With the unanimous approval of the Health Care Security Ordinance by the San Francisco Board of Supervisors, the city will be the first in the nation to provide universal access to all residents of the city.
The Health Access Program (HAP) will provide adults with access to care, regardless of their immigration or employment status, by establishing medical homes and designating a primary care clinician for the over 80,000 uninsured residents in the city.
While the HAP program has been designed to cover virtually all services from preventative visits to inpatient operations, it is not an insurance program. Participants can only access care at participating clinics and public hospitals participating in a city-wide managed-care program. Services sought out outside the city will not be reimbursable by the program. Vision, dental, infertility, and cosmetic services are not included.
The program, which will cost approximately $200 million annually, will be financed through various funding sources including local government and employer contributions and sliding-scale employee contributions. “Covered” employers, those holding a city business license and employing more than 20 employees or—if they are nonprofit corporations—with more than 50 employees, must spend a certain amount on health care per hour per covered employee.1 Those employers already providing coverage but spending less than the amount determined by the city will be required to contribute as well.2 As approved by the city’s board of supervisors, the ordinance requires that employees work at least 12 hours a week to be eligible (with the hours-per-week threshold decreasing over the next few years). Those employees with access to insurance through another employer or through their spouse or domestic partner will be able to opt-out of the program.
The city intends to implement the program in phases. Employers with 50 or more employees will be eligible to apply for the program beginning July 1, 2007. Those with 20 to 49 employees will be eligible to participate starting March 31, 2008.
While much recent health reform activity has occurred at the state level, as evidenced by Massachusetts and Vermont, local-level universal access programs such as the San Francisco reform may spark interest in other major cities across the country. Mayor Newsom stated in a recent interview, “If it’s not going to happen through national leadership or statewide leadership, then it has to happen on the local level.”3
1For large employers (those with 100 or more employees), the required expenditure rate is $1.60 for each hour paid per covered worker; for medium businesses (20-99 employees or 50-99 employees for nonprofits), the expenditure rate is $1.06 per hour. Those rates increase five percent annually.
2Expenditures that count toward the required contribution include contributions to employee health insurance, contributions to employee health savings accounts, third-party payments for health services provided to their employees, and costs for direct services for covered employees with any remaining amount being paid to the Health Access Program.
3TIME.com.
San Francisco
’s Latest Innovation: Universal Health Care. June 23, 2006. http://www.time.com/time/nation/printout/0,8816,1207599,00.html
