Pricey universal local health care 

San Francisco and San Mateo counties both pride themselves on thinking boldly when attempting to resolve major public needs. San Francisco’s Health Access Program begins phasing into operation this July, with controversial new business contribution mandates. San Mateo has actively provided its low-income Children’s Health Initiative coverage since 2003.

So it is not surprising that San Mateo is also systematically exploring the feasibility of establishing some sort of universal health coverage for the county’s 44,000 uninsured adults. The Blue Ribbon Task Force on Adult Health Care Coverage Expansion got its first look Monday at an independent actuary’s preliminary cost estimate — and it was not cheap.

Covering the county’s entire uninsured adult population would require as much as $155 million per year, based on an average $294 monthly claim cost per person. Admittedly this could not be done from existing revenue, according to task force member and county Supervisor Jerry Hill.

The $155 million projection must be considered a very preliminary number. On the positive side, the proposed coverage fund is supposed to absorb the more than $34 million the county already pays for health care of low-income families plus the additional $33 million a year that Peninsula hospitals provide in charity care. This would reduce new net spending to some $88 million annually.

But on the negative side, the $294 monthly per-person cost also did not factor in estimated administrative expenses of up to 15 percent. Neither does it include probable county subsidy programs to help the low-income uninsured reduce their out-of-pocket costs. So the actual yearly county expenses could climb closer to $130 million.

Of course, San Mateo officials would count on regular federal and state grants to help ease the fiscal burden. San Francisco received $24.4 million in federal funds last month, as part of a national program to test innovative ways of providing health services to the uninsured. But this level of funding support is unpredictable at best and should not be relied upon to keep universal local health care sustainable.

San Mateo is generally a well-run county, unafraid to think outside the box to solve problems. We also believe it was a sensible beginning for the county to analyze how much its proposed health coverage would cost before working on how to pay the bills.

But from the first, we were doubtful that San Mateo County had sufficient revenue flow to afford a responsibility as ambitious as universal local health care. This daunting preview of the cost burden should be seen as a clear signal to scale back the plan, perhaps focusing more closely on easing the budget drain of indigent care costs at county-owned San Mateo Medical Center, which ballooned from $28 million in 2000 to $54 million in 2005.

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Staff Report

Staff Report

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A daily newspaper covering San Francisco, San Mateo County and serving Alameda, Marin and Santa Clara counties.
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