Can Healthy San Francisco Withstand the Recession?

By ANRICA DEB

Mayor Gavin Newsom’s effort to provide health care to the city’s uninsured has been praised by many, including President Barack Obama. But the statewide budget crisis and jump in unemployment indicate that, mathematically, the well intentioned effort might not add up for the Mission District.

Health care providers say the neighborhood’s clinics are already near capacity and medical funding is getting cut from all directions. San Francisco alone needs to eliminate $100 million from its health care budget, and no one’s sure what’s going to happen with Medi-Cal, which covers the poor. The stimulus package may help, but it’s unclear how that money will be doled out.

On the surface, these budget cuts might not seem to touch Healthy San Francisco. But because of the way health care funding is structured, it will not be immune.

By the numbers, Healthy SF is progressing well. Since the program launched in July 2007, more than half of the city’s roughly 60,000 uninsured residents (upwards of 36,000 at last count) have signed up. In February, Healthy SF expanded to include uninsured residents making up to $52,000 a year, or up to $106,000 for a family of four.

But the city might be volunteering to provide more health care than it bargained for, particularly as the best guess at uninsured numbers comes from a 2007 statewide phone survey. That estimate could grow considerably as residents lose their jobs and subsequently their insurance.

Moreover, Healthy SF is not actually funding health care in the three clinics that see its patients in and around the Mission. The neighborhood’s nonprofit clinics are run by the San Francisco Community Clinic Consortium, and only a fraction of its budget comes from the city program.

Healthy SF takes in roughly $200 million a year from federal and state grants, city and county funding, participant fees, and fees on businesses. The San Francisco Community Clinic Consortium sees 43 percent of the patients enrolled in the Healthy SF program, according to its website.

But the consortium’s 10 clinics received just under $3 million this year to provide care for program enrollees, according to Allen Meyer, vice president of programs for the consortium.

Tangerine Brigham, director of Healthy SF, said the program budgeted $8 million for its “provider network” this year, including the consortium. The bulk of the rest of the money, some $120 to 140 million, goes to a general fund at the city’s Department of Public Health, according to Brigham. There, the money pays for health care at other facilities such as Laguna Hospital.

“Healthy SF isn’t a separate budget, departmentally,” Brigham said. Care providers within the city’s health department system—Mission clinics are not operated by the health department—serve a variety of patients who fall under any number of programs, including Healthy SF. “The revenues don’t meet the expenses, generally, so the city’s general fund is used essentially to fill in the gap,” Brigham explained.

For the consortium clinics, their much smaller grant works out to about $180 per patient in Healthy SF, or less if you consider that the clinics are expecting to serve 23,000 Health SF patients by the end of the year. Meyer said the money the consortium receives is enough for administrative costs such as signing residents up for Healthy SF. The latter requires that patients be vetted by a certified application assister to see if they’re eligible for Medi-Cal, another public health care plan, before they enroll.

“We really haven’t gotten additional dollars for health care services,” Meyer said.

Brigham said clinic reimbursement is based on enrollment, and that the clinics are surveyed twice per month to make sure they have the capacity to sign up new patients.

The consortium isn’t complaining that the city doesn’t fund its health care. According to Brigham, 76 percent of patients enrolled in Healthy SF were already using clinics.

A little more than 15,000 of the consortium clinics’ 70,000 patients are in Healthy SF. And, as they have in the past, the clinics find fund sources to provide care for their patients. But strains could come with the nearly 4,000 new patients signed up through Healthy SF.

At present, the consortium receives money for their other clients through various reimbursements, grants and donations. However, Medi-Cal reimbursements are going to see steep cuts unless the stimulus money makes up the difference. Moreover, as other San Francisco health services get pared down by the city’s new budget, Mission neighborhood health providers will have to pick up additional clients.

And the likelihood of more clients increases with every unemployment report. In 2008,  San Francisco’s unemployment rate was 5.3 percent. By the first month of this year, it had jumped to 8 percent, according to the state Employment Development Department.

San Francisco residents under 65 and earning less than five times the poverty level can join Healthy SF  as long as they have been uninsured for more than 90 days and are ineligible for public insurance like Medi-Cal.

Already, most of the consortium’s clinics are near capacity, according to Meyer. Mission Neighborhood Health Center’s clinic on Shotwell Street, for example, is no longer accepting adult clients, according to its director Brenda Storey.

Given all the budget constraints, city clinics simply aren’t prepared for a rush of uninsured San Franciscans seeking care.

“We don’t really want to displace the people we’re already seeing,” said Meyer, who nevertheless remains hopeful that clinics will continue to provide care to everyone in need. Meyer later added, “Our clinics have hung in there and said, ‘We want this to work too.’”

Healthy SF’s program director acknowledged that limitations might arise. “There could be a time when there’s not sufficient capacity,” Brigham said. “We don’t want to enroll someone in a program where they can’t get any services.”

Marnette Federis contributed to this story.