San Francisco’s Universal Health Care Plan Eyed As Model For California

SAN FRANCISCO — Maria Consuelo believes she’s alive today because of a groundbreaking program this left-leaning city created a decade ago – one that guarantees health coverage to every one of its 864,000 residents.

It’s made San Francisco the only place in the country where truly universal health coverage exists, similar to what’s available in every other developed nation. Called Healthy San Francisco, it offers health care to those who can’t afford private insurance and are ineligible for other government health programs.

In Consuelo’s case, she visited a government-funded clinic in the fall of 2015 and told a doctor she had pain in her pelvis. Tests later showed cancer in her ovaries, leading to successful surgery to remove them in January 2016.

“This law really helped me,” Consuelo, a 55-year-old mother of five grown children, said while waiting to pick up some medication last week at San Francisco General Hospital. “If it could help others, that would be great.”

A similar thought is percolating in the mind of Lt. Gov. Gavin Newsom, a Democrat who helped implement the plan when he was San Francisco’s mayor.

Now, two years after he launched his campaign to succeed Gov. Jerry Brown, Newsom has been wondering: Would such a program work in every county in the Golden State?

His suggestion comes at a time when proposals for universal health care are receiving a surprising amount of attention. Last week, Sens. Ricardo Lara, D-Bell Gardens, and Toni Atkins, D-San Diego, unveiled details of their bill to create a single-payer system that would cover all California residents – just a few days after Vermont Sen. Bernie Sanders vowed to introduce a bill to launch a similar system nationwide.

Ironically, all of the universal health care buzz is coming after the GOP’s plan to replace the Affordable Care Act with a bare-bones substitute plan collapsed. The Congressional Budget Office had estimated that the Republican plan would have decreased the federal deficit by more than $300 billion, but increased the ranks of uninsured Americans by 24 million by 2026.

But Republicans in Congress are still vowing to chip away — if not replace — the law, commonly called “Obamacare,” which has insured five million Californians since 2014, bringing down the state’s uninsured rate from 17 percent to 7.1 percent in just three years.

“California is in a unique and historic position to make universal health access a reality and become a model for the rest of the nation,” Newsom said in an email. “And I know from firsthand experience that it can be done.”

Healthy San Francisco, the brainchild of then-San Francisco Supervisor Tom Ammiano, is available to all city residents, ages 18 and older, who earn up to 500 percent of the federal poverty level — $60,300 for a single person — and who have no other health coverage option. Undocumented residents are also eligible.

Under the model, nearly three dozen San Francisco community health centers and six hospitals take care of about 14,000 patients — down from a high of 65,000 before Obamacare kicked into high gear in January 2014.

Dr. Alice Chen, chief medical officer for the San Francisco Health Network — which administers Healthy San Francisco — emphasizes that what the city offers isn’t true health insurance because it’s not portable outside San Francisco.

That means if enrollees are seriously sick or injured outside the city limits — and not transported back — they could face exorbitant medical bills, Chen said.

Partially because of that drawback, the advent of Obamacare started an exodus from Healthy San Francisco to the expanded Medi-Cal program or subsidized private health plans available on the state’s new health insurance exchange.

Healthy San Francisco is partially funded through the city’s general fund, which in the last fiscal year paid out $27 million to the health plan, while San Francisco employers contributed $15 million and participants kicked in $2 million in fees.

Under the law, businesses with 100 or more employees must pay $2.64 an hour per covered employee on health care, while those businesses with 20 to 99 employees must pay $1.76 an hour per worker.

In 2006, three months after the program was signed into law, the Golden Gate Restaurant Association sued the city in federal court to block the employer contributions from taking effect. The lawsuit was unsuccessful, but the result is that many restaurants now point out on receipts or menus what percentage of the bill covers health care and other government-mandated costs.

Finally, some of the program’s patients must contribute on a sliding scale. Consuelo, for example, pays $240 a year. The most an individual can pay is $1,800 a year.

But Merrill Buice, director of health care coverage and access at the San Francisco Community Clinic Consortium, argued that the program’s efficiencies and cost-savings are a great improvement on what existed in the years leading up to the law, when more of the city’s uninsured residents relied on the hospital’s emergency rooms, forcing taxpayers or private hospitals to pick up the tab for extremely expensive medical care.

Instead, Buice said, Healthy San Francisco patients now enroll in a “home clinic” where they get coordinated care, giving people a sense of belonging. Their clinic doctor then decides with the patients when they need any specialty care at a hospital.

Still, many conservative critics see people like Consuelo — a decades-long San Francisco resident who is undocumented — as the impetus behind the GOP’s goal to slash taxpayer-funded programs that benefit people like her.

“Providing this coverage for undocumented immigrants only encourages more to come to California,” said Sally Pipes, president and CEO of the San Francisco-based Pacific Research Institute, a nonprofit that promotes limited government. “Personally, I resent paying that Healthy SF tax for mainly undocumented workers on my restaurant bills in San Francisco as I am already paying for my own health care.”

But not everyone who benefits is undocumented, and George Thompson is the first to admit he once depended on the law to survive. The 63-year-old former mortgage insurance salesman has diabetes. And when he lost his job following the housing crash, he said, Healthy San Francisco was a godsend.

“A lot of people might be against it,’’ said Thompson, who is now enrolled in an Obamacare plan. “But you could lose your job and you could be sick. You never know when it will happen to you — and the city has a plan.’’

Nothing contained in this blog is to be construed as necessarily reflecting the views of the Pacific Research Institute or as an attempt to thwart or aid the passage of any legislation.

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