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San Francisco, The Spirit Of The Pioneers: Taking Steps To Improve Both Healthy San Francisco And The ACA

San Francisco is pioneering yet again. It’s proposing to modernize the “City Option” by creating a new Bridge to Coverage and expanding its Healthy San Francisco program for the remaining uninsured. Most city businesses either offer coverage to their employees or help pay for their care through medical reimbursement accounts or Healthy San Francisco. This updates them to better coordinate with the Affordable Care Act (ACA).


The Bridge to Coverage will offer financial help with premium assistance under Covered California as well as with more affordable copays and deductibles. It will supplement the ACA’s refundable tax credits available in Covered California and help working San Franciscans better afford the premiums for coverage and the out of pocket for care. It limits out of pocket exposure to 5% of an individual’s income. It will extend financial assistance to workers and their families who are eligible for Covered California as long as their employer contributed to the “City Option” for their coverage rather than purchasing employment based coverage for them. This will be particularly important for the flex workforce and for the employees of smaller businesses – about 3,000 to 4,000 San Franciscans will be helped.


The proposal will also align the Healthy San Francisco program with the ACA. Eligibility is extended to those with incomes up to 500% of FPL who are not eligible for any public programs and either cannot afford the Covered California premiums or are exempt from the individual mandate. We think that it is vital to parallel existing county health programs like Healthy San Francisco for the uninsured with the ACA’s coverage expansions. It will be far simpler to understand and administer for everyone involved “you are either eligible for the ACA or for Healthy San Francisco”, there is no overlap and everyone is covered. About 15,000 San Franciscans will qualify.

The proposal will also help to design and create a new Employee Wellness Fund to reimburse for employee wellness programs for those employers who have contributed to the “City Option”. In concert these programs should help the San Francisco residents to improved health status and better financial security. They will be considered by the Health Commission on Tuesday, August 4.

What a great way for a City to celebrate the 50th Birthday of Medicare and Medicaid.

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