Gov. Arnold Schwarzenegger’s proposal to require all Californians to have health insurance and to subsidize coverage for the poor calls into question San Francisco’s recently passed universal health care plan, which was scheduled to start in July.
San Francisco’s groundbreaking plan, championed by Mayor Gavin Newsom and Supervisor Tom Ammiano, provides every resident with either employer-provided or city-provided health care. The controversial aspect of the plan was a mandate requiring businesses with 20 or more employees to invest $1.06 to $1.60 for each employee hour worked for health care.
Under the governor’s proposal, unveiled Monday, Californians would be required to have health insurance for all family members, and employers with 10 workers or more would have to provide health insurance for their workers or contribute to a state fund. The state would pay for insurance for individuals and families living under a poverty threshold.
Ammiano, who authored the original health plan legislation for The City, said San Francisco must move forward as originally scheduled with its plan. Limited enrollment for the San Francisco plan was scheduled to begin in July with sign-ups first for uninsured workers funded through employers.
“There are those with life-and-death conditions that need access as soon as possible,” Ammiano said. “Time’s a wasting and legislative gridlock in Sacramento will slow [the governor's plan] down.”
Newsom said San Francisco would not retreat from its plan to provide health care for all residents, but it would be prudent to wait and see how the governor’s plan evolves as it makes its way through the Legislature.
“It’s now just a question of timing. We need to be thoughtful about not getting ahead of ourselves and spending time and money only to find out the state is filling a particular void that’s not apparent today,” said Newsom, who noted that The City was poised to make substantial investments in computer systems to manage the San Francisco plan.
The governor’s plan — which has only been presented in broad terms — doesn't provide as comprehensive coverage for as many people as San Francisco’s plan, said Dr. Mitch Katz, director of San Francisco’s Department of Public Health.
For example, 40 percent of San Francisco’s uninsured — who would be covered under the San Francisco Health Access Program — are undocumented adults, who would not be covered under the governor’s plan. It’s also unclear under the governor’s initial proposal if employers would be required to provide insurance for part-time workers.
The amount that businesses would have to contribute for some employees is less however, since San Francisco plan requires a minimum of $1.06 per hour — which is 11 percent of The City’s minimum wage of $9.14 an hour — whereas the state’s plan requires only a 4 percent payroll tax. Higher-paid employers are more likely to receive employer-provided health insurance, according to studies.
San Francisco’s plan could also be put in jeopardy by the state’s universal health program because under the governor’s plan some of the state money that is sent to cities and counties would be used to subsidize the insurance for the poor. San Francisco had also planned to use that money to fund more than half of its $200 million plan.
“The state’s proposal could take away as much as $100 million in state funding,” Katz said. “The loss of that funding wouldmake it difficult to take on an initiative of this size.”