That health care surcharge on your restaurant bill isn’t always spent on doctor’s visits, or any health care. But under a proposed change to San Francisco’s landmark health care law, it would be, guaranteed, and it would also create a new city option for health insurance.

The City’s 2007 Healthcare Security Ordinance, which created Healthy San Francisco to give uninsured people cheaper access to city clinics, also mandated businesses spend a set amount per employee on health care coverage.

Currently, businesses are considered in compliance with the law if they put that money into a health care spending account, whether or not employees actually use it for medical expenses.

If the money isn't spent after a certain time, the employer can take it back. And further changes made by the federal Affordable Care Act mean that money can only be spent on vision or dental care, not health insurance.

That’s a loophole exploited by some employers that has long needed closing, according to Supervisor David Campos.

In order to make health care spending “irrevocable,” Campos is proposing locking the spending accounts, incentivizing businesses to choose a city option routed through the Department of Public Health.

“We want to maximize access to health care,” Campos said. “This is the way to do that in the context of the changes at the federal level.”

If the plan is approved by the Board of Supervisors, the money now sent to health care spending accounts would fund a program called Covered San Francisco.

Covered San Francisco would provide extra subsidies for health care plans bought on the Covered California marketplace.

If Covered California plans are deemed unaffordable even with that extra subsidy, Healthy San Francisco would still be available.

That assuages other fears that Healthy San Francisco would be eliminated for everyone but undocumented immigrants.

Health care spending accounts would still exist and money put into them would still satisfy employers’ spending requirements. However, they would be overseen by the health department and would cover any out-of-pocket expenses.

If approved, Covered San Francisco would be available starting Oct. 1. Campos’ proposal has yet to be calendared for a hearing. Lawmakers and The City’s business lobbies have long sparred over changes to health care spending.

The City Attorney’s Office in December secured a $2 million settlement with 57 restaurants that had been accused of under-spending on health care requirements.

Business groups are opposed to Campos’ plan.

“Our concern is that we’ll just be giving money to the health department,” said Gwyneth Borden, executive director of the Golden Gate Restaurant Association, who said there’s no guarantee the cash intended for health care won’t end up in The City’s general fund.

“The City also makes it hard not to choose the city option,” she added.