At least in San Francisco we can rest assured our city leaders are battle-ready, organizing their troops and laying out strategies for fending off the destructive flanks of Donald Trump's approaching armies.
The Board of Supervisors has created a new committee specifically dedicated to dealing with the various fallout from policy decisions made by the incoming Trump Administration, and first up on the agenda may be the expansion of San Francisco's pioneering, decade-old public healthcare program, Healthy SF. It was suggested in the weeks following the election that our city was uniquely well equipped to deal with the possibility that the Affordable Care Act, a.k.a. Obamacare, would be repealed by Trump and a Republican led Congress, because unlike most localities across the country we have our own program for insuring low-income individuals and those otherwise uninsured that launched three years before the ACA.
"A repeal vote will start us down the path... to chaos in the insurance market and declines in coverage," said Mayor Ed Lee at a rally on Sunday at City Hall that drew thousands of people to protest Congress's impending action on the ACA. As ABC 7 reported, another march in defense of the ACA here in SF is scheduled for February 1.
But some, like SF's Republican Hispanic Assembly chair Leo Lacayo, say "It's a done deal," and Congress will now "take six months to design a new program that will work for the entire country."
The new Board committee to deal with such matters is called the Federal Select Committee, and as the SF Public Press reports, it's chaired by Supervisor Malia Cohen, and she's joined by two new supes, District 8's Jeff Sheehy and District 1's Sandra Fewer. Their job will be to anticipate local needs created by such things as the ACA repeal which is still not a done deal, and Republicans have yet to propose anything to replace it and any crackdown on SF's Sanctuary City policy, which could include the cutting off of federal funding to the city. As reported earlier, that could spell a $478 million hole in the city budget, and threaten a large portion of the $915 million a year we get from the state which is derived from federal funds.
Expanding the rolls of Healthy SF will come at a cost, too. Enrollment in the program reached a peak of about 54,000 people in the 2010-2011 fiscal year, as the Department of Public Health tells SF Public Press. That's now down to about 14,000 people six years later, largely due to the expansion of the state's Medi-Cal program, and to those getting insurance via Covered California under Obamacare. In that time the cost to the city for Healthy SF has gone from about $150 million to $44 million, meaning that re-expanding the program which could include loosening eligibility requirements would mean needing to find another $100 million in the city budget, at the least.
The ACA was enacted in 2010, however the state insurance exchanges set up under the law as well as the tax credits and penalties associated with it didn't come into being until January 2014, just three years ago. Healthy SF came into being in 2006, and in addition to providing access to healthcare to individuals regardless of employment or income, it requires employers in the city with 20 or more employees to provide health insurance or, at the very least, flexible spending accounts for healthcare. The law has been a sticking point for the restaurant industry in particular, which took to adding Healthy SF surcharges to checks to try to disown the line item as out of their hands a practice that has largely gone away as the costs have been rolled into menu prices.
As enrollment in the ACA was taking place, Mayor Lee contemplated doing away with the Healthy SF program, promising a task force of business leaders and others to discuss it, but that never materialized, perhaps as enrollment in the program continued declining.
Now, those enrolled in Healthy SF tend to be the poorest of city residents, according to the program's most recent annual report. Most are between the ages of 24 and 44, living at or below the poverty line, and concentrated in the Mission, Excelsior, and Bayview neighborhoods. Also, Healthy SF has always provided coverage to undocumented immigrants, which most other programs do not.
And we should be glad that the program was not dissolved for this very, unforeseen reason universal healthcare still doesn't exist, and the idea of healthcare being a human right is not settled law in this country. Good luck to the Republicans in coming up with a more affordable, more politically expedient version of the ACA, but in the meantime, we're good.