As much of the rest of the nation continues to grapple with the issue of making medical services available to millions of uninsured Americans, health care for uninsured San Franciscans was debated at a public hearing held Monday, June 26 in City Hall.

"This is a historic day for San Francisco," said Supervisor Tom Ammiano as he opened up the hearing for discussion on both the Worker Health Care Security Ordinance (WHCSO) and the Health Access Program (HAP). The two components seek to complement one another; Ammiano worked on the HAP with Mayor Gavin Newsom, who unveiled the proposal last week. Ammiano's component seeks to fund the healthcare insurance.

City leaders say both ordinances would work together to provide health and medical services to residents in San Francisco, including the estimated 82,000 that are currently uninsured.

Opponents of the ordinances say city officials need to take another look at the way they are going to pay for the plans and that it unfairly targets small business owners.

The WHCSO, sponsored by Ammiano, would require medium and large-sized employers in San Francisco to spend a minimum amount per hour, per employee on health care for their employees. For the majority of employers who already provide health insurance, no new costs would be incurred by the mandate.

HAP would replace the city's current system for taking care of the uninsured by providing medical care through the Department of Public Health and nonprofit clinics and hospitals, including the county-run San Francisco General Hospital.

"This is the most pressing issue in the country right now," Ammiano said. "This is groundbreaking legislation. Many places are experimenting with some type of universal health care, but I think we have the ticket."

Ammiano said together, the plans would provide each San Franciscan with a primary care doctor, medical care, including preventative, dental, and mental health services. He said many uninsured San Franciscans are forced to wait until they have to see a doctor and end up going to the emergency room, costing the city and taxpayers more money.

Under Ammiano's plan, large companies (100 or more workers) would be required to spend a minimum of $1.60 and medium-sized (20-99 workers) would be required to spend $1.06 per hour, per employee in health care services for their employees. Small companies (less than 20) and nonprofit organizations with less than 50 employees would be exempt.

HAP is designed to provide preventative services, covering tests such as Pap smears, and managing illnesses like asthma, diabetes, and high blood pressure.

The city estimates HAP would cost about $200 million annually, or about $201 per enrollee. Funding would come from city coffers (about half), about $38 million from local business contributions, and the remainder from monthly premiums paid by plan participants. But Newsom acknowledged last week that the plan, which is currently voluntary and to which businesses would be required to contribute financially, might need to be changed to require businesses to contribute in order for it to work.

That's where Ammiano's proposal comes in – as a way to help pay for the coverage for plan participants.

Public opinion during Monday's hearing ran about 50-50 pro and con the plans.

Most opponents were small- or medium-sized business owners who said the plan unfairly targets them for financial support and that they could not remain in business with the added expense. Most opponents said they did not oppose the universal health care concept, but said the city had not done a thorough job exploring funding means for the plans.

Many queer and progressive activists support universal health care in the city, and note that many LGBTs and people living with HIV/AIDS would benefit from such coverage.

Ammiano told the Bay Area Reporter at a press conference after the hearing that criticism of the funding was unfounded and that he thought the plans would work the way they are designed.

"I heard some of the negativity, it is the same that we heard when we talked about the domestic partners and living wage plans. I would tell them the sky is not falling," he said. "When we look at the numbers, we don't see it that way. These plans will work. They are receiving a lot of attention nationally."