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Health Aff (Millwood). 2018 Sep;37(9):1375-1382. doi: 10.1377/hlthaff.2018.0432.

Universal Health Care: Lessons From San Francisco.

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Ken Jacobs ( ) is chair of the Center for Labor Research and Education, University of California Berkeley.
Laurel Lucia is director of the Health Care Program, Center for Labor Research and Education, University of California Berkeley.


The San Francisco Health Care Security Ordinance is the country's only local law designed to promote universal health care. It provides access to health services for the uninsured while requiring employers to contribute financially toward employees' health care costs. Enrollment in Healthy San Francisco, a program for the uninsured that is one component of the ordinance, fell significantly after the Affordable Care Act extended other types of coverage. Healthy San Francisco continues as a major source of care for undocumented people. Many other California counties have programs that provide at least some nonemergency care to undocumented residents, which demonstrates the versatility of this approach for localities. San Francisco employer contributions also fund medical reimbursement accounts that help insured people pay their health costs, including through a program added in 2016 to make Marketplace insurance more affordable. The city's experiences show that programs to help people pay for private coverage should be simple and include strong outreach and education and that the affordability of Marketplace coverage would be most easily addressed at the state level.


Access To Care; Health Reform; Insurance Coverage < Insurance; State/Local Issues

[Indexed for MEDLINE]

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