San Francisco Divided Over Novel Healthcare Plan

City officials joined by labor, nonprofit and business leaders Tuesday unveiled a plan to offer comprehensive healthcare to this city’s 82,000 uninsured residents.

The novel plan is not health insurance, but rather would grant residents who enroll access to a wide range of preventive as well as long-term care at clinics and private hospitals within city boundaries.

Nor is it finalized: Critical legislation requiring private employers to participate -- strongly opposed by many in the business community -- will be introduced today before the San Francisco Board of Supervisors.

Despite remaining hurdles, San Francisco Mayor Gavin Newsom lauded the plan as a national model. “Rather than lamenting that we live in a country where 48.5 million Americans have no health insurance ... San Francisco is doing something about it,” Newsom said at a news conference.

Because San Francisco is both a city and county, officials have been able to press for sweeping changes to county-controlled systems such as public health and voting more easily than other cities could.

The “San Francisco Health Access Plan” announced Tuesday evolved after San Francisco Supervisor Tom Ammiano floated a proposal to compel businesses here to provide employee health insurance.

Newsom stepped in after the business community balked, bringing them to the table with the city’s private hospitals, philanthropists, county public health officials and others.

Offering universal insurance would prove too costly, the council members soon learned. Instead, they opted to expand access to care through a public health program already administered for low-income residents. The distinction allows the city to continue to draw on state and federal programs to pay for care.

But the program is not likely to pencil out unless private employers step in to fill a $28-million annual gap. To accomplish that, Ammiano has drafted legislation requiring businesses with more than 20 employees to pay a minimum amount per worker toward health insurance -- be it private care or the San Francisco public plan.

Without that mandate, proponents fear, employers who currently provide health insurance are likely to pull the plug and abandon their workers to the city plan. That would drive the number of San Francisco uninsured skyward.

Ammiano said Tuesday that he has already garnered enough support from colleagues on the Board of Supervisors to pass the measure. But a bitter fight is guaranteed.

“If the Ammiano legislation passes in its current form, businesses will go under and people will be laid off,” said Nathan Nayman, executive director of the San Francisco Committee on Jobs, which represents large employers.

The experiment comes as states struggle to increase access to care and reduce the number of uninsured in the face of skyrocketing insurance and healthcare costs, said Joel Miller, senior vice president for operations at the Washington-based National Coalition on Health Care.

Though Miller applauded San Francisco’s effort, he cautioned that “unless we get a handle on healthcare costs, it’s going to be very difficult for any city, county, state or the federal government to address the uninsured issue.”