Newsom and Ammiano unite on San Francisco universal health care

Supervisor Tom Ammiano explains need for collaboration on health care plan despite holding Board of Supervisors veto-proof majority backing for funding mandate.
Photo(s) by Luke Thomas

By Pat Murphy

July 12, 2006

The two chief architects of workable universal health care shook hands in agreement Tuesday, de facto and by force of will making the unique San Francisco program launch a certainty next July.

Workable because Supervisor Tom Ammiano and Mayor Gavin Newsom persevered to acceptable agreement setting the stage for both branches of City government to fully cooperate rather than resist implementation.

"This would not have happened if it had not been for Supervisor Ammiano's extraordinary willingness to work together," Newsom reflected.

Ammiano returned, "How much better it is to have the cooperation and the involvement (of the Mayor's Office). If there's no cooperation from departments, if there's no good faith effort, the thing could never get off the ground."

Supervisor Tom Ammiano, left, and Mayor Gavin Newsom seal the deal
following a press briefing for reporters stationed at City Hall.

Newsom agreed, noting the District 9 supervisor did not need the mayor's backing.

Nine members of the Board of Supervisors had given veto-proof support to the Workers Healthcare Security Act (WHSA) authored by Ammiano.

"I think what the Supervisor has done with his willingness, in spite of eight co-sponsors, to work together on the mandate with this office, is a desire that we actually executed and implemented in an appropriate manner so that he doesn't have to call hearings every week saying, 'Mitch (Katz, Director of the Health Department) isn't implementing it, Controller's not, the rest of us aren't,' " Newsom explained.

"There is a fundamental here where Supervisor Ammiano and I are not going to deviate and that is an obligation to provide a strategy to provide health care for 82,000 people where everybody participates - employee, employer, and government," Newsom recognized.

"That's to me the real victory, that have all agreed on that principle and that is a big deal because it is simply without precedent."

Newsom and Ammiano made the remarks in a 1:00 p.m. briefing for the City Hall press corps which followed a morning hearing on the issue before the Budget and Finance Committee of the Board of Supervisors.

It was the 16th public hearing before the committee on universal health care, Committee Chair Chris Daly pointed out, with one more hearing set Monday at 1:00 p.m. to finalize WHSA amendments.

Supervisor Chris Daly leads the Budget and Finance Committee hearing Tuesday
on universal health care delivery in San Francisco.

Ammiano presented two substantive amendments unanimously adopted yesterday by the five-member committee.

District 9 Supervisor Tom Ammiano delivers final amendments
to the Budget and Finance Committee.

In addition, the committee announced its intention to merge WHSA and the mayor's plan into one piece of legislation.

Amendments include preventing workers who already have health insurance through a spouse's coverage from SFHAP enrollment, and increasing the number of hours which employees must work to qualify for the plan.

Beginning in July, 2008, to qualify employees must work a minimum of 12 hours weekly raised from previous requirement of two hours per week. Weekly work requirement drops to 10 hours in 2008, and to nine hours weekly in 2009.

Ammiano announced the amendments as agreed by his office and the Mayor's Office.

Wade Crowfoot, left, the mayor's liaison to the Board of Supervisors
in consultation Tuesday with Zach Tuller, legislative aide to Supervisor Ammiano.
By City Charter, the mayor or the mayor's liaison have a voice on the floor
of the San Francisco Board of Supervisors.

Committee member Sean Elsbernd

Committee member Ross Mirkarimi

Committee member Bevan Dufty

Committee member and president of the San Francisco Board of Supervisors Aaron Peskin

Newsom's plan, known as the San Francisco Healthcare Access Plan (SFHAP), originally was separate from SWHA legislation, but dependent on SWHA for creating an employer contribution funding floor.

The SWHA required employer contribution came to be known as 'the mandate' component of San Francisco health care access for 85,000 uncovered workers.

If all 85,000 workers enroll in SFHAP total first-year costs are estimated at $198 million, a projection made by Dr. Mitch Katz, Director of the San Francisco Health Department.

Ammiano agreed to co-author SFHAP with Newsom following creation by the Universal Healthcare Council (UHC) convened by Newsom in November. Some 125 stakeholders participated on UHC collaboration, including labor and business representatives as well as elected officials representing divergent interests.

Total first-year costs are estimated at $198 million if all 85,000 eligible San Francisco workers enroll in SFHAP, a figure determined by Dr. Mitch Katz, Director of the San Francisco Health Department.

Dr. Mitch Katz, center, attends press briefing.
San Francisco Chronicle reporter Charlie Goodyear at right.

Some $28 million would be raised by mandated employer contributions, with $10 million provided by federal and state funding. An additional $56 million is estimated from worker co-payments ranging from $3 to $201 monthly. The $104 million now being spent on public health care would be reshaped to SFHAP delivery format.

No one would be required to enroll in SFHAP although the incentive to do so is great.

Those choosing not to enroll would receive a full-cost bill for public medical services. Workers already receiving health care coverage through a spouse's plan would not be able to double their coverage through SFHAP enrollment.

The legislation requires businesses with more than 50 employees to contribute $1.60 per hour worked by employees beginning in July, 2008. It caps employer contribution at $180 per month per worker.

During the first three years of the plan additional SFHAP funding would be held to a five percent increase. Businesses with from 20 to 50 workers would pay $1.06 per hour starting July, 2009.

The Board of Supervisors will vote on the finalized measure at its 2:00 p.m. meeting Tuesday.

Passage begins one year of preparation for implementation, which provides for revision based on business and worker needs during that time.

With passage appearing certain, the innovative program already is receiving study by city and county governments nationwide, both Ammiano and Newsom noted.

Ammiano described creation of a workable universal health care plan has having broader impact than any achievement in his multi-decade service in San Francisco governance.

He has been in public life since the 1970s, first as elected member of the San Francisco School Board, elected member of the San Francisco Board of Supervisors, and president of the Board of Supervisors. He led creation of the first domestic partnerships legislation.

"Domestic partners... set a very important worldwide stage but I think this is even more comprehensive than that," Ammiano told the Sentinel.

"Even that as heady times as that was when we got that passed... this is wider in scope and had a lot more cooperation and interaction with the Mayor's Office."

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