Supervisors like David Campos are fighting to keep San Francisco's pioneering Healthy S.F. ordinance in place after Obamacare takes effect in January, but Mayor Ed Lee is saying all options are still on the table, including doing away with it. At issue is the fact that Healthy S.F. has steeper requirements for employers, like it requires that insurance, or flexible spending accounts, be provided by companies with more than 20 employees, while the federal law requires insurance of companies with more than 50 employees.

Some argue that the two laws conflict with each other, but so far the City Attorney's office is saying no, they don't.

If the local ordinance is repealed, that would essentially let companies with between 20 and 50 employees off the hook for health care, and labor leaders and others are saying it could leave as many as 68,000 workers without insurance.

Healthy S.F. has been in place since 2006 and businesses have fought against it as much as they could, with the Golden Gate Restaurant Association taking their battle all the way to the Supreme Court. Restaurants, which often are in that 20- to 50-employee sweet spot, have been especially whiney about the law, claiming it eats into their already slim margins, and as we're all aware they largely chose to pass the burden on to consumers with a visible surcharge on restaurant checks over the past seven years. This past year a number of larger restaurants settled a dispute with the city in which they were dinged for improperly pocketing the majority of those surcharge funds and not paying them out for employee health care. (Businesses are still allowed to pocket unused funds from reimbursable accounts after two years, and only about $26 million of the $107 million set aside for health care was spent on health care in 2012.)

Mayor Lee has promised to reconvene his "task force" on health care, made up of insurers, labor leaders, business people, and medical people, to discuss the issue, but that hasn't happened yet.

If you don't yet understand how Obamacare will affect Californians, you can read this handy primer over at KQED. Basically, it's going to be a great thing for people who are currently buying their own health insurance, because starting in January they will be able to shop for insurance via Covered California, and likely get much lower rates than before. Insurers will no longer be able to deny you coverage based on a pre-existing condition, and they will not be able to set rates based on medical history either.

[Business Times]