San Francisco residents could still have access to health care under Healthy SF if Obamacare is repealed. (Jessica Christian/S.F. Examiner)

Trump’s threat to health care could be mitigated in SF

San Francisco residents would remain covered if President-elect Donald Trump is successful in his push to repeal expanded health care for low-income individuals across the nation under the Affordable Care Act.

Healthy San Francisco, a local program from the Department of Public Health that provides health care to low-income individuals, could regrow its enrollment to pre-Obamacare levels if the law is repealed, according to DPH Deputy Director Colleen Chawla.

But the size of the bill that San Francisco would have to foot under a rollback of Obamacare has yet to be realized. Trump has pledged to repeal the law and Republicans in both the Senate and House could begin to weaken Obamacare as early as January, according to media reports.

Chawla said the local program is still intact from when Medi-Cal — California’s version of Medicaid — was expanded to cover low-income individuals in 2014 under the ACA.

Healthy SF has just 14,000 low-income residents enrolled at present compared to its peak before the Obamacare rollout in 2010-11, when enrollment was at 54,000. Enrollment began to fall the following year leading into the Medi-Cal expansion in January 2014, Chawla said.

Though Healthy SF enrollment could grow back to prior year numbers if the Medi-Cal expansion in so longer intact under the Trump administration, “what would change is that we wouldn’t have a funding source,” Chawla said.

“We would likely have to absorb [the expenses] in our operations,” Chawla said.

Healthy SF spent almost $150 million on uninsured residents at its peak in 2010-11, according to the program’s annual report for that year. In 2014-15, the most recent annual report available, the program spent just over $70 million.

Adams Dudley, a professor of medicine and health policy at UC San Francisco, said that Congress cutting federal subsidies to California would make programs for low-income individuals more expensive for local jurisdictions like San Francisco.

“It’s not like when they repeal Obamacare they’re going to raise local taxes,” Dudley said. “Suddenly you have all these extra burdens and strains … You have to either cut services, cut coverage or raise taxes.”

The U.S. spends an estimated $9,000 a year on health care per person. In 2014, there were an estimated 61,000 uninsured residents in San Francisco, according to census estimates. As a result, San Francisco could be stuck paying a hundreds of millions of dollars for those
who turn back to The City for coverage if the Medi-Cal expansion is repealed.

“It could easily be a billion [dollars],” Dudley said after performing a similar calculation and factoring in the high cost of health care in San Francisco.

Chawla said that estimate seems overblown, but that she could not yet say what the impact would be because the health department has not done a financial analysis.

Since no changes have been made to Obamacare, Healthy SF and DPH have been focused on letting people know their coverage is still unimpaired.

The department put up flyers at its service locations this week, reminding residents of their coverage and that San Francisco is a sanctuary city that protects the information of undocumented immigrants from federal immigration authorities.

“We’re trying to address any kind of anxieties that are happening to make sure that they know that nothing has happened yet,” Chawla said.

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