The coming implementation of national health care reform is sparking some concern about what will happen with the coverage San Francisco already provides for thousands of people.
But according to at least one city official, there shouldn't be a problem.
At a recent hearing of the Board of Supervisors Neighborhood Services and Safety Committee, Deputy City Attorney John Givner said the Affordable Care Act "includes some language that says it does not pre-empt local laws" such as the health care security ordinance, and that the ordinance actually complements the national law.
The city's health care security ordinance, enacted several years ago, has two main components – Healthy San Francisco, the city's locally designed and funded universal health care program, and the employer spending program.
Through the program, any business with 20 or more employees nationwide who work at least eight hours a week has to pay in to health care funds.
The national law, which goes into effect October 1, is less stringent. A requirement that's been delayed would apply to businesses with 50 or more employees who work at least 30 hours a week.
The Golden Gate Restaurant Association, which has opposed local health care mandates, and, despite Givner's assurance, appears to be doubtful that Healthy San Francisco can remain.
Asked whether it was his understanding that the Affordable Care Act would not trump Healthy San Francisco, GGRA Executive Director Rob Black said, "The way you're asking the question is a very vague one," and he asked, "You don't think federal law supersedes local law?"
Reminded that the city attorney's staffer indicated it doesn't, Black said, "I haven't seen anything in writing from the city attorney's office," and Givner "did not say federal law does not pre-empt local law. ... I'm not sure I agree with the characterization you're making."
Supervisor David Campos, who lead the Thursday, July 25 committee hearing, said in an interview that his support of the local ordinance remains strong.
"I think that we want to make it clear that we need the health care safety ordinance, that as San Franciscans we should be very proud of what the ordinance has meant" to those who are "covered because of it, including members of the LGBT community. And we're not going to let anyone take it away," said Campos.
Steven Porter, the general manager of Harvey's, the longtime Castro neighborhood restaurant and bar, also hopes the local ordinance remains in place.
It's Porter's understanding that the local ordinance can remain in place regardless of what happens with the federal law.
"We're still going to be bound by the laws of the city, which are going to supersede whatever the federal requirements are," he said. "... The city has been way ahead of the federal government on this entire issue, and I just think it's fantastic we're able to offer health care to our employees at virtually no expense to them."
Porter said "most if not all" businesses in the city offer either a Health Maintenance Organization, which involves paying premiums, or Healthy San Francisco.
Using the nickname for the federal law, he said, "We already satisfy the Obamacare employer mandate, so, in our discussions, we've pretty much foreseen that we're going to continue to do things the way we've been doing them since the health care security ordinance passed in the city" several years ago.
"We feel like Healthy San Francisco is a pretty good thing for people that don't necessarily need portable health care and that don't have chronic medical conditions," said Porter.
Harvey's employs 32 people and last year spent $55,000 on health care costs. Eighty percent of the workers chose Healthy San Francisco, while 20 percent opted for Kaiser Permanente.
Harvey's is part of the GGRA, and Porter said, "We do not support their view" of the health care security act. He declined to elaborate.
Black maintains that his organization supports workers.
"The issues we're talking about are very complex," he said. "Our first priority is to ensure our workers are able to access the full benefits and subsidies under the Affordable Care Act."
Asked if he thought the health care security ordinance needs to be changed or done away with, Black said, "We're looking forward to the mayor's reconstitution of the universal health care council to address where we see there may be some areas where the two laws need to be better coordinated. ... We are concerned that certain aspects of the local ordinance could limit an individual's ability to get subsidized care on the exchange. We want to make sure that doesn't happen."
Black was referring to Mayor Ed Lee re-launching the city's Universal Health Care Council, which is to provide recommendations on implementing the federal law and "ensure access to quality health care for San Francisco's uninsured residents," a statement from Lee's office last week said. Lee appointed Department of Public Health Director Barbara Garcia to lead the council.
"Implementing the Affordable Care Act is a top priority for San Francisco," Lee stated. City officials "need to provide guidance to our local businesses about how the ACA integrates with our local policy – namely the health care security ordinance."
In Lee's statement, House Minority Leader Nancy Pelosi (D-San Francisco) said, "San Francisco's leadership in health care is a model for cities across the country. Our city led the way toward universal access to quality care starting in 2008. Moving forward, San Francisco will again lead the charge to ensure health care remains a right, not a privilege, for all Americans – and to make the Affordable Care Act a clear victory for America's patients, workers, and middle class."
Campos expects to have another hearing in September. That meeting will focus on enrolling in coverage through the Affordable Care Act. A date hasn't been set.
Theresa Sparks, executive director of the city's Human Rights Commission, said she and others have been working with the health department to ensure universal coverage for transgender people "over and above just city employees."
Sparks, a transgender woman, said that she's been assured that transgender health care "will continue going forward."
Sparks foresees a "transgender center of excellence" at San Francisco General Hospital, UCSF, or another hospital. Such a program would ensure that transgender people could get affordable care, regardless of whether Healthy San Francisco or the Affordable Care Act is in place. The national law doesn't include transgender care.
Planning committees are under way, said Sparks, and UCSF already has "an excellent program that is doing consulting around the country. They're working with the San Francisco health department to try to come up with a program that works side by side with UCSF."
Sparks and others are hoping part of the new center will be rolled out this year, "possibly in the form of retaining an outside contractor" or provider to start offering services for transgender people. Implementation of the program could take 18 months to two years. During that time, the city would look at developing the capability to provide care "in house."
That could mean SF General or another city facility training medical personnel in "current state-of-the-art procedures," cultural aspects, and other areas "to make sure that when transgender people are treated in those facilities, they have the best treatment, the best care available."
HIV panel recommendations
Earlier this week, the San Francisco HIV Health Care Reform Task Force released a set of recommendations to ensure the safe transition of residents living with HIV "into a broader system of care as the Affordable Care Act is implemented in 2014 and beyond," the panel said in a news release.
"Health care reform will result in better access to care for many people – including those with HIV. But it also includes major changes to the way HIV-related medical care and support services will be funded and delivered," stated Mike Smith, executive director of AIDS Emergency Fund and president of the HIV/AIDS Provider Network. "Our recommendations call for a transition plan that minimizes disruption in client care and establishes a comprehensive system of care that meets the needs of all people living with HIV in San Francisco."
The goals of the recommendations include promoting "successful community-based interventions aimed at outreach, testing, and linkage to care" and reducing "barriers to timely engagement in quality, affordable, and patient-centered care," the group stated.