Mirkarimi says the board should be "extremely sensitive" to the small business community's concerns.
"The business community knows best how to speak about profit margins. Right now, an employer spending mandate is the only option in orbit. If there are other options, great, but so far all we're hearing is nothing but distortion," Mirkarimi told the Guardian. He said the proposal by some downtown leaders to increase the sales tax by a half cent — an alternative to Ammiano's mandate — comes from "the same community who would sabotage any attempt to enact a tax-based funding mechanism."
Mirkarimi told us the mayor's plan was "prematurely pitched through the media on a national stage," while Ammiano's legislation, "which is really the heart and soul of the plan, has struggled to get any notoriety locally." Mirkarimi told us he hopes Newsom will directly address small business concerns — including the reality that his health access plan can't work without Ammiano's mandate.
"The mayor needs to make an effort to show small business that he intends to mitigate the negative financial side effects of his plan. But what is the mayor's communication? And why is he relying on the Board of Supes to fill in the blanks? The mayor needs to exercise leadership, to admit that for his plan to work somebody has to pay, and decide who that somebody is going to be, then build confidence that he has adequate answers. But right now, he's deflecting that responsibility onto the board."
Dr. Katz, who was a member of the Universal Healthcare Council that created the plan to offer health access to all the city's uninsured residents, said he neither hopes nor believes that all 82,000 of the city's uninsured will enroll.
"We hope that large employers continue to chose commercial health insurance," Katz said at the meeting, noting that 95 percent of businesses with more than 100 employees already have commercial health insurance.
"If people enroll in a commercial health insurance plan, the city doesn't get the revenue, but we also don't get costs," said Katz, who believes the city can offer health access to all uninsured residents without building additional health centers.
"All existing clinics and facilities have shown a desire to join the program and accept people," Katz said, noting that the $104 million the city already spends on San Francisco's uninsured is on the lowest-income individuals, plus a minute subsidy to small- and medium-size business but no subsidy for large businesses.
"Most of SF's 82,000 uninsured residents are getting care right now, but not in a rational way," Katz explained. "I look at how much capacity could we add to health centers by only paying for additional providers, like nurses, doctors. And the answer is a lot. We're not doing evenings or Saturdays, so we just need to open for more hours and hire more doctors, nurses."
Acknowledging that the Department of Public Health already saw 49,000 uninsured residents last year, Katz said that doesn't mean that people are getting what he calls "rational care."
"So when we create a system, we'll create a demand," he said. "It's not just the woman with a bad cough who comes in, but now she'll also get a pap smear." SFBG
For coverage of the July 11 hearing and other updates on the health plan, visit www.sfbg.com.
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