Court Upholds San Francisco Health Care Coverage

San Franciscans without health coverage won a major victory when a federal appeals court lifted an injunction against the city’s Healthy San Francisco Program (formerly called the Health Access Program) January 9 that provides health coverage to all uninsured adults and requires employers to share the costs.

The plan was approved by the city’s Board of Supervisors in July 2006. The program offers comprehensive health care services to uninsured San Franciscans and their employers at a reasonable cost, with subsidies for small- and medium-sized businesses and low- and moderate-income individuals.

The ordinance splits the costs among employers, employees and the city. To prevent employers from eliminating coverage, the San Francisco health care initiative establishes a minimum health care spending requirement for businesses in the city, depending on the number of employees.

But in November 2006, the Golden Gate Restaurant Association filed suit against the health care ordinance, and last December, a federal judge granted the business group’s request for an injunction barring the city from enforcing the health program.
The city, joined by several San Francisco unions, appealed the decision. The U.S. Court of Appeals for the 9th Circuit lifted the injunction pending a decision by the court on the merits of the appeal.

The San Francisco Labor Council, UNITE HERE Local 2 and SEIU Local 1021 joined in the city’s request to strike down the injunction

The Healthy San Francisco Program was authored by Supervisor Tom Ammiano and passed by the Board of Supervisors in July 2006, with strong support from labor. The program to offer uninsured San Francisco residents access to comprehensive medical service enrolled over 7,000 individuals in the first six months of the program starting in July 2007. The first phase of enrollment limited eligibility to individuals making less than the federal poverty level of $10,210 a year. The City had planned to expand enrollment January 3 to those making three times the poverty level, which would cover about 47,000 San Franciscans.

The program is the first of its kind in the nation, and provides care at a network of hospitals and clinics for uninsured adults who are not covered by the Medi-Cal or Medicare. The $200 million annual cost of providing health care to the uninsured is funded by a mix of state and local taxes, patient payments based on income, and contributions by employers who don’t offer insurance. The state awarded San Francisco $73.1 million in funding from the State Department of Health Services to implement the program over a three-year period.

“We have funding to cover the lowest paid workers but to cover those who make up to 300 percent of the poverty level, we need the employer mandate,” Ammiano said. The GGRA argued that the mandate conflicted with a 1974 federal law prohibiting state and local governments from regulating employee benefit plans.

“It’s distressing that a small group of wealthy restaurant owners are resisting providing health care for their lowest paid workers,” Ammiano said. He added that since the December court ruling, many people are confused about whether they can enroll in the program. “It’s unfortunate that the GGRA has tried to poison the process and confuse people about the program.”

San Francisco Labor Council executive director Tim Paulson said, “I am disappointed that a small group of restaurant owners have decided to stand in the way of the will of San Franciscans. The healthcare legislation was passed unanimously by the Board of Supervisors and signed into law by the Mayor with a huge amount of public support.” Along with the Labor Council, major community groups including ACORN, Bay Area Organizing Committee, Senior Action Network, Healthcare for All, and Young Workers United worked to get the ordinance enacted.

“San Francisco is a city that stands for more healthcare, not less,” said Paulson.