Business leaders are raising concerns about possible conflicts between San Francisco's landmark health care law and President Barack Obama's federal Affordable Care Act, pressuring city officials to re-examine required employer-spending mandates.
As the federal law commonly known as Obamacare goes into effect next year — requiring individuals to have health insurance — the old debates over San Francisco's Health Care Security Ordinance, often referred to as Healthy San Francisco, have resurfaced.
"We struggled with the same issues in 2006 that we are talking about today," said Jim Lazarus, a leader of the Chamber of Commerce. There is a need, he said, to find an "economically viable solution" for how the local mandates "properly dovetail" with the new federal ones.
Back then, tempers were heated and politics raged as San Francisco politicians took the lead in the health care reform debate. The Golden Gate Restaurant Association, an advocacy group representing hundreds of restaurants, sued The City and lost.
And now the City Attorney's Office is defending the legality of having both the local and federal laws.
"In this case, the Affordable Care Act expressly allows local jurisdictions like San Francisco to adopt ordinances like the Health Care Security Ordinance," Deputy City Attorney Jon Givner said.
Under the local law, most employers must make contributions to health care expenses for their employees — $1.55 per hour worked for businesses of 20 to 99 employees and $2.33 for companies of 100 or more workers. Employers can meet the requirement in several ways, such as providing actual health insurance or choosing The City's option.
The latter helps fund HealthySF. The program is a network of community clinics, hospitals and Department of Public Health services with an annual budget of about $130 million, of which $14 million comes from employer contributions, said Colleen Chawla, deputy director of the health department.
A 2011 count as part of the census found that about 84,000 people in The City between the ages of 18 and 64 are uninsured. There are currently 60,000 participants in HealthySF, which is not considered health insurance.
Under the Affordable Care Act, two-thirds of the 60,000 participants would be eligible for some kind of insurance while 19,500 would be ineligible, largely because they are undocumented immigrants.
Supervisor David Campos said The City's health care spending requirement is "needed more now than ever." He explained that it was designed to either encourage employers to provide health insurance or provide workers with economic assistance for medical needs, which he said will remain necessary under the federal act.
"In these high-cost places like San Francisco, lower-wage employees will continue to find health insurance unaffordable," he said.
Amid the dispute, Mayor Ed Lee announced Thursday the reactivation of the Universal Healthcare Council, a body set up in 2006 by then-Mayor Gavin Newsom that helped shape HealthySF. It will be led by the head of the Department of Public Health, Barbara Garcia.
In a statement issued Thursday that did not mention the employee spending requirement, Lee said, "Healthy San Francisco will be funded largely through our own general fund support in addition to the financial support of our many provider partners and will remain for those ineligible for federal benefits."
The council is expected to begin meeting in August, with recommendations expected in the fall.