Healthy San Francisco To See Changes in Wake of Health Reform Law

Implementation of the federal health reform law could compel Healthy San Francisco -- the city's universal health care program -- to revert back to being a network of safety-net clinics and hospitals for low-income residents, the San Francisco Public Press reports (Hart, San Francisco Public Press, 3/15).

Background on Healthy San Francisco

The city launched Healthy San Francisco in 2007 to provide health insurance coverage to adult residents who earn too much to qualify for Medi-Cal, but not enough to purchase private insurance. Medi-Cal is California's Medicaid program.

Healthy San Francisco receives funding from the city, the federal government, patient contributions and fees imposed on San Francisco businesses that do not provide health coverage for their workers. The program receives no funding from the state (California Healthline, 4/19/11).

Over the past five years, Healthy San Francisco has evolved from its origins as a safety-net insurance option to a program that covers about 85% of San Francisco's uninsured residents.

The program now provides coverage to more than 50,000 beneficiaries.

In 2010, user fees, federal grants and business contributions accounted for $78 million in funds for Healthy San Francisco, according to city data. The program costs $178 million annually.

The program has been touted a national model for providing inexpensive health care access to higher-income residents who lack insurance and for its long-term promise of cost containment.

Reform Law's Effect on Healthy San Francisco

In 2014, patient fees and business contributions that fund Healthy San Francisco will be eliminated, as more residents become eligible for Medi-Cal or are able to purchase insurance through the state health insurance exchange created under the federal health reform law.

In addition, federal grants that currently help local programs like Healthy San Francisco will be diverted to fund the reform law, the San Francisco Public Press reports.

Health care experts warn that Healthy San Francisco also could lose political support as middle-income beneficiaries leave the program. As a result, the program could become more vulnerable to budget cuts, according to supporters.

Officials Still See a Need

According to a report by the San Francisco Reform Task Force, nearly 70,000 San Francisco residents will remain uninsured after the health reform law is fully implemented.

Assembly member Tom Ammiano (D-San Francisco) -- one of the original authors of Healthy San Francisco -- said that Healthy San Francisco will adapt to serve residents not covered by the reform law.

He said, "The way we see it, Healthy San Francisco can pick up who Obama's plan leaves behind."

Lt. Gov. Gavin Newsom (D) -- who signed Healthy San Francisco into law in 2007 when he was the city's mayor -- said, "The reality is there are millions of Americans who will fall through the cracks when health reform is implemented federally." He added, "It's a legitimate question to ask how we're going to keep paying for the program. No doubt it's going to change who we cover."

According to the San Francisco Public Press, Healthy San Francisco could serve as a safety-net model that offers lessons for other cities (San Francisco Public Press, 3/15).