Mayor on local health care policy: “Everything is on the table”

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PHOTO BY SFDPH

A recent controversy has been brewing around San Francisco’s Health Care Security Ordinance, the 2006 legislation authored by then-Sup. Tom Ammiano that created Healthy San Francisco, the city’s medical services safety net program for the uninsured.

As we explain in greater depth in an article for tomorrow’s issue of the Guardian, influential forces in the business community such as the San Francisco Chamber of Commerce and the Golden Gate Restaurant Association have been publicly raising questions about the Health Care Security Ordinance in light of the federal implementation of the Affordable Care Act, aka Obamacare.

In a recent article in the San Francisco Business Times, Small Business California President Scott Hauge was quoted as saying, “We question whether Healthy San Francisco should continue in its current form with the ACA coming in.” And an article published today suggests that some are continuing to question whether the HCSO can legally coexist alongside the federal requirements under the ACA despite clarification given by Jon Givner of the San Francisco City Attorney’s Office last Thursday stating that the ACA expressly allows jurisdictions like San Francisco to adopt health-care policies such as the HCSO.

Meanwhile, the message from defenders of the city’s health care policy at a hearing called by Sup. David Campos last week was clear: Funding for employee health care generated by employer contribution provisions under the HCSO will be needed more than ever once the ACA is implemented, because many people who now rely on the low-cost Healthy San Francisco for medical care will suddenly find themselves ineligible for that program and automatically funneled into a new system where they are eligible to sign up for subsidized health care, but won’t necessarily be able to afford it.

The ACA will begin enrollment in October, and will take effect in January of 2014. At that point, roughly two-thirds of current enrollees in Healthy San Francisco will either transition to Medi-Cal (if they earn up to 138 percent of the federal poverty level) or qualify for subsidized health care coverage under Covered California, the health benefit exchange created under the ACA. Things are apt to be the most complicated for Healthy San Francisco enrollees who discover they cannot actually afford to take advantage of the options offered under Covered California. 

For this reason, Campos stressed that the HCSO should remain in place without being scaled back or tampered with, because medical reimbursement accounts provided by employer contributions under the ordinance could serve to fill those gaps and help low-wage earners obtain coverage regardless of income. As things stand, Campos and Healthy San Francisco advocates said, gaps created under the ACA will be filled by stronger HCSO provisions, so the programs stand to complement one another.

But the business community, seeking what GGRA executive director Rob Black described to the Guardian as “guidance” from the city on how to move forward given the pending implantation of federal health care reform, wishes instead to open up a new policy dialogue about the HCSO. The mayor has been receptive to their concerns, and recently reconstituted the Universal Healthcare Council, a body that was previously formed to hash out local health care policy.

A key question is who will be appointed serve on that board: Department of Public Health Director Barbara Garcia will chair it, but so far the only indication of who else will be named is that it will consist of "community, healthcare, labor and business stakeholders," according to a quote attributed to Garcia in the Business Times. Will the makeup include members of the GGRA, the business organization that sued the city to overturn the employer contribution mandate under the HCSO? 

In response to questions about whether the mayor believed the employer spending requirement ought to be revisited in light of ACA implementation, and who would be appointed to the newly convened healthcare council, mayoral spokesperson Christine Falvey responded ot the Guardian with the following statement: “Everything is on the table as the City develops a plan to best implement [the Affordable Care Act]. This is a great opportunity to see how the city can continue to be a leader in making sure San Franciscans have access to quality healthcare. We are currently updating a membership list for the Universal Healthcare Council. More information on that as it becomes available.”

Comments

“Everything is on the table as the City develops a plan to best implement [the Affordable Care Act]. This is a great opportunity to see how the city can continue to be a leader in making sure San Franciscans have access to quality healthcare. We are currently updating a membership list for the Universal Healthcare Council. More information on that as it becomes available.”

"Everything is on the table." I've never heard that phrase before. I wonder when politicians and their spokesliars will start using it on a regular basis? [sarcasm intended]
Maybe it can be taught in schools when people are earning a PhD in the Bull Shit and Propaganda curriculum.

Posted by Guest on Jul. 30, 2013 @ 4:34 pm

Since the local program is effectively being superceded by the federal program, it's important to consider all options i.e. retaining HSF, changing HSF and abolishing HSF.

Simple enough for you?

Posted by Guest on Jul. 30, 2013 @ 10:06 pm

I am confused by this: “Funding for employee health care generated by employer contribution provisions under the HCSO will be needed more than ever once the ACA is implemented, because many people who now rely on the low-cost Healthy San Francisco for medical care will suddenly find themselves ineligible for that program and automatically funneled into a new system where they are eligible to sign up for subsidized health care, but won’t necessarily be able to afford it.”

So:

1. Many people who rely on Healthy SF will be ineligible;
2. Thus, they will be funneled into ACA
3. But they can’t afford ACA.
4. So we should keep funding Healthy SF, since these people are ineligible for it?

Posted by The Commish on Jul. 30, 2013 @ 4:49 pm

Or do only "trolls" find run-on sentences confusing at times...?

Posted by Guest on Jul. 30, 2013 @ 5:17 pm

It is a complex topic. So, if you read down a little further in the story you'll see a reference to medical reimbursement accounts, which are funded by employer contributions mandated under the HCSO. Based on my conversations with people in City Hall, it seems that once federal health care reform has been implemented, the expectation is that these accounts, which are administered by the city, will continue to be made available for employees who can't necessarily afford federally subsidized insurance plans under the ACA (eligibility for ACA, meanwhile, will automatically disqualify those enrollees from Healthy SF). These reimbursement accounts for employee health care are separate from Healthy San Francisco, which was also created by the HCSO, but they are funded by an employer spending contribution that is a key provision under the HCSO. So it's really a matter of whether this funding will continue to be made available for employees who need the extra help obtaining federally subsidized health care insurance. It should also be noted that standalone health care reimbursement accounts established by employers (which generated controversy in recent years because employers were placing restrictions on them or else neglecting to inform employees that the funding was available) will no longer be legal under the federal health care reform law.

Posted by rebecca on Jul. 30, 2013 @ 7:54 pm

..."it seems that once federal health care reform has been implemented, the expectation is that these accounts, which are administered by the city, will continue to be made available for employees who can't necessarily afford federally subsidized insurance plans under the ACA..."

I'm clear on how the medical reimbursement accounts (MRA) work.

How is "employees who can't necessarily afford subsidized ACA insurance" going to be defined? Does this mean via some form of means testing, some employees currently using MRAs will no longer be eligible and some will remain eligible - i.e. lowering this particular cost to employers?

And for those who remain eligible, will they be allowed to use MRA funds to purchase subsidized ACA insurance...? (Seems like an overlapping double subsidy.)

Maybe you can help clarify here.

Posted by Guest on Jul. 30, 2013 @ 9:22 pm

These are good questions but I'm not sure I actually have enough information to give you complete answers here. Sounds like you might want to follow the deliberations of the Universal Healthcare Council, where finer policy and legal questions will be hashed out.

Posted by rebecca on Jul. 30, 2013 @ 10:10 pm

Jason Grant Garza here ... dear Rebecca ... I had written to you on another article in regard to healthcare, the farce of getting it, and what happens if the LAW is broke and NO ONE to enforce. It is strange that apparently you are writing on this subject ... yet, when I can provide proof of FAILURE such as a signed confession and many videos on youtube ... you have not written back nor contacted me. Why is that? Could it be that the REAL TRUTH regarding how healthcare DOES NOT WORK is NOT something that would interest you in BURSTING the propaganda BUBBLE? Why not go to an article written at the San Francisco Bay Guardian http://www.sfbg.com/2007/06/27/crazy where the byline is "This is nuts: A bizarre tale of the insanity that is SF's mental health system." Then you can go to the CRIMINAL FRAUD by DPH http://www.youtube.com/watch?v=7cP3jCmJFRo&list=TLydqaaUtbe1g unless your purpose is like those in the video ... to appease, not perform and twist reality. So which is IT? Do you want to KNOW the RIGGED and DELIBERATE FAILURES set into receiving healthcare and how it is "flowcharted" to NO WHERE, NO ACCOUNTABILITY, NO HUMANITY or will you just believe what they tell you and IGNORE my PROOF? Please let me know ... wait, I still await a response from before; but, thank you for the opportunity to bring this forward. I await your contact and doing an in depth article on DPH, SFPD, Sheriff, OCC, HRC, MOD and other failures. I can even show you a signed confession sitting next to an arrest record (never having been arrested before in my life) for a CRIME that DPH committed and admitted to. I can NOT wait for you to ask DPH, the city attorney and the COURTS how this is possible and WHY by GOD are they still BREAKING MEDICAL LAW in the delivery of care to me as MANDATED by LAW? I believe that the readers will be interested to see HOW FAR YOU GO in regard to this delicate and grave matter (healthcare, etc)

Posted by Jason Grant Garza on Jul. 31, 2013 @ 7:50 am

Jason Grant Garza here ... go to youtube and type in Jason Garza to see 200 videos on the DENIAL of healthcare, proper followup, law enforcement regarding healthcare and agencies in charge of enforcement ... such as the Office of Citizen's Complaints in regard to MEDICAL LAW ENFORCEMENT and disability rights, the Human Rights Commission for ADA enforcement, the Mayor's Office on Disabilities for ADA and Disability Right Law enforcement and the Police Commission for the enforcement of MEDICAL LAW. Let me let you start with DENIAL and CRIMINAL FRAUD by DPH with the Sheriff and SFPD abrogating their duties https://www.youtube.com/watch?v=7cP3jCmJFRo&list=TLwyadn6lyUPo , How is this possible ? Go to http://myownprivateguantanamo.com/settle1.html to see a copy of a signed confession/settlement agreement in 2007 admitting fault and guilt for BREAKING MEDICAL LAW in 2001 and it will link you to where the city had my case thrown out of FEDERAL COURT in 2003 with FRAUD and TESTILYING. It is 2013 and NO ONE from DPH to the city attorney nor the COURTS have explained and you want to know HOW THIS IS POSSIBLE? Keep watching the videos and lean that the Sheriff nor SFPD enforce MEDICAL LAW allowing for DPH to .... (watch the rest of the DPH videos on youtube to see the IMPUNITY.)
Keep DRINKING the KOOL- AID and let the GAMES and ILLUSIONS continue ... watch the videos learn the TRUTH and KNOW THAT YOU ARE NEXT ...
Yes, the Universal Healthcare Council will be as USELESS as OCC, HRC, MOD, the Police Commission and healthcare's motto ... "TO DO NO HARM."

Posted by Jason Grant Garza on Jul. 30, 2013 @ 6:20 pm

Healthy SF was a response to there being no federal and state provision. Now there is going to be, so it would be dumb to ignore that massive change in availability.

I'd prefer to see the SF scheme subsumed under the Federal scheme. Healthcare is too important to have it vary by fiefdom.

And that 4% charge on restaurant bills really galls me. Healthcare is a matter between employer, employee and the government. I shouldn't have to pay for the healthcare of another, except thru taxes and MediCaid.

Posted by Guest on Jul. 30, 2013 @ 9:43 pm

and admit that SF will maintain Healthy SF because the politicians want us to pay for healthcare costs of illegal aliens.

Posted by Guest on Jul. 31, 2013 @ 7:52 am

Sorry, everyone, that's it for now. Come to our forum tonight or send a letter to news@sfbg.com if you want to comment further this week. http://www.sfbg.com/politics/2013/07/25/calling-all-trolls-youll-have-co...

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in uk and was born in California.
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i got married 4months ago. My
husband and I have been
living a very happy and lovely
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began to notice this strange
attitude that he was
possessing. He was now going
out with other girls, to the
extent that he was no longer
picking up my calls, and he
was not even sleeping in my
house anymore. I became
confused and didn't know what
to do anymore. So i
became worried and stranded,
that brought so many
thoughts into my mind, because I
have never experienced
a thing like this before in my life.
So I decided to visit a spell
caster, to see if he can help
me out. So immediately I went
to the internet, where I
saw an amazing testimony of a
spell caster who brought
someone's ex lover back,so I
contacted him immediately
and I explained to him all my
problems and he told me
that it will be very easy for him
to solve, compare to the
ones he has done before. And he
also gave me some
proof to be really sure of her
work, and he assured me
that my husband will come back
to me immediately after
he is through with the spell
casting. And also he told me
to put all my trust in him and I
really obeyed him.
So it was 8:00 am on the next
morning, when I was about
going to work, when i received
my husband's call, and he
told me that he was coming back
home, and he apologized
to me, and told me that he is
very sorry for the pain that
he has cost me. And after some
hours later, he really came
back home, and that was how we
continued our marriage
with lots of love and happiness,
and our love was now
stronger than how it were
before.
And these great man also told
me that once my heart
desire has been granted unto me
that i should go and
testify of his work right here on
the internet. Right now I
am the happiest woman on earth
today as I am writing
this testimony, and I want to
really thank
dr alexzander for
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love to my family.so you
all there having dificulties or the
other don,t worry every
thing will be fine
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behaving the same way
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