Healthy San Francisco

Healthy San Francisco is a program launched in 2007 to subsidize medical care for uninsured residents of San Francisco, California.^[1] The program's stated objective is to bring universal health care to the city,^[2][3] and the program website states that insurance "is always a better choice."^[4] The program is open to city residents, ages 18 and up, whose incomes and net worth are low but who do not qualify for other public coverage, and who have had no insurance for at least 90 days.^[5] Eligibility is not conditional on citizenship, immigration, employment or health status.^[5][6] The program covers a range of services, but only pays providers within San Francisco.^[3]

History

In Mayor Gavin Newsom's first term, he worked to extend the city-funded health insurance program, started under Mayor Brown, to young adults, a program that had been previously offered only to children. Newsom's more ambitious plan on healthcare began to take shape in 2007. In his budget proposal for fiscal year 2007-2008, Newsom announced his intention to provide universal health care for all city residents, based on long-time City Supervisor Tom Ammiano's plan. The care would be provided through the San Francisco Health Access Plan also known as Healthy San Francisco.^[7][8] The system planned to use more electronic referrals and focus on preventive care.^[9] Newsom's proposal has prompted Oakland mayor Ron Dellums and San Mateo County's Board of Supervisors to look into possibilities for providing their own taxpayer-subsidized health care.^[10][11]

A legal challenge against the program which was filed by the Golden Gate Restaurant Association in 2006 was denied a hearing by the US Supreme Court on June 29, 2010, legally clearing the program for continued existence for the foreseeable future.^[12]

With implementation of the Patient Protection and Affordable Care Act starting in 2010 and the setting up of health exchanges in 2013, half of the 60,000 patients enrolled in 2013 are eligible for Medi-Cal because of the expansion of that program by the Affordable Health Care Act.^[13] Another 10,000 or so people are likely to get health insurance through the Covered California health exchange that was created as part of the Affordable Health Care Act.^[13] The remaining patients are likely to be undocumented immigrants and people who live in the city for less than 5 years, so are not eligible for Covered California, and people who make too much money for Medi-Cal but not enough to afford health insurance.^[13]

Funding

"Healthy San Francisco receives funding from the city, the federal government, patient [co-payments] and fees imposed on San Francisco businesses that do not provide health coverage for their workers."^[1] The Health Care Security Ordinance included a requirement that employers with more than 20 workers spend at least a minimum amount towards employee health coverage. The minimum payment for 2014 ranges from $1.63 to $2.44 per hour, depending on firm size; for-profit employers with fewer than 20 workers and non-profits with fewer than 50 workers are exempt.^[14] Employers can elect to satisfy this requirement by paying into Healthy San Francisco, in which case their workers may apply for the program.^[6] As of early May 2008, over 700 employers had decided to participate in the program.^[15][16] Early evidence suggest that employers are spending more on health benefits, but some are raising prices and cutting back on hiring.^[16][17]

The Golden Gate Restaurant Association filed a lawsuit seeking to overturn the Ordinance, claiming it conflicted with ERISA. The Ninth Circuit Court of Appeals rejected their arguments in May 2009, and an appeal to the U.S. Supreme Court was declined.

Healthy San Francisco reportedly costs about $140 million per year, which is expected to go down as the 2013/2014 health exchanges start.^[13]

Reception

A 2009 survey of participants found more than 90% were "at least somewhat satisfied" and would recommend it to a friend, but only 40% of participants said their care was considerably better since joining the program, and the survey only included participants who had been allowed to join.^[18]

A 2011 report found that federal health insurance legislation, better known as Obamacare, signed in 2010 could reduce enrollment by up to 60%, but some would remain enrolled, including undocumented residents, prisoners, and the indigent.^[1]

See also

• Health care reform in the United States

Notes