Prop 72, Local Edition?

by Eric Schaefer on April 21, 2005

70% of San Franciscans voted for it and 1 in 8 San Franciscans don’t have it, but health coverage for the working uninsured may be in mid-range future if the city can make what Supervisor Tom Ammiano called “an extremely reasonable, incremental step toward universal health care.” Yesterday Ammiano sponsored a Budget and Finance Committee hearing on the feasibility of city-mandated health insurance, which could add to the mosaic of city-sponsored programs already in place, and reduce the pressure on city health services, by requiring larger businesses to pay for their employee’s health coverage.

An assortment of labor leaders and public health advocates turned out to speak in favor of the idea. Mike Casey, of the local 2 hotel workers’ union said that “If you look at every labor dispute now, it’s all about health care.” He added that mandating health care could not only improve his members’ standard of living, it could also reduce the number of labor disputes by “leveling the playing field.” Many employers refuse to provide health care because the extra cost would make them less competitive, but an across the board requirement would remove that impediment.

In a report to the committee, Greg Sachs of the DPH estimated that SF General Hospital spent $24M on patients who identified an employer but were uninsured or partly insured. That estimate does not include a breakdown of the size or nature of the employers identified.

No legislation has been submitted yet, and none will be submitted this fiscal year, but the legislative Analyst’s report looked at a hypothetical situation that would require businesses with 20 or more employees to foot 80% of their health-care costs.

Such a plan would cost 530 of the city’s 30,000 businesses about $73M and would save the DPH $11M in spending on medical services at the city’s hospitals. It could benefit 50,000 uninsured and underinsured residents. The legislative analyst’s report did not study the current costs or possible savings to non-profit clinics.

Most people at the hearing supported the idea of mandated health care and had worked with Ammiano’s office, but one opposing voice did show up. Stephen Cornell, of the Council of District Merchants, accused the Ammiano of leaving business out of his plans saying “San Francisco’s businesses now pay more than in any other city in the United States, and now you want us to pay more?” Ammiano reacted hotly to the accusation, saying “I don’t think it’s quite fair for you to characterize us this way” and complaining that business had a history of reflexive “naysaying.”

Legislation is still in the “working group” stage, but Supervisor Daly asked that the board push to have something ready for the 2006-07 fiscal year, in light of the deep budget cuts expected at DPH.

Proposition 72, last year’s failed state ballot measure that would have forced large employers to provide health insurance to their employees, was on everyone’s mind. The potential reaction of the business community was also on the committee’s mind. Supervisor Elsberd said at the end of the hearing that the board must proceed very deliberately, saying: “The last thing any of us want to do is create an excuse for the opposition.”

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