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A public option -- and an employer mandate -- are working in San Francisco

People don't talk much about the health-care reforms San Francisco put into place in 2006, but Carrie Hoverman Colla, William H. Dow and Arindrajit Dube have looked into the early evidence, and it's encouraging:

In 2006 San Francisco adopted major health reform, becoming the first city to implement a pay-or-play employer health spending mandate. It also created Healthy San Francisco, a “public option” to promote affordable universal access to care. Using the 2008 Bay Area Employer Health Benefits Survey, we find that most employers (75%) had to increase health spending to comply with the law, yet most (64%) are supportive of the law. There is substantial employer demand for the public option, with 21% of firms using Healthy San Francisco for at least some employees, yet there is little evidence of firms dropping existing insurance offerings in the first year after implementation.

I guess in San Francisco, even the private businesses are run by socialists.

By Ezra Klein  |  July 14, 2010; 10:28 AM ET
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come on now you're better than this.

Healthy San Francisco is NOT insurance and you'd better not go outside the city limits when you get sick or injured.

Sure its a good deal but again you get what you pay for. This is akin to you shilling for mini med plans that cap coverage at $50k.

Posted by: visionbrkr | July 14, 2010 10:42 AM | Report abuse

How is healthcare and immigration working out in Mass?

Posted by: FastEddieO007 | July 14, 2010 10:42 AM | Report abuse

It's not the job of local gov't to provide health care, whether thru a tax or employer mandate. Either one is a disincentive to local prosperity. All the other civilized countries of the world do it nationally. The county I live in in Fla. provides health care to the partially employed only, thru a local tax. The fund has over 20 mil in it and is just barely utilized since so few qualify, yet everyone, including the poor, pays more sales tax.

Posted by: rjewett | July 14, 2010 10:49 AM | Report abuse

I love Klein's new propensity to link to articles that most people can't afford to read.

Posted by: msoja | July 14, 2010 10:57 AM | Report abuse

The finding "that most employers (75%) had to increase health spending to comply with the law" isn't at all surprising. In fact, I wouldn't be surprised if that same 75% cost increase spreads nationwide... which means that businesses must cut jobs, cut wages, and raise prices.

Does the study mention longer lifespan due to the increased spending? Back during the discussions of the PPACA, health care spending without increased lifespan was a bad thing...

Posted by: rmgregory | July 14, 2010 11:07 AM | Report abuse

I'm pretty sure the program hasn't been going on long enough to measure lifespan changes with any statistical clarity.

I'm pretty sure that the SF program hasn't led to the death of business and employment as the opponents of HCR like to predict. Someone had a post on this awhile back, but I don't remember who it was...

Posted by: mschol17 | July 14, 2010 11:26 AM | Report abuse

Freedom-hating communist nazis, to be precise.

Posted by: will12 | July 14, 2010 11:47 AM | Report abuse

Will12 calls us San Franciscans communist, freedom hating nazis. My what sophisticated verbage! He's able to wrap historical enemies into an ironic twist of a place he's probably never visited and certainly has no understanding of beside what he hears from Rush, Glenn and Sarah.

Gosh we are such a horrible, horrible lefty place. Of course people come from around the world to visit us and set-up businesses here and generally innovate all over the place in bioscience, high tech and design and did I mention we have some great restaurants that pay their workers a living wage and who have health insurance under Healthy SF?

But we're communist, nazis, freedom hating folks so I guess I'm wrong.

Posted by: melbaker1 | July 14, 2010 12:00 PM | Report abuse

Come on Ezra-

Your post implicates, "well if a public option works in SF, gosh, it must work elsewhere too."

But as you note at the bottom of your post, "I guess in San Francisco, even the private businesses are run by socialists," it's likely that firms that like San Francisco's social climate move to... San Francisco. Also, you don't tell us what percentage of firms had to increase costs **AND** are supportive of the program. Since 25 percent didn't have to increase spending, they're probably at worst indifferent to the law (assuming it doesn't affect them in other ways). This potentially reduces the 64% in favor to a just under 50% if we ignore those who didn't have to increase costs.

It'd be also nice if you could tell us who those 'some employees' these firms choose to put on SF's public plan. What are their health status' like? Also, how solvent is this program?

Most of us can see past this dumb reporting.

Posted by: thedu3 | July 14, 2010 12:09 PM | Report abuse

I guess you forget the name for a political system where private businesses are run by socialists... it's called fascism. Please refer to Mein Kampf for details.

Posted by: agnesbernstein | July 14, 2010 12:23 PM | Report abuse

Hawaii has had an employer-mandate for more than 35 years. Employers are required to offer health insurance to anyone working 20 or more hours per week (yes, 20 hours). Not familiar with any studies of the Hawaii model. The law does have an effect on hours that strapped small businesses offer to their part-time employees based on anecdotal evidence. Overall health insurance coverage in the state is relative high.

"Originally enacted in 1974, the Hawaii PHC Act was the first in the nation to set minimum standards of health care benefits for workers. Employers, excluding Federal, State and City government and other categories specifically excluded by the law (sections 393-3(8), 393-5 and 393-6) are required to provide Hawaii employees, who suffer a disability due to non-work related illness or injury, with adequate medical coverage for non-work related illness or injury, protecting them from the high cost of medical and hospital care.

Employers must provide health care coverage to employees who work at least twenty (20) hours per week and earn 86.67 times the current Hawaii minimum wage a month ($7.25 x 86.67 = $628). Coverage commences after four (4) consecutive weeks of employment or the earliest time thereafter at which coverage can be provided by the health care plan contractor, which is usually the first of the month."

Posted by: tuber | July 14, 2010 1:36 PM | Report abuse

Posted by: aaroneous | July 14, 2010 2:41 PM | Report abuse

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