Opinion, Berkeley Blogs

Where federal health care reform falls short, local reform steps up

By Susan Fang

San Francisco is an exciting place to be especially because of its history of progressive politics and culture of grassroots organizing. The citys passage of the Health Care Security Ordinance (HCSO) in 2006 represented an attempt to implement near-universal health care throughout San Francisco and reaffirmed the citys commitment to vulnerable people.

No doubt the focus of this legislation on prevention, primary care, and increasing equity in access to care has this UC Berkeley student in public health and doctor-in-training jumping for joy. Through innovative experiments in social responsibility, San Francisco has managed to make leaps in health care reform locally that the federal government cant or wont make.

The laws Employer Spending Requirement is a play-or-pay type mandate in which employers play by providing health insurance or pay by putting funds aside for employees in health or medical reimbursement accounts or to the city for Healthy San Francisco. Given that job-based coverage is still the main way non-elderly Americans receive health benefits, any serious health care reform in todays political climate needs to work with and build on this system of employer-based coverage something the HCSO does so strategically.[1] And despite the burden of complying with the ordinance, the majority of San Francisco employers have been shown to be supportive of the local policy.[2]

With the implementation of federal health care reform just around the corner, how will the national Affordable Care Act (ACA) and the local HSCO play out in San Francisco? While the ACA represents a huge step forward for our nations health care system, it does not go far enough in fulfilling the dream of quality, affordable, culturally and linguistically appropriate health care for all. One glaring shortcoming of the ACA is the fact that undocumented immigrants are completely left out of health care reform without any real or affordable means of accessing care except to rely on over-burdened county emergency rooms.

In addition to undocumented immigrants, many others will not be covered under the federal law. Since the ACA employer mandate which has been delayed until 2015only applies to employers with 50 full-time employees or more, employers across the country are cutting workers hours in order to evade the federal mandate. This trend makes it even harder for people who are trying to work and live in high-cost areas like the Bay Area.[3]

Already well-institutionalized here in San Francisco, the HSCO attempts to fill in some of these gaps. For example, undocumented immigrants who are San Francisco residents are still able to access a regular source of care, as Healthy San Francisco does not require a social security number or ask about status. And since the local Employer Spending Requirement is based on hours worked by an employee, employers have less of an incentive to cut workers hours, as they have elsewhere in the country. As such, the citys policies are an even more vital means of ensuring that low- and moderate-income individuals particularly immigrants and communities of color still have a means of accessing robustly funded health care.

If youre like me and you agree with the need to support San Franciscos progressive health care policies, join unions, community-based organizations (such as the Chinese Progressive Association), community clinics, and other allies to show your support for the Health Care Security Ordinance this Thursday (July 25, 2013) at 2 p.m. at San Francisco City Hall (Rm 263). Your voice matters.

Cross-posted from the Human Rights Center Blog.