Healthy San Francisco: Snapshot of Universal Care

It's been almost five years since San Francisco launched its innovative, universal health plan--Healthy San Francisco--and last night a panel of public health experts and care providers gathered at the Tenderloin's Glide Foundation to provide a snapshot of how the program is faring.

Glide has a long history of providing services to the poor and marginalized--and advocating on their behalf. Glide's Freedom Hall was packed, with a smattering of people who indicated they were participants in Healthy San Francisco. Tangerine Brigham, director of the program, spoke first and described the program's goals: to provide improved access to care through a network of community clinics and hospitals. Of primary importance is for people to have a relationship with a doctor or clinic so they don't resort to the emergency room for what are essentially primary care problems.

Since its inception in 2007, Healthy San Francisco has enrolled 80 percent of San Francisco's uninsured--about 55,000 adults. And people are using the primary care benefits. "Over 70 percent of the people in Healthy SF are getting a primary care visit at least once a year," Brigham said. "Because they're using primary care, we saw a reduction in emergency room utilization at San Francisco General Hospital. We compared that to other public hospitals in California and what that analysis showed was that San Francisco emergency utilization was declining while others' was rising."

Healthy San Francisco is not health insurance. Participants pay a quarterly fee--on a sliding scale--for care at the clinics and hospitals that participate in the program, which are in San Francisco only. But people don't seem to be bothered by the geographic constraints. A 2009 survey by the Kaiser Family Foundation found that 94 percent of participants were at least "somewhat satisfied" with the program and 92 percent would recommend to a friend.

Karen Hill is the clinic manager at Glide Health Services. As a provider, she is also highly satisfied with Healthy San Francisco. "From a clinic manager's perspective," she says, "I don't have to worry about where I need to send someone for specialty care. I know they have a place to go. ... We are going to be able to get those specialty tests they need. We have access for blood tests and for medications."

As part of San Francisco's health care overhaul, businesses with more than 20 employees are required to provide health insurance to their employees. Before implementation of the plan, employers--especially restaurant owners--had worried that this requirement would cost jobs, since businesses in surrounding cities and counties might not bear the same health insurance costs. William Dow, Professor of Health Economics at UC Berkeley, has looked at this issue extensively. "Were there fewer jobs in the City after this happened?" he asked, in reference to the implementation of Healthy San Francisco. "The answer is no." You can read his full analysis here.

The discussion was peppered with comments and questions from the audience. Many spoke in favor of Healthy SF, including Jack Snook. "I think Healthy San Francisco is the best thing that ever happened to me other than being a teacher for 20 years," he said. "I'm able to easily attain care through Healthy SF. ... It's been a big blessing in my life."

Looking ahead to the rollout of federal health care reform in 2014, panelists agreed that San Francisco's near-universal health coverage makes the upcoming change easier. "We will be in a very unique position as a provider community in 2014," said Tangerine Brigham, "because we will be far better prepared with our residents in Healthy San Francisco to transition either from Medicaid or into another program."

The panel unfortunately ended before any discussion of cost of the program could be addressed. The San Francisco Public Press--sponsor of last night's event--featured an in-depth special report last November. The entire edition is worth a read, but one ominous parting note:

The employer contribution raised relatively modest revenues. Of Healthy San Francisco’s total $177 million budget in the last fiscal year, businesses covered just $12.9 million, or about 7 percent. When city officials created the program they envisioned businesses covering $30 million to $40 million, or at least 15 percent of the cost.

The city’s General Fund picked up nearly eight times that amount — $99.7 million. The contributions of individuals opting to buy Healthy San Francisco for themselves contribute just $5.9 million or a bit more than 3 percent of total costs.