Health Commission adopts updated Health Care Accountability Ordinance after labor-backed compromise

The San Francisco Health Commission voted to adopt updates to the Health Care Accountability Ordinance after commissioners heard public comment from labor and nonprofit representatives endorsing a compromise designed to reduce out-of-pocket costs for workers on city contracts.

The ordinance update, introduced for a final vote at the meeting, expands the draft resolution to include 16 minimum standards recommended by the stakeholder work group, up from an earlier 14-standard draft. Patrick Chang, who presented the item, said there were no substantive changes since the commission last reviewed the proposal and that the expanded draft reflects full consensus from the work group.

Members of labor and community groups urged adoption. "We came up with the solution of raising the deductible to $2,000 . . . and having the HRA or HSA cover the first $2,000 basically deductible," said Greg Brown, a labor representative who described the work group discussions and recommended plan changes as a "win-win" for employers and workers. Emma Gerald of SEIU Local 1021 told commissioners she and the San Francisco Labor Council strongly support the recommendations and urged the commission to adopt them.

Advocates cited research presented at the meetings showing deductible burdens can deter needed care. "The health department study found that recent surveys indicate that nearly a quarter of adults with insurance are still unable to cover their deductible," said Carl Kramer of the San Francisco Living Wage Coalition, citing the Health Department study and national surveys. Debbie Lerman of the San Francisco Human Services Network said the proposal balances employer and employee needs and that more than half of the small-business market plans studied would be compliant under the proposed standards.

Commissioners praised the stakeholder process and the work group's ability to reconcile differing perspectives. Several commissioners asked staff to provide a clearer breakdown of the cohort affected by the change, including which businesses and how many employees would be impacted, to give the commission better context for future decisions.

A motion to approve the ordinance updates was made and seconded; commissioners voted in favor. Commissioners also discussed sharing the work-group findings with Covered California and monitoring how federal and state policy changes may affect local implementation.

The commission recorded no further amendments at adoption. The ordinance will move forward per the commission's approval, and staff were asked to prepare any follow-up analyses requested by commissioners.