Universal Health Care: Lessons From San Francisco

Abstract

The San Francisco Health Care Security Ordinance is the country's only local law designed to promote universal health care. It provides access to health services for the uninsured while requiring employers to contribute financially toward employees' health care costs. Enrollment in Healthy San Francisco, a program for the uninsured that is one component of the ordinance, fell significantly after the Affordable Care Act extended other types of coverage. Healthy San Francisco continues as a major source of care for undocumented people. Many other California counties have programs that provide at least some nonemergency care to undocumented residents, which demonstrates the versatility of this approach for localities. San Francisco employer contributions also fund medical reimbursement accounts that help insured people pay their health costs, including through a program added in 2016 to make Marketplace insurance more affordable. The city's experiences show that programs to help people pay for private coverage should be simple and include strong outreach and education and that the affordability of Marketplace coverage would be most easily addressed at the state level.

Cancer screening and breast cancer family history in Spanish-speaking Hispanic/Latina women in California

“…We limited the program to women older than 21 years of age, and the average age for all participants was 43 years, with some variation by geographic area, with San Francisco (57,58). The addition of the comprehensive health care program in San Francisco likely explains why a smaller proportion of individuals were uninsured (9.3%) compared to Los Angeles and Sacramento (44.3% and 44.0%, respectively).…”

“…California’s Medicaid-managed care legislation established a two-plan model in 14 counties with the largest Medicaid population ( 57 ). Medicaid recipients in these counties can choose between a local initiative and a commercial plan, with the local initiative being the state’s effort to help traditional safety net providers compete to retain Medicaid patients.…”

“…The Los Angeles Care Healthy Plan and the San Francisco Health Plan resulted from this initiative. San Francisco additionally has a program called Healthy San Francisco which provides access to comprehensive health services for uninsured workers and residents of San Francisco ( 57 , 58 ). The addition of the comprehensive health care program in San Francisco likely explains why a smaller proportion of individuals were uninsured (9.3%) compared to Los Angeles and Sacramento (44.3% and 44.0%, respectively).…”

“…For programs working with promotores, this may be important as it helps demonstrate that promotores may recruit individuals within their social circles that resemble some of their own characteristics. Having promotores of similar age of the target population of a specific program may be important.California's Medicaid-managed care legislation established a two-plan model in 14 counties with the largest Medicaid population(57). Medicaid recipients in these counties can choose between a local initiative and a commercial plan, with the local initiative being the state's effort to help traditional safety net providers compete to retain Medicaid patients.…”

Cities as Platforms for Population Health: Past, Present, and Future

“…San Francisco chose to pair this program with a unique municipal requirement that employers contribute financially to employees' health care costs. 135 My Health LA and NYC Care provide similar functions in Los Angeles and New York City, respectively, for people who cannot afford health insurance or are ineligible-for instance, due to immigration status.…”