Julio Lopez works at Jay’s Cheesesteak on 21st Street.

“I don’t usually get sick,” he said when asked why he hasn’t looked for health coverage. He is 24, and like many young men, Lopez doesn’t have health insurance.

He didn’t know he might be eligible for San Francisco’s health care program, though he vaguely remembered his mother had mentioned it to him, maybe something with the word “health or healthy.”

Lopez is not alone.

It’s been more than a year and a half since the Healthy San Francisco program started providing uninsured residents with a base level of care. It’s not health insurance, but the program gives enrollees access to most basic health care services such as checkups and prescriptions. There’s been limited outreach, and like Lopez, plenty of uninsured Mission residents are unaware of being eligible.

Nearly 4,400 residents from the Mission and Bernal have enrolled in Healthy San Francisco. Assuming residents are going to keep signing up at the same rate,  there’s a paltry 3,000 or so adults in the Mission and Bernal Heights who could still sign up. That’s using the city’s total estimate of uninsured residents: 60,000.

However, it took a Mission Loc@l reporter a matter of minutes to find uninsured San Franciscans in the Mission, and all were unaware of the Healthy San Francisco program.

Next door to Lopez, Justin Freund works at Sidewalk Juice. The 20-year-old had no idea the city had a program to cover his basic health needs.

It’s the same for Javier Romero, 28, who works at Muisca Café on South Van Ness Avenue when he’s not taking photographs.

What Romero, Lopez and Freund have in common, other than being unaware of Healthy San Francisco, is that they all work for small businesses—a group that has not been recruited.

Nevertheless, like others who earn no more than $4,300 per month or $50,000 per year, they are eligible.

But instead of going after the uninsured working for companies with fewer than 20 employees, the city’s gone after those with companies required to participate. Those were businesses hiring 20 or more people who had to pay money toward their employees’ health care by providing insurance or cash, or paying the city for Healthy San Francisco based on the hours worked.

Some 950 employers selected the city option as of August 2008, meaning they send their employees to Healthy San Francisco or set up medical reimbursement accounts.

Nonetheless, since these three young men live in San Francisco, they’re all eligible even if their employers pay nothing.

Tangerine Brigham, Healthy San Francisco’s director, said the program isn’t deliberately keeping the public uninformed.

“We’ve focused our strategies on what we call inreach,” Brigham said, explaining that they took this approach because the budget is limited and 70 percent of the enrolled patients were already clients of city clinics.

“Inreach” means Healthy San Francisco tries to ensure clinics have all the information necessary to do outreach at clinic sites; people get signed up when they come in sick to a participating clinic.

However, the fact that 70 percent of enrollees already used city health care might point to the opposite of successful outreach: If most people in Healthy S.F. were already using services, then Healthy S.F. isn’t reaching other kinds of residents—at least a good chunk of them being the kind of healthy patients insurance companies seek, because the fees they pay help to support those at a more vulnerable age.

The Healthy S.F.-affiliated clinics in the Mission are nearing capacity, but signing up the younger and healthier patients could provide revenue. These groups would use the services less but still pay to participate in the program.

The three—Lopez, Freund and Romero—would pay no more than $600 per year for Healthy S.F., and probably significantly less, depending on financial details.

Program Director Brigham said revenue generation isn’t a goal, and since Healthy S.F. isn’t health insurance, they consider all clients the same, regardless of health.

The Office of Labor Standards Enforcement has done its own outreach campaign for workers’ rights, but their ads refer to Healthy S.F. from an employer standpoint. “If you work eight or more hours per week in San Francisco and your employer has at least 20 employees, your employer is required to spend a minimum amount (set by law) on your health care.”

Some restaurants in the Mission, like Aslam’s Rasoi, have decided to go ahead and provide their employees with health insurance. Others, like Dosa, pay into the city’s program and let their employees use Healthy San Francisco.

The staff at Dosa was very aware of the health care options, and quickly pointed to the menu, which states, “a San Francisco health care surcharge of 4% will be added to all checks.”

Chris O’Keefe, 22,works at Dosa part time and uses Healthy San Francisco.

His coworker Ron Baker decided to go with private insurance years ago when he could no longer stay on his parents’ plan. It’s more expensive, but unlike Healthy San Francisco users, Baker has coverage that extends beyond the city limits and will stay with him even if he moves out of San Francisco.

Mary LeClair is a bartender at Dosa who just finished law school and has yet to find a job in law. She signed up for Healthy San Francisco and has been going to a program clinic recently for a chronic shoulder injury.

LeClair said Healthy San Francisco is better than nothing, particularly if you don’t have health insurance and “you’re bleeding in the street.”

Though Dosa’s employees had some health coverage, one needn’t go far to find more stories of the uninsured.

Seated at the bar at Dosa while LeClair worked, Samantha Garcia said she gets health insurance through her employer, the Arc of San Francisco on Howard Street. However, her boyfriend does not have health insurance and hasn’t yet signed up for Healthy San Francisco, even though he knew it exists.

She thought for a moment and added, “I would say 80 percent of my friends are uninsured.”

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Anrica is a science reporter and twice Cal grad, with a degree in engineering and a master of journalism. She's a Bay Area native and lives in Oakland. She's enjoyed wide-ranging professional endeavors, including shoveling manure, researching human signaling proteins, volunteering in a leprosy hospital, using an atomic force microscope, and modeling the electricity grid.

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  1. You are correct. I am an experienced physician in SF and health policy advisor. I sat on the Mayor’s Task Force for the Uninsured and was strongly opposed to the”solution” which is merely a tax on small biz to support the already inefficient SF DPH delivery system and passed off as “insurance”
    It is NOT insurance in any way shape or form.
    These people were already in the system for God’s sake!

    The number of uninsured in SF is at least 120k, an that would be conservative.