Mayor on local health care policy: “Everything is on the table”


A recent controversy has been brewing around San Francisco’s Health Care Security Ordinance, the 2006 legislation authored by then-Sup. Tom Ammiano that created Healthy San Francisco, the city’s medical services safety net program for the uninsured.

As we explain in greater depth in an article for tomorrow’s issue of the Guardian, influential forces in the business community such as the San Francisco Chamber of Commerce and the Golden Gate Restaurant Association have been publicly raising questions about the Health Care Security Ordinance in light of the federal implementation of the Affordable Care Act, aka Obamacare.

In a recent article in the San Francisco Business Times, Small Business California President Scott Hauge was quoted as saying, “We question whether Healthy San Francisco should continue in its current form with the ACA coming in.” And an article published today suggests that some are continuing to question whether the HCSO can legally coexist alongside the federal requirements under the ACA despite clarification given by Jon Givner of the San Francisco City Attorney’s Office last Thursday stating that the ACA expressly allows jurisdictions like San Francisco to adopt health-care policies such as the HCSO.

Meanwhile, the message from defenders of the city’s health care policy at a hearing called by Sup. David Campos last week was clear: Funding for employee health care generated by employer contribution provisions under the HCSO will be needed more than ever once the ACA is implemented, because many people who now rely on the low-cost Healthy San Francisco for medical care will suddenly find themselves ineligible for that program and automatically funneled into a new system where they are eligible to sign up for subsidized health care, but won’t necessarily be able to afford it.

The ACA will begin enrollment in October, and will take effect in January of 2014. At that point, roughly two-thirds of current enrollees in Healthy San Francisco will either transition to Medi-Cal (if they earn up to 138 percent of the federal poverty level) or qualify for subsidized health care coverage under Covered California, the health benefit exchange created under the ACA. Things are apt to be the most complicated for Healthy San Francisco enrollees who discover they cannot actually afford to take advantage of the options offered under Covered California. 

For this reason, Campos stressed that the HCSO should remain in place without being scaled back or tampered with, because medical reimbursement accounts provided by employer contributions under the ordinance could serve to fill those gaps and help low-wage earners obtain coverage regardless of income. As things stand, Campos and Healthy San Francisco advocates said, gaps created under the ACA will be filled by stronger HCSO provisions, so the programs stand to complement one another.

But the business community, seeking what GGRA executive director Rob Black described to the Guardian as “guidance” from the city on how to move forward given the pending implantation of federal health care reform, wishes instead to open up a new policy dialogue about the HCSO. The mayor has been receptive to their concerns, and recently reconstituted the Universal Healthcare Council, a body that was previously formed to hash out local health care policy.

A key question is who will be appointed serve on that board: Department of Public Health Director Barbara Garcia will chair it, but so far the only indication of who else will be named is that it will consist of "community, healthcare, labor and business stakeholders," according to a quote attributed to Garcia in the Business Times. Will the makeup include members of the GGRA, the business organization that sued the city to overturn the employer contribution mandate under the HCSO? 

In response to questions about whether the mayor believed the employer spending requirement ought to be revisited in light of ACA implementation, and who would be appointed to the newly convened healthcare council, mayoral spokesperson Christine Falvey responded ot the Guardian with the following statement: “Everything is on the table as the City develops a plan to best implement [the Affordable Care Act]. This is a great opportunity to see how the city can continue to be a leader in making sure San Franciscans have access to quality healthcare. We are currently updating a membership list for the Universal Healthcare Council. More information on that as it becomes available.”