Mar 22, 2008

Businesses worry about expanded health coverage

By Shaun Bishop / Daily News Staff Writer

San Mateo County leaders' effort to expand health coverage to thousands of uninsured residents has small business owners worried that they will be stuck with an unfairly large portion of the bill for the ambitious plan.

Local business leaders expressed those fears Friday, the same day the Blue Ribbon Task Force on Adult Healthcare Expansion voted 31-1 to approve its final recommendations for providing health care to an additional 36,000 to 44,000 adults 19 to 64 years old.

"They're very concerned about the current economic environment," said David Amann, who represented the Redwood City Chamber of Commerce on the task force and was the only dissenter. "They're worried an additional cost at this point in time could really affect whether they can come out on the other side of this recession."

The county already offers coverage to children and some low-income adults and wants to include adults who don't qualify for public programs such as Medi-Cal or Medicare but can't afford private insurance.

The task force - made up of 36 representatives from government, hospitals, labor, businesses and nonprofits - pledged to develop a plan that would cover residents who make less than 400 percent of the federal poverty level, or $84,800 annually for a family of four.

Its recommendations, developed over a period of more than 1 1/2 years, call for:

_ a strong emphasis on primary care to reduce expensive emergency room visits

_ careful management of patients with chronic diseases to control costs

_ expanding public health system capacity through partnerships with private hospitals

_ better coordination among health care providers

The system would be administered by the Health Plan of San Mateo, which runs the county's Medi-Cal and children's health programs, if the recommendations are approved May 20 by the San Mateo County Board of Supervisors. However, the biggest hurdle remains - how to pay for the expansion, which a consultant estimated will cost $100 million to $150 million.

Enrollees will be asked to pay up to $100 per month for coverage, depending on income, but the coverage is expected to cost $300 per person, so other funding sources will be needed.

On Friday, the task force agreed to form a committee to look into requiring employers to pay a certain, undetermined amount toward the program. Under that scenario, each city would propose ballot measures to require employer contributions.

Business leaders said they fear having to shoulder a greater share of the cost than citizens, who would benefit more directly from the coverage. A countywide sales tax is another idea, though businesses have concerns about that, too.

"We just want to make sure it is a shared approach and we don't put the burden of this on the back of small businesses," said Dan Cruey, president of the San Mateo County Economic Development Association.

Other task force members stressed the importance of having business representatives involved in finance discussions so their concerns can be heard.

"They need to know it's not a threatening thing," San Mateo County Supervisor Adrienne J. Tissier said.

Supervisor Jerry Hill said he wants to make sure the process is collaborative and the county isn't viewed as making unilateral decisions.

"There always seems to be some negativity when government is moving the agenda," Hill said.

The task force is scheduled to reconvene in October to discuss financing options. Meanwhile, county staff will focus on expanding the system's capacity and try to learn from a three-year pilot program that began in September to cover 2,100 patients.

Despite the work ahead, task force members praised the process of drawing up the recommendations, saying it helped them think differently about improving the health care system. Ultimately, the money question will determine when or if the plan becomes a reality.

"I think some of the toughest nuts to crack are in this next piece," Tissier said.



E-mail Shaun Bishop at sbishop@dailynewsgroup.com.