S.F. works to care for all its uninsured
CITY'S PLAN WOULD BE FIRST IN THE NATION
By Mary Anne Ostrom
Mercury News

San Francisco, eager to put its stamp on the health care debate, unveiled an ambitious plan Tuesday that would make it the first city in the nation to provide every uninsured resident with access to medical services.

When the plan is rolled out next year, the city's 82,000 uninsured residents would become eligible for a wide array of benefits, regardless of employment or immigration status. The complex $200-million-a-year plan requires funding from existing government sources, uninsured residents who will pay based on income and a mandated contribution from all San Francisco employers with more than 20 workers.

At a packed news conference, San Francisco Mayor Gavin Newsom declared that the city would set a national standard for universal access to health care. The city says nearly half of the uninsured work and businesses need to step up, but several employers in the audience said the mandates would force them to shut their businesses.

The proposal comes as Massachusetts, New York and a few other states have moved ahead with employer mandates. In 2004, California turned down a plan to impose them.

“Rather than lamenting the fact that we live in a country with 45.8 million who don't have health insurance, San Francisco is doing something about it,'' Newsom said. “San Francisco is not waiting around'' for state or federal fixes.

The San Francisco plan, hashed out over the past 125 days with labor, business and health care providers, is hardly a finished work. A highly charged political battle between labor and business interests is still brewing over the employer mandates.

The mandates remain a ticklish issue for the pro-business mayor, but he has lost some negotiating clout as Supervisor Tom Ammiano has rounded up enough support from his colleagues to try to make the mandates veto-proof.

A key committee hearing is scheduled today on what form the mandates will take, and the full package of legislation is scheduled for a vote at next Tuesday's board of supervisors' meeting.

Under the plan, employers with more than 100 workers would be required to kick in $1.60 for each hour a non-management employee worked, or provide at least the equivalent in premium contributions to a private plan for that employee. The requirement drops to $1.06 if the workforce is between 20 and 100 employees.
Jim Lazarus, a representative for the San Francisco Chamber of Commerce, said his group has “a huge problem'' with the dollar-per-hour formula. Business leaders, he noted, had offered an alternative plan to raise $50 million by imposing fees on businesses.

City officials say they are not creating a new insurance plan but rather access to an array of health care services already offered by the city health department and non-profit community clinics and hospitals.
The city already spends $104 million a year on services to the uninsured. That amount would be diverted to the new program. The rest of the $200 million annual cost would come from individual contributions and city employers.

Only residents would be eligible and only for services offered in the city. The poorest would pay as little as $3 a month to join the San Francisco Health Access Plan. That amount would climb to $200 a month for individuals earning nearly $50,000 a year or more. Higher-income individuals might still find that a deal, say city officials, if they have costly-to-insure pre-existing conditions such as AIDS or breast cancer.

As children do under state and county programs now, adults would have to apply for federal and state aid before dipping into city funds. The plan would allow adult immigrants living in San Francisco illegally to participate -- believed to be the country's first for a plan offering such a wide range of benefits.

Since 1989, San Francisco law has banned city workers from asking the immigration status of any applicant seeking city services. The city would pick up the costs of undocumented residents, because state and federal law doesn't allow funds to be spent on them.

Health care experts said Tuesday they were awed by the ambitions of the liberal city's leaders, yet predicted it would be hard to replicate elsewhere -- particularly the employer-mandate portion.
“If there is any chance of it happening anywhere, it would be San Francisco,” said Leona Butler, chief executive officer of the Santa Clara Family Health Plan.

Butler is working with labor and county health officials to develop a plan to provide health care to uninsured lower-income adult employees in the county. But, she stressed, employer participation would be voluntary.

In addition to the city's more liberal mindset, San Francisco also has unusual demographics, including fewer families and a younger population, that generally are less costly to serve.
Butler also warned of the complexity of meshing together funding sources and health care providers. “It's very sexy to say we're going to cover everyone at once. But it really needs to be tried,'' she said. “But, you know, bless their hearts.''

Contact Mary Anne Ostrom at mostrom@mercurynews.com or (415) 477-3794