Healthy San Francisco may be extended until the end of 2015

Healthy San Francisco participants may be able to stay covered under The City's public health care option until the end of 2015.

And the surcharges tacked onto the bill at restaurants to support employee health care are not only expected to stick around well beyond then, they could become even bigger beginning next year.

Employers in The City have been mandated to pay for employee health care in some way since 2007, under San Francisco's landmark Healthcare Security Ordinance.

That law also created Healthy San Francisco, which allows low-income San Franciscans to access preventative care as well as emergency room access via a network of city clinics.

Currently, businesses with 100 employees or more in The City must shell out $2.44 per worker per hour for employees who work eight or more hours a week and earn at least the minimum wage.

That money has either gone toward health insurance or to The City's Department of Public Health, which used some of the cash to fund Healthy San Francisco.

However, The City's public option has changed under the Affordable Care Act, often referred to as Obamacare, and people eligible to buy health insurance on the Covered California exchange are being phased out of Healthy San Francisco.

Initially, Healthy San Francisco participants for whom Covered California plans were available had until the end of this year to switch plans.

Instead, the Department of Public Health is now poised to extend the transition period until Dec. 31, 2015.

The City's Health Commission could vote to extend the deadline as soon as Oct. 7, health department Deputy Director Colleen Chawla said Friday.

Additionally, cash from employers that originally went to The City for Healthy San Francisco will now go directly to employees — into accounts called medical reimbursement accounts — who will then be able to use that money to buy insurance.

Under the Affordable Care Act, almost every American citizen is eligible for some kind of insurance, whether Medi-Cal or a purchased plan. While many will eventually be phased out of the insurance option, Healthy San Francisco will still be available for undocumented immigrants.

The City is also poised to remove an age limit — previously, people 65 or older were ineligible — and to lower the income-level eligibility requirement from 500 percent of the federal poverty level to 400 percent.

Other changes to The City's public option this summer included a provision that will make the employer spending irrevocable.

That is, the employer contribution must be spent on health care and cannot be returned to the employer if not spent within a given timeframe.

This means that businesses including restaurants that add a surcharge to diners' bills to cover their mandated health care spending — listed as “S.F. mandate” or something similar — will likely continue to do so, Chawla said.

There's no requirement that the cost be passed on to customers, but businesses are allowed to do so under city law.

And the employer contribution will increase Jan. 1 to $2.48 per worker per hour for big businesses with 100 employees or more.

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