At the end of last year, a federal judge ruled that the San Francisco Health Access Plan's "pay or play" mandate (that employers provide health benefits or pay a tax of $1.17 to $1.76 per hour per worker) violated ERISA (the Employee Retirement Income Security Act) and tossed it out.

Undaunted, the City & County expanded the program's eligibility to residents earning up to 300% of the Federal Poverty level (FPL) on Wednesday.  The program launched with great fanfare last July, but San Francisco limited eligibility to those earning up to only 100% of the FPL, hoping to expand it to everybody in the new year. 

Unfortunately for the Department of Public Health, but fortunately for taxpayers, the federal court's ERISA decision means the City & County does not have enough of our money to rope everybody in, so the income-eligibility just got bumped up to 300% of FPL.

Happy New Year!

But nobody showed up.

Well, one person did, but it looks like she was below 100% of FPL: a 63-year old woman who's dependent on her 25-year old daughter and had been unaware of the program.

San Francisco figures it has 73,000 uninsured people (down from 82,000 last year, with no explanation for the reduction).  The Department of Public Health's breakdown indicates about 15,000 under 100% FPL, about 30,000 between 100% to 300% FPL, and about 26,000 above 300% FPL.

At the end of 2007, 7,350 people had signed up: only about half of those eligible from the 100% FPL group.  Let's face it: after half a year, they've probably reached saturation point.  Obviously, people in the 100% to 300% FPL group (up to $32,000 annual wages for an individual) will be even less likely to sign up, because they have more likely made a deliberate decision to take a job with all cash remuneration instead of health benefits.

It's starting to look a lot like...... Massachusetts.

Remember, we should be thanking these people for paying extra, voluntary taxes (about $2,000 federal income taxes for someone earning $50,000), instead of taking health benefits in lieu of cash wages.

But San Francisco will not do that.  Instead, expect to see "outreach": balloon-decorated tables at the Ferry Plaza Building, stunts in schools, advertising at 49ers and Giants games, and whatever it takes to cover the uninsured - whether they want it or not.