Health policy follies at the local level

Supervisor David Campos trying to make the city health insurance system work for all

Nothing in health policy is simple -- and since the existing profiteers (insurers and their running buddies in hospitals, medical device sales, and big pharma) decree we can't simplify it by making the government the single payer, we must navigate an awkward edifice of teetering workarounds.

San Francisco has had a Health Care Security Ordinance (HCSO) since 2006 that aims to give every resident access to insurance. The Restaurant Association fought this measure tooth and nail because they don't like paying toward care for their underpaid labor force, but eventually it launched. Most San Franciscans, including the undocumented and people excluded in other categories, got some kind of coverage and health access. Good.

Then along came Obamacare, a worthy, but different, approach to the similar ends. In this state called Covered California, it doesn't cover the migrants. And lots of low paid San Franciscans still can't afford insurance on the market exchanges, even with the federal subsidies. So the Healthy San Francisco program, through the city's Public Health Department, has promised that these people can stay on the coverage they already have.

And there is even a pot of money that could be used to pay for this -- but to get at it would require amending the HCSO. Under that law, employers have been paying into health saving accounts for their workers. The idea was that this money could be used for dental or eye care or to bridge the cost of insurance. But this turned out (unintended consequences and all) to work very poorly. Workers couldn't or didn't get the funds when they needed them. In 2012 employers put $107 million into health accounts and paid out $26.4 million. Employers think this is fine; after two years if their payments have not been used, they can take the money back! At one hearing, I heard a restauranteur explain that this was an essential part of her "cash management" strategy.

But this is not supposed to be the restaurant owners' money! It is supposed to pay for health care access for their employees. And the way that Obamacare was written, that money can't just be given to the employees to help them purchase subsidized insurance. That would be too simple.

A Chronicle story captured one worker's point of view:

For [Brent] Sanchez [a waiter and bartender], it makes sense that his employer's contributions would help subsidize insurance, since he and other workers will be subject to a penalty under federal law if they don't have full health coverage.

"Consumers are paying for it, and my company is paying for it while I am on the floor," he said. "Then I am not going to see it?"

That, he said, doesn't add up.

Campos has been working for years to close the loophole in the HCSO; he's now agreed to let the Public Health Department study how they'd use this money to provide access for another year while setting a deadline for action of January 2016. As of a hearing Thursday, he'd lined up four co-sponsors on the 11 member board. That's plenty enough to force a real debate on this; do the rest of the supervisors represent the business owners or the people of the city? That usually seems to be the question these days.

***If you've followed this thus far, you know why I support David Campos in the race for Tom Ammiano's Assembly seat. We need people who can thread their way through this stuff -- and who know whose side they are on!