By Richard C. Paddock
The federal health care overhaul signed last month by President Obama will not prompt significant changes in the short term for Healthy San Francisco, the city program that provides medical care for more than 51,000 low-income residents.
And even when most major provisions of the federal law take effect in 2014, city officials say, there will still be a need for Healthy San Francisco to serve an estimated 20,000 patients who will not have health insurance under the federal law, including many who are in the country illegally.
Healthy San Francisco Director Tangerine Brigham said a preliminary analysis of the changes in federal law indicate that about 60 percent of the patients now receiving care under the innovative city program will be able to obtain health insurance and leave Healthy San Francisco once the federal law fully takes effect.
But precisely how the federal overhaul will affect the city’s universal health care program will remain uncertain until the federal government drafts regulations for the state to follow in implementing the law, she said.
“As you can imagine we are still in the process of going through the legislation,” Brigham said in an interview Tuesday. “There is much more to come once we have the federal regulations and the state has its regulations.”
The city program, which was approved in 2006 and began enrolling patients in 2007, goes farther than the federal legislation in several ways. It is designed to ensure that every San Francisco resident receives health care; it has a public option and does not exclude anyone with a prior medical condition.
Employers with 20 or more employees are expected to provide health care for their workers or pay into a fund that finances Healthy San Francisco. The poorest patients pay no monthly fee; others pay up to $150 a month, depending on their income.
The major drawback, however, is that Healthy San Francisco is not health insurance. Members who become ill outside the city have no health coverage. For that reason, Brigham said, the city will encourage patients who qualify under the federal law to obtain health insurance
“We have been very clear that health insurance is preferable to Healthy San Francisco,” Brigham said. “For one, it’s portable.”
As features of the federal law begin kicking in this year, some Healthy San Francisco members will be able to get health insurance and leave the city program.
For example, patients who had been denied health insurance because of pre-existing conditions will have access to high-risk insurance pools beginning in July. And young adults under 26 will be eligible for dependent coverage under their parents’ insurance starting in October.
But city officials say the decrease in Healthy San Francisco patients will be relatively small until 2014, when key features of the law take effect, such as the creation of subsidized health insurance exchanges for the uninsured to purchase insurance and the expansion of public health insurance programs.
But even when the federal health care overhaul is complete, Brigham pointed out, not everyone will have health insurance.
While most Americans will be required to purchase insurance under the law, there are some exceptions, she said, including Native Americans and those whose religious beliefs prohibit buying health insurance. In addition, the federal law denies health coverage to undocumented residents, who have a considerable presence in San Francisco.
Based on today’s numbers, Brigham estimates that there could be about 20,000 San Franciscans who come under these exceptions and will still need health care through Healthy San Francisco in 2014. One city clinic already is dedicated to serving Native Americans, she said.
“The provisions don’t apply to those who are undocumented,” she said, noting that San Francisco is a sanctuary city. “We would certainly still have a program for that population.”
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