Thousands of Healthy San Francisco enrollees will soon face a dilemma.
Federal health care reform will hold them to the “individual mandate,” a requirement to obtain health insurance – but Healthy San Francisco doesn’t count. Roughly 70 percent of uninsured San Franciscans currently rely upon the city-administered program, created by San Francisco’s Health Care Security Ordinance, to access medical care.
Anyone who doesn’t satisfy the individual mandate will be made to fork over $95 as a penalty – but that noncompliance fee will skyrocket to $625 in 2015.
Meanwhile, people who are eligible for subsidized health insurance under the Affordable Care Act will automatically become ineligible for Healthy San Francisco under current rules, according to San Francisco Department of Public Health Deputy Director of Health Colleen Chawla.
For many – especially those currently experiencing health problems – this change spells trouble.
The prospect of becoming suddenly ineligible for Healthy San Francisco will leave thousands of residents in the bind of being unable to rely on the system they now use to access care, while also being unable to afford the new insurance option – and so far, city officials have found no clear resolution to this dilemma.
Assemblymember Tom Ammiano, who authored the legislation that created Healthy San Francisco as a member of the Board of Supervisors, admonished the Department of Public Health last week for turning away enrollees, conveying to program participants that only those who are undocumented would be eligible to remain in Healthy San Francisco.
"It's really outrageous," Ammiano told the San Francisco Chronicle .
Ammiano’s legislative aide, Carlos Alcala, said the Assemblymember was aghast at DPH’s approach, because “this is what Healthy San Francisco was intended for – the city agreed to be committed to helping people who can’t afford insurance.”
Alcala said that over the course of the last week, numerous conversations had taken place between Ammiano’s staff and DPH staff, including Director Barbara Garcia.
On Feb. 18, the San Francisco Health Commission approved a temporary solution, signing off on a resolution that creates a “transition period” allowing Healthy San Francisco enrollees to remain in the program until the end of the 2014.
"SFDPH is making every effort to help San Franciscans enroll in the best health insurance option available to them," according to the resolution. "Still, navigating the various options can be confusing and SFDPH wants to be sure that no one is left without health care options particularly during this time of transition."
For some, the change under ACA will mean migrating from Healthy San Francisco to subsidized health insurance under Covered California, the state-administered program created by the ACA. But for low-wage earners and others struggling to make ends meet in pricey San Francisco, the monthly Covered California premiums may be unaffordable; even the options with lower premiums come with $5,000 deductibles and high co-payments.
The transition period extends Healthy San Francisco eligibility through December for San Franciscans who qualify for Covered California but haven't enrolled.
Prior to this stopgap measure – apparently largely a product of the discussions between DPH and Ammiano – many would have faced being cut off from Healthy San Francisco in March, when full ACA implementation kicks in.
“Healthy San Francisco eligibility has not changed,” Garcia confirmed at the Feb. 18 meeting. “But the world around it has changed.”
The Department of Public Health’s mantra since the start of ACA implementation, repeated by Garcia at the Health Commission meeting, is that “health insurance is better than Healthy San Francisco.”
But for those who cannot afford the new subsidized health insurance option, “better” may remain out of reach.
“When people come in for renewal … we will counsel them to make sure they know that health insurance is better, and counsel them on affordability,” Chawla noted at the meeting. She added that if participants wish to remain in Healthy San Francisco, they will be able to do so – for now.
To be eligible for Healthy San Francisco, enrollees must live on a combined family income at or below 500 percent of the federal poverty level ($57,450 per year); be a San Francisco resident; have been uninsured for at least 90 days; not be eligible for Medi-Cal, and be between the ages of 18 and 64.
Between now and December, when the transition period comes to an end, DPH and other city agencies will presumably try and hash out a solution for people who are threatened with a loss of access to medical services.
In 2013, San Francisco Mayor Ed Lee re-convened an ad-hoc body called the Universal Healthcare Council to address the looming problem of how ACA implementation would affect the city’s existing healthcare policies. However, the final report  produced by that group did not offer much in the way of guidance.
Instead of drawing any solid conclusions, the various stakeholders drafted a set of recommendations – many of which stood in direct contradiction to one another.
That report is supposed to help city officials identify a solution going forward.
Deena Lahn, Director of Policy at the San Francisco Community Clinic Consortium, thanked the health commissioners for approving the transition period during the Feb. 18 meeting, saying nobody was sure what would happen in March, when thousands of Healthy San Francisco enrollees would have been suddenly unable to access services through the program.
“We had been especially concerned about people needing their medications,” she told them.