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Today’s joint meeting of the two Authorities was interesting. Mitch Katz, MD, MPH, San Francisco’s health director presented on their Healthy San Francisco program. The city isn’t waiting for the state or the fed.s to do something — they created their own program to cover everyone. The crux of the model is a medical home for everyone – your place to get health care, a provider who is responsible to you and to the city for your health. Every adult resident of San Francisco, who doesn’t qualify for another program, is eligible with no pre-existing condition exclusions – including undocumented immigrants. It is built on the safety net, and doesn’t waste money on insurance – every dollar is spent on care and coordination. It is also built on electronic records and eligibility systems; the resulting administrative efficiencies are a critical part of the program. Healthy San Francisco includes coverage for a very comprehensive set of services. Consumers know what their costs of care will be before they sign on – a critical component when half of bankruptcies are due to medical bills. They already have 20,600 enrollees in only ten months, well on the way to their 60,000 person goal. Over 700 businesses have chosen the city option to cover their employees. Financing includes government funds as well as both employer and individual contributions. The San Francisco restaurant association has filed an ERISA challenge in federal court, which is on appeal. Meanwhile, the program continues to provide care. Believing that they could create public resistance to the program, city restaurants added a note to their menus stating that recent price increases were the result of Healthy San Francisco. But that backfired on them, 95% of comments to the notice were positive — supporting a price increase that goes to provide health coverage. Dr. Katz’ lesson for Connecticut – be brave and be creative; progress isn’t coming from Washington.
Ellen Andrews