Mayor presses ahead with health plan 

Mayor Gavin Newsomis implementing his groundbreaking plan to provide comprehensive health care to San Francisco’s 82,000 uninsured residents, even though The City's Board of Supervisors has not yet approved a controversial and key funding component to the plan.

San Francisco would be the first city in the United States to ensure that every resident has access to affordable health care — including primary care, hospital services and prescription drugs.

Estimated to cost nearly $200 million, The City is redirecting $104 million of funds already used for medical care of the uninsured to pay for the plan, and another $56 million is expected to be raised through sliding-scale premiums paid by participants. San Francisco’s business community is expected to pick up the estimated $40 million gap through a proposed per-employee payment mandate against which business owners and industry advocates are aggressively lobbying.

Newsom’s plan, called the San Francisco Health Access Program, is drafted as legislation that outlines the infrastructure to provide the health services but does not include the details of how it would be funded. The funding mandate, legislation that would require businesses to provide health care for all employees, was first proposed by Supervisor Tom Ammiano in November.

In announcing his ambitious plan June 20, Newsom shared credit with Ammiano and mentioned Ammiano's parallel funding mandate, noting that, "the business community needs to participate in this."

However, in the days and weeks that followed, Newsom distanced himself from the specifics of Ammiano's proposed ordinance, while still conceding that the business funding was needed.

Under Ammiano's ordinance, businesses with 100 or more employees would be required to pay an average of $273 per month for each full-time employee; businesses with 20 to 99 employees would pay $182.50 per employee per month. A prorated amount would be required for part-time employees. Businesses with fewer than 20 employees would be exempt.

In a meeting with The Examiner's editorial board June 22, Newsom said the business-funding mandate needed "work to make [the Health Access Program] more palatable." Nonetheless, Newsom said Ammiano's proposal would "mandate a spending floor" that would prevent businesses from withdrawing health care benefits from current employees, while at the same time providing the missing funding piece to his program.

A proposed compromise announced Wednesday at the Board of Supervisors Budget and Finance Committee would allow San Francisco's smaller businesses — which would be hardest hit by the funding mandate — to delay payment until 2008.

However, under another proposed change, Ammiano's legislation incorporated language about Newsom's Health Access Program, linking the popular health program with the less-popular funding mandate. No action was taken on Ammiano's ordinance, which will have a full hearing before the Board of Supervisors on Tuesday.

The committee also made no decision on Newsom's Health Access Program. Nonetheless, immediate implementation of the program is moving forward, according to the mayor's press director, Peter Ragone.

"The administration is capable of taking the first steps and we intend to do that," Ragone said, hours after the supervisors' committee meeting had concluded.

Comparing plans

The differences between health care access ordinances proposed by Mayor Gavin Newsom and Supervisor Tom Ammiano:

Newsom’s "San Francisco Health Access Program" ordinance

» Creates a $200 million infrastructure to provide health care services — including primary care, hospital services and prescription drugs — to San Francisco’s estimated 85,000 uninsured residents

» Does not outline in writing the funding mechanism for the program

» $104 million would come from redirected public health dollars already in the system, according to Newsom, and another $56 million would come from sliding-scale co-payments from plan participants. City businesses would be expected to pick up a $40 million funding gap.

Ammiano’s "Worker Health Care Security Ordinance"

» Requires San Francisco businesses with 20 or more employees or nonprofits with 50 or more employees to pay up to $1.60 per employee work hour for health coverage for their employees, prorated on an hourly basis, even if they are part-time employees, are covered by their spouse or do not live in San Francisco.

» Prevents businesses from dropping existing employee health coverage, but money required for previously uninsured employees can be paid to The City to cover employees’ participation in new San Francisco Health Access Program.

» An estimated 16,000 previously uninsured workers would be provided health care at a projected cost of up to $49 million, according to the Office of Economic Analysis.

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Bonnie Eslinger

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