So goes San Francisco, so goes the Nation?

The healthcare debate of 2009 has become a topic of great importance with 45 million Americans uninsured (Kaiser 2009). The 6 percent annual increase in healthcare costs is unsustainable leading to costs doubling in the next decade (Callahan 2009). From single-payer healthcare to fully privatized insurance, we have heard the gamut of what is best for Americans. The cost of health insurance and service has increased dramatically over the past twenty years (National Governors Association 2008). Federal legislators are debating as we speak as to what is the most effective way to provide healthcare to uninsured citizens. One new policy that has been successful in providing insurance or access to care is the Healthy San Francisco Program (HSF), enacted in 1997 (the coverage then expanded in 2006). HSF was expanded when voters supported the initiative in 2006 (Kaiser 2009). HSF could be a model for the rest of the nation if it is sustainable financially and health outcomes are better with the program than without.

Healthy San Francisco is not considered insurance, but a reorganization of the San Francisco health care safety net, that allows residents to access primary and preventive care through a private and public system partnership (Healthy San Francisco 2009). Participants of HSF choose a medical home where all services are coordinated (including laboratory, hospitalization, and prescriptions). This allows a greater focus on primary care, followed by secondary and tertiary care (Healthy San Francisco 2009).

Healthy San Francisco is only one option by which a covered employer can satisfy its obligation to make the required health care expenditure (HCE). In complying with the San Francisco Health Care Security Ordinance, employers have a variety of options to choose from, such as private health insurance, direct reimbursement to employees, health-spending accounts, the HSF City Option or a Medical Reimbursement Account (San Francisco Health Care Security Ordinance 2006). The Medical Reimbursement Account (MRA) account does not have to be used in the community to which they reside.

In order to see if this program can be implemented statewide in California, the political climate and leanings of the legislature needs to be evaluated. This is important because the passage of HSF statewide will depend or legislators preferences as well as the voter’s if this becomes a ballot initiative. An individual district analysis of the state house and senate would help to either support the passage of statewide legislation or reveal that HSF does not have the legislative support it needs. A survey of voter’s preferences and political leanings will also help to support or show a lack of support for the initiative.

Healthy San Francisco is a major progressive move toward universal access to health care. To research whether this is a sustainable policy it is necessary to evaluate the funding methods of HSF and whether or not this places an undue burden on County businesses. To understand if HSF is placing an undue burden on employers a review of the lawsuit and challenges to the legality of HSF is necessary. It is also imperative that HSF does not stagnate businesses because of the employer mandate.