Tens of thousands of San Franciscans will be insulated from state budget cuts, thanks to the Healthy San Francisco, the city's plan to provide health care to all its residents, local officials said.
While Medi-Cal patients would see expensive new co-payments and have their coverage capped under proposals announced Monday by Gov. Jerry Brown, Jim Soos, assistant director of policy and planning for the San Francisco Department of Public Health, said the 55,000 people enrolled in the San Francisco program would see no change.
“It's not horrible news for us,” said Soos, whose agency oversees Healthy San Francisco, the first such plan in the country. “There are no cuts to us directly.”
That is because the program, which was created in 2007, receives no state financing. Instead, it depends on a mix of city dollars, federal money, patient payments and fees on businesses that operate in the city that opt not to provide health coverage for their workers.
Patients who get care through Healthy San Francisco typically make too much to qualify for Medi-Cal but not enough to buy private insurance. Others have low incomes but do not qualify for Medi-Cal because they do not meet the eligibility criteria. Childless adults typically do not qualify for Medi-Cal unless they are elderly, disabled or pregnant.
“San Francisco is an island on its own,” said Sean South, spokesman for the California Primary Care Association, which represents more than 800 community clinics across the state.
But frontline doctors are not celebrating. “Every government program is dependent on funding streams,” said Dr. Kenneth Tai, the medical director of North East Medical Services, which sees one in six Healthy San Francisco patients at its four clinics in the city.
San Francisco is facing its own $379.8 million deficit. With the program's chief cheerleader, Gavin Newsom, having left his post as mayor to become lieutenant governor, Tai said he was not confident about the program's future.
In the meantime, Tai is trying to figure out how he will manage care of his Medi-Cal patients, who would be limited to six medical prescriptions a month and 10 doctors' visits a year under Brown's budget proposals.
At North East Medical Services' clinic on Stockton Street, patients said they would wait longer before seeing a doctor to avoid exceeding the maximum number of doctors' visits, and worried about $50 co-payments for emergency room visits and $100 a day for hospital stays, which could become more common if patients delay regular doctors' visits.
Tai said he would “have to start staggering their prescriptions, giving six one month and six the next.”
But that could lead to medical complications. “Some of these patients have Alzheimer's, and it's already difficult to get them to take their medicine,” he said.
According to the California Department of Health Care Services, 124,000 San Franciscans receive Medi-Cal, more than double the number of city residents enrolled in Healthy San Francisco.