OPINION The question before us as San Francisco voters, health care providers, activists, legislators, and consumers is: "Can our community provide access to health care for people who work?"
In a surprising, welcome, and wise political partnership, Sup. Tom Ammiano and Mayor Gavin Newsom have joined their hearts and minds in a two-pronged approach to improve health access. The scope of the problem is simple.
In San Francisco, 84 percent of workers are privately insured. Employees contribute through premiums and co-payments. But there are now 82,000 uninsured adults in San Francisco. They rarely use preventative or primary care health services and (because of cost) only pursue health services when acutely ill. The overwhelming majority find their way to the overburdened emergency department at San Francisco General Hospital, where the taxpayers pick up the cost, estimated at more than $29 million a year.
It's difficult and prohibitively expensive for individuals to get private health coverage. So group insurance is the obvious solution — and right now, that means insurance from employers.
The first of two complementary endeavors, initiated in November 2005 by Supervisor Ammiano, is the Worker Health Care Security Ordinance. It would direct employers with 20 employees or more to provide health insurance or contribute financially toward paying the cost of health care services for uninsured employees who work at least 80 hours a month.
The second part of the initiative comes from Mayor Newsom, who appointed a 37-member Universal Health Care Council, which will submit recommendations by May 2006 for a "defined benefits plan" establishing a "medical home" for the uninsured. It will also clarify the scope and cost of defined services, such as prevention and primary care, including behavioral or mental health services, dental health services, and prescription drugs, all in a plan delivered by the Department of Public Health clinics and the nonprofit coalition of community clinics.
San Franciscans overwhelmingly support universal health care.
By May the Universal Health Care Council, led by Sandra Hernandez, who runs the San Francisco Foundation, and Lloyd Dean, CEO of Catholic Health Care West, will recommend the scope of a plan, and health care benefits and costs, for both uninsured employees and the unemployed. For uninsured employees, this defined benefit plan could be heard at the same time as the final hearings on the Worker Health Care Security Ordinance currently in the budget and finance committee.
The opportunity to legislate a defined health care benefit for 30,000 uninsured working people in San Francisco is a historic step forward in improving the health status of all San Franciscans. Let us join both Sup. Tom Ammiano and Mayor Gavin Newsom to make history by the summer of 2006 and expand health coverage to working San Franciscans. SFBG
Roma Guy is a member of the clinical faculty of the Health Education Department at San Francisco State University and a city health commissioner.
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