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Thursday, July 18, 2013

Will Lee abandon Healthy San Francisco?

The San Francisco Chamber of Commerce and the Golden Gate Restaurant Association are moving to gut the employer mandate in San Francisco's landmark health-care law -- and Mayor Ed Lee is so far refusing to take a firm stand on the issue.

The Business Times notes that the restaurant group -- which has long balked at the notion that businesses have to pay for employee health care -- wants Healthy San Francisco changed to eliminate that requirement.

The argument: Obama's Affordable Care Act ought to replace Healthy SF and with the new requirement that everyone buy insurance, the city program is no longer as necessary.

It's odd, since at the same time, the national press is giving Lite Guv Gavin Newsom props for creating the program (although it was really Tom Ammiano who proposed and pushed it, and Newsom had to be dragged kicking and screaming into supporting the idea). And Healthy SF is, for the most part, pretty complementary to the federal Affordable Care Act.

"ACA still leaves so many gaps," Sup. David Campos told me. "Why aren't we all talking about how brilliant San Francisco was in creating a program that can close those gaps?"

For one thing, the cost of insurance under the new federal program is still way too high for a lot of people -- particularly low-income people who don't have employer-paid policies and self-employed people who will enter a pool that offers little of value for less than $500 a month.

A lot of those people may simply chose to pay the $100 fine for failing to secure insurance instead of paying a rate they can't afford for coverage that's limited anyway. And there are perhaps 20,000 people who take advantage of Healthy SF who lack legal documentation and thus won't be protected by the federal law.

Oh, and it appears the employer mandate in Obamacare will be delayed until 2015 anyway.

So there will still be a need for Healthy SF. And if companies that don't pay for employee health care are able to duck out of the mandated payments to the city for Healthy SF, the program's going to run into money problems.

I get where the GGRA is coming from; health care is expensive. But I didn't see the San Francisco Chamber of Commerce lining up business leaders to pressure Obama and Congress to create a national health insurance system or even a single-payer option that would make this whole debate moot.
 Mayor Lee with this week with Ammiano and Campos, and Campos said he made it clear that there will be a strong push-back against any effort to weaken the program.

So where is the mayor? Well, he gave the BizTimes about the most cryptic and meaningless statement I've seen from a politician in a long time. Check this out:

“We are very grateful that President Obama and Leader Pelosi have pushed hard for federal health care reform, and made it happen. That effort has been more than 50 years in the making, and our country is now on the path to providing insurance for all. Healthy San Francisco, which San Francisco started in the absence of any universal federal or state insurance programs, has been a great success, providing health care access for over 116,000 uninsured adult San Franciscans since 2008. But, in our policy discussions, we have always been very clear in acknowledging that health insurance is a better option for our residents than just health access. Approaching 2014, we as a City are focused on how best to implement federal health care reform. We are deep into the process of working with our Department of Public Health, our community health care experts, the business community, and workers’ rights stakeholders to make sure that we support San Francisco in its implementation of this new federal policy; that we maintain our Healthy San Francisco program to provide medical access to those not eligible for federal benefits; and that we identify those populations who need support in accessing the Medi-Cal expansion and the new Covered CA insurance exchange and work together as a City to help them successfully take advantage of the benefits of the new federal program.”
 You got that?

I'm not sure I do -- but if I can see any message here, it's that the mayor is open to what the restaurant folks are saying and is ready to move to amend the employer mandate. That will be a huge battle.


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