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By Heather Knight
San Francisco Chronicle
San Francisco’s unique experiment in providing health care for all its residents took a significant step forward Monday - moving beyond its trial phase at two clinics in Chinatown and into 20 additional clinics around the city.
The expansion comes as the national debate over how to solve the country’s health care problem continues to rage. Sen. Hillary Rodham Clinton on Monday announced her national plan for universal health care should she be elected president, and California lawmakers are in a special session trying to hammer out a state plan for health care.
"They’re still messing around with it, and we moved it forward - that’s what San Francisco does," Supervisor Tom Ammiano, an author of the city’s plan, said on Monday. "It’s a real shining jewel in San Francisco’s crown."
The expansion will likely prove a make-it-or-break-it period for public health officials, who have said their only real hurdle since starting the program July 2 has been keeping up with demand.
The city aims to cover all 82,000 uninsured residents under its program - called Healthy San Francisco - in phases, culminating in about 18 months. So far, 1,548 have enrolled at the two Chinatown clinics alone, more than the city anticipated.
"Eighty thousand-plus more to go," Mayor Gavin Newsom said Monday. "This is the next bold phase. From two clinics to 22."
The clinics in the new phase are evenly split between public clinics and private, nonprofit ones; they are spread out to cover just about every neighborhood in the city.
As with the Chinatown phase, the expansion includes only people earning 100 percent of the federal poverty level or less. For one person, that’s $10,210 a year; for a family of four, it’s $20,650.
The next phase, starting in November, will cover people of all incomes. That will be the real determination of whether the program can succeed, Dr. Mitch Katz, head of the city’s Public Health Department, said Monday.
"I don’t yet see the program as a success," Katz said. "The vision of the program is universal health access that anyone can enroll into, and we’re not there now. What I’ll be happy with is when anyone can enroll regardless of income."
The program, the first of its kind in the country, was crafted last year by Newsom and Ammiano and was passed unanimously by the Board of Supervisors.
It isn’t considered insurance, because it doesn’t cover participants if they travel outside the city. Rather, it is intended to provide them with a medical home where preventive care is stressed. They also have access to emergency care, mental health care, substance abuse services, radiology, pharmaceuticals and other medical services.
Adults qualify if they are uninsured, live in the city and don’t qualify for Medicare or Medi-Cal. Pre-existing medical conditions, employment and immigration status don’t matter. Children and young adults up to age 24 are covered through a separate city program.
By most accounts, the trial phase in Chinatown has gone remarkably well, with the only major hiccup being keeping up with the crowds of people who have overwhelmed intake workers trying to sign up participants. On July 2, many people who didn’t yet qualify had to be turned away, and others didn’t bring the proper documents to enroll and had to return another day.
The health department has tried to stem the confusion by setting up a new system for enrolling. People can call a centralized phone number to determine whether they qualify and to begin the enrollment process. They are also told which documents they need to provide as proof of eligibility and can finish the process by bringing those documents to their clinic.
All the eligibility information, as well as a host of other information about the program, is also available on a new Web site.
In addition, participants’ medical information is now kept on one new centralized computer system, accessible to all medical care providers participating in Healthy San Francisco. That system also can be used to determine if patients qualify for other government programs, such as food stamps.
Healthy San Francisco is estimated to cost about $200 million a year and will be paid for with a combination of city and state money, participants’ co-payments and quarterly fees figured on a sliding scale, and contributions from employers who don’t provide health insurance for their workers.
Employers with 50 or more employees must start paying up Jan. 1, and those with 20 or more on April 1. Those with fewer than 20 are exempt. Employers can fulfill the requirement by contributing to Healthy San Francisco, to private insurance plans or to health savings accounts.
The Golden Gate Restaurant Association has filed a lawsuit to try to block the city’s employer spending requirement, saying it would force some businesses to shut down. A federal judge has pushed back a hearing to Nov. 2, but the city attorney’s office is trying to move up the court date.
In the meantime, Healthy San Francisco is in the national eye. Ammiano said his office has received many calls from government officials - including those in Berkeley and Oakland - who are thinking about replicating the program.
Tangerine Brigham, the director of Healthy San Francisco, said she also fields numerous phone calls from around the country, including from officials in New Orleans who are looking at how to rebuild their health system in the wake of Hurricane Katrina.
"We’re not secretive about what we’re doing," she said. "We want to share it with everyone so ultimately it increases overall access."
Healthy San Francisco
For more information about the program:
Call: (415) 615-4500 Online: www.healthysanfrancisco.org
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October 3rd, 2007 at 10:04 am
Universal Health Care is a right for every one in this country. We strongly support Mayor Newsom bold approach to making unconditional medical care a reality in San Francisco. Kudos to the Mayor, Supervisor Tom Ammiano, the board of supervisors and all the community advocates making SF healthcare secure for all the people.