Healthy San Francisco

Prior to the implementation of Healthy San Francisco, the city's safety net health care system for the low-income and uninsured consisted of several community health clinics, a public hospital (San Francisco General Hospital), and a citywide managed care plan. The system planned to improve coordination between the current health care safety net, focus on preventive care, and implement information technology through the use of electronic enrollment and referrals. Newsom's proposal has prompted Oakland mayor Ron Dellums and San Mateo County's Board of Supervisors to look into possibilities for providing their own taxpayer-subsidized health care. Golden Gate Restaurant Association v. City and County of San Francisco Healthy San Francisco mandated large businesses to provide health insurance for their employees, or instead either pay into a citywide healthcare fund or contribute to employees' health savings accounts. The Ninth Circuit Court of Appeals rejected their arguments in May 2009, and an appeal to the U.S. Supreme Court was declined on June 29, 2010, legally clearing the program for continued existence for the foreseeable future. Impact of the Affordable Care Act The Patient Protection and Affordable Care Act (ACA) was implemented in 2010 and health care exchanges were established in 2013. The 2010 Affordable Care Act also removed categorical eligibility for Medicaid, thus expanding the number of people who could enroll in the public insurance program. As a result, many who previously did not qualify for Medicaid and instead relied on Healthy San Francisco could enroll in Medi-Cal. Another 10,000 or so Healthy San Francisco enrollees were predicted to get health insurance through the Covered California health exchange that was created as part of the Affordable Care Act. A 2011 report found that the passage of the ACA could reduce Healthy San Francisco enrollment by up to 60%. Although the ACA led to many people becoming insured, there were still millions who were left without health coverage. Today in San Francisco, these patients are still eligible for Healthy San Francisco. These remaining patients include undocumented immigrants, prisoners, people who have lived in the city for less than 5 years and are thus ineligible for Covered California, and people whose incomes are too high above the Federal Poverty Line to qualify for Medi-Cal but not enough to afford private health insurance. ==Funding==

Healthy San Francisco is funded by the city, the federal government, patient co-payments, and fees imposed on San Francisco businesses whose owners do not follow the mandate to provide health coverage for their employees. Employers can elect to satisfy this requirement by paying into Healthy San Francisco, in which case their workers may apply for the program. Early evidence suggest that employers are spending more on health benefits, but some are raising prices and cutting back on hiring. Healthy San Francisco reportedly costs about $140 million per year, which is expected to go down as the 2013-2014 health exchanges start. ==Results and reception==

94% of surveyed Healthy San Francisco enrollees reported that they were somewhat or mostly satisfied with the health access program. More than 90% would recommend it to a friend, but only 40% of participants said their care was considerably better since joining the program. Usage of primary and specialty care services among Healthy San Francisco enrollees was similar to that of the uninsured across the state of California. ==See also==