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SFMTA home > About Us > Meetings > Taxicab Commission > February 6, 2007 - Health Care

[DRAFT] MINUTES

Room 201

City Hall,1 Dr. Carlton B. Goodlett Place

February 6, 2007

2:00PM

Working Group on Taxi Driver Health Care Subcommittee Meeting

Present: Paul Gillespie; Tom Oneto; Ruach Graffis; Brian Browne, Dennis Korkos

MEETING CALLED TO ORDER AT 2:05 P.M.

STAFF IN ATTENDENCE: Executive Director Heidi Machen, Deputy Director Jordanna Thigpen

NON-VOTING MEMBERS IN ATTENDANCE: Tom Owen, Todd Rydstrom, Ilene Levinson, Carrie Winsten

1. CALL TO ORDER/ROLL CALL – Roll Call showed a quorum was present.

2. PUBLIC COMMENT:

· Michael Spain: I will repeat my comments from before. You are being totally unrealistic in your ambitions to create a health plan. You are not looking at plans. All plans are going to fall on the owner drivers. Companies have a marginal profit - the only funds are from the permit. I believe you will be laughed out of the room.

· Mark Gruberg: I feel compelled to respond. I take objection at “owner” – there is no property right here. The Controller has picked $1900/month and many companies here are paying $2,000. The vast majority of profits go to medallion holders. It comes out to $1.50/hr, or $30/$40 shift that goes to the medallion holder.

· Dennis Korkos: You refer to our income as unearned income, but if we had bought our permits on the open market, would you still do that?

· Charles Rathbone: I am a so-called owner. I have no qualms about sharing profits. The $1800/month he refers to is virtually all my profit. There is no reason to say profits are pernicious. I am not sure why that keeps getting repeated.

· Tom Owen: Please do not respond during public comment to the comments of other individuals.

· Carl MacMurdo: I am going to violate what Tom Owen just said. The $21,000 is before taxes. Aaron Peskin actually called the income measly, in a raucous Budget and Finance Committee hearing. When Rivera’s medallion was revoked, the decision said “owner,” even though technically the city is the owner.

3. SUBCOMMITTEE’S DRIVER SURVEY [STATUS REPORT].

· Deputy Director Jordanna Thigpen gave a report on the Driver Survey and presented some pie charts indicating percentages per question for the currently tabulated total of 3351 completed surveys. She thanked Todd Rydstrom from the Controller’s Office to help create a template for the charts. She explained that the Taxi Commission lacks the software to do cross tabulation but that the Controller’s office had generously agreed to provide help with that. Todd Rydstrom offered to provide the help with staff in his department so a more full report could be presented for the February 20, 2007 meeting, and Jordanna Thigpen promised to put the rest of the survey responses in so they could be tabulated.

PUBLIC COMMENT:

· Charles Rathbone: On the question, why don’t you have any insurance, there are plenty of people who can’t afford it. I have many friends who can’t afford to contribute. A key finding of the survey is that only 39% are willing to contribute. There is a remarkable lack of interest in the rank and file. It raises a question, as to the basis of what we are doing?

· Mark Gruberg: The Committee should expect spin from the group. 33% said they would not make a contribution. Without cross tabulation, there is no reference as to who these people are and whether or not they already had insurance.

· Carl MacMurdo: Thanks to Jordanna Thigpen, Todd Rydstrom, and staff.

· Michael Spain: The 60% who have coverage, I don’t want to pull them over to the 40%. Are we going to devise a plan that pulls them over from plans they are already in? It’s obvious that there are people who want to pay less. I don’t want to encourage people to abandon their plan and I think you are going to throw people into a plan. We should do a study on actual driver income. Without that, we should not be going ahead with this. You have not done your homework no how much drivers really make.

· Mary McGuire: I said it last week, If I have to pay for everyone else’s health plan, I’ll have to go on to the SF General Hospital Plan or whatever you’re proposing. I have a pre-existing condition and I have a partnership with my doctor. If you’re a medallion holder like myself, I can’t afford to pay for Kaiser when my COBRA runs out. I don’t see this surviving, because you’ll have people like me back on the dole. Kaiser doesn’t want older people with pre-existing conditions.

DISCUSSION:

· Ilene Levinson: When individuals are paying out of their own pocket, they are more conscious of what is being paid out. In terms of individual coverage, I raised the Health Savings Accounts as one option. In the individual marketplace this is like picking up money. It would be great to see more analysis of the individual plan holders.

· Paul Gillespie: I’ll follow up on what Charles Rathbone said - either no contribution or no response was 60% of people, so only 39% of people say they want to contribute. There’s a lot larger number of no responses for that question. 82% who can’t afford health care and that’s why they don’t have it. For the no contribution, I think I know who these people are – they’ve talked to me over the past few months and they don’t want anything to do with this plan. We need to know how this is going to affect real people. There’s no answers there, I know, but when I see that 60% of people don’t want to make a contribution, and 82% can’t afford it and that’s why they don’t have it, it’s a problem.

· Ruach Graffis: We need to remember it was probably medallion holders who said they did not want to contribute. We are looking at something that’s good for the city. If we have drivers who aren’t covered, we have problems in the city. There’s precedent for laws that take care of people, whether they want to be taken care of or not – like a seatbelt or helmet law.

· Paul Gillespie: Why did only 537 medallion holders answer?

· Jordanna Thigpen: Only post Prop-K would be likely to get an A-card, based on the corporate ownership and elderly population who owns pre Prop-K. We still have more surveys to put in.

· Brian Browne: Who designed this survey?

· Jordanna Thigpen: The Committee designed it, based on staff recommendations and the Controller’s survey from the past.

· Brian Browne: It was well designed. Many years ago we tried to design a mathematical model to determine why people seek health care. We looked at variables like age, gender, ethnicity. We looked at a multivariate analysis. That was Stockton Medical Foundation. We need to put our finger on what the problem is, why people aren’t interested.

· Paul Gillespie: What I am talking about now is the mandatory element. There are people who don’t want to be in. There are people who are going to push back and resist.

· Brian Browne: Do you think our mandatory decision was right in light of this survey?

· Paul Gillespie: I still would like to have the option to offer mandatory vs voluntary, but I’ve been working since this first meeting to make it mandatory. We’ve decided that only people who have insurance can opt out. Is what we’re going to offer them going to be better? We’re going to be the first to require people to pay for their health care. People worry about long lines at SFGH. Mary’s case is compelling, she has good coverage with Kaiser. People shouldn’t be led down the garden path and think it’s $40/month. There were a lot of people who have told me they are interested, but there are many others who said they are not interested.

· Larry Winsten: We’ve been providing healthcare for many city employees through a health care trust. The essence of group insurance is having everybody in it. The response as a defense mechanism is, I can’t afford it or I don’t need it. There’s a commitment to knock down the gates. The next assumption blocks out the concern. It’s going to be better quality coverage then a person can get on their own. The economics will be better and they will be driven to this plan.

At the Chair’s request, the Committee skipped Item 4 on the agenda.

5. GETTING VALUE FOR OUR MONEY [DISCUSSION AND POSSIBLE ACTION ITEM]

· Heidi Machen: We discussed a lot of Item 4 last time. We still have the discussion about percentage contribution to decide on. I would recommend changing the order of items. We have members of our working group here to discuss three proposals.

· Ilene Levinson: I have listened and learned a lot from all these committee meetings. The question is, what does this represent? We want to truly think about what we can deliver. The very first challenge is that as a whole, the drivers don’t have access to a whole plan. The second issue is access for all drivers. We are proposing plans where everyone has access, no matter where they live. The third issue is administration. The trust that we’re proposing has dealt with these groups in the past. Another challenge, offering value. We can give you a $70 plan as well, but what is that buying? We can guarantee coverage. We’ve addressed all concerns. [Ilene Levinson then went over a handout which she had brought for the meeting and is part of the public record; Carrie Winsten and Ilene Levinson answered questions about the handouts.]

· Dennis Korkos: So for all of your plans, it doesn’t matter if they are employees or independent contractors?

· Ilene Levinson: No, it is group coverage for whatever group you create.

· Paul Gillespie: What about the network?

· Larry Winsten: Any provider, any hospital is the network – no limitation. Some physicians have better deals than others.

· Brian Browne: What is the size of the pool needed, and what plan do they have to belong to?

· Ilene Levinson: It’s a minimum 500 drivers and they don’t have to all belong to Kaiser or CCHP. Some could choose Kaiser, some could choose CCHP. How it ends up being mandatory, voluntary, whatever, these rates are on the table. We just need 500 drivers in the pool.

· Paul Gillespie: So if we wanted to put options out there, we can put out all options, as long as 500 people enroll. Mary, what are you paying now for Kaiser?

· Mary McGuire: I’m still on the city health plan, which is the best deal going. I pay $370. It’s COBRA. Then I will pay $500, $600. I know people paying $900.

· Paul Gillespie: What about pre-existing conditions?

· Ilene Levinson: Everyone is included. No exclusion for pre-existing condition.

· Tom Oneto: What if the plan goes away?

· Larry Winsten: There is no COBRA – if it goes away, it is gone, because there is no more sponsor. They come in during open enrollment.

· Ilene Levinson: These plans are guaranteed issue. When any new group is rolled out, any eligible people are offered the plan equally. They have to choose within sixty days. The guaranteed part is only within the 60 days. It’s offered every year.

· Charles Rathbone: Thank you for shedding light on these plans. As someone who is likely to end up floating the bill, I’d like to say that AARBIS has created a cheaper plan that is half the price of this, which is similar, but not the same. My question is, when I lose my ability to drive, how do I keep my coverage?

· Carrie Winsten: I cannot answer that right now.

· Brian Browne: I have some questions which may or may not be brief. If we get involved in all these options, they could choose any, at different rates?

· Larry Winsten: They are all insured by the carriers. We are not the insurer like Kaiser, Chinese Community, etc. We’re just the facilitator. We’re the administrators.

· Brian Browne: So regardless of how many show up, the plan accepts them? Pre-existing conditions should not be excluded.

· Ilene Levinson: Yes.

· Carl MacMurdo: What if a driver has a serious accident in the first 1.5 years? If someone with a Kaiser Plan, they can continued to be covered. But under this plan, given the eligibility, once you’re in the hospital for 6 months, you’re stuck.

· Larry Winsten: His hypothetical alluded to the fact that if you’re no longer eligible for the plan, you’re knocked off. That won’t eliminate you. If you were covered at the time you got sick, you remain covered.

· Ilene Levinson: The San Francisco Health Plan is an “all or nothing” plan according to Ellen Kaiser but we can administer something different.

· Paul Gillespie: There was never a commitment to administer this program, from SFHP.

· Heidi Machen: The HAP had to be ERISA-proof. So you can’t say to an employer, you have to offer a certain benefit. We have to come back to the Board with a menu of options. We need to go with the SF Health Plan proposal or with this menu of options.

· Paul Gillespie: I want to do this right and I am interested in this Kaiser option, as well as Select Benefits.

· Brian Browne: I am working on my own alternative, my own plan. There are a lot of big numbers being thrown around – we don’t know what we’re going to get for $16 million. It’s s question of where you put the tax and who pays for it eventually.

The Chair continued discussion of Items 4 and 5 to the next agenda.

· Mary McGuire: You need to go back and rethink this. If they only need 500 people to sign up, maybe you want to make this voluntary. It seems a lot better than shoving things down people’s throats. It’s going to fail. No disrespect to Commissioner Oneto, but when you organize people you go from the bottom up. Drivers without medallions don’t even want this health plan and they say they will quit driving. And then you could eliminate those eligibility requirements as well. I have shopped and I think they have good prices. It seems like you should reconsider and it is more sane to make it voluntary.

· Tom Owen: What did you mean by the Taxi Commission sponsoring the plan and what would we be undertaking to do that?

· Larry Winsten: You have all the elements – you’re disseminating information about the plan and can make a group.

· Jordanna Thigpen: What are the ERISA implications though of the Taxi Commission doing that?

· Tom Owen: You can’t say it’s a negotiated benefit, because they’re not our employees. This is governmental fiat, not a negotiated benefit.

6. ADJOURNMENT

The meeting was adjourned at 4:08 PM.

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