Harry Moroz

Health Care Reform and Healthy San Francisco

Below, Karin points out an important defense from San Francisco officials yesterday of the continued need for Healthy San Francisco even after passage of the Patient Protection and Affordable Care Act. I think why this is so needs some clarification.

In theory, the health care reform bill signed into law Tuesday should make Healthy San Francisco obsolete because of the individual mandate that requires all citizens to obtain insurance (Healthy San Francisco is open only to the uninsured). In practice (as Karin points out), undocumented immigrants are not covered by the bill’s expansion of Medicaid and are not eligible for subsidies through government exchanges, making Healthy San Francisco a crucial backstop (and one of the only backstops) for the undocumented who are otherwise forced into the less stable and more expensive care of emergency rooms. According to the CBO, undocumented immigrants account for about one-third of the 23 million individuals who are expected to remain uninsured. A handful of other folks will receive hardship exemptions from the individual mandate and so will not be required to obtain insurance. The remaining individuals who are uninsured will be those eligible for but not enrolled in Medicaid- a sizeable group. Healthy San Francisco will actually be one way to connect the uninsured with Medicaid. As Healthy San Francisco’s director told the San Francisco Chronicle: “program officials will work with participants at their annual [Health San Francisco] renewal meetings to determine whether they qualify for another program [e.g. expanded Medicaid benefits or a subsidy through the exchanges].” Presumably, San Francisco officials could also help struggling individuals obtain a hardship exemption, hooking them up with Healthy San Francisco services instead.

But perhaps most importantly, the best parts of the bill – the individual mandate, the subsidized exchanges, and the expansion of Medicaid eligibility to 133 percent of the poverty line – do not take effect until 2014. Until then, Healthy San Francisco will be the only game in town for many uninsured San Franciscans. They, in fact, are the lucky ones: the uninsured everywhere else are out of luck until 2014.

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Posted at 5:07 PM, Mar 23, 2010 in Health Care
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