CAlifornia Women's Agenda

Plan of Action for Health in California

Creating an Employer Based Health Care System for San Francisco

By Roma Guy, MSW

The question before us as San Francisco voters, health care providers, activists, legislators and consumers is, “Can our community provide access to health care in San Francisco for people who work?”

In a surprising, welcome and wise political partnership, Supervisor Tom Ammiano and Mayor Gavin Newsom have joined their hearts and minds in a two-pronged approach to improve health access. The scope of the problem is simple.

In San Francisco, 84% of workers are privately insured. Thus, for most workers in San Francisco and the Bay Area, we access health care through employer driven (but not mandated) health care insurance. Employees contribute through premiums and co-payments. According to a recent report by Blue Shield of California, health insurance coverage is decreasing at a rate of 2% a year.

“Uninsured adults” is a growing group now numbering 82,000 in San Francisco. They rarely use preventative or primary care health services and because of cost only pursue health services when acutely ill. The uninsured and underinsured find their medical home at non-profit or public clinics, but the overwhelming majority find their way to the overburdened Emergency Department at San Francisco General Hospital where the taxpayers pick up the cost, minimally estimated at over $29 million each year.

Private insurance for an individual is at best a very expensive method to provide health coverage and it is a cruel and costly joke to continue to believe that 100% coverage will ever be achieved through this approach. The cost ranges into the hundreds of dollars a month, the equivalent of leasing a European luxury car. Group insurance is the obvious solution, although it must be offered by employers, and that is the rub. Increasingly, the trend has been to drop or lower coverage, placing employers who do the right thing by offering full coverage at a competitive disadvantage.

The first of two complementary endeavors, initiated in November 2005 by Supervisor Tom Ammiano, is the Worker Health Care Security Ordinance. It would direct employers with 20 employees or more to provide health insurance or contribute financially towards paying the cost of health care services for their uninsured employees who work a minimum of 80 hours a month. The rate would be set at 50% to 75% of insurance costs in the Bay Area – about $1 or $1.50 an hour.

The second part of the initiative comes from Mayor Gavin Newsom, who appointed a 37 member Universal Health Care Council, which will submit recommendations by May 2006 for a “Defined Benefits Plan” establishing a “medical home” for the uninsured, clarify the scope and cost of defined services such as prevention and primary care including behavioral or mental health services, dental health services, and prescription drugs, all in a plan delivered by the Department of Public Health clinics and the non-profit coalition of community clinics.

San Francisco voters have for two decades supported expanding universal health coverage for all residents. A supermajority of SF voters supported a state initiative, Proposition 72, to expand employer based health coverage, in November 2004. It was narrowly defeated statewide. Supervisor Ammiano’s Worker Health Care Security Ordinance, currently at the Budget and Finance Committee of the Board of Supervisors, seeks to build on employer based health care for approximately 38,000 uninsured employees who work 80 hours a month in San Francisco.

By May, the Universal Healthcare Council, led by Co-Chairs Sandra Hernandez, MD, CEO, of the San Francisco Foundation and Lloyd Dean, CEO of Catholic Health Care West, will recommend the scope of a plan, and health care benefits and costs, for both uninsured employees and the unemployed. For uninsured employees, this defined benefit plan could be heard at the same time as the final hearings on the Worker Health Care Security Ordinance currently in the Budget and Finance Committee.

The opportunity to legislate a defined health care benefit, including cost for defined benefits, for a population of 30,000 uninsured working people in San Francisco is a historic step forward in improving the health status of all San Franciscans. Defining benefits and establishing costs for employed and unemployed San Franciscans who are uninsured is a major step forward. Let us join both Supervisor Tom Ammiano and Mayor Gavin Newsom to make history by the summer of 2006 and expand health coverage to working San Franciscans. Now is when!


Roma Guy, MSW
Clinical Faculty, Health Education Department, San Francisco State University;
Health Commissioner, City and County of San Francisco;
Health Task Force, California Women’s Agenda and Women’s Leadership Alliance;
Member of Board of Directors, Health Access California

 

Last updated on December 26th, 2005 by Molly Klett