People earning between $40,000 and $50,000 pay $1,350 a year.
There are also co-pays of $10 for medical visits and $5 to $25 for prescriptions again, typical of health insurance plans.
Bay Area Legal Aid and the Western Center on Law and Poverty are representing three San Francisco residents who say those fees violate federal and state mandates, which stipulate that the city must provide free health care to those who can't afford to pay. Healthy San Francisco is only one element of the lawsuit; it also claims that San Francisco General Hospital charges low-income people too much and that the city's medical bills and collection practices aren't fair.
One of the plaintiffs is Robyn Paige, a San Francisco resident with spine, foot, and hip injuries. Paige contends that she can't afford the co-payments on her multiple medications each month and must either go without pain medication or borrow money. Lisa Qare, 21-year-old resident with MS, had to wait three weeks for medication for an eye condition that developed as a result of her condition.
A $10 co-pay may not seem like much, but when a patient needs several doctor visits a month and must pay $5 to $25 each for multiple prescriptions, it adds up. "As a result," Michael Keys, a Bay Area Legal Aid lawyer, told us, "those who can't afford the charges are falling into medical debt or skipping services or medication."
And, not surprisingly, the cash-strapped city is having trouble finding enough staff and facilities to meet all the needs. Nancy Keiler, a Mission District resident and HSF participant, complains that clinic visits are too short, and that "the doctor is too hurried and has too many patients." (That's a common complaint about private health plans, as well.) After waiting three hours, another HSF participant had to leave without her prescription to get back to work on time.
The long lines and waits will only get worse in the face of budget cuts. Pink slips were already handed out to several hundred San Francisco health care workers and 1,000 more may be laid off this fall.
Robert Haaland, who works with the Service Employees International Union Local 1021, told us the staffing cuts will make the situation much worse. Martha Hawthorne, a public-health nurse, said she thinks that there won't be enough providers to provide good care and that many health care workers losing their jobs will have to enroll in HSF themselves, putting even more strain on the system.
Ammiano, the author of the plan, is concerned too. "I'm very worried about it," he said. "It seems to me now that if there's this budget pain, there will be impacts to San Francisco."
Nathan Ballard, the mayor's press secretary, tersely denied that HSF will feel any budget pain. Asked about critics' allegations, he said, "They're wrong. We are going to expand Healthy SF this year."
Earlier this month, insurance giant Kaiser Permanente joined HSF meaning that the health care giant will now participate as a provider in the program. Haaland voiced concern about that move, calling it "privatizing through the back door."
Mitch Katz, the city's public health director, agrees there are flaws to the system, but defends its success. "It is by no means a perfect program," he said, "but we've made a big impact." With national health care costs rising three times faster than wages (some believe that health care costs are rising five times faster than wages) the nation is starting to seriously talk about overhauling the entire system. San Francisco is being considered as a model for national health care reform.
Labor leaders have lauded the basic formula of HSF and pushed for the federal reforms to use it as a model.