How One City Copes With A Governor’s Negligence

On an uncharacteristically warm, clear San Francisco late afternoon in May, we dined with Ron’s mother and brother at the Beach Chalet Restaurant across the highway from the Pacific Ocean and abutting Golden Gate Park. A continent away from our home and health care reform battleground, we did not expect to be writing our June column based on a California vacation experience. But the subject of health care seems to find us wherever we are, in this case on the dinner bill. Tucked below the subtotal for food, drinks, and tax was an added charge identified as SF-HCSO. What, we wondered, was that? Turns out it stands for San Francisco Health Care Security Ordinance.

The next evening, the dinner bill at Pasta Pomodoro identified the charge as SF Healthcare. The check was accompanied by an explanatory flier from the owner and chef, Adriano Paganini. It said, “Pomodoro has always provided health insurance to full-time employees. Recently, in response to the high cost of health care and the lack of coverage for many San Franciscans, the city enacted a health benefit mandate. Businesses in SF with more than 20 employees are now required to provide health coverage to all employees, including part-time. We considered options to cover these new costs ($1.76/hr./person). Rather than raise menu prices, we chose to cover some of this new cost by adding a 4% surcharge to each check. I appreciate your understanding and support as we all contribute to this necessary effort.”

Here is a brief history. In February, 2007, San Francisco Mayor Gavin Newsom formed a Universal Health Care Council (UHC) to devise a plan to make health care accessible for San Francisco’s approximately 80,000 uninsured residents. This plan was known as San Francisco Health Access Program (SF HAP). Previously, the city council unanimously passed the Worker Health Care Security Ordinance (WHCSO). By April, 2007, these programs morphed into Healthy San Francisco (HSF).

Healthy San Francisco is an initiative that makes health care accessible to San Francisco residents by providing a primary medical home, usually a clinic. Any health care received outside the city of San Francisco will not be paid for by Healthy San Francisco. This health care access program, warns information on its website, is not insurance, and those who have health care insurance are advised not to drop it.

A May 1, 2008, press release from Mayor Newsom provides an overview and update of Healthy San Francisco. According to the statement, 734 employers chose HSF for their employees at a cost of $6 million, affecting 12,900 workers. The release states, “Health Care Security Ordinance (HCSO) is the San Francisco law that created an Employer Spending Requirement (ESR) and requires the Department of Public Health to create the Health Access Plan, now called Healthy San Francisco. The ESR requires employers to spend a minimum amount of money on health care expenditures for their employees. Healthy San Francisco is one option by which an employer can satisfy its obligation to make the required health care expenditure. Other options include providing private health insurance plans or medical reimbursement accounts.

For employers with 50 or more employees, the ESR went into effect on January 9, 2008. Employers with 50 or more employees were required to make health care expenditures for the first quarter by April 30. On April 1, the ESR went into effect for employers with 20-49 employees. The first expenditure deadline for covered employers with 20-49 employees is July 30. The Office of Labor Standards Enforcement has held over 50 public informational sessions with employers to educate them about the ESR.”

Is your head spinning yet? Too often, attempts at health care reform result in complicated schemes that are neither universal nor comprehensive. While Mayor Newsom and city council are to be commended for trying to address the problem, their initiatives still leave many San Franciscans uninsured. Even with HSF coverage,benefits are basic, not comprehensive. For example, among services not covered are allergy testing and injections, dental, vision, chiropractic, organ transplants, and long-term care. Patients do not have a choice of health care providers. All hospital-provided care must be performed at San Francisco General Hospital and all primary care must be done at the assigned clinic location.

The really frustrating and maddening thing about all this is the fact that in 2006, to their credit, both houses of the California legislature passed a public, single-payer health care reform package that was truly universal (covers everyone) and comprehensive (covers all medical necessities). Unfortunately, this landmark legislation was vetoed by Governor Schwarzenegger. What a crime!

Similar legislation in Pennsylvania, the Family and Business Health Care Security Act (Senate Bill 300/House Bill1660), spearheaded by Chuck Pennacchio, executive director of Health Care for All PA, along with 4,000 citizen activists, would provide superior medical benefits with choice of doctors and hospitals, with no deductibles or co-pays. It includes prescription drugs, medical, and dental coverage for everyone including Medicare recipients. This simple, easily understood plan with no convoluted or complex formulas replaces the profit-first insurance industry with one public insurer – a single group insurance plan for all Pennsylvanians. Commonly called a single-payer approach, it brings simplicity and predictability to businesses, government entities, and individuals. It becomes more obvious every day to more and more people that this is what real health care reform looks like. We think the employers in San Francisco would prefer such a plan.