Mayor signs healthcare measure
by Rob Akers
It is probably no coincidence that city officials chose a public health clinic as the site for the official signing of legislation implementing San Francisco's Health Access Plan on Monday, August 7. A large percentage of the clients who visit the tiny Southeast Health Clinic nestled in the Bayview-Hunter's Point area, one of the city's poorest neighborhoods, ultimately stand to benefit from HAP, designed to provide healthcare access to all San Franciscans.
"San Francisco is the first city in the nation to provide universal healthcare access to the uninsured," Mayor Gavin Newsom said prior to signing the ordinance at a news conference held outside of the health clinic.
"We have created a plan that will allow for every San Franciscan to have access to ongoing primary and preventive healthcare. I am proud of the commitment demonstrated by Supervisor [Tom] Ammiano, as well as San Francisco's healthcare, business, labor, advocacy and philanthropic communities in helping us create this plan and legislation," Newsom said.
The ordinance is the culmination of Newsom's pledge to provide access to healthcare for the city's estimated 82,000 uninsured. Ammiano, who sponsored legislation that in part funds HAP, including mandated fees on businesses, joined the mayor at the signing ceremony.
"This is a very important first step," Ammiano said. "San Francisco has already been contacted by a number of other cities, including Chicago, who all want to know about this."
Ammiano praised the supervisors' support of the plan.
"With the passage of the San Francisco Health Care Security Ordinance by a unanimous vote by the Board of Supervisors – which is unheard of I might say – our city sends a strong message to state and local governments across this nation. The message is that when the community speaks up, and the political will is there – no problem is too great. Even the question of universal health care can be surmounted," said Ammiano.
Newsom also announced the formation of a 19-member HAP advisory council to oversee and shape the defined benefits of the program. Modeled after the recommendations of the city's Universal Healthcare Council, advisers and officials will now work to provide consultation to the Department of Public Health for design and implementation of the program.
That includes setting membership rates, designing the range of benefits and health care services, researching utilization and costs and evaluation of the program, including areas of improvement.
"This committee is ready to go to work," said Catholic Healthcare West CEO Lloyd Dean, who with Health Director Dr. Mitch Katz will co-chair the advisory council.
"This legislation is so very significant and so very important. It is inspiring to stand here in front of this building and tell the public that we are ready to take this dream that the mayor and Supervisor Ammiano have had and make it into a reality," Dean said.
The ordinance takes effect in January and city officials expect to see the program's first enrollees by July 2007.
"We anticipate the first 15,000 enrollees by that time," said David Grant, director of health policy at Senior Action Network and member of the advisory committee. "Before that time we will be talking about what computer software we will be needing and methods to enroll and educate the participants."
"This next phase will be the most complex," Newsom said of HAP's implementation. "We don't want to over promise and under deliver. San Francisco has come up with a lot of great ideas in the past and we want to know this plan is going to be no exception."
Some city business owners say they will be hard-pressed to make the co-payments necessary to help fund HAP, as outlined by Ammiano's legislation, and there has been some talk of possible litigation against the plan's implementation.
"We may see some litigation, but I do not foresee it stalling HAP getting off the ground," Newsom told reporters after signing the bill. "We are all in this together and rightfully so," he said.
Newsom was quick to point out that of the expected $198 million price tag on HAP, only about $28 million will be coming from the mandated fees on businesses. A total of $160 million will be covered by the city while the balance will be funded by enrollees' co-payments.
San Francisco Labor Council Executive Director Tim Paulson, who also attended the event, issued a statement backing the legislation.
"Workers and residents of San Francisco won a major victory today when Mayor Newsom signed the San Francisco Health Care Security Ordinance," he said in a statement. "For over a year, the San Francisco Labor Council and major community groups, including Senior Action Network, ACORN, Bay Area Organizing Committee, Healthcare for All, and Young Workers United, have been working with Supervisor Tom Ammiano to pass meaningful healthcare reform for the city of San Francisco. Today, our hard work is realized."
Paulson said the spending requirement is not only a critical funding source for the program, but also levels the playing field for the majority of San Francisco employers already providing health benefits to their employees.
"The Health Care Security Ordinance ensures all members of the community – government, employers, and individuals – contribute fairly to create a healthier community. Everybody deserves quality healthcare. Workers without health coverage are just one accident or illness away from poverty and unemployment. San Francisco is choosing to act rather than stand by and wait while the federal government fails to address the health care crisis in this county," Paulson said.
The HAP advisory council meets for the first time on August 25 and plans on having a Web site providing information on the plan up and running by September 1.
Once up and running, HAP is expected to provide access to medical home and primary care physicians, allowing a greater focus on preventive care, as well as specialty care, urgent and emergency care, laboratory, inpatient hospitalization, radiology and pharmaceuticals. It will be administered by the San Francisco Health Plan, the city-sponsored program that currently provides care for 50,000 city residents.
All San Franciscans are eligible for the program regardless of employment or immigration status. In order to join HAP, an individual must be uninsured, live in San Francisco, and be willing to apply for state and federal health benefits. Primary care and specialist physicians, clinics, and hospitals that currently comprise the city health network will deliver the services.