Details key in health access plan

More than 80,000 San Francisco residents are uninsured, and that lack of insurance is contributing to increasingly unmanageable emergency medical costs that have reached crisis levels.

But how a system of universal health care access should work — and who pays for it — are tough questions without easy answers.

City officials took steps toward addressing the first part of that question Tuesday with the release of the San Francisco Health Access Plan. The plan, sponsored by Mayor Gavin Newsom and Supervisor Tom Ammiano, was the product of months of meetings by a council made up of health care, business, labor, philanthropy and research representatives.

Under the plan, any uninsured San Francisco resident could be connected to a primary care physician and would have access to an array of medical services available at the majority of hospitals in The City.

While providing a blueprint for health access for all city residents, the plan does not specify exactly how the new system would be paid for. It does indicate that employers, individuals, city government and other sources would provide the funding. The City currently spends more than $100 million annually on the uninsured, which would be redirected to the Health Access Plan. That would leave about $100 million in funding that must be identified.

Supervisor Ammiano has released a separate plan that would require that San Francisco businesses with more than 20 employees pay for health care services for their workers. Businesses with 20-99 employees would end up paying $182.50 per month per employee, and businesses with more than 100 employees would pay $273.75 per month per employee.

The funding mechanism, which Ammiano says was crafted with the help of labor groups, raises serious questions about how it would affect local businesses, particularly smaller businesses with high overhead and relatively small profit margins such as restaurants. For many of those businesses, suddenly being forced to pay up to several thousand dollars extra each month seems destined to result in businesses being closed and jobs being lost.

The funding component must be closely looked at for its economic impacts on both businesses and workers before it is rushed into law or onto a ballot. That kind of economic analysis was mandated by voters under Proposition I in 2004, but the Board of Supervisors has been slow to fulfill that mandate.

City officials are doing the right thing in focusing on important public policy matters. But on an issue like health care access, which is of such concern to so many San Franciscans, it is important that careful analysis be given to all the potential effects, both intended and unintended, so that sensible and effective legislation is crafted.

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