Under fire again

Employers use Obamacare to launch fresh challenge to SF's healthcare safety net

SF Examiner file photo by Cindy Chew


At a recent hearing on San Francisco's Health Care Security Ordinance — once-controversial legislation that is now in the business community's crosshairs once again — a nursing student stood at the podium to address members of the Board of Supervisors Neighborhood Services & Safety Committee.

She told them about her mother, who battled illness but did not have access to healthcare for 14 years due to her immigration status, recalling a day when her mother explained why she wasn't seeking medical attention: "If I go to the hospital, I'll bury you in debt."

For the uninsured and undocumented, going without medical care or going into insurmountable debt could be the only options if it weren't for Healthy San Francisco, a medical services safety net that was created by the HSCO in 2006. The program is expected to continue to provide care for undocumented enrollees who won't be eligible for federal assistance once the Affordable Care Act, also called Obamacare, takes effect early next year.

The HCSO's mandate that businesses provide some healthcare coverage for their employees was fiercely opposed by the business community, which challenged it all the way to the US Supreme Court. Now, those same powerful forces are gearing up for a fresh challenge that could jeopardize HCSO's potential to fill coverage gaps that will be created under Obamacare.

Under federal health care reform, two-thirds of the enrollees in Healthy San Francisco will become ineligible to continue receiving coverage because they will automatically gain eligibility for some form of federal assistance. Those earning up to 138 percent of the federal poverty level will be guaranteed coverage under Medi-Cal. But for low-income earners whose wages hover around $14 an hour, things are far less certain because they will be eligible to enroll in the federally created health benefit exchange, Covered California, although they won't necessarily be able to afford it. For someone earning around $30,000 per year before taxes, the estimated monthly cost for a health insurance plan under Covered California hovers at more than $200 per month, in many cases making it too much of a stretch.

As things stand, uninsured San Francisco employees who earn too much to qualify for Medi-Cal, but not enough to afford enrollment in Covered California — despite being eligible — can still access funds set aside for them in medical reimbursement accounts under the HCSO. This option may provide enough of a financial boost for low-wage earners to take advantage of federally subsidized health insurance after all.

"For working people, the implementation of the Affordable Care Act actually makes the Health Care Security Ordinance more important," explains Ian Lewis, research director at UNITE-HERE Local 2. "There are many consequences of the ACA ... and the Health Care Security Ordinance is a buffer against them."

As it stands, the local law "makes Covered California actually work in a high-cost city like ours," Lewis added.

Under HCSO, San Francisco employers are required to contribute toward employees' health care on a per-hour basis for each employee working more than eight hours per week, regardless of immigration status or city of residence, amounting to an estimated $255 per participant per month.

This mandate, known as the Employer Spending Requirement, has been the target of multiple lawsuits brought against the city by the Golden Gate Restaurant Association since the landmark health care ordinance, authored by then-Sup. Tom Ammiano, was first enacted in 2006.