Help make Dutchess Healthcare Access Plan a reality...

You're all invited to join the CHANGES/Real Majority Project's Eleventh Annual Holiday Interfaith Candlelight Vigil for Economic Justice Thursday, December 21st at 5:30 pm in frontof our County Office Building at 22 Market Street in Poughkeepie!...

We'll be officially kicking off our efforts to get our County Legislature topass a home rule request asking permission from Albany for a Countywide HealthcareAccess Plan for Dutchess similar to the one being implemented on a local level inSan Francisco (see http://SFHP.org )...

Speakers will include Rabbi Paul Golomb (Dutchess Interfaith Council President), Rev. Philip Carr-Harris (current Dutchess Interfaith Council Executive Director), Rev. Gail Burger (former Dutchess Interfaith Council Executive Director), Rev. Luis Perez (Rhinebeck Reformed Church), Michael Ignatowski (Hudson Valley Network of Spiritual Progressives Cofounder), Brian Riddell (Dutchess Outreach Executive Director),Brian Doyle (Chair of City of Poughkeepsie Common Council), long-time community activists Mae Parker-Harris, Ann Perry, Willye Bromfield, and Carola Madrid, PatLamanna (Dutchess Peace Coalition Cofounder), Peter Leonard (Vassar College Field Work Director), and Tom Midgley (of AllianceIBM); Richard Hathaway of PoughkeepsieFriends Meeting and Mar Peter-Raoul of the Marist College Praxis Project have also endorsed this effort and will try to attend (Fred Nagel of the Dutchess Greens has endorsed the effort too but will be unable to attend)...

The fact is that county taxpayers already spend millions each year reimbursing local hospitals for health care for the uninsured at the most expensive point-- in emergency rooms-- why not divert some of those millions to help the uninsured have health insurance?...

Fact: County taxpayers pay millions more annually on Medicaid for employees of profitable companies that still pay poverty wages (see Westchester County report on this). Why not move to do what the Republican-led Suffolk County Legislature did over a year ago and make sure those profitable companies help pay for their employees' health care so other responsible businesses and the rest of us don't have to unfairly subsidize such poverty wages?...

The San Francisco Health Access Plan combines both of these common-sense ideas to save tax dollars; "according to San Francisco County Supervisor Tom Ammiano,SFHAP could save taxpayers $8-24 million annually" ( http://www.NewRules.org/equity ).

They've crunched the numbers in San Francisco and found that combining the two ideas above brings in enough revenue for the county and city there to offering the voluntary option of health insurance coverage to local residents at the cost of only $35-a-month premiums for those making between $20,000 and $40,000 a year-- and $200-a-month premiums for those making $50,000 a year-- a bargain...

Sign on to http://www.PetitionOnline.com/duhealth if you think we need the same type of program here in our county-- pass it on!

Note-- the specifics of a plan for our county don't necessarily have to be completely identical to the San Francisco model-- but it's a viable one that provides a good starting point for us to do something real here in Dutchess like this.

Fact: St. Francis Hospital spokesman Larry Hughes stated on his radio show on WHVW 950 AM this summer that the hospital spent $14 million over the last two years alone on care for uninsured patients.

Fact: "Uninsured patients treated at Saint Francis Hospital climbed dramatically from 16 percent in 2000 to 33 percent in 2004. The cost escalated too, up 20.6 percent to $12.9 million from 2004 to 2005 alone. That amounted to 9 percent of the Poughkeepsie hospital's budget."
[from "Soaring Health Costs Leave Many in a Bind" by Dan Shapley Poughkeepsie Journal 3/23/06 http://www.poughkeepsiejournal.com/apps/pbcs.dll/article?AID=/20060323/NEWS01/603230332/0/NEWS01&theme=NIF ]

Fact: "New York has 2.9 million uninsured residents, who last year cost hospitals $1.7 billion in so-called uncompensated care...$908,000 in 2002 at Northern Dutchess Hospital, $4.1 million at St. Francis Hospital, and $1.7 million at Vassar Brothers Hospital."
[from "New York's Uninsured Need Not Be" by Mary Beth Pfeiffer (9/03 Poughkeepsie Journal): http://www.cdfny.org/News/clips/PoughkeepsieJournalUninsured%20need%20not%20be.pdf ]

This excerpt below from a November 1st report from Westchester County Executive Andrew Spano points out how taxpayers in counties like ours now are forced to shell out millions for health care for workers of profitable companies paid poverty wages... [ http://www.westchestergov.com/currentnews/2006pr/medicaidsurvey.htm ]

"An extensive survey by Westchester County of its employed Medicaid recipients has revealed that many of them are not provided adequate health insurance by their employers and therefore turn to the government for health care -- at an estimated cost to Westchester taxpayers of between $11.5 million and $34.5 million...
It is estimated that it costs about $4,000 a year to provide Medicaid to an adult who is neither disabled nor elderly and $12,000 for a family of four where the main wage earner is covered. Based on these numbers, the county estimates that the total cost to county taxpayers for providing Medicaid to the county's working poor is between $11.5 million and $34.5 million, depending on size of family (this range represents the county?s 16 percent share of the program. The remainder of the costs is picked up by the state and federal governments)...

Based on the total survey results, the following companies were the ten largest employers of individuals receiving Medicaid benefits (and the number of employees involved):

A&P Supermarket (55)
Stop & Shop Supermarket (55)
McDonald's (48)
Mile Square Transportation Inc. (37)
Best Care Inc. (36)
Shop Rite Supermarket (33)
Pathmark (31)
Royal Coach Bus Lines Inc. (31)
Dunkin' Donuts (29)
Personalized Home Care Service (27)"

On that note-- this from the New Rules Project/Institute for Local Self-Reliance... [ http://www.newrules.org/retail/econimpact.html#7 ]

"Hidden Cost of Wal-Mart Jobs - by UC Berkeley's Institute for Industrial Relations, August 2004

California taxpayers are spending $86 million a year providing healthcare and other public assistance to the state's 44,000 Wal-Mart employees, according to this study. The average Wal-Mart worker requires $730 in taxpayer-funded healthcare and $1,222 in other forms of assistance, such as food stamps and subsidized housing. Even compared to other retailers, Wal-Mart imposes an especially large burden on taxpayers. Wal-Mart workers earn 31 percent less than the average for workers at large retail companies and require 39 percent more in public assistance. The study estimates that if competing supermarkets and other large retailers adopt Wal-Mart's wage and benefit levels, it will cost California's taxpayers an additional $410 million a year in public assistance.

Everyday Low Wages: The Hidden Price We All Pay for Wal-Mart - by the Democratic Staff of the House Committee on Education and the Workforce, Feb.2004

Although this study uses different methodology than the one above, it arrives at the same conclusion: Wal-Mart's low wages and meager benefits are costing taxpayers. The average Wal-Mart employee requires $2,100 per year in public assistance, including Section 8 housing vouchers, reduced-cost lunches for dependent children, health care programs, and tax credits for the working poor."

On a personal note, honestly, this issue is rather personal for me-- May 29th this year marked the seventh anniversary of the death of my stepfather, Bob ("Piggy") Malstrom from heart attack at 59-- way too young.
Though he worked most of his adult life (twenty years for IBM), he didn't have health insurance at the end, and was too proud to go to anyone for help, though he knew something was wrong with his health; the CPR I gave him in his last dying minutes failed (recall-- http:/petitiononline.com/forpiggy/petition.html).

It's not just Bob Malstrom though...

Fact: In 2002 the National Academy of Sciences' Institute of Medicine found in their "Care without Coverage: Too Little, Too Late" study that 18,314 Americans die each year because they lack preventative services, a timely diagnosis or appropriate care. This includes about 1,400 people with high blood pressure, 400 to 600 with breast cancer and 1,500 diagnosed with HIV. Odds are the number of deaths is even higher.
[see http://books.nap.edu/books/0309083435/html/161.html#pagetop ]

Fact: That's over a thousand New Yorkers dying each year because they don't have access to health insurance.
Fact: A 2001 Dyson Foundation/Marist Institute survey found uninsured in one of every four households here in the Hudson Valley. Basic insurance costs for individuals range anywhere from $350 and above per month, while a family plan is over $1000 per month and is too prohibitive for most residents. [ http://www.DysonFoundation.org/resources/resources_show.htm?doc_id=212586 ]

Fact: 80 percent of those without health insurance have jobs or live in working families, according to the Cover the Uninsured Week, a national coalition that includes both the U.S. Chamber of Commerce and A.F.L.-C.I.O.
[ http://www.CovertheUninsuredWeek.org ]

Fact: Three years ago an ABC News/Washington Post survey of over 1000 Americans found that 80 percent of us say it's more important to provide health care coverage for all Americans-- even if it means raising taxes-- than to hold down taxes but leave some people uncovered. [ http://www.abcnews.go.com/sections/living/US/healthcare031020_poll.html ]

Fact: "The overwhelming majority [of Americans]-- 75 percent, according to an October 2005 Harris Poll-- want what people in other wealthy countries have: the peace of mind of universal health insurance."
[ http://www.commondreams.org/views06/0818-27.htm ]

Fact: 89% of Americans believe our system of health care is broken. [ http://www.americansforhealthcare.org/media/pressreleases.cfm?pr_id=119 ]

Of course I still support health care reform at the national and/or state levels to cover everyone with health insurance-- but how many more years do we have to wait for this?

Recall-- hundreds of us from across the county came out to the big Poughkeepsie Journal National Issues Forum at DCC earlier this spring to deliberate on health care-- and how the overwhelming, vast majority of those there were decidedly for universal health care-- that's our local mandate right there; failing to act on this is just plain irresponsible.

Letters to county legislators can make this a reality-- at countylegislators@co.dutchess.ny.us and countylegislature@co.dutchess.ny.us.

You never know what might happen if enough of us pull together on this-- tens of thousands of Dutchess County residents need a Dutchess Health Access Plan like the one being implemented in San Francisco; let's not let them down.

Joel Tyner
Dutchess County Legislator, D. #11
Clinton/Rhinebeck
joeltyner@earthlink.net
(845) 876-2488
[for more info on San Francisco model see http://www.SFHP.org and below; also http://www.sfhp.org/about_us/whats_new/SF_HAP_faq.aspx?show=-1 ]

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More from the New Rules Project/Institute for Local Self-Reliance...
[ http://www.newrules.org/equity/sfhealthcare.html ]

San Francisco Universal Healthcare Initiative

"The San Francisco Board of Supervisors unanimously approved the San Francisco Healthcare Access Program (SFHAP) in July 2006 with legislation entitled the San Francisco Health Care Security ordinance. The program would give the city's 82,000 uninsured adults access to healthcare regardless of income, immigration status, or medical condition. The majority of the uninsured cannot afford healthcare, yet earn too much money to qualify for the state public health insurance program, Medi-Cal. SFHAP is not insurance in that it is not portable--residents must be treated within the city limits.

The plan would be paid for with tax dollars, local business contributions and individual enrollment fees that are income-adjusted. The 15% of local businesses that do not currently provide healthcare to employees will be required to pay an annual fee to go towards the program?a provision that has put many from the business community on edge.

SFHAP is a merging of different plans by Mayor Gavin Newsom and Supervisor Tom Ammiano. The mayor's Universal Healthcare Council released a report in June with recommendations for the creation and implementation of SFHAP. Shortly thereafter, Ammiano incorporated SFHAP into his Worker Healthcare Security Ordinance. The plan has been enthusiastically received by many-- when the first reading of the ordinance passed on July 18, it was followed by a standing ovation...

The program is voluntary; it is hoped that 15,000 people will enroll when phase one of the program debuts in 2007. If all 82,000 uninsured residents were to enroll in SFHAP, it would cost approximately $200 million per year. The city already pays $104 million annually to cover uninsured care in emergency rooms and clinics. According to Ammiano, SFHAP could save taxpayers $8-24 million annually by requiring employers to share the costs of healthcare..."

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"Newsom Urges Health Care for the Uninsured: Proposal to Cover Health Costs Would Be Subsidized by Taxpayers" by Cecilia M. Vega
[excerpt below from San Francisco Chronicle 6/21/06] sfgate.com/cgi-bin/article.cgi?file=/c/a/2006/06/21/SFHEALTH.TMP

Mayor Gavin Newsom announced an ambitious proposal Tuesday that would make San Francisco the first city in the country to provide taxpayer-subsidized health care to all uninsured residents, covering services like doctor visits, surgeries and prescription drugs.

San Francisco is home to an estimated 82,000 uninsured residents, who typically go to public clinics and hospitals for treatment. The plan, dubbed San Francisco Health Access Program, would offer people the primary and preventative health care they lack and allow them to access hundreds of doctors in public and private hospitals and clinics.

Efforts to provide universal access to health care in San Francisco have been attempted before but have failed. But Newsom, who is facing re-election in 2008 and has made the topic a cornerstone of his administration, is optimistic that his plan will be implemented beginning next year.

"This is not a pipe dream," Newsom said. "This city is going to be the first city in America to achieve universal health care access."

The plan is not health insurance and therefore differs from other proposals. Those who sign up would have access to care only in San Francisco and, despite paying monthly premiums, would not be covered by the plan if they sought treatment outside the city limits.

The estimated $200 million-a-year price tag, or $2,400 per person, would be paid through a combination of sources, including tax dollars, local business contributions and individual premiums.

In April, Massachusetts became the first state in the country to require individuals to carry health insurance or face financial penalties. San Francisco's plan would not be mandatory and assumes people without other coverage will volunteer to chip in for the coverage.

"To treat chronic health issues, to treat ear infections and strep throat so they don't get really bad and end up in the emergency room ... ultimately that's what most people want," said Nathan Nayman, executive director of the business lobby group Committee on Jobs and a member of a task force created by Newsom to study and devise the health care plan.

Individuals who earn $50,000 a year, or 500 percent of the national poverty level, would pay $201.25 a month in premiums under the proposed San Francisco Health Access Plan, Newsom said. Those who make between $19,600 and $40,000 a year would pay $35 a month. The figures are comparable to what individuals pay for insurance under private providers, industry experts said.

"This is about the people in the middle," Nayman said. The plan applies only to those people whose incomes are too high to qualify for federally subsidized health care under Medicaid...the proposal introduced Tuesday is backed by a broad coalition of business groups, labor unions, health care providers and members of the Board of Supervisors...

Newsom proposes a voluntary program and predicts that businesses opting to join to provide their health care to their workers probably would spend about $30 million. Meanwhile, the city would chip in $104 million annually by redirecting funds that it already pays to cover the cost of treating those uninsured who visit emergency rooms and clinics. The rest would come from premium payments and other sources.
But today the Board of Supervisors is scheduled to discuss legislation introduced by Supervisor Tom Ammiano that would require every business with 20 or more employees to contribute $1.60 an hour into health care savings accounts that the city could use to in turn provide health care to the uninsured...

Ammiano's measure could be merged with the mayor's plan, making the employer contribution mandatory rather than voluntary...

Under Newsom's plan, all adult city residents would be eligible, regardless of employment, immigration status or pre-existing medical conditions. Children in San Francisco already have access to government subsidized health care.

Newsom said the plan is not meant to take the place of private health insurance. It would, however, offer a means of treating people without insurance so they don't rely on hospital emergency rooms for care.

The plan would be administered by the San Francisco Health Plan, which currently provides health insurance to more than 50,000 low-income city residents and who receive care at city public health clinics, city-supported private nonprofit health clinics and most city hospitals, including city-owned San Francisco General Hospital.

Participants in the new program essentially would join the existing San Francisco Health Plan. They would receive a medical card and could seek treatment from more than 400 primary care providers in the network and at nearly all private and public hospitals in the city.

Everything from emergency room stays, physical therapy and psychiatric care to radiology, allergy tests and prosthetics would be covered. Dental care and fertility and cosmetic procedures would not.

"San Francisco," Newsom said, "is moving forward to fulfill its moral obligation."

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From http://laborcenter.berkeley.edu/healthpolicy/sf_security_ordinance.pdf ...

The San Francisco Health Care Security Ordinance

What does it do?

The San Francisco Health Care Security Ordinance creates a Health Access Program(HAP) that will offer comprehensive healthcare services to uninsured San Franciscans and their employers at a reasonable cost. The program will emphasize preventive care that keeps people out of emergency rooms by providing regular checkups, performing screenings and managing chronic conditions such as asthma, diabetes and high blood pressure. The ordinance also sets a "minimum health spending requirement" for medium-sized and large businesses. This helps level the playing field for the majority of businesses that already pay for their workers' coverage and discourages companies from dumping even more of their workers into the taxpayer-financed public health system. By establishing an affordable Health Access Program for the uninsured, the ordinance helps better guarantee access to care for all San Franciscans. By requiring medium-sized and large businesses to pay their fair share, the Health Care Security Ordinance will help reduce the taxpayers' burden to shoulder the costs of caring for uninsured workers.

The Health Access Program-- what is it?

The Health Access Program will replace San Francisco's current system for taking care of the uninsured. Employers and individuals will be able to enroll in the program for an affordable monthly fee. The cost of the program will be subsidized for low- and moderate-income individuals and small- and medium-sized businesses. The Health Access Program will assign individuals to a primary care doctor, nurse or medical assistant at one of the City's public or nonprofit clinics, deliver acute care and specialty services through a network-- including San Francisco General Hospital and the city's nonprofit hospitals-- and cover prescription drugs and home health care. By expanding access to health care, rather than creating an insurance program, the City can maximize the funds it receives from state and federal programs, including Medicare. However, the structure of the plan will not cover services residents receive outside of San Francisco.

What services will participants get that they don't get now?

The HAP will place an increased emphasis on preventing illness by providing an integrated package of primary care, hospitalization services, specialty care and prescription drugs. These services will be more highly coordinated, easier for participants to navigate, and will allow enrollees to have a "medical home"-- a place they can go for primary care. One of the goals of the program is for patients to be able to get primary care early in their illness, rather than emergency care later on. That said, the HAP is not an insurance program but rather an integrated package of health care services available only inside San Francisco County.

How do people enroll in the HAP?

The uninsured will be able to be enrolled in one of two ways:

1) individual enrollees could pay a premium, set according to an income-based sliding scale;
2) employers could enroll their employees as a group, by paying their premiums.

The Department of Public Health will develop the rules and regulations governing enrollment-- including rules to discourage employers who currently provide health insurance from dumping their employees into the Health Access Plan.

How much does it cost?

The Department of Public Health has estimated that the program would cost about $201 per enrollee if it were implemented today. If all of San Francisco's 82,000 uninsured residents were to enroll in the HAP, the total cost would be about $200 million. To finance the program, the City will contribute $104 million that it currently spends onthe uninsured; the remaining costs will be borne by individual enrollees and businesses that enroll their employees. If fully enrolled, premiums and co-payments (mostly from higher income individuals) would make up about $60 million of the total, and business premiums would raise another $30 to 40 million. The program is expected to reap another $10 million through increased federal cost-sharing.

The minimum health spending requirement-- what is it?

The Health Care Security Ordinance will require medium-sized and large employers in San Francisco to spend a minimum amount per employee per hour on health care for their workers. Large companies (100 or more workers) will be required to spend a minimum of $1.60 an hour per employee on health care services. For a full-time employee, this is equivalent to 75 percent of the average amount that the 10 largest counties in California (other than San Francisco) spend on individual health coverage for their employees. This rate will go up 5 percent in 2007, 5 percent in 2008, and 5 percent in 2009. From 2010 on, the rate will be indexed once again to 75 percent of the 10-county rate. Medium-sized companies (20 to 99 workers) will be required to spend a minimum of $1.06 an hour per employee on health care services. For a full-time employee, this is equivalent to 50 percent of the average amount that the 10 largest counties in California (other than San Francisco) spend on individual health coverage for their employees. This rate will go up 5 percent in 2007, 5 percent in 2008, and 5 percent in 2009. From 2010 on, the rate will be indexed once again to 75 percent of the 10-county rate. Small companies (fewer than 20 workers) are exempt. Non-profit organizations with fewer than 50 employees are also exempt, as are non-profit job-training programs.

Which employees does it cover?

Companies will have to meet the spending requirement for all workers, except for managerial, supervisory, and confidential employees who earn over $72,450 per year. Employees who are eligible for Medicare and/or CHAMPUS/TRICARE (veterans' benefits) are also exempt (so that they continue to receive those benefits). Employers will pay on hours worked by part-time as well as full-time workers, up to a cap of 172 hours per month. This avoids any incentives to cut employees' hours in order to avoid the requirement. To be a covered employee, an individual must work a certain number of hours per week. This threshold is set so that businesses can more easily anticipate for whom they need to make contributions, and so that there is no incentive to adjust workers' schedules in order to evade the ordinance. This requirement is phased in: during 2007, a worker must work 12 hours per week; during 2008, a worker must work 10 hours; from 2009 on, a worker must work 8 hours. Workers who verify that they receive health services through another employer (either as an employee, or as a spouse, domestic partner, or child of another person) and who sign a voluntary waiver will also be exempted. This opt-out can be revoked by the worker at any time.

What are employers required to spend money on?

Health care expenditures are defined as "any amount paid by a covered employer to a covered employee or to another party on behalf of its covered employee for the purpose of providing health care services for its employees." This includes, among many other options:

1) insurance;
2) contributions to a public program for the uninsured (i.e., the Health Access Program);
3) health savings accounts;
4) direct reimbursement to employees for health expenses.

The Health Care Security Ordinance gives employers a choice as to how to spend this money-- it does not require employers to buy health insurance or to pay money to the Health Access Program. These are just two options for meeting the spending requirement.

Why are the minimum health care spending requirement and Health Access Program so closely linked together?

Without making medium-sized and large businesses pay their fair share of health costs, the Health Access Program would fail. Many businesses that currently provide health coverage to their employees might drop that coverage and force their employees onto the public health care system. Conversely, without the HAP, medium-size businesses would have few affordable options for meeting the health spending requirement. One way to meet the minimum health care spending requirement will be to enroll uninsured employees into the HAP. The financing model for the HAP assumes that the payments required of businesses under the ordinance will be sufficient to enroll that employer's eligible workers in the HAP. At $1.06 an hour, employers with between 20 and 99 workers would be paying $182 per month for a full-time employee and $91 per month for a half-time employee to enroll those workers in the Health Access Program.

Why place a minimum health care spending requirement on employers?

The minimum health care spending requirement will help maintain the current base ofemployer-sponsored health insurance while also securing the resources necessary for the City to offer the Health Access Program. The minimum health care spending requirement will significantly diminish the incentive for employers to drop their employees' existing health care coverage and dump them into the HAP. The vast majority of San Francisco's employers currently provide health care coverage for their employees. If these employers were to drop that coverage in response to the HAP, the City's health care system as well as its budget would be swamped. Creating a floor for health care spending by medium-sized and large businesses will help ensure that these businesses maintain employer-sponsored health care coverage for their employees, while at the same time securing the additional resources necessary to offer the Health Access Program from those employers who aren't currently doing their fair share.

Isn't this unaffordable to smaller businesses?

No. Small businesses are exempted entirely. And among businesses that are covered by the minimum health spending requirement, the vast majority already pay for their workers' health care. In fact, 83 percent of all workers at companies of 20 or more employees have employer-sponsored health coverage. It is a small minority of businesses that don't provide coverage. The Health Care Security Ordinance levels the playing field for those businesses that are already doing the right thing, and reduces their competitive disadvantage. Moreover, the ordinance will provide a steeply-discounted program for medium-sizedbusinesses to enroll their uninsured workers. For a full-time employee who works 40 hours, the $1.06 spending requirement amounts to just 50 percent of what other employers pay for individual coverage. For part-time employees, it's even less-- because this is an hourly spending requirement, an employer would pay just 25 percent for a half-time worker. This makes the program much more affordable for restaurants and other businesses that rely heavily on part-time workers. Finally, the spending requirement is phased in over several years, allowing companies to plan ahead of time. For the first three years (through 2009), the spending requirement will rise by a fixed 5 percent per year. Each year thereafter, the rate will be pegged to the 10-county survey amount. For businesses with 50 or more employees, the spending requirement does not go into effect until July 1, 2007. For businesses with 20 to 49 employees, it doesn't go into effect until March 31, 2008.

If this is so affordable, won't businesses dump workers into the HAP?

In addition to the disincentives to dumping created by the minimum health care spending requirement, the Department of Public Health will set enrollment rules to restrict crowd out. If there is a problem, DPH will have the flexibility to revise regulations accordingly.

Why not just require businesses to pay directly into the HAP?

Federal law (ERISA) prohibits state and local governments from doing this. Moreover, it is good for employers to have a choice as to how they meet the spending requirement. What option is best will vary for both workers and businesses.

Health care costs are soaring-- doesn't this create huge liability for the City in the future?

Health care inflation is currently leading some businesses to dump their workers into the public health system-- so that taxpayers are increasingly footing the bill for irresponsible employers. By creating a floor for health spending, the Health Care Security Ordinance actually reduces the City's exposure to this trend. The costs of the Health Access Program will rise over time with inflation, as will premium rates. The program will utilize best practices from around the country to contain costs while providing quality care. The spending requirement is in turn indexed to actual employer healthcare spending in California. As a result, employers will continue paying their fair share for health care over time and the City will be able to meet its ongoing obligations.

Has any one else done this?

Many different jurisdictions are experimenting with health care reform, including the States of Massachusetts and Maryland, the Cities of New York, Chicago and Los Angeles, as well as many others. The San Francisco ordinance has the broadest reach of any local health care reform effort and is being studied closely by other jurisdictions.