, and manny, and kathleen, you guys have been rock stars throughout this whole thing. I mean, rock stars. And manny is i dont want to say a podthe cast, but your questions and answers, this has been great. And im so proud of all of my fellow commissioners. Weve all stepped up during this thing and its not that easy. It hasnt been easy on me or anybody else. I mean, im worn out at the end of each day. And so, yo hats off to you guys. Youve done a fantastic job, just fantastic. Thank you, commissioner adams. I just want to echo the support for the entire team and it an honor to serve with all of you and the more i get to know some of you, the more impressed i am well, i mean, thats true for all of you, but some i know less than others, just youre newer to the commission. I think the commission has probably stepped up and we have an Incredible Team and it is a privilege and an honor to serve with all of us. Commissioner ukudio. Thank you, is thank you so much, commissione for representl on the Economic Recovery Task force. You represent a broad spanie swf the city and my question is about the 42 point proposals we spent so much time and energy coming up with. I think youll remember two weeks ago, i felt lining a little bit of a stick in the mud saying if these will be anything more than a piece of paper, we need to not just send it places, but actually do our own Due Diligence and our own work to see what was feasible and concurrently bring the people and the enforcement agencies to us, to talk through how we might get these done. We are the Small Business commission and we represent the Small Businesses and we have an amazing office of Small Business and last time on the node to movneed tomove quickly and deli. I wanted to understand what happened between last time and this time, what progress was made on these set of proposals other than sending it to people and getting responses saying thank you so much for coming up with it. And where are we with the office of the thresher and op oewd to e to our commission to talk about feasibility on making these things happen. Thank you, commissioner. Let me address the easier part of this, which is i do know our memo ha a had an impact as i mentioned earlier. The Mayors Office told me directly. But with that being said, i completely support where youre coming from. We have to do better. Where were at right now is not satisfactory and, honestly, i thought that i made a request per your suggestion that we bring in a couple of folks for this meeting so they could present as to the feasibility of some of the ideas, some of the names that were discussed, ted eagan from the controller and jorge sineros. I did not get any followup. Director, could you help us to understand did we get an invitation out to them and what was the why are we not speaking to anybody today. The Department Heads that i have determined that are relevant to the memo have received the memo, but was not able to have a discussion, enough with them in regard to the mel mo memo to schedule the. Many of the Department Heads need more than a weeks time to be able to get into their schedule. So i appreciate your disappointment and your urgency. I think, also, a challenge for both dominica and i, theres a lot of conceding effort that is being not target th targetedt directed at us. And for us to be wor working ond tracking. It is to dominica is i to set up a process, one, to be tracking what efforts are being done, such as the shared spaces concept, that those are ideas that generate may not necessarily be specifically listed but those concepts are initiated from the type of action that you have asked the city to take in regard to that memo. So for today, what i would like is i node to interject. You mentioned you determined the Department Heads that were responsible. Which Department Heads are these . The tax and Treasurers Office, the economic and Workforce Development and could be the Assessors Office in some cases, the department of planning. Not just planning bug as we get into the concept of shared spaces, that public works is involved. And so those are the key ones to start off with. Did we get an invitation out to them . No, we did not. Lets try to correct that for the next meeting. Just to close my point, if im out on a limb, if this isnt what we want to do, i want to make sure that if im pushing for something, i want to make sure this is what the Commission Wants and what the office of Small Business thinks is the best usage of this bodys time. I want to make sure if im the only one that wants to push for this, i dont want to be the only one. If this is where we want to move, let move in this direction. But i want to confirm that people want to take time to do this. I support you. I unequivocally support you, commissioner ukutio and i feel strongly that we need to follow umand that one of the ways to build consensus is to make sure that our ideas as presented are feasible and we make forward process and its urgen urgent be of the crisis and terro directom sorry to put you on the spot. That wasnt my intention. We have to make forward progress and have to walk and chew gum at the same tomb. Time. If there are any commission thats feel this is not a good use of our time, to hear from these Department Heads about that memo, please, you know, now would be a good time to let us know because i agree with commissioner that we should have some consensus how to move forward, but speaking as the president , i think that it is a wise use of our time to make sure that we follow up on this. And commissioners, i do have a question for you, because will work to schedule them as soon as we can part of our challenge is that we dont have set meeting times, so were fo goino need to work on that. And in my communication, i need to also understand, are you going to need to in my communication to them, i can community katcommunitycommunitcg about and will you need the authority and the licensing permitting in each of the jurisdictions and how do they relate and all of that takes time to prepare, as well. What i would like today is to look at the memo, to look at the list and for you to prioritize and we know evacuee talked abo t the Planning Department and tax is Treasurers Office and if were talking about data, do we want to bring in the tax and treasurer, chief economist and oewd at the same time to have the conversation . Understood. Well narrow the scope. I dont want to bur burden the office with creating an expansive list for osb to do and i think we can probably manage asking questions that are jer ningermane to our interests and most are top level. But commissioner dooley has been patiently waiting and has asked to speak. Lets make the room for commissioner dooley. I wanted to chime in that we have been working at north beach for six weeks on the shared spaces project and weve been working with supervisor peskins office and i will have to say that its slowgoing. Theres a lot of discussion in your neighborhood of who wants the shared spaces, who doesnt and its pretty complex and it seems to change everyday. Right now, we have settled on what well do forward, which is starting small and just with closing the Parking Spaces and see how that goes and we may expandeexpand on allowing streeo close. We have our sign saying no parking. We have barriers up and i just want to urge all of the neighborhood associations that might be listening to this that you should just go ahead, work with your supervisor, oneonone, and get this ready to go so when we are allowed to have things on the Parking Spaces or the streets, were ready to jump because otherwise, youre looking at four to six weeks before youll actually be able to get everything in place. Commissioner dooley, i could not agree more. In my conversations with cd may and at the meeting i attended and other merchants and Business Owners, what im learning is that in order for shared spaces to be successfully executed, the needs vary from block to block and that were not going to have a onesizefitsall solution. I know there are people in the city at large that are very upset about the progress that would like to snap their fingers and make it all happen overnight, but theres a lot of people that are impacted and affected bi by the changes. We have to move quickly, but there has to be a way to have input about what the Community Looks like. I was talking to a west portal merchant and, obviously, you cant shut down the street on west portal because muni runs through it and that particular community is very hilly and fairly spaced out and many of the people that shop there are fairly distant so there needs to be a provision for parking. As you know, its challenging. So thank you for that comment. I agree wholeheartedly and we have to be thoughtful in what we support and make sure theres good feedback for everyone. Commissioner doole earthquakes. Ey. I just wanted to share that i dont know, what it be helpful to go through this like, for me, i guess, could you use my help to go through this and kind of, like, put status updates and who need t need to talk to for h one. I shared with supervisor fewer, she had a great meeting for all of the merchants associations and i got a little bit of a time to share that we did put together this memo. She included it into everybody in d1 and highlighted that we had this. And so, i mean, i kind of think, would it be helpful to carve out serve things to able to have those conversations oneonone with the supervisors . Because i cant imagine she would able to, like, go through all 42 items and they dont all fall under her purview kind of thing. But i would be happy to do that in the districtsvs i have relationships with. I know the Recovery Task force are work on certain things, like the city should purchase ppe in bulk and ive had conversations where i know just because of that conversation, that certain things are being worked on. Would it be helpful for me to and for all of us to able to collectively look at this document and see where there has been movement from our knowledge and see where we can kind of, like, go further with those things . Because i do think i can see its hard to digest all 42 points for each person. Yeah, so to that point, the short answer is yes. The long answer is that i think director dikendrizie wanted to establish, from your comments, she wanted to establish some sort of triage on how to move forward. Is that right . Or set a prioritization of what you want to begin to work on or get reports back on. So as for an example, under general support and if i need to bring up the document, let me know, but booklet 3 says create a onestop shop specifically for Small Business support and representatives for all agencies planning dpw fire may process permits, fees and applications. There should be a fast lane. So the city is developing a onestop permit center. Prepandemic, it was slated to open in the fall of this year and i think this have been minor delays but the person, of course, who is staffed with getting the permit center open is melissa whitehouse, who is ahead of the Recovery Task force. So that question, i mean, so that, it does involve me reaching out to both melissa whitwhitehouse to see who can present and whats the timeline and will that be extended out to a degree that the commission thinks Something Else needs to be in place prior to the opening of the Onestop Center and then, also, have the discussion with each of those agencies that have been identified as to, are there internal discussions amongst agencies about what theyre doing for any Small Business needs, to sort of expedite those permits and processes. So thats why im saying, it would be helpful for me to begin to get the list of priorities of what you want to have the entities present to you, in terms of what the priorities of these items . First, in terms of scheduled meetings, i would propose we get back on our normal, regular schedule for meetings. The next one, i think, would be june 8th. And so, you had mentioned earlier, having some uncertainty when the next meeting was, was the complicated factor. And my recommendation is, we get back to that second and fourth monday. My amendment to that would be able thwhile the shelterininin place, we hold that at 1 00 p. M. Announcement that order is not longer in effect. Sorry. One the shelterinplace order is no longer in effect and we can go back to meeting in person, we can revert to 5 30, unless we dont have a quorum, in which case well have to engineer something so that it works and we have a quorum. But we do kne knee need to estad it will help you and me in terms of planning. Does that sound right to you, reggie that . Yes. Regina . Yes in. In terms of establishing priorities here, what i think how would you propose that we proceed in a way thats helpful to you and how can the commission help facilitate your understanding of what the commissions priorities are . How would you like to proceed at this moment . I would like to hear because ive heard outside of the meeting, priorities of different commissioners. And what will be helpful for me is for the commission today, take a look at this list and it doesnt need to be done by vote but through discussion, communicate to me what areas you want to start addressing first. I open it up to any commissioner that wants to comment. And if i need to bring the document up on the shared screen just for a quick review, im happy to do that, but i sent it to you earlier today. You have particular insights into what is most feasible and least feasible, understanding all of dynamics of city hall and i dont know that i have, like, a preference level of one of these qualities over the other, but i think for me, its what is the best use of our time and gunpowder to fight for and so im comfortable let you make the decision about of these 42 things, what are the 23 that have the most likelihood to being done if were coordinated and organized enough and which enforcement agencies touch that issue and inviting each agency head to come so that we can talk about whether or not thats feasible. That would be something i would be comfortable with. Because that feasibility question is the most important for me. You know, manny, i agree and disagree, in part. I agree that we need to give staff some agency but i think were but give them a starting point. Theres 42 points here and i think the director is asking for some guidance. And so what i think is helpful here is if there is something on these 42 points that youre, like, man, the people i talk to, this is something i hear a lot about and this would be really helpful, this stands out to me, let not worry about plausibility just let but what are the concerns of the community that were representing. And the other thing i would add to that is, i know all of us are regularly talking with everybody out in the community and these things will change over time, right . And so, you know, i wouldnt foreclose the commissions ability to communicate, what the community is expressing and just turn that over to staff who doesnt have the same influence as we do. And so, commissioner adams just noticed that he has to jump to another work meeting and ill turn it over to you for a minute or two. If theres anything that jumps out to you, commissioner adams, as high priority. Im hearing a lot from people in the community. A lot of this has to do with Planning Issues and having to do with having stuff done when we open and to be successful. So mostly in the landuse category, then . Yes, and a lot of restaurateurs, that. Were all hearing about it from all of the restaurant associations. Great. I wanted to make sure we got your input. If you have any further input, communicate to the director. Certainly. So that regina can be advised. And is there any other commissioners. Commissioner dooley, i think. Go ahead. Isyoure muted. The most important part of the 42 items is just strictly about helping Small Businesses open. Im sorry. I didnt understand you. I think your finger was over the microphone. To me, the most important part is the reopening and helping the Small Business corridors. And if i could just response to your response to my response. I would say that the order of priority would be putting money into Small Business owners pocket, so the Funding Sources would have an immediate effect to help Small Businesses and i think the retrofit should be easy win and so, thats something that i think should definitely be pushed. And i dont think we should i think the hgso reshaping would be a high priority because its, again, something to put money into pockets of Small Business owners or stopping money from being taken out. And the land use and fee mitigation. I think the communications, the general support and the data pieces, those are all helpful, but i get the sense, at least the reopening with the communications in general support, a lot of that its stuff thats already happening or stuff, in my mind, not putting stuff in Small Business owners pockets or the neglect t flexibility to do what they need to do to survive. I would focus on those things first. And then data is so important and its important to do our work. If i had to prioritize this, the data would probably come toward the end after putting money in Small Business owners pocket and maintaining their business to stay open and preventing things like retrofits and hgso for making it harder for Small Businesses over the next six to nine months. Any other commissioner that wish i dont want to talk over anybody. In my conversations with the community about the land use stuff, getting flexibility to do whatever they need to do to survive, i think the fee mitigation issue is important, but i think to commissioner huey earlier, this is not a big help. So in terms of priority and, you know, supervisor mars office has indicated theyre working on stuff on fee mitigation and i dont know i think we should apply our efforts where its actually going to make a material difference and not only things that are already slotted to happen. I think i know i said forget about plausibility but im overlay plausibility. Of course, we would all love more money from the city. I have some question marks about the plausibility of getting any meaningful amount of money out of the city. So i have questions about whether that is sna something to prioritize and as much as i would like to have it, im not sure that is on my short list i i think the onestop shop would be tremendously helpful to businesses. Acso is something that drives all Business Owners birzark and it goes to the general fund. We need to measure were at and where were going. And so im actually fairly agnostic on that. It talks about 463 properties and i can picture that this would be really big and important and critical for those people affected by it, but it doesnt outside of the commission, its not something anybody tries to grab my attention about. Its possible i could have a blind spot there. I thought it was interesting that you highlighted that. And you know, so ok. inaudible . You were surprised about this and i didnt hear you. Well, im surpri t