As California and the nation worked last year to implement the Affordable Care Act, San Francisco had the opportunity to brag. San Francisco has long been a leader in trying to guarantee health for all. City officials could point to our progressive vision on this topic. Just look at how successful San Francisco has been with the Health Care Security Ordinance I pushed for when I was on the Board of Supervisors.
Since it went into effect, HCSO has ensured residents and workers have access to the health care they need. Job-based health coverage for San Franciscans increased even as it fell for workers in the rest of the Bay Area. Thanks to our efforts, more than 50,000 people were enrolled in the Healthy San Francisco portion of HCSO last year.
The ACA provides important new options for San Francisco residents and people throughout the state, but no law is perfect. The ACA will leave some gaps in coverage and affordability. That’s why it is so important that San Francisco stays the course with HCSO.
The two laws complement each other. If employers choose the city option, workers who are not eligible for Healthy SF will have access, under HCSO, to medical reimbursement accounts that they can use toward their deductibles and co-pays when they purchase coverage through Covered California.
Reimbursement under HCSO helps our working residents afford coverage. Other parts will continue to serve people who may not be eligible for ACA plans. That includes many hardworking immigrants in our San Francisco neighborhoods. When everyone has health care, The City as a whole benefits. With HCSO in place, San Francisco will continue to set the gold standard.
The bad news is the things that have been left unsaid or unclear, and the efforts by some people to take advantage of that situation.
I’m still concerned about efforts to preserve an option that allows some employers to contribute less than their full share. I am not anti-business, and I am proud of the fact that around 90 percent of San Francisco employers offer health insurance for their workers. But a small percentage of businesses tried to block programs to help workers with health care, and some of them want to continue making contributions to an eligible benefits account. When those accounts are limited — limited to dental and vision, or not permitted for dependents — employers can recoup unused funds. They end up paying less. Workers get less.
Thankfully, not many employers are acting on this loophole, but we need to eliminate it. The Board of Supervisors had a chance to strengthen requirements before, but some supervisors acted to water down the changes. I support efforts by Supervisor David Campos to revisit this issue. City leaders need to join together to close the holes and make sure employees get all the benefits they are entitled to.
Likewise, we need to make sure the Healthy SF safety net under HCSO — health care for those who don’t have an insurance plan — has no holes in it. It’s important to cover the undocumented, but they are not the only San Franciscans who won’t be able to find an affordable insurance plan under the new laws. Healthy SF has to be open to all who need it.
We have a program that has been successful and a model for the rest of the country. While we can applaud the roll-out of ACA and Covered California, let’s not take any backward steps here at home.