Healthy San Francisco enrollees can stay – for now

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SF EXAMINER FILE PHOTO BY CINDY CHEW

Thousands of Healthy San Francisco enrollees will soon face a dilemma.

Federal health care reform will hold them to the “individual mandate,” a requirement to obtain health insurance – but Healthy San Francisco doesn’t count. Roughly 70 percent of uninsured San Franciscans currently rely upon the city-administered program, created by San Francisco’s Health Care Security Ordinance, to access medical care.

Anyone who doesn’t satisfy the individual mandate will be made to fork over $95 as a penalty – but that noncompliance fee will skyrocket to $625 in 2015.

Meanwhile, people who are eligible for subsidized health insurance under the Affordable Care Act will automatically become ineligible for Healthy San Francisco under current rules, according to San Francisco Department of Public Health Deputy Director of Health Colleen Chawla.

For many – especially those currently experiencing health problems – this change spells trouble.

The prospect of becoming suddenly ineligible for Healthy San Francisco will leave thousands of residents in the bind of being unable to rely on the system they now use to access care, while also being unable to afford the new insurance option  – and so far, city officials have found no clear resolution to this dilemma.

Assemblymember Tom Ammiano, who authored the legislation that created Healthy San Francisco as a member of the Board of Supervisors, admonished the Department of Public Health last week for turning away enrollees, conveying to program participants that only those who are undocumented would be eligible to remain in Healthy San Francisco.

"It's really outrageous," Ammiano told the San Francisco Chronicle.

Ammiano’s legislative aide, Carlos Alcala, said the Assemblymember was aghast at DPH’s approach, because “this is what Healthy San Francisco was intended for – the city agreed to be committed to helping people who can’t afford insurance.”

Alcala said that over the course of the last week, numerous conversations had taken place between Ammiano’s staff and DPH staff, including Director Barbara Garcia.

On Feb. 18, the San Francisco Health Commission approved a temporary solution, signing off on a resolution that creates a “transition period” allowing Healthy San Francisco enrollees to remain in the program until the end of the 2014.

"SFDPH is making every effort to help San Franciscans enroll in the best health insurance option available to them," according to the resolution. "Still, navigating the various options can be confusing and SFDPH wants to be sure that no one is left without health care options particularly during this time of transition."

For some, the change under ACA will mean migrating from Healthy San Francisco to subsidized health insurance under Covered California, the state-administered program created by the ACA. But for low-wage earners and others struggling to make ends meet in pricey San Francisco, the monthly Covered California premiums may be unaffordable; even the options with lower premiums come with $5,000 deductibles and high co-payments.

The transition period extends Healthy San Francisco eligibility through December for San Franciscans who qualify for Covered California but haven't enrolled.

Prior to this stopgap measure – apparently largely a product of the discussions between DPH and Ammiano – many would have faced being cut off from Healthy San Francisco in March, when full ACA implementation kicks in.

“Healthy San Francisco eligibility has not changed,” Garcia confirmed at the Feb. 18 meeting. “But the world around it has changed.”

The Department of Public Health’s mantra since the start of ACA implementation, repeated by Garcia at the Health Commission meeting, is that “health insurance is better than Healthy San Francisco.”

But for those who cannot afford the new subsidized health insurance option, “better” may remain out of reach.

“When people come in for renewal … we will counsel them to make sure they know that health insurance is better, and counsel them on affordability,” Chawla noted at the meeting. She added that if participants wish to remain in Healthy San Francisco, they will be able to do so – for now.

To be eligible for Healthy San Francisco, enrollees must live on a combined family income at or below 500 percent of the federal poverty level ($57,450 per year); be a San Francisco resident; have been uninsured for at least 90 days; not be eligible for Medi-Cal, and be between the ages of 18 and 64.

Between now and December, when the transition period comes to an end, DPH and other city agencies will presumably try and hash out a solution for people who are threatened with a loss of access to medical services.

In 2013, San Francisco Mayor Ed Lee re-convened an ad-hoc body called the Universal Healthcare Council to address the looming problem of how ACA implementation would affect the city’s existing healthcare policies. However, the final report produced by that group did not offer much in the way of guidance.

Instead of drawing any solid conclusions, the various stakeholders drafted a set of recommendations – many of which stood in direct contradiction to one another.

That report is supposed to help city officials identify a solution going forward.

Deena Lahn, Director of Policy at the San Francisco Community Clinic Consortium, thanked the health commissioners for approving the transition period during the Feb. 18 meeting, saying nobody was sure what would happen in March, when thousands of Healthy San Francisco enrollees would have been suddenly unable to access services through the program.

“We had been especially concerned about people needing their medications,” she told them.

Comments

quirky municipal system that could vanish under a new mayor or board.

And I'd be happy to see the restaurant surcharges vanish so I can start tipping normal amounts again:

http://insidescoopsf.sfgate.com/blog/2014/02/12/tipping-etiquette-do-you...

Posted by Guest on Feb. 19, 2014 @ 12:44 pm

scaling down their tips to account for the extra 4% the workers are getting.

It makes perfect sense, and 11% could become the new 15%.

Posted by Guest on Feb. 19, 2014 @ 12:54 pm

Under affordable care low income people (starting at about $46K) start getting significant subsidies. If their income is very low then they can get insurance for $1 a month from Anthem, Kaiser, or whomever they wish. The Federal Gov will make up the rest to the insurer.

And then under that is Medi-Cal.

So...not sure of the point of this article or what research was done regarding it.

Posted by Guest on Feb. 19, 2014 @ 1:08 pm
Posted by Guest on Feb. 19, 2014 @ 1:12 pm

Under Obamacare, people earning up TO about $46,000 are eligible for a subsidy, but the subsidy goes down as your income goes up. Some people can only afford Bronze-level plans (the least expensive in terms of premiums) even with subsidies, and those plans have $5,000 deductibles and high co-pays. Healthy San Francisco requires only low quarterly "premiums" (based on income) and has no deductibles and very low co-pays. That's why Healthy SF is still necessary. Some people can get good insurance with their subsidies from Obamacare; many others cannot.

Posted by Guest on Feb. 26, 2014 @ 7:03 pm

Under Obamacare, people earning up TO about $46,000 are eligible for a subsidy, but the subsidy goes down as your income goes up. Some people can only afford Bronze-level plans (the least expensive in terms of premiums) even with subsidies, and those plans have $5,000 deductibles and high co-pays. Healthy San Francisco requires only low quarterly "premiums" (based on income) and has no deductibles and very low co-pays. That's why Healthy SF is still necessary. Some people can get good insurance with their subsidies from Obamacare; many others cannot.

Posted by Guest on Feb. 26, 2014 @ 7:04 pm

"The prospect of becoming suddenly ineligible for Healthy San Francisco will leave thousands of residents in the bind of being unable to rely on the system they now use to access care, while also being unable to afford the new insurance option – and so far, city officials have found no clear resolution to this dilemma."

Remember to send a thank-you note to Nancy Pelosi for this.

Posted by Guest on Feb. 19, 2014 @ 3:39 pm

We don't need HealthySF because we now have a federal equivalent program.

Posted by Guest on Feb. 19, 2014 @ 3:50 pm

What federal program might that be.

Posted by Guest on Feb. 19, 2014 @ 11:36 pm

He already told you.

Posted by Guest on Feb. 20, 2014 @ 7:10 am

Told me what.

Posted by Guestjerry on Feb. 20, 2014 @ 3:25 pm
Posted by Guest on Feb. 20, 2014 @ 3:42 pm

Isnt Obamacare the great big rip off.

Posted by Guest on Feb. 20, 2014 @ 8:51 pm

But is'nt Obama care a rip off.

Posted by Guest on Feb. 20, 2014 @ 8:53 pm

"thousands of residents in the bind of being unable to rely on the system they now use to access care, while also being unable to afford the new insurance option – and so far, city officials have found no clear resolution to this dilemma."

Here is the solution to the dilemma:

https://www.coveredca.com/fieldcalc/#premiumAssistance

I understand, you would have had to go to Covered California or have a basic understanding of the Affordable Care Act to know about this.

Posted by Guest on Feb. 19, 2014 @ 6:29 pm
Posted by Guest on Feb. 19, 2014 @ 6:43 pm

That is not a solution for low income san franciscan residents, the charges and prices are unreachable.

Posted by Guest on Feb. 19, 2014 @ 11:50 pm
Posted by Guest on Feb. 20, 2014 @ 7:11 am

You are right. And not only for low-income San Franciscans. The premiums go up with age, so older people with moderate incomes may have affordability issues too.

Posted by Guest on Feb. 26, 2014 @ 7:11 pm

What in the name of Sam Hill are you talking about.

Posted by Guest on Feb. 19, 2014 @ 11:52 pm

What in the name of Sam Hill are u talking about.

Posted by Guest on Feb. 19, 2014 @ 11:54 pm

What in the name of Sam Hill are you talking about.

Posted by Guestjerry on Feb. 19, 2014 @ 11:57 pm

What in the name of Sam Hill are you talking about.

Posted by Guestjerry on Feb. 20, 2014 @ 12:01 am

Premium assistance goes down as a person's income goes up, and if the only kind of insurance he/she can afford even after premium assistance has a $5,000 deductible and high co-pays, this may very well be unaffordable for that person. Some people can get Medicare or low-cost insurance with good coverage through Obamacare; many others can not.

Posted by Guest on Feb. 26, 2014 @ 7:09 pm

It's fun to see liberals complain about getting the free stuff they wanted.

Posted by Chromefields on Feb. 20, 2014 @ 7:09 am

Not clear how any act of the City of SF would trump the new federal law that individuals must purchase health insurance.

I assume when we hear someone can't afford subsidized health insurance- none of these folks have cable tv, unlimited data plans and other such luxuries.

Posted by Guest on Feb. 20, 2014 @ 10:16 am
Posted by Guest on Feb. 20, 2014 @ 10:37 am

The issue is complex. You have a large group of San Franciscans that are going to be searching help. The first group are those that are currently using HSF say family of 4 and are in the 500% crowd. HSF covers them however the ACA only goes up to 400%. I don't know how many SF'cans that accounts for but my notion is there are plenty of families making under 117k p/y in the city that are going to have a difficult time transitioning when 2015 comes around.

The 2nd group are the undocumented workers that make up your hospitality, retail and restaurant jobs. They will have to rely on emergency rooms for care. Look at Los Angeles and how much they pay out because there program is not as robust as HSF. My vote KEEP HSF!

Posted by Guest on Feb. 20, 2014 @ 3:21 pm

Thank you.

Posted by Guestjerry on Feb. 20, 2014 @ 3:30 pm

may can it at any time. ObamaCare, for all it's faults, is not going away, and I'm not sure even if the GOP wins in 2016 they will dump it.

Dumping HSF also removes the local liability for paying for it, and makes the Feds responsible.

Illegals are probably hosed either way, but I'm not sure there is a solution to that. I suspect there is an underground network of Hispanic doctors who treat these guys in return for some payback south of the border. Who knows?

Posted by Guest on Feb. 20, 2014 @ 3:32 pm

What's the problem? Obama said if you like your doctor (at HSF) you could keep your doctor. Done

Yeaaaa Obama Obama

Posted by Bill on Feb. 20, 2014 @ 4:32 pm

Buy the right insurance and you can have any doctor

Posted by Guest on Feb. 20, 2014 @ 4:46 pm

I was told by my clinic (affiliated with city health system )that I had to switch from Healthy SF to SF Path and then in December I would have to switch to Medi-Cal, but that would happen automatically. Then I tried to refill prescriptions in January the Walgreens pharmacist advised I had NO health insurance. So I called back at another time and reached a knowledgeable pharm tech who said many people were having this problem, but she could fix it with a phone call and to call back in an hour. Sure enough I was then OK with Medi-Cal and could pick up my prescription. One of these was a psych med which I had to go without for several days. The whole thing has been screwed up for a lot of low-income folks - many with psych meds.

Posted by Guest on Feb. 23, 2014 @ 12:18 am

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