San Francisco moves to cover its uninsured

The San Francisco Board of Supervisors last week unanimously gave initial approval to a bold new plan to provide health coverage for the city’s uninsured. After the supervisors vote on the San Francisco Health Care Security Ordinance a second time, the plan, which merges separate proposals by Supervisor Tom Ammiano and Mayor Gavin Newsom, will be on the mayor’s desk for his expected signature.

All uninsured city residents — an estimated 82,000, or about 11 percent of the population — will be able to join the Health Access Program, without reference to employment, immigration status or any pre-existing conditions. The program will provide primary and specialty care, hospitalization and prescription drugs. Participants will be assigned a primary care physician, and will be cared for at medical facilities and hospitals already treating patients receiving Medi-Cal (California’s Medicare).

Emphasis will be on preventive care, managing chronic conditions, and treating illnesses early rather than through emergency care later.

Rather than offering traditional insurance, the plan expands access to the city’s public health system.

Calling the new program “a great step forward,” Martin Martinez, policy director for the California Pan-Ethnic Health Network, said if it can be carried out successfully, it can show the role government can play in health care. Martinez pointed out that significant gaps remain, including lack of coverage for any services outside San Francisco.

The ordinance combines two proposals — one introduced last November by Supervisor Ammiano, and another last month by Mayor Newsom. After 17 separate hearings and a number of amendments, the two approaches were brought together earlier this month.

Uninsured people can join either by paying an individual premium based on income, or employers could pay premiums for their workers as a group. The ordinance also sets a “minimum spending requirement” for medium and large businesses, to discourage companies from dumping workers into the publicly funded health system. Small employers with fewer than 20 workers are exempt.

To pay for the program — estimated to cost about $200 million a year — the city will put in the $104 million it now spends on care for the uninsured, while premiums and co-payments mostly from higher-income participants will bring in about $60 million. Business premiums, initially pegged at $1.06/worker/hour from medium-sized businesses and $1.60 from large firms, will bring in some $30-40 million. Another $10 million is expected through greater federal cost-sharing.

If approved, the program’s first phase will go into effect July 1, 2007.

Martinez said he was not aware of other comparable city plans, although since incoming Oakland Mayor Ronald Dellums emphasized health care in his campaign, “Oakland is being inspired to consider the possibility.”

Luella Penserga, project director at Oakland-based Community Voices: Health Care for the Underserved, said her organization is considering what can be done at the Oakland and Alameda County levels.

“We also need to look at other key issues, such as affordable housing and the lack of mental health services,” she added.

Both Martinez and Penserga highlighted the importance of state Sen. Sheila Kuehl’s bill, SB 840, for a single-payer system in California. The measure, which passed the state Senate last year, is now going through the Assembly’s committee process.

Predictably, representatives of San Francisco’s business community have voiced their opposition to the San Francisco program, claiming it will drive some of them away.

Ammiano spokesperson Zack Tuller called their concerns “overblown — the same people who objected to the Living Wage ordinance are now opposing the Health Security ordinance.” But, he noted, “they’re still here, despite their earlier threats to leave.”