San Francisco's landmark plan to provide healthcare coverage to most of its uninsured residents has been an operational success but is under persistent financial strain, reports the San Francisco Public Press.
The financial issues confronting Healthy San Francisco could be templates for other metropolitan areas trying to stretch their primary care capabilities.
Although Healthy San Francisco has been able to enroll more than 54,000 residents into primary care medical homes--about two-thirds of those who lack health insurance citywide--much of the cost of the coverage has been borne by community clinics and local businesses.
The San Francisco Department of Public Health spends about $100 million a year on the program but it relies on another $78 million that comes from private businesses, hospitals, community clinics, and the federal government.
"Healthy San Francisco is a model for healthcare delivery but not for payment," Stephen Shortell, the Dean of the University of California-Berkeley's School of Public Health, told the San Francisco Public Press.
As a result of the financial pressures, several clinics have stopped taking new patients. And should the Affordable Care Act be overturned by the U.S. Supreme Court, it's unlikely the program would continue to receive more grants from the federal government.