Healthy San Francisco Clears Another Hurdle
by The Opportunity Agenda, Fri Mar 13, 2009 at 09:29:15 AM EDT
Access to quality health care isn't something that affects us as individuals; it impacts us as families, friends, neighbors, and coworkers. Health care is fundamental to the well-being of us as persons and equally fundamental to the well-being of communities, cities, states and the country. It was with this understanding that the City and County of San Francisco undertook a bold and audacious effort to ensure that everyone in the City By The Bay has not just the promise of health care in the form of insurance, but actual, delivered health care.
The program, Healthy San Francisco, currently provides health care to over 27,000 uninsured San Franciscans, including an estimated 37% of the City's uninsured adults, and looks to triple in participation by the end of 2009.
The program is funded in part by a per employee health care tax, levied by the City upon local businesses, requiring them to spend a certain amount on employee's health care or to pay into a City fund if they spend less than the requirement. By establishing a tax rather than creating a "mandate" for employers to provide health care to their, Healthy San Francisco avoids a federal law--the Employee Retirement Income Security Act of 1974, known by the acronym ERISA--that prohibits states and localities from regulating or interfering with employer-based health insurance or pension benefits.
As with any innovative program, however, Healthy San Francisco faces some challenges to its continuation, one being the question of whether the program does actually escape running afoul of ERISA. Yesterday, the entire federal Ninth Circuit Court of Appeals (the federal appeals court that includes California) upheld the ruling of an earlier panel of the appellate court's judges, finding that Healthy San Francisco can continue without running into ERISA problems.
The case will now likely go before the U.S. Supreme Court. The decision by the Supreme Court may have a major impact on the ability of states and cities to attempt health care reform absent Congressional action.
The case is Golden Gate Restaurant Association v. City and County of San Francisco, No. 07-17370 (9th Cir. Mar. 9, 2009).