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reprint or license this San Francisco's plan: health care for all By Mary Anne Ostrom Mercury News San Francisco, eager to put its own stamp on the health care debate, unveiled an ambitious plan Tuesday that would make it the first city in the nation to provide every uninsured resident with access to medical services. When rolled out next year, the city's 82,000 uninsured residents would become eligible for a wide array of benefits, regardless of employment or immigration status. The complex, $200-million-a-year plan requires funding from existing government sources, uninsured residents who will pay based on income and a mandated contribution from all San Francisco employers with more than 20 workers. At a packed news conference, San Francisco Mayor Gavin Newsom declared that the city would set a national standard for universal access to health care. The city says nearly half of the uninsured work and businesses need to step up, but several employers in the audience said the mandates would force them to shut their businesses. The proposal comes months after Massachusetts, New York and a few other states began moving ahead with employer mandates. In California, voters turned down a 2004 initiative that would have imposed them. A highly charged political battle between labor and business interests is still brewing over the employer mandates. The mandates are still a ticklish issue for the pro-business mayor, but he has lost some negotiating clout as Supervisor Tom Ammiano has rounded up enough support of his colleagues to apparently make the mandate veto-proof. A key committee hearing is scheduled today on whether to impose the mandates, and the full package of legislation is scheduled for a vote at next Tuesday's board of supervisors' meeting. The president of the San Francisco Chamber of Commerce President appeared at the press conference and did not comment on the mandate proposal, but a spokesman for the agency later said the group has a huge problem'' with the dollar-per-hour formula that they say amounts to an extra payroll tax. Business leaders had pushed for a plan to raise $50 million through a fee levied on businesses depending on size. City officials say they are not creating a new insurance plan but rather access to an array of health care services already offered by the city health department and non-profit community clinics and hospitals. The city already spends $104 million a year on services to the uninsured. The rest of the $200 million annual cost would come from individual contributions and city employers. Only residents would be eligible and only for services offered in the city. The poorest would pay as little as $3 a month to join the San Francisco Health Access Plan. That amount would climb to $200 a month for individuals earning nearly $50,000 a year or more. Higher-income individuals might still find that a deal, say city officials, if they have costly-to-insure pre-existing conditions such as AIDS or breast cancer. As children do under state and county programs now, adults would have to agree to apply for federal and state aid before dipping into city funds. The plan would allow adult immigrants living in San Francisco illegally to participate -- believed to be the country's first for a plan offering such a wide-range of benefits. Since 1989, San Francisco law has banned city workers from asking the immigration status of any applicant seeking city services. San Francisco would pick up the costs of undocumented residents, since state and federal law doesn't allow funds to be spent on them. Health care experts said Tuesday they were awed by the ambitions of the liberal city's leaders, yet predicted it would be hard to replicate elsewhere -- particularly the employer-mandate portion. If there is an chance of it happening anywhere, it would be San Francisco,'' said Leona Butler, executive director of the Santa Clara Family Health Plan. But Butler also warned of the complexity of meshing together funding sources and health-care providers. It's very sexy to say we're going to cover everyone at once.
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