Healthy SF: Who Pays?
“Healthy San Francisco: Who Pays?” was a special four-page section in the Winter 2011 edition of the print newspaper.
Three reporters, two photographers and a graphic designer contributed to the research, interviewing the director of the program, clinic directors, technology specialists, medical staff, independent experts and dozens of patients. They visited nearly a third of the medical clinics and hospitals in the Healthy San Francisco network and discovered some compelling trends:
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- While the program has succeeded at providing something like health insurance to tens of thousands of people who never had access to that level of care, without taking into account pre-existing conditions, most of the patients are poor–below 200 percent of the official poverty level. As a result their contributions are millions of dollars below the planners’ initial projections.
- The requirement that medium-size and large businesses pay for the program by giving some level of coverage to their employees, including an option for medical savings accounts and direct contributions to Healthy San Francisco, the program has brought in less money than projected.
- Some businesses are exploiting a loophole in the law to drain unused funds at the end of the year. And there is evidence that some businesses, after initially complying with the law, are lately dropping private insurance in favor of reimbursement plans that are much cheaper. They also leave patients not fully insured.
- Healthy San Francisco appears to be a big bargain, with the average cost of care calculated at $276 per person per month. That compares with an average of $402 for private insurance. But the accounting does not include millions of dollars that clinics and hospitals have had to absorb to care for the additional patient load and technology upgrades to make the system function efficiently.
- Federal grants to spur innovation in health care helped get the program off the ground but may not be renewed, especially if political winds change direction. And while the program was intended to be a bridge to national reform efforts, those programs now face challenges in Congress and the courts.
Buy the Winter 2011 edition of the print newspaper.