Businesses Concerned About Aligning Healthy San Francisco, ACA

San Francisco business leaders are concerned about potential conflicts between the Healthy San Francisco program and the Affordable Care Act, the San Francisco Business Times' "Bay Area BizTalk" reports (Rauber, "Bay Area BizTalk," San Francisco Business Times, 7/30).

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.

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 (California Healthline, 3/16).

This month, San Francisco Mayor Ed Lee (D) tasked the city's Universal Healthcare Council with reviewing implementation of the ACA in San Francisco.

The move comes amid debate over how Healthy San Francisco -- the city's near-universal health care program -- will align with the ACA.

Lee said that the city remains committed to providing universal health coverage within city limits and that Healthy San Francisco will continue, "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" (California Healthline, 7/26).

Details of Business Leaders' Concerns

Amy Jensen -- a labor and employment law attorney at Hinshaw & Culbertson in San Francisco -- said, "Logistically and administratively, it's a nightmare" to determine whether the Healthy San Francisco program and the ACA can "coexist."

She added that many small businesses mistakenly believe that Healthy San Francisco will end on Jan. 1, 2014, when the ACA is fully implemented.

Jensen said businesses also are concerned that Covered California -- the state's health insurance exchange -- will not be operational or effectively regulated by Oct. 1, the beginning of enrollment.

Scott Hauge -- a small business advocate who heads a San Francisco-based insurance brokerage -- praised Lee's decision to analyze the ACA's effect in San Francisco but said the study panel should have included members of the business community.

Jim Lazarus -- senior vice president of public policy at the San Francisco Chamber of Commerce -- said that about 1,800 small businesses in the area rely on the Health Care Security Ordinance to use health reimbursement accounts for employee costs.

Lazarus said that many small businesses "would close" if HRAs are discontinued under the ACA ("Bay Area BizTalk," San Francisco Business Journal, 7/30).