• Ammiano Ordinance Would Require Employer Contribution to Coverage
  • Newsom Proposal Would Set Up Health Access Program

This past week, the City and County of San Francisco announced pending policy changes that would expand access to health care to 82,000 uninsured residents. However, crucial elements have yet to be finalized, with major actions anticipated in the next few weeks.

While the conversation about expanding health care coverage seems stalled at the federal level, it is active at the state level with live proposals on everything from expanding children’s coverage programs to establishing a universal system in California . There is also strong support for health reform at the local level.

Because San Francisco voted over 70% for Proposition 72 in 2004, which would have expanded employer-based coverage, local consumer, community and labor activists have been pressing for universal coverage in that county.

The San Francisco effort includes two distinct components:

OF WORKER HEALTH CARE SECURITY ORDINANCE: The effort to expand health coverage in San Francisco actually started last year, when Supervisor Tom Ammiano proposed a employer mandate to provide health coverage to their workers, and community advocates started to consider a county ballot measure, given the success of Proposition 72.

Supervisor Ammiano’s “Worker Health Care Security Ordinance” is seen by advocates as an essential complement to the Health Access Program (described below). Similar to Proposition 72, Supervisor Ammiano’s ordinance would set a dollar standard for health benefits on the job, just as the minimum wage does for pay. This standard would require businesses to pay a percentage of the cost of health care coverage. It would apply to businesses with 20 or more workers, or nonprofits with 50 or more workers, and would expand coverage to over 16,000 San Franciscans, while also protecting the coverage of San Franciscans who already depend on employment based coverage.

SF HEALTH ACCESS PROGRAM: Mayor Gavin Newsom announced the “San Francisco Health Access Program” a week ago, unveiling the work of an over 40-member Universal Healthcare Council that had been meeting for the last several month. Administered by the existing San Francisco Health Plan, this new program is available for all uninsured SF residents, regardless of income, immigration status, or pre-existing conditions. People would join through their employer, or as individuals. In this way, it would be one of several options for employers that fall under the Worker Health Care Security Ordinance.

It is not traditional health insurance–and it does not guarantee “all medically necessary care,” but would still provide a comprehensive set of benefits, including preventative, inpatient and outpatient services, prescription drugs, and other treatments. These benefits would provide a medical home, but would only be provided in San Francisco , through San Francisco ‘s public health infrastructure and other participating San Francisco health providers.

(This San Francisco effort is not related to the consumer advocacy group Health Access California, other than that the advocacy group has been a supporter, working alongside key local groups such as Senior Action Network, the San Francisco Central Labor Council, ACORN, San Francisco Organizing Project, California Women’s Agenda, and many others.)

COMPLEMENTARY EFFORTS: If these elements come together in the next few weeks, the combination of the two efforts would give uninsured San Franciscans access to a broad range of primary, preventive and inpatient health services at a lower cost than they would otherwise pay, while giving employers a more affordable option for providing access for their workers.

All San Francisco workers would get more security with regard to their coverage, some would have new coverage, and all San Franciscans would have better access to health care services. The package could also provide a funding source to reimburse city clinics and hospitals for care they are already providing to the working uninsured, thereby shoring up the City’s health care safety net.

UNIQUE CIRCUMSTANCES: This activity in San Francisco has been possible due to several factors, some unique to San Francisco . This includes the political environment in the city, including the support for Proposition 72, and the leadership of key political and community leaders. The fact that San Francisco is both a city and a county has permitted consideration of a range of policy options that are not easily accomplished in other localities.

Most importantly, San Francisco has a public health infrastructure, including hospitals, clinics, and other health providers, that has substantial public support and that is better funded proportionately than the county hospitals and clinics in most other California counties. Because San Francisco has invested in health care, it is easier to build on previous policies, such as San Francisco ’s program to cover all children. It also provides the economic basis for the policy change: given that San Francisco has already made the commitment to provide care to the uninsured through public health providers (rather than letting them go without care), it makes financial sense to provide better coordination of care.

MOMENTUM: San Francisco ’s action should provide momentum to efforts—in other counties, cities, and the state—in the area of health reform and expanding access to care. Already, the City of Oakland and the County of San Mateo are investigating what health reforms they might pursue. With recent employer requirements passed in other localities around the country (most recently in New York City and neighboring Suffolk County ), it helps advance the national discussion. It will help frame the emerging debate in California ’s gubernatorial race on health reform.

ACTIONS: The votes on these items will be held in short order. Health, community, and labor groups are urging CALLS TO MAYOR GAVIN NEWSOM, 554-6141 or 554-7111 to support the Worker Ordinance. (Also E-mail at While nine Supervisors have expressed their support for the measure, calls to express support would also be appreciated.

There was a hearing yesterday, Monday, June 26th, but a committee vote is expected next week.

For more information, feel free to call Pilar Schiavo at the San Francisco Central Labor Council for more information at (415) 440-4809.


  • Monday, July 5th: Vote and Final Report on both the Health Access Program and the Worker Healthcare Security Ordinance, by the Budget and Finance Committee, at the Board Chambers in San Francisco City Hall .
  • Tuesday, July 11th: First vote by County Supervisors .
  • Tuesday, July 18th: Second vote by County Supervisors
  • Friday, July 28st: Deadline for the Mayor to sign or veto the measures.
Health Access California promotes quality, affordable health care for all Californians.
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