John Petro
Health Care Reform Doesn’t Just Come From DC
This week, President Obama is increasing his pressure on Congress to pass health care reform legislation. Even if a bill does make it through both houses of Congress, it will do nothing to help those who are currently uninsured until 2013. However, there are more than 1.2 million New York City residents who are uninsured right now. With more and more people being added to the unemployment rolls every month, the number of uninsured is sure to increase. These individuals will not have access to the most basic health insurance and many will be forced to forego needed treatments and prescriptions because they cannot afford it.
One city has taken steps to ensure that its uninsured residents still have access to health services: San Francisco. Through its three-year-old program Healthy San Francisco, nearly 75 percent of the city's uninsured are able to access health services. Speaking at a roundtable discussion with mayors, urban thinkers, and cabinet officials, Obama spoke about the importance of local-level policy innovation.
"Instead of waiting for Washington, a lot of cities have already gone ahead and become their own laboratories for change and innovation, some leading the world in coming up with new ways to solve the problems of our time."
San Francisco has done just that with Healthy San Francisco. The program is not insurance. Rather, it provides essential health services to program participants, from primary and preventive care, to emergency room visits, prescription medications, and more. Participants are residents of San Francisco, must make less than 500 percent of the federal poverty level, and must be ineligible for public insurance programs such as Medicaid.
If New York City were able to replicate the successes of San Francisco, 864,000 uninsured New Yorkers would have access to health care. However, the city agency that provides health services to the uninsured, the Health and Hospitals Corporation, is facing severe budget shortfalls that are resulting in the closing of clinics and the elimination of hospital-based services. Without a reliable funding source, replicating the success of San Francisco in New York is not possible.
Healthy San Francisco is paid for through a combination of user fees (based on a participant's ability to pay) as well as federal, state, and city funds. However, more than half of the program's revenues will come from the employee spending requirement. It requires medium and large-size employers to make minimum health care expenditures on behalf of their employees. A business is exempt if it already makes contributions toward health care for their employees.
It is important that employers pay their fair share. Many of the nation's uninsured are also employed. In New York City, for example, seventy percent of uninsured adult New Yorkers are actually employed. Employers that do the right thing and provide health benefits to their employees are put at a disadvantage. San Francisco's policy levels the playing field.
For more on Healthy San Francisco, and how it can be implemented in New York City, see DMI's latest report, No More Delay: Proven Policy Solutions for New York City.
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Posted at 5:51 PM, Jul 20, 2009 in
Urban Affairs
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