WEST HOLLYWOOD SINGLE PAYER COMPREHENSIVE UNIVERSAL HEALTHCARE COVERAGE PLAN

By Patricia Nell Warren

Comprehensive document outlining Patricia Nell Warren's plan to make West Hollywood the first city in the United States to offer all residents and employees a true, single-payer comprehensive Universal Healthcare Coverage plan

Some will question whether or not we should have a Comprehensive Universal Healthcare program in West Hollywood. But, with healthcare costs rising by double digit percentages every year, and the number of uninsured growing exponentially, that question has already been answered with a resounding "yes!" The only questions that remain are how soon can we get this started, how do we fund it, and what is the scope of coverage we are able to offer.

The issue of healthcare coverage is at the top of nearly every American's list of concerns. As an elder who spent many years without adequate healthcare coverage, I can personally relate to the plight of the uninsured. This is not a political issue; rather, it is a moral and ethical issue.

The plan I am outlining below is a first step towards bringing Comprehensive Single Payer Universal Healthcare Coverage to West Hollywood. The first section analyzes many of the programs and proposals which currently exist. The second section describes a proposed scope of coverage. The third section describes both costs and potential funding mechanisms for the proposal, and covers some of the broader public policy implications contained in the funding scheme. Finally, the fourth section creates a blueprint and timetable for the implementation of my plan.

Current Healthcare Situation

According to recently published reports, it is estimated that some 45.8 million people in the United States are uninsured. According to figures gathered by Sen. Sheila Kuehl, Chair of the Senate Health Committee, and published in her January, 2007 Healthcare essay, "One in five Californians has no health insurance at all and most of these people are average working people." In addition to the uninsured, there is an increasingly large segment of the population which is underinsured, meaning that their insurance coverage fails to cover a large portion of their costs if they get sick or injured.

According to Sen. Kuehl's essay, insurance premiums have increased by double digit percentages in each of the past five years, while overall spending and wages have not kept up. And while insurance premiums have increased exponentially, scope of coverage has decreased, through narrowing provider networks, more exclusions for pre-existing conditions, drug formularies which exclude the most common and most effective brands, and limitations based on types of employment. A recent Field Poll commissioned by the California Wellness Foundation revealed that 80% of Californians want the government to guarantee access to affordable healthcare coverage. Excessive insurance company profits, waste, fraud and inefficiency plague our current system.

Massachusetts was the first state to attempt to tackle the healthcare situation by creating their own brand of Universal Health Coverage. Unfortunately, their plan is modeled much after the failed auto insurance model, where very few limitations and regulations are placed on the health insurance companies, and all residents are required to carry the insurance or face fines and penalties. And much like auto insurance, we know that many don't carry it, and the "scofflaws" will be identified only when they make contact with the healthcare industry. Sadly, the model recently discussed by California Governor Arnold Schwarzenegger very closely follows the Massachusetts model, and fails to acknowledge the plethora of problems which already exist within our automobile insurance industry. The Governor's model employs a similar paradigm, but for something far more important than automobiles--namely our collective health and well-being.

San Francisco, under the leadership of Mayor Gavin Newsom, created the first county-wide universal health care system. While there are many good things about Mayor Newsom's plan, it still falls well short of true single-payer universal healthcare coverage for everyone. The San Francisco plan guarantees universal health access for those who voluntarily participate in the program, and receive all of their health care services within the City and County of San Francisco. The San Francisco Health Access Plan uses an existing network of city public health clinics, city-supported private nonprofit health clinics and most city hospitals. The San Francisco plan excludes Dental coverage, fertility treatments and cosmetic procedures, and also excludes any care, even on an emergency basis, received outside the City and County of San Francisco or from a provider not currently part of the San Francisco Health Access Plan.

The San Francisco plan is estimated to cost $200,000,000 per year, or approximately $2,400 annually per participant. Monthly premiums in this voluntary program range from $3.00 per month for the most indigent, to $201.25 per month for individuals earning more than $50,000 per year. Funding for the San Francisco program comes from a $1.60 per employee hour worked assessment on businesses with more than 20 employees and a $1.06 per employee hour worked assessment on smaller businesses, and by redirecting some $104 million that the City and County of San Francisco already spends to covers the costs of treating the uninsured in its emergency rooms and clinics.

While I applaud Mayor Newsom and the San Francisco County Supervisors for their bold step, I believe that West Hollywood can still do better, and provide a true, comprehensive, single-payer universal healthcare coverage for all of our residents.

The only truly comprehensive solution to the current health care crisis is Sen. Kuehl's Senate Bill 840. According to Sen. Kuehl, "It establishes universal, affordable, comprehensive health insurance for all Californians..." and replaces existing insurance companies with a statewide trust fund to collect all employer and individual paid premiums, placing everyone in the same risk pool and significantly reducing the administrative costs of healthcare by two-thirds. A similar bill was vetoed by Gov. Schwarzenegger last year, and he has already promised to veto SB840 if it reaches his desk after Sen. Kuehl reintroduces it this session. With nearly four more years of Gov. Schwarzenegger, the fate of Sen. Kuehl's excellent, thoughtful and comprehensive bill is sadly dubious at best.

West Hollywood has long been a city of firsts. We were the first pro-choice city. We were the first city to have an openly LGBT majority on our City Council. And now, once my plan becomes a reality, we will be the first city to offer its residents affordable and comprehensive universal healthcare coverage.

Proposed scope of coverage

The comprehensive coverage plan I have envisioned will provide treatment coverage in four major areas: hospitalization, non-emergency urgent/critical care, non-facility and other medical needs. Coverage will be available to all residents of the City of West Hollywood, with specific criteria developed to determine residency. Coverage will also be available to non-residents who are employed by any entity currently domiciled in West Hollywood and holding a valid business license or business tax certificate from the City. All West Hollywood based employers will be required to provide its employees with private health insurance at a level equal or greater than that which is envisioned in this plan, or alternately, to participate in this program and pay a premium at a level set annually by the governing body of the West Hollywood Comprehensive Universal Healthcare Coverage Plan. In keeping with West Hollywood's moral obligation and ethical responsibility to treat all human beings with dignity, coverage will be provided without regard to immigration status to West Hollywood residents and employees, and we will fully recognize the rights of domestic partners to fully participate in the medical decisions of their entire family.

Hospitalization coverage will include inpatient services such as surgery, anesthesia, psychiatric care, substance abuse treatment, laboratory work, diagnostic testing, maternity and skilled nursing care, as well as outpatient services including emergency room visits, minor surgical procedures, radiology and pathology, pharmacy services, cardiovascular health, women's health, physical and occupational therapy and certain types of exigent pre-natal care. This list is far from complete, and is only used for illustrative purposes.

Emergency and non-emergency urgent and critical care coverage will overlap with the hospitalization coverage and is intended to cover many of the same situations on an unscheduled or non-routine basis.

Non-facility treatments are those which occur outside of a hospital, urgent care or critical care facility. This includes both the traditional medical office, as well as clinics and hospice care. Examples of non-facility treatments would include certain substance abuse treatment and prevention programs, mental health wellness, minor surgical procedures, pre-natal care, allergy tests and injections, routine physicals, office visits and check-ups, medical consultations, physical therapy, immunizations, preventative medicine, women's health, vision exams, hearing exams, radiology, pathology, and HIV/AIDS and STD testing.

Other covered treatments will include certain home health care and private duty skilled care, hospice, ambulance services, medical transportation, medically indicated prosthetics, chiropractic treatment, podiatry, and certain non-Western medical treatments such as acupuncture.

The program would also provide a comprehensive prescription drug benefit for all participants, through the use of effective generic drugs as well as cutting edge name brand formulas as necessary. Using our collective buying power, we will negotiate the purchase of these medications directly from manufacturers, through discount buying cooperatives, and even with Canadian and European pharmacies and pharmaceutical companies, to ensure that we are able to best provide necessary medications at a reasonable cost.

One of the cornerstones of the West Hollywood Comprehensive Universal Healthcare Coverage Plan will be its education and prevention plan. Health education can go a long way in reducing the number and severity of the ailments which affect people. A healthy West Hollywood will spend less overall on healthcare. Preventative medicine is also a key component to this program. Many people are forced to deal with healthcare situations on an exigent basis in the emergency room of a hospital because they have not had adequate healthcare insurance coverage to allow them to treat the problem while it was still relatively minor. Allowing people to seek preventative and early treatment for many ailments will not only greatly improve the overall health of West Hollywood, but will also greatly reduce the costs of a comprehensive health program.

One of the big drawbacks of the San Francisco plan is the complete lack of portability. There is no coverage whatsoever, under any circumstances, for treatments received outside the City and County of San Francisco. This type of plan cannot work in West Hollywood. At present, there are no trauma centers or hospitals located within the corporate boundaries of the city, and residents are served by a small number of facilities located primarily within the City of Los Angeles. The San Francisco plan also fails to account for the realities of every day life, where people travel for both business and leisure, and do not spend all of their time within the small confines of a single city and county. While my plan will focus and direct primary coverage to be from a network of preferred vendors and providers within a small radius of West Hollywood, there will also be provisions to cover emergency situations which arise when a covered person is unable to receive treatment within that network.

One of the hurdles that we will face is the full and complete integration of Medicare and Medi-Cal participants into the funding mechanism of this program. Cooperation from all levels of government will be required to allow the West Hollywood Comprehensive Universal Healthcare Coverage Plan to take full advantage of the healthcare dollars already being spent by these other programs. Our ultimate goal will be to offer participants the ability to completely opt out of their existing government program (i.e., Medicare or Medi-Cal) and have those programs contribute directly, on a pro rata basis to the West Hollywood Comprehensive Universal Healthcare Coverage Plan so that we can provide singular coverage. Until those waivers and memoranda of understanding are negotiated and finalized, we envision that we will still provide some level of coverage to those individuals. The West Hollywood Comprehensive Universal Healthcare Coverage Plan would directly bill the Medicare and Medi-Cal programs as the service provider, and receive the reimbursement according to usual and customary schedules. The West Hollywood Comprehensive Universal Healthcare Coverage Plan would still pay directly to its own vendors and service providers, so that it would be a seamless process for the patient and end user of the healthcare services.

Costs and sources of funding

As with Senator Kuehl's SB840 plan, all revenues generated for this program, including the premiums paid, reimbursements from other municipal, state and federal programs, grants, and the anticipated proceeds from the fees and other contributions listed below, will all be paid into a central fund. This fund will be segregated from the city's general fund to ensure that all funds therein are used for the sole benefit of the West Hollywood Comprehensive Universal Healthcare Coverage Plan, and that these funds cannot be used to balance the General Fund budget of the city. All disbursements, including overhead and payments to healthcare providers and vendors, will also be made through this fund.

Until a full survey is conducted, as indicated in the final section of this proposal, we cannot know the exact number of uninsured people in West Hollywood. Most state and national estimates place the number between 15% and 20%. There is an additional segment of the population which is classified as "under-insured," meaning that while they do carry some medical insurance coverage, it is inadequate to cover the full scope of their healthcare needs. Using those broad estimates, we should have between 5500 and 7500 uninsured persons in West Hollywood.

We believe that many West Hollywood residents already covered by health insurance, and many West Hollywood based employers already offering adequate healthcare coverage will elect to participate in this program due to the quality of care we will provide, along with the cost savings we are able to offer.

Two of the largest expenses covered by traditional healthcare insurance premiums are company overhead and profit. According to published reports, overhead expenses at most insurance companies average approximately 30% of total operating costs, and while most pay their top executives in excess of $10,000,000 per year, some CEOs have received total compensation packages in excess of $100,000,000. That is more than the entire annual budget for the City of West Hollywood!!! Many insurance companies are for-profit entities, and many need to deliver a consistent return to their shareholders. According to Senator Kuehl's report, a government run single payer universal healthcare coverage plan would have overhead costs closer to 10%. Considering that the program would not need to make a profit, and would have lower overhead, this would already account for a savings of nearly one-third of healthcare costs.

West Hollywood based employers participating in the program would make direct contributions to the West Hollywood Comprehensive Universal Healthcare Coverage Plan in the form of premiums. Because of economies of scale, and the reduction of overhead and profit, we believe that we will be able to offer employer-paid premiums at a significantly lower rate than that which they are currently paying to their existing healthcare insurance providers. Similarly, we believe that many West Hollywood residents who currently carry private healthcare insurance will also drop their existing coverage in favor of the West Hollywood Comprehensive Universal Healthcare Coverage Plan, as it will offer greater flexibility, a wider scope of benefits, and do so at a significantly lower cost.

Individuals joining the West Hollywood Comprehensive Universal Healthcare Coverage Plan through direct employer participation should not be a financial drain on the system, as their employer-paid premiums will cover the cost of their participation in the program. Uninsured, underinsured and currently insured individuals (who drop their current insurance program in lieu of the West Hollywood Comprehensive Universal Healthcare Coverage Plan) joining the program will pay premiums on a sliding scale, according to household size, income and other demographic factors which determine ability to pay. For the most economically disadvantaged individuals and households, premiums may be completely waived.

Implementation of the West Hollywood Comprehensive Universal Healthcare Coverage Plan will also allow the city to redirect some of the funds it otherwise spends on healthcare related programs into this fund. To protect many of the long standing relationships that the City has maintained with service providers, particularly for seniors, the disabled, and persons living with HIV/AIDS, where it is possible and practical, these providers will be brought into the preferred network of the West Hollywood Comprehensive Universal Healthcare Coverage Plan, and the funding that they receive now will come directly from the plan, which will have received an allocation from the city's Social Services budget.

One of the largest financial burdens on the program will come from providing premium subsidies for those who lack the ability to completely cover the cost of their participation in the West Hollywood Comprehensive Universal Healthcare Coverage Plan. Until the full study envisioned below is completed, it is impossible to give a complete breakdown of all anticipated costs associated with the program. For the purposes of this initial proposal, we can look at the study completed by the San Francisco Health Access Plan, and extrapolate an estimate from there.

The San Francisco plan estimated a yearly cost of $2,400 per participant. Because our scope of coverage will exceed that of San Francisco, we will estimate annual costs of $3,000 per person. Using the average estimate of the number of uninsured in West Hollywood at 6,500 persons, this produces an annual program cost of $19,500,000. Assumed in this estimate is the fact that some of the 6,500 uninsured persons do have the ability to pay some or all of the anticipated premium, that some of the underinsured who join this program will not have the ability to pay the full amount of their premium, and these two categories should roughly balance each other out, again leaving an amount just below $20,000,000 annually which will need to be covered through secondary revenue sources.

The list below details multiple potential revenue sources to fund the unfunded portion of the West Hollywood Comprehensive Universal Healthcare Coverage Plan. Some would be very simple to implement through minor revisions and amendments to the West Hollywood Municipal Code enacted by the City Council. Others might require action from other legislative bodies, and others yet may require approval from West Hollywood voters at a special, municipal or general election. All of the proposals will be considered as part of the task force study envisioned herein, and the ultimate funding source will likely come from a combination of several of the options listed herein. It will certainly require great political will to take all of the necessary steps to ensure that this program succeeds and that the proper funding mechanisms are in place, but it is too important of an issue for us not to take all necessary steps to ensure complete success. Some of the funding mechanisms also dovetail directly with other public policy initiatives which provide an overall benefit to the West Hollywood community.

• ¼% sales tax. Of the 8.25% sales/use tax currently collected on designated purchases, 1% comes to the City of West Hollywood general fund. Raising the sales tax to 8.5%, which would bring our sales tax rate equal to that of the City and County of San Francisco, would generate about $3,000,000 a year, and would have a negligible effect on most consumers. The cost of a fancy $100.00 dinner for two at a nice West Hollywood restaurant would only be increased by $0.25. And since sales tax is paid by both residents and non-residents, it would allow people residing outside of West Hollywood who enjoy the high quality of services offered by our community to help contribute to our overall operating costs.

• Ellis Act registration fee. Nearly all residents of West Hollywood share universally in their disdain for Ellis Act evictions. Because Ellis is state law, we are unable to unilaterally remove it or change it. What we can do, however, is use our Municipal Code to create certain disincentives for these evictions. And because these evictions are certainly taxing on the mental and physical health of those being evicted, it is fair to share the health care costs with property owners who choose to exercise their rights under Ellis. As a funding source for the West Hollywood Comprehensive Universal Healthcare Coverage Plan, we would impose a five thousand dollar ($5,000) per unit Ellis Registration Fee, immediately payable upon a property owner declaring his or her intent to exit the rental market and proceed with Ellis evictions.

• Condominium development fee. A majority of the Ellis evictions in West Hollywood are instigated so that property owners can redevelop their property into more lucrative condominium projects, many with luxury units valued in excess of $1,000,000. A condominium development fee of $25,000 per unit will be added to the current permit application process, with the entire amount directed into the general fund of the West Hollywood Comprehensive Universal Healthcare Coverage Plan. The added benefit of this would be that this significant fee would serve as a disincentive to Ellis Act conversions, thus creating a win-win situation for West Hollywood residents. Also, to foster West Hollywood's strong commitment to the development of affordable housing units, any new unit which is permanently dedicated to low income, low income senior or low income disabled housing shall be exempted from this development fee.

• Luxury apartment development fee. Developers of luxury market-rate apartments will also pay a per unit development fee of $10,000 per unit, added to the current permit application process, with the entire amount directed into the general fund of the West Hollywood Comprehensive Universal Healthcare Coverage Plan. Any unit permanently dedicated to low income or disabled tenants shall be exempt from the fee. Units designated for Section 8 tenants will also be exempt from this fee.

• Gasoline retailer business license fee. Currently, gasoline retailers pay a business license gross receipts tax of $0.48 per $1,000 of gross revenue. West Hollywood has three categories of business license tax rates: $0.48 per $1,000, $0.96 per $1,000 and $1.44 per $1,000 based on the type of business entity. Gasoline dealers are not environmentally friendly and sell products (including gasoline and tobacco) which generally contribute to negative health consequences. Gasoline dealers have also experienced record profits from their significantly higher prices. Gasoline retailers should be moved to the highest level of business license gross receipts tax at $1.44 per $1,000 gross revenue, and with the extra $0.96 per $1,000 directed into the general fund of the West Hollywood Comprehensive Universal Healthcare Coverage Plan. Because of gasoline retailer business license fee would be comparable with that in neighboring Los Angeles (which currently charges $1.43 per $1,000 for gasoline retailers); retailers would have no factual basis for arguing against this fee on the basis of business competition.

• Medical Marijuana dispensary fees. A special category would be created in the Business License Ordinance for "for profit" dispensers of medical marijuana as well as "for profit" medical offices specializing in referrals for medical marijuana as their primary goal. As part of their application for their conditional use permit, new for-profit facilities would be required to pay a permit application fee of $50,000. They would also be assessed a business license fee of $100 per $1,000 of gross revenue, and the usual and customary rebates and fee waivers available to new business shall not be made available to these facilities.

• Transient Occupancy Tax. Currently, short term hotel guests pay a 14% transient occupancy tax on the nightly room rate at West Hollywood hotels. This money currently funds the West Hollywood Convention and Visitors Bureau as well as a sizeable portion of the city general fund. Many cities around the country, including New York City, have both a percentage and a flat rate room tax. As an additional funding mechanism for the West Hollywood Comprehensive Universal Healthcare Coverage Plan, a $2.00 per night surcharge would be added to all hotel room nights, with the proceeds entirely dedicated to the healthcare plan.

• Rental car surcharge. Car rentals originating or terminating in West Hollywood would be subject to a $2.00 per day surcharge, with the proceeds entirely dedicated to the healthcare plan. To encourage the use of alternative fuels, hybrid, electric and fuel cell vehicles, rental of any such vehicle would be exempt from this surcharge.

• Property transfer tax. Real estate prices have more than doubled in the past decade in West Hollywood. Many individuals have profited greatly through the practice of "flipping" houses, and have helped to decrease the already dwindling supply of affordable market-rate housing available for purchase. The City of West Hollywood does not have its own property transfer tax. Santa Monica currently assesses a transfer fee of $3.00 per $1,000 or 0.3%. Culver City and Los Angeles assess a transfer fee of $4.50 per $1,000 or 0.45%. An additional funding source for the West Hollywood Comprehensive Universal Healthcare Coverage Plan could be the implementation of a property transfer tax which is competitive with other rates in the immediate vicinity of West Hollywood, and with the proceeds of this fee directly benefiting the healthcare fund.

• Direct benefit assessment district. In 1978, California voters passed Proposition 13, which severely limited the ability of municipalities to assess certain property taxes in excess of 1% of assessed value. This significantly impaired local governments in their ability to finance many local projects. In 1982, The Community Facilities District Act was authored, which allowed for the creation of community facilities districts, commonly known as Mello-Roos districts, after Sen. Harry Mello and Rep. Roos who authored the plan. Under this law, counties, cities, and any other legally definable district can authorize the sale of tax-exempt bonds to fund public improvements and services, with the property owners within the district paying a special tax to repay the bonds. Proposition 218, passed by California voters in 1998, limited Mello-Roos districts, requiring an approval by 2/3 of the voters in the proposed district before the taxing authority can be created. Mello-Roos districts have been used to fund street repairs, police protection, fire protection, ambulance services, elementary schools, parks, libraries, museums, cultural facilities and water facilities, and a citywide district could be used to fund the West Hollywood Comprehensive Universal Healthcare Coverage Plan.

• Employer contributions. As mentioned earlier, all West Hollywood based employers will be required to provide its employees with approved private health insurance at a level equal or greater than that which is envisioned in this plan, or alternately, to participate in this program and pay a premium at a level set annually by the governing body of the West Hollywood Comprehensive Universal Healthcare Coverage Plan. This contribution requirement will be applied to businesses of all sizes, with a lower rate available for businesses with less than ten employees. While I fully expect some small businesses to complain about having to pay any healthcare costs for its employees, studies bear out the fact that healthy workers are more productive and have less absenteeism, and thus a true cost-benefit analysis would actually show that even small businesses will benefit from this program. Moreover, beyond the financial considerations, the issue of providing healthcare is a moral issue, not a financial issue, and we are morally obligated as a civilized society to provide adequate healthcare for our people. The West Hollywood Comprehensive Universal Healthcare Coverage Plan is the first step in meeting that obligation, until our state and federal governments meet their own moral and ethical obligations. Initial rates would be capped at $1.95 per hour per employee in businesses with 10 or more employees, with a maximum monthly contribution of $280.00 per employee. For businesses with less than 10 employees, rates will be capped at $1.25 per employee, with a maximum monthly contribution of $195.00 per employee.

• Sliding scale premiums. Program participants in the West Hollywood Comprehensive Universal Healthcare Coverage Plan will also pay premiums into the general fund on a sliding scale, based on ability to pay. Ability to pay must be tied to some statistical guideline to allow for objective criteria to be established, and this plan will use the United States Department of Health and Human Services Poverty Guidelines. 2006 Guidelines set the poverty level at $9,800 for a single person household and $13,200 for a two person household. Persons living at up to 300% of the federal poverty level would have their entire premium waived, with full premiums assessed only for those living at 1000% of the poverty level or higher.

This document is intended to be a skeleton blueprint of the full and complete West Hollywood Comprehensive Universal Healthcare Coverage Plan. It is meant to be a roadmap for the envisioned Healthcare Taskforce to help us fully develop and implement the final plan. Much work is left to be done, and it will be possible if we have the political will to fulfill our moral and ethical obligation to society.

The first step in this process would be for the West Hollywood City Council to empanel the Healthcare Taskforce to use this blueprint, and create the mechanics of a full working plan. Experts in the medical and insurance field, public policy scholars and members of the community would all need to be part of this task force. The taskforce would be asked to do its complete research and return a comprehensive report to the Council by a date certain, probably between 120 and 180 days later. Once the taskforce report is submitted to the council, and it is approved by the City Council, multiple departments within the city will begin working on implementation. The City Manager and City Attorney will begin putting the framework in place for any negotiations with other governmental authorities, while the City Clerk will prepare for any ballot initiatives or special elections necessary to implement funding mechanisms. The City Attorney will draft any language necessary to amend the municipal code, and the City Manager will begin putting out RFPs for any consultants necessary to bring the plan to its full implementation.

The task force itself should be small enough to be workable, yet large enough to be fully representative of all of the stakeholders in the city. The task force should include: 1 member each from the Human Services Commission, Eastside Project Advisory Committee, Senior Advisory Board, Women's Advisory Board, Lesbian & Gay Advisory Board, Russian Advisory Board and Disabilities Advisory Board. It should also include 1 member of the city council, a representative of the City Manager's Office, a representative from the Department of Finance, a representative from the Human Services Department, an attorney from the City Attorney's office, a representative from the West Hollywood Municipal Employees Union, a representative from the West Hollywood Chamber of Commerce, and a member of the West Hollywood clergy. The taskforce should also contain at least two members of the medical profession, a representative of the health insurance industry, a representative from the pharmaceutical industry and a recognized academic scholar on public healthcare issues. Each councilmember would also be allowed to make one direct appointment to the task force. Because of her strong commitment to social justice and universal health care for all Californians, we would also invite our state senator, Sheila Kuehl, to participate and serve as an ex-officio member of the task force.

The task force would hold regular meetings and public hearings in full compliance with the Brown Act.

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