Where federal health care reform falls short, local reform steps up

San Francisco is an exciting place to be—especially because of its history of progressive politics and culture of grassroots organizing. The city’s passage of the Health Care Security Ordinance (HCSO) in 2006 represented an attempt to implement near-universal health care throughout San Francisco and reaffirmed the city’s commitment to vulnerable people.

No doubt the focus of this legislation on prevention, primary care, and increasing equity in access to care has this UC Berkeley student in public health and doctor-in-training jumping for joy. Through innovative experiments in social responsibility, San Francisco has managed to make leaps in health care reform locally that the federal government can’t or won’t make.

The law’s Employer Spending Requirement is a “play-or-pay” type mandate in which employers “play” by providing health insurance or “pay” by putting funds aside for employees in health or medical reimbursement accounts or to the city for Healthy San Francisco. Given that job-based coverage is still the main way non-elderly Americans receive health benefits, any serious health care reform in today’s political climate needs to work with and build on this system of employer-based coverage—something the HCSO does so strategically.[1] And despite the burden of complying with the ordinance, the majority of San Francisco employers have been shown to be supportive of the local policy.[2]

With the implementation of federal health care reform just around the corner, how will the national Affordable Care Act (ACA) and the local HSCO play out in San Francisco? While the ACA represents a huge step forward for our nation’s health care system, it does not go far enough in fulfilling the dream of quality, affordable, culturally and linguistically appropriate health care for all. One glaring shortcoming of the ACA is the fact that undocumented immigrants are completely left out of health care reform without any real or affordable means of accessing care—except to rely on over-burdened county emergency rooms.

In addition to undocumented immigrants, many others will not be covered under the federal law. Since the ACA employer mandate—which has been delayed until 2015—only applies to employers with 50 full-time employees or more, employers across the country are cutting workers’ hours in order to evade the federal mandate. This trend makes it even harder for people who are trying to work and live in high-cost areas like the Bay Area.[3]

Already well-institutionalized here in San Francisco, the HSCO attempts to fill in some of these gaps. For example, undocumented immigrants who are San Francisco residents are still able to access a regular source of care, as Healthy San Francisco does not require a social security number or ask about status. And since the local Employer Spending Requirement is based on hours worked by an employee, employers have less of an incentive to cut workers’ hours, as they have elsewhere in the country. As such, the city’s policies are an even more vital means of ensuring that low- and moderate-income individuals—particularly immigrants and communities of color—still have a means of accessing robustly funded health care.

If you’re like me and you agree with the need to support San Francisco’s progressive health care policies, join unions, community-based organizations (such as the Chinese Progressive Association), community clinics, and other allies to show your support for the Health Care Security Ordinance this Thursday at 2 p.m. at San Francisco City Hall Rm 250. Your voice matters.

Susan Fang is pursuing an MS and MD at the UC Berkeley-UC San Francisco Joint Medical Program. She was selected as a University of California Human Rights Fellow to work as the Community Health Policy Research Fellow at the Chinese Progressive Association (CPA), which organizes low-income Chinese immigrants in San Francisco.

The views expressed in this blog are not necessarily the views of the Human Rights Center at the University of California, Berkeley, School of Law.


[1] Jacobs, K. Hacker, JS. “How to Structure a ‘Play-or-Pay’ Requirement on Employers: Lessons from California National Health Reform.” UC Berkeley Labor Center. June 2009 Policy Brief.

[2] Colla, C. H., Dow, W. H., & Dube, A. (2013). San Francisco’s “Pay Or Play” Employer Mandate Expanded Private Coverage By Local Firms And A Public Care Program. Health Affairs, 32(1), 69–77. doi:10.1377/hlthaff.2012.0295

[3] Weber, L. “Risky Business: Cutting Workers’ Hours to Save Costs.” The Wall Street Journal. July 15, 2013.

Missing Peace to help shape world’s response to sexual violence

How do we effectively respond to sexual violence during war, and how can we better protect people during and after violent conflicts? International scholars, policymakers, human rights advocates, and foreign military leaders will take up this issue and more in The Missing Peace Symposium 2013 in Washington, D.C., co-hosted this week by the Human Rights Center at the University of California, Berkeley, School of Law.

“Sexual violence against women, men, and children during war is a human rights abuse that threatens international peace and security,” explains Kim Thuy Seelinger, director of the Sexual Violence Program at the Human Rights Center. “Even when fighting ends, sexual violence often does not.”

Seelinger, a lawyer and international expert in sexual violence, has worked with the U.S. Institute for Peace, the Peace Research Institute of Oslo, and the Stockholm International Peace Research Institute North America for the past year to organize and lead the global event that runs from Thursday, February 14–Saturday, February 16.

A live webcast of the Missing Peace Symposium will begin at 8:30 a.m. (EDT) on Feb. 14. The link and further details can be found at: www.usip.org/events/the-missing-peace-symposium-2013

Three UC Berkeley School of Law students who work with Seelinger in the International Human Rights Law Clinic will act as rapporteurs and help to draft the symposium’s final policy brief. A fourth Berkeley Law student was selected to attend as a “Young Scholar.”

The three-day global symposium will feature Nobel Laureate and human rights security expert Jody Williams, the vice president of the World Bank, special advisers to the prosecutor of the International Criminal Court, academics, and key practitioners and funders who provide support to survivors of conflict-related sexual violence.

Missing Peace will provide an opportunity to take stock of current knowledge about conflict-related sexual violence; exchange information about the latest research on causes, scope, and patterns of sexual violence; and strengthen an understanding of sexual violence beyond national boundaries. Participants will identify priority areas for research and policy development, as well as ways to improve documentation and response.

For more information, contact the Human Rights Center at 510.643.7215.