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Mayor Thome asked and Mr. Cleveland confirmed that Measure AA would not take effect until 2019. He said one of the more common questions posed to relates to what might be a premature reaffirmation of Measure A, in light of the unknown impacts of the Affordable Care Act. Mr. Cleveland acknowledged the concern. He explained that while the Affordable Care Act attempts to ensure that individuals have health insurance, it does not necessarily guarantee access to healthcare. California has some'of the lowest Medi-Cal reimbursement rates in the county, which means that many providers cannot afford to see these patients. Measure A helps to fund these services and increase the safety net providers. He also explained that while 2019 may seem to be far in the future, there are only three elections between now and the expiration of the tax. With other important measures on each of those ballots, many see it as critical that this measure be given an opportunity to pass now. Councilmember Cook-Kallio asked if the lower Medi-Cal reimbursement rates relate to the high cost of living in the Bay Area. Mr. Cleveland explained that it is a product of California being an early proponent of managed care and tightening its expenditures on Medi-Cal. He further explained that one of the problematic assumptions of the Affordable Care Act is that there will be fewer uninsured, which ultimately decreases federal funding for those hospitals that see a disproportionate share of uninsured and Medi-Cal patients. Measure A funds will help to bridge this gap. Councilmember Brown referred to a recent editorial piece in The Contra Costa Times, which noted challenges with monitoring the success of the program because fund recipients often fail to provide the data that would justify their programs. With over $125 million in annual Measure A funds, she asked whether there are any plans to improve this process so that a measurable difference can be demonstrated to the public. Mr. Cleveland said he disagreed with the editorial. He explained that the comment to which she referred was taken out .of context and that the oversight committee has questions regarding data related to the smaller discretionary fund used by the Board of Supervisors for their respective districts. He said that while those fund recipients have not always provided the level of detail the oversight committee would like, it has improved. He directed her attention to the last two paragraphs of the editorial, which say there is no question of misappropriation but rather that the oversight committee felt there was not clear reporting from a couple of small grant recipients. He stressed that this does not relate to Alameda Health Services or the organizations represented here tonight. Given the overall importance of the measure, he suggested it would be irresponsible to vote "no" over tens of thousands of dollars out of$125 million. Councilmember Brown asked and Mr. Cleveland confirmed that the state actually withdrew some related funding as a result of Measure A funds being available instead. Mr. Cleveland noted that the state is withdrawing funding from every county, not only Alameda County. Recent figures suggest that the county may lose $10 million in state funding as a result of Measure A. He questioned the wisdom of placing $125 million in Measure A funds at risk simply because the county might lose $10 million in state funds. Councilmember Cook-Kallio said there is a conflict in that no one particularly wants to pay taxes and yet we have a law ensuring that anyone who presents themselves to an emergency room receives the necessary care. She asked what the real impact would be on those who legally and ethically deserve care if Measure A funds were to disappear. Mr. Cleveland explained that the impacts are different for private hospitals, which don't receive Measure A funds, than public hospitals. If Alameda Health System were to lose this funding it would likely be forced to close down its primary care clinics, which are actually more cost effective, in favor of keeping the hospitals open. City Council Minutes Page 5 of 20 May 6,2014