In a bold experiment, San Francisco moved a step closer this week to accomplishing what no municipality has done before: offering comprehensive healthcare services to all uninsured residents.
The Board of Supervisors does not plan to offer universal insurance, but it would expand access to San Francisco's public health system to residents who lack coverage.
The proposed Health Access Plan, scheduled for a final vote next week, would offer preventive, primary and emergency care by hospitals and county- and community-run clinics in the city.
With the number of uninsured Americans estimated at 46 million, healthcare experts described the proposal as an innovative local attempt to address a growing national crisis.
"This is an example of a city stepping forward saying, 'We're going to get our hands around this problem and do the right thing,' " said Dr. Kevin Grumbach, a UC San Francisco professor and chairman of the department of family and community medicine.
"It is possible to achieve universal healthcare. If it doesn't start nationally, it'll have to start city by city," said Grumbach, who served on a mayoral committee that proposed details of the plan.
The proposal, tentatively approved by the supervisors Tuesday on an 11-0 vote, would offer anyone seeking care within the city the option of enrolling in the program. Patients would get a card and pay a monthly fee on a sliding scale, based on income.
Among the more controversial elements of the plan is a requirement that businesses employing 20 or more people either pay into the plan or contribute to the cost of their employees' healthcare through other means, such as private insurance or health savings accounts.
Enrollees would be assigned to a primary-care doctor and clinic to receive regular and preventive care. Patients would be able to receive comprehensive services from any participating hospital or clinic. Illegal immigrants living in the city would also be eligible.
"Our goal is to provide an actual system whereby people have everything from primary care to pharmaceuticals, including access to specialty care, if needed, for all uninsured San Franciscans," said Jennifer Petrucione, spokeswoman for Mayor Gavin Newsom, who worked on the measure with Supervisor Tom Ammiano.
Ammiano had initially proposed a requirement for businesses to provide health insurance to employees. After businesses balked, Newsom got involved, appointing a task force that devised the latest plan.
The mandate that businesses participate, however, remained an issue. Most of the 82,000 uninsured San Francisco residents are not employed. The plan's backers feared that without a requirement that employers pay a minimum amount toward healthcare, businesses would drop the coverage they do provide.
By rejecting an insurance program in favor of expanded access to healthcare, San Francisco officials can continue to take advantage of state and federal programs that defray the cost of care for the indigent, including Medicare. Because the plan is not insurance, however, it will not cover enrollees who get sick outside the city.
If all uninsured residents enrolled in the plan, the proposal would cost $200 million. San Francisco already spends about half that amount on care for the uninsured, and the rest would be covered by enrollee fees and contributions from employers.
If it receives final approval next week, it is expected to be signed by the mayor. The first phase of the Health Access Program would begin operation July 1, 2007.
Times staff writer Lee Romney contributed to this report.