Universal Health Care Plan Approved in San Francisco

The San Francisco Board of Supervisors voted unanimously Tuesday to approve a plan that would give adults access to medical services regardless of their immigration or employment status.

Financed by local government, mandatory contributions from employers and income-adjusted premiums, the universal care plan would cover the cost of everything from checkups, prescription drugs and X-rays to ambulance rides, blood tests and operations.

Unlike health insurance, however, it would not pay for any services participants seek outside San Francisco. Instead, residents would receive care at existing clinics and public hospitals and from doctors who already participate in an HMO for low- and middle-income clients.

With backing from both Mayor Gavin Newsom and all 11 supervisors, the so-called Health Access Plan proved to be a politically popular concept in liberal San Francisco despite unmitigated opposition from the business community.

“What feels very good is the full board and the mayor getting on board,” said Supervisor Tom Ammiano, who first championed the idea of making employers pay for some part of their workers’ medical costs. “That says the political will is there to make it happen.”

To offset the estimated annual price tag of $200 million, firms with 20 or more workers would be required to spend $1.06 for each hour worked by an employee, and those with more than 100 workers would have to pay $1.60 per hour up to a monthly maximum of $180 per worker. Companies that already offer health coverage would still have to pay if their insurance contributions did not meet the city’s funding levels.

The Board of Supervisors still needs to vote on the plan once more for it to become final. The ordinance adopted Tuesday calls for businesses with more than 50 employees to start participating starting next July, while it would take effect for enterprises with 20 or more workers in April 2008.

Michael O’Connor, a nightclub owner who serves on the San Francisco Small Business Commission, predicted that the “noble burden” of the mandate would keep businesses from locating in the city and make goods and services here more expensive as employers pass on the costs to customers.

O’Connor said many business owners were disappointed by Newsom’s backing of the plan since the mayor got his start in business as the owner of a wine shop and several restaurants.

“One would think that someone who has owned and opened restaurants would be pretty clear on what the profit margin is, and how hard it is to get them open. A $5,000 licensing fee is difficult. A new $60,000 (health care) fee is disabling,” he said.

Before the board vote, Newsom defended the proposal as a creative solution to the problem of securing decent health care for uninsured residents, noting that businesses would not be alone in defraying the costs. Of the $200 million, the city would provide $104 million and participants would contribute about $56 million.

“This is a moral debate as much as a political debate,” Newsom said.

The initiative adopted Tuesday developed as a compromise between Newsom and Ammiano, who last year introduced legislation that would have required businesses to create health savings accounts for uninsured workers. In a nod to concerns from business, the final plan requires employees to work at least 12 hours a week to be eligible and has an opt-out provision for workers who are insured through their spouses.

Because fees would be adjusted on a sliding scale, city officials did not expect to see a rush of residents canceling their existing health insurance to take part in the city program.