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Healthy San Francisco Expansion; Healthy Families in Jeopardy

November 2, 2007
Healthy San Francisco announced yesterday, November 1, 2007, a great expansion of its program that will allow a larger number of San Francisco residents to receive access to health care.  Previously, those eligible had to have an existing appointment with one of 27 participating clinics in San Francisco and have an income at or below 100% of the Federal Poverty Level; the November 1st expansion will include all uninsured San Francisco residents between the ages of 18 and 64 with a yearly income at or below 500% of the Federal Poverty Level ($51,000) who do not quality for other publicly-funded health care programs. Healthy San Francisco is not insurance, but a reorganization of the health care system that enables residents to access primary and preventative care. It provides a medical home and a primary physician to each program participant, providing a greater focus on preventative care as well as providing access to specialty care, urgent and emergency care, laboratory, inpatient and hospitalization, radiology, and pharmaceuticals. To be enrolled in the program, each participant pays a monthly fee, which is based upon income level as well as moderate service fees for each medical visit. Healthy San Francisco is a groundbreaking program for artists in San Francisco as it will grant access to affordable health care to many artists who do not have access to health insurance through work and who make a comfortable enough living to not quality for state funded health care programs but who do not make enough extra income to afford health insurance on the individual market. In addition, Healthy San Francisco has received a lot of state and national recognition; program officials report having received many calls from government officials, including those in Berkeley and Oakland, who are thinking about replicating the program. In addition, a similar program exists in New York called Healthy NY.

On a national and state level, State Children’s Insurance Program (SCHIP) and California’s version of the program, Healthy Families, is being debated. SCHIP funds Healthy Families, which is low cost insurance for California’s children and teens. It provides health, dental, and vision coverage to 850,000 children who are at 250% of the Federal Poverty Level, do not have health insurance, and do not qualify for Medi-Cal. On September 30th of this year, SCHIP expired. The bipartisan bill HR 876, which planned to expand SCHIP to 4 million more participants by 2012, was vetoed by President Bush on October 3rd after having been passed by majority vote in the House of Representatives and by a veto-proof majority in Senate. The bill was then voted on again by the House of Representatives on October 18th, unfortunately falling 13 votes short of the 2/3 majority required to override the President’s veto; federal funds from SCHIP funding California’s Healthy Families program will run out by November 16th without Congressional action. HR 876 would have provided federal funds for children in families up to 300% of the Federal Poverty Level ($61,950 for a family of four), which would have helped California achieve near-universal coverage for children, qualifying 650,000 more children for the program. Managed Risk Medical Insurance Board (MRMIB) oversees the Healthy Families program and has decided to wait until at least November 5, 2007 to decide whether it should adopt emergency regulations that would create waitlists and take enrollment away from some children already in the program. Healthy Families could be in financially dire straits should additional funding not come through; a congressional report optimistically said California could continue its program until July 1, 2008, but after July 1, the program will likely shut down. Presently, President Bush and Congress are still debating on a compromise on how to continue the program.