It shows that it is off to a good start…
Does San Francisco offer lessons for the special session? The article goes into all the ways that San Francisco is advantaged, including a relatively small uninsured population, and an already heavy investment in caring for them through a robust safety-net of clinics and hospitals. In other words, the opposite of California as a whole.
Yet even with this program–which is not coverage and does not offer access to coverage outside of San Francisco, they needed to take a second step–place a minimum spending requirement for employers, to prevent certain employers from abandoning their contribution to their workers’ health care. The issue is called “crowd out.”
Most employers provide health care, to attract and retain workers, and because it is expected. But if workers would get benefits anyway, why would employers spend the money to provide it? That means some employers would drop or scale back coverage. The issue is that the public program gets more expensive, since it is now covering more folks. It’s not an issue if you can get enough money from the employer to actually pay for the care provided to his/her workers.
So when we hear of proposals to “replace” the employer fee in AB8 or the Governor’s plan with another revenue source, the main issue is not some attachment to employer-based coverage; it’s that you have to raise a lot more money to make up for it. There’s also an equity issue, between those employers who provide coverage, and those who don’t.
Healthy San Francisco is showing the way.