Newsom, Ammiano agree on universal health care access plan

By Pat Murphy

January 31, 2006, 8:00 p.m.

Mayor Gavin Newsom and Supervisor Tom Ammiano today praised their newly agreed approach to universal health care access in San Francisco.

Termed the Defined Benefit Program (DBP), early details came on the eve of a preliminary vote on Ammiano's initial proposal to mandate health insurance for San Francisco employees working 80 hours or less per month.

The issue will be heard Wednesday before the Budget and Finance Committee of the Board of Supervisors at 1:00 p.m.

Businesses will still be mandated to participate, although under DBP the cost and timing would be determined a Health Care Council comprised of stakeholders.

Appointments to the council will be made jointly by Ammiano and Newsom, Ammiano told the Sentinel tonight.

DBP cost is projected much lower than the estimated $345 per employee proposal first advanced by Ammiano. Although Ammiano would not say whether he would drop his immediate mandate requirement at Wednesday's hearing, "I'm sure we can work that out," Ammiano told the Sentinel.

Essentially DBP is built on three pillars.

It draws on use of 26 city and non-profit health clinics throughout the city, thus avoiding brick and mortar construction cost.

It also establishes a one-stop administrator, thereby removing the burden of plan administration for every employee by business owners.

And it shifts emphasis on health care delivery away from expensive emergency care to preventive care.

The administration of city employee health plans is currently provided by The San Francisco Plan, which would become the single administrator for DBP.

Only San Francisco residents would be eligible for DBP, and its benefits are not portable. Health care services would be provided only in San Francisco.

Those who enroll would choose their primary care physician and primary care clinic. Enrollment is good for six months, after which it may be renewed.

Coverage includes routine health screening and physical exams, prenatal care, primary care, specialty care (through San Francisco General Hospital (SFGH) and back-up by private hospitals), pharmacy, planned SFGH hospitalization with back-up by private hospitals, and emergency services (only at SFGH with high co-pay fee if not admitted).

Co-pay by patients would be determined through implementation tasking of the Health Care Council.

In separate press briefings, both Newsom and Ammiano noted they individually had been out front on the issue.

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