Please call Michael Lyon, 415-215-7575 or email with corrections and additions.

Supervisors pass Budget Committee's budget on first reading. Final
reading is Tuesday, July 27.

No more Health Restorations (DEAP, Clinic Directors, Clerical Staff).

No more business taxes than Mayor proposes. Sales tax passed, no
increase in Gross Receipts tax rate for business. Board refuses to
consider ammendments.

Congratualtions over a collaborative process is the dominant theme.
Sandoval: ""A lot of people thought we would fight, and we didn't,"
Sandoval said. "Instead, we set an example for Sacramento. Nobody was
interested in lobbing grenades."

For a summary of of health cuts and restorations

For a summary of People's Budget on making downtown pay revenue

"The middle class and working poor are told that what's happening to
them is the consequence of Adam Smith's 'Invisible Hand.' This is a
lie. What's happening to them is the direct consequence of corporate
activism, intellectual propaganda, the rise of a religious orthodoxy
that in its hunger for government subsidies has made an idol of power,
and a string of political decisions favoring the powerful and the
privileged who bought the political system right out from under us."
Bill Moyers, in a recent speech that's relevent to San Francisco,
though he describes US history as a struggle of ideologies as opposed
to class struggle, like Howard Zinn. Read the entire speech

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Supes Quietly Approve Mayor's Proposed Tax Increases

Beyond Chron, Wednesday, July 21, 2004

It is an issue that has generated heated debate throughout the course
of recent history. It has led to broken-bottle bar fights, local
uprisings and national revolutions.

Why, then, did the question of taxation seem to raise little
discussion at the San Francisco Board of Supervisors meeting on
Tuesday?

With virtually no voicing of opinion and hardly any serious debate,
the Board of Supervisors approved two tax ordinances that would appear
before voters on the fall ballot. The first measure, which would raise
the local sales tax a quarter-cent to 8.75 percent, secured a dominant
9-2 victory. The second, a proposal to reinstate a gross receipts tax
on businesses, also passed with flying colors, 8-3.

These revenue-boosting proposals come as the Board tries, with time
running out, to crank out a sound budget for the upcoming fiscal year.
Having already tweaked Mayor Gavin Newsom's recommended budget to
minimize the loss of programs and positions that they have deemed
essential, the supervisors have taken up the mayor's proposed tax
increases to fill in the gaps and shortfalls in the proposed $5
billion budget.

It is clear, from the final votes at least, that the Board is ready to
put the issue of increased taxation in the hands of the voters. But,
to many, this decision seemed unnecessarily hasty, leaving some
progressives wondering why the Board did not at least discuss other
methods of taxation before approving the mayor's recommendations.

At least one supervisor was openly baffled by the lack of deliberation
over the seemingly highly contentious issue. "There's no engagement at
all here. I'm not sure what our job description is" if it's not to
discuss legislation like this, Supervisor Chris Daly said.

Earlier, members of the public articulated ideas for alternate tax
increases that could benefit the city in various ways while raising
revenue to cover departmental needs.

Jeremy Nelson of Transportation for a Livable City, for one, asked the
Board to consider raising the parking tax by 10 percent. Raising the
parking tax, he said, was the only pro-transit and environmentally
beneficial tax increase being discussed. Furthermore, the parking tax
spike, unlike other tax increases, would win on the November ballot
because most people who pay the parking tax do not live in the city
and are therefore ineligible to vote on the issue.

But Nelson's argument apparently did not rub off on the Board. When
Daly readdressed the issue, asking his colleagues what they thought,
no clear response emerged. Daly pressed the Board to consider
alternatives to the sales tax increase, noting that low-income San
Franciscans were unlikely to vote for a raise in a regressive tax. But
only one other supervisor, Board President Matt Gonzalez, opposed the
sales tax ordinance when it came time to vote.

Supervisors Aaron Peskin and Jake McGoldrick conceded that no one
likes paying taxes. Still, they voiced in harmony, a raise in sales
tax was a necessary step that would not have a substantial impact on
any one demographic.

After agreeing to send the sales tax measure to the ballot, the Board
also passed Mayor Newsom's proposed one-tenth-percent gross receipts
business tax. Daly's modified proposal, a gross receipts tax of 0.15
percent that would have generated, on an annual basis, $14.8 million
more than a 0.1 percent tax, was soundly rejected - again, after
practically no debate.

Following the vote, members of the public could only guess what the
supervisors who refused to speak were thinking. And, more importantly,
why they had not participated in what an article in Monday's Chronicle
predicted would be a "vigorous debate, especially over taxes on
businesses."

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Thursday, July 15

The Coalition for Public Health met today and discussed where things stand. We agreed that although significant restorations had been made, there were still significant cuts that endanger DPH patients, and endanger the long-term survival of major programs in DPH such as the Primary Care Clinics administrative structure, the DEAP program, and Jail Health. The fact that DPH is cutting programs generating considerable revenue makes one wonder if DPH is committed to keeping these programs going over the long run.

Coalition members will be visiting as many Supervisors as possible today (Friday, 7-16-04) and Monday, 7-19-04 to bring them this message. We will be meeting at 10:00 AM those days at the City Hall first floor Light Court with the coffee stand. Please come if you can. Our estimate is that it is important to speak with them before the first and second readings of the budget.

The first and second reading and votes on the budget are at the supervisor's meetings of July 20 and 27, starting at 2 PM. We have been told there is only 30 minutes of public commentary at these meetings.

Following is the message we will be bringing:

Continuing Problems With The San Francisco Department Of Public Health Budget

The Coalition for Public health recognizes that San Francisco is in a difficult and painful budget crisis. We applaud and appreciate the Supervisors' Budget Committee's restorations for DPH. We believe, however, there remain cuts that endanger both uninsured City residents and the continued existence of important programs. At least one cut threatens the long-term survival of DPH as a department that delivers healthcare. We urge the Board to look closely at some of the cuts still in the budget.

Our position has consistently been that this year's proposed cuts were poorly thought out and would cost the City more money than they saved. It is still true for the cuts that remain in the budget. These cuts eliminate revenue generating positions and programs, and undermine the ability of DPH to function. The Coalition for Public Health will support and work for any revenue generating measure that will restore funding to DPH.

Cuts to Community Health Center Directors and to Some Nurse Managers

We appreciate your $300,000 restoration for Nurse Managers. As you know, it was supposed to be supplemented by DPH funds in order to retain all Primary Care Clinic Nurse Managers. This has not happened yet. This is important from a health delivery standpoint, since the Nurse Managers also provide direct services. Both the Community Health Center Directors and the Nurse Mangers play essential managerial and leadership roles at the Community Health Centers. If the primary care providers have to assume these roles, it will decrease their care for patients and billable hours. More importantly, there will be nobody within the Department to advocate for the neighborhood clinics as continuing providers of primary and preventive care, or even for their continued operation. We all remember that last year DPH proposed closing half the clinics and selling off the buildings.

Cuts to the Disability Evaluation Assistance Program (DEAP)

Again, we appreciate you $192,000 restoration to the DEAP program, but contrary to what you might have been told, this is not sufficient to restore the essential nature of the program, and DEAP workers have already had to turn away clients. DEAP's specialty is enrolling homeless who are not in treatment into SSI/SSDI, a painstaking, specialized task other City agencies cannot do, because it is extremely difficult to demonstrate disability for clients whose past medical records are either non-existant or badly scattered. DEAP also connects these homeless with other health services through case management. These functions are ceasing. Each year, DEAP enables over 100 patients to get Social Security. This allows the City to collect $750,000 - $5 million or more in revenues from Medi-cal and Medicare. While some funding has been restored, the program needs to be fully funded, which would require $309,000 to restore 5 FTEs. Eliminating this program means not only that revenue will be lost but also SFGH will have to provide medical care without reimbursement.

Eliminating the Executive Secretaries and other clerical workers in DPH

Many of the Executive Secretary positions generate revenue through their billing responsibilities. In addition, they play a critical communications role for SFDPH. Eliminating them will only exacerbate current problems with billing. The cuts to clerical workers in DPH undermine the entire support infrastructure necessary to provide health services.

Understaffing of forensic nurses in the San Francisco jails

Reports from the jails indicate that understaffing has already resulted in being unable to triage prisoners. This means prisoners will either go without care or be diverted to the SF General Emergency Room, which is already over-stressed. How much more overtime will it cost as police or sheriffs wait with their prisoners in the ER? If San Francisco uses the Health Department to duplicate the cost savings of the notorious prison health contractors, they will run the same risks of prisoner injury or death.

Reorganizing the Field Public Health Nurses

In the middle of this budget crisis, DPH is planning a reorganization of the Public Health Nurses that by their own admission will lose revenue. It will also cut services to Maternal Child health services, which are largely responsible for reducing San Francisco infant mortality to the lowest in the US. The Public Health Nurses participated in a labor-management planning process and developed their own proposal which demonstrated that their existing programs would generate 2 times the revenue of that the proposed reorganization if supported by a functional billing system. DPH's reorganization also calls for the creation of two new Nurse Manger positions that would provide no direct services and would be responsible for supervision of small numbers of nurses. Reorganizing a program that has received accolades for its accomplishments and works at this point makes no sense.

We urge The Board and Mayor to look at these cuts and reverse them

Monday, July 5, 10 AM:

Early Saturday morning, July 3, was the last big day of Supervisors' Budget Committee deliberations before submitting a budget to the full Board. Decisions made in the last 12 hours of that meeting will be announced this week.

As things stand now, this is the status of the Health Department budget:

Primary Care: $1.74 Million restored, is sufficient to restore the docs, nurses, nurse practitioners, and health workers that were cut in the contingency budget. Not restored at this point: on-site Heath Center Directors and Health Center Nurse Managers, or the system-wide administrators, and Medical Directors whose positions are threatened or already eliminated.

AIDS: 900,000 restored for SF AIDS Foundation and Shanti Emotional and Practical Support for HIV/AIDS clients with extensive needs: 50% mentally ill, 1/3rd have substance abuse problems, and 1/3rd are homeless, and Positive Resources Reentry to Work Program, for 400 clients of very low income, largely minority.

SF General Hospital Interpreters: $372,000 restored, saving 5 of 14 FTEs, in a program with over 150 encounters per day.

SF General Hospital Dialysis: $340,000 restored to keep Renal Center open at SF General until Dialysis Center is ready at Laguna Honda Hospital, estimated at three years. (Assumes JCHAO will allow continued operation at SF General, which seems reasonable since SFGH Renal Center recently passed State Title 22 inspection.)

Mental Health: $196,000 restored to allow Southeast Mental Health Clinic (general and geriatric care), Team II Clinic (general and LGBT care) to remain in their current locations.

Major DPH programs not restored at this point:

Disability Evaluation and Assistance Program (DEAP): connnects homeless and other highly vulnerable people with both SSI and City Health and Social Services, generates Federal matching grants and gets clients off GA. Serving 739 clients. Restore cost: $529,000.

Ten Senior Medical Social Workers and one Medical Social Worker Supervisor: They include two at Tom Waddell Health Clinic, two at Laguna Honda Hospital, two at Children's Health Services, and one each at SF General Hospital Emergency Room/Labor-Delivery, Bayview-Hunters Point's Southeast Health Center, Health at Home, Southeast Child and Family Therapy, and Curry Senior Center. Estimated restore cost: $800,000

Mandatory $5 and $10 prescription co-payments for DPH's 3800 patients who above the poverty line: DPH's budget depends on 13% of prescriptions not being filled due to patients' not being able to afford the co-pays, the equivalent of going without medicines one day per week. Restore cost: $232,500

Primary Care Clinics: on-site Health Center Directors and Nurse Managers, as mentioned above, who do a considerable direct patient care, co-ordinate activities at the clinics. Also The Medical Director for Primary Care has been eliminated in the current budget and there has been no Director of Primary Care for over a year. Estimated restore cost: $1.3 million.

Jail Health:There has been heavy pressure from Mayor's office and at least some supervisors to balance the budget through major cuts from Jail Health, by forcing DPH Jail Health to lower its costs to be competitive with private prison health contractors. The City's stated goal was $4.5 million reductions; Fragmentary reports suggest the City is backing off the Prop J contracting out demand, the City has suceeded in taking away $3.0 million, in effect of making Jail Health absorb inflationary cost increases that have occured in Jail Health's $20.5 million 2003-2004 budget. A Blue Ribbon committee, probably comprising of City, Labor, and other interests, will decide how the cuts are to be made, and is due to report March 1, 2005. Some 25 City workers are expected to be offered other City jobs. Although more news will come soon, many questions are left unanswered.

Read the SF Sentinel article on this.

This list does not begin to include cuts to non-profits delivering health care. Some highlights:

Private Provider Network for outpatient mental health: 177 clients lost, 53 clients transferred so care disrupted, $352,500

Bayview Hunters Point Adult Day Health: 125 seniors loose adult day services, at least 10 to be displaced to nursing homes. $47,000

People's Budget list of budget cuts