San Francisco expects tens of thousands to remain uninsured after federal law takes effect 

click to enlarge The majority of uninsured residents in The City are currently covered by HealthySF, but many will soon be eligible for other coverage under healthcare reform. - CINDY CHEW/2008 S.F. EXAMINER FILE PHOTO
  • Cindy Chew/2008 S.F. Examiner file photo
  • The majority of uninsured residents in The City are currently covered by HealthySF, but many will soon be eligible for other coverage under healthcare reform.

Tens of thousands of San Francisco's uninsured will obtain medical coverage under the federal Affordable Care Act, but at least 35,000 are expected to remain without it, health officials said.

At the beginning of next year, the federal individual mandate to have health insurance begins. In October, the statewide marketplace for affordable health insurance, Covered California, will open for business for people to buy health insurance coverage.

City officials are preparing for the transition, and it's becoming clearer what impact it will have on San Francisco's currently uninsured.

Since 2007, The City has had in place Healthy San Francisco, a program in which the uninsured receive affordable medical services from a network that includes the Department of Public Health, health clinics and physicians. Though not considered health insurance, the effort has allowed The City to better understand its uninsured, which could help make for a smoother transition to mandates under the federal care act.

Of the estimated 84,000 adults without health insurance in San Francisco, 60,000 are enrolled in HealthySF.

"For 71 percent of our uninsured, we can send them a letter, we can call them on the phone, we can text-message them," Colleen Chawla, a deputy director with the Department of Public Health, said during a hearing last month on the federal law. "We can get in touch with them to tell them of the changes that are coming with health reform and help them enroll in health insurance."

Public health officials know that two-thirds of the 60,000, some 40,500, will be eligible for some type of insurance: 28,000 for Medi-Cal coverage and 12,500 for Covered California.

The 19,500 not eligible are mostly undocumented residents, said Chawla. Of the 40,500 eligible, it's estimated that about 25,000 will begin paying for an insurance plan. The others won't enroll, she said, for varied reasons like the enrollment process is too complex or they might "decide it is cheaper to pay the penalty." The federal penalty for not having health insurance starts at $95 in the first year and increases to $695 by 2016.

That leaves 15,500 of those eligible and the 19,500 undocumented residents as the 35,000 folks not expected to enroll.

Under the federal law, for the first time Medi-Cal, a program for low-income families, or seniors, will open up to low-income adults who earn $15,800 or less a year.

For those not qualifying for Medi-Cal, they can buy insurance through Covered California. About 28,000 San Francisco residents will qualify for some type of federal subsidy to help out with those costs, Chawla said.

Health officials are expected to give an update about outreach and the enrollment process during a September hearing at the Board of Supervisors requested by Supervisor David Campos.

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