Proposition G - Authorizing Health Plans for City Residents

Voter Guide
This measure appeared on the November 2004 San Francisco ballot.


What it does

The Health Service System was established in the Charter in 1937 to provide medical benefits to employees and retirees of the City, College District, and School District , and their dependents. It is currently managed by the Human Resources Department with rate and plan decisions proposed by the Health Services Board and approved by a supermajority of the Board of Supervisors. This amendment would authorize the Health Services Board to adopt plans or make other provisions for health or dental benefits for residents who have never been employed by City government.

Why it is on the ballot

Nearly 45 million Americans, or 15.6 percent of the country's population, were without health insurance in 2003 according the United States Census Bureau. The uninsured are disproportionately concentrated in central cities, where 19.5 percent of all residents are without coverage. Lack of health insurance is even more prevalent among immigrants and the poor.

A non-binding policy statement was adopted by the voters early in the Brown Administration urging creation of a resident health plan. The Mayor's Office and Health Department spent some time exploring options for coverage but the effort stalled as the economy faltered.

Proposition G was placed on the ballot by the Board of Supervisors.


Those who support Proposition G state:

  • The voters have already encouraged the City to develop resident health insurance. This will vest in a City department the authority to research and recommend, if feasible, such a plan.
  • Prop. G sets forth supermajority requirements for adoption of any such recommendations. The amendment is a reasonable grant of authority to a department that maintains appropriate oversight controls.


Those who oppose Proposition G state:

  • The Health Service System has gone through a very difficult decade and only recently got its management house in order. Adding this potentially huge undertaking to the department could again result in mismanagement of the employee-retiree health plan.
  • While expanded public health coverage is an important goal, it only makes sense for the state or federal government, not the City, to provide it. If San Francisco provided health coverage for residents, it would provide an incentive for people to move to the City who have health problems and need insurance, resulting in higher costs and undermining the original intent of providing insurance.
  • It is very unlikely that a cost-effective resident plan could be developed just in San Francisco . Despite the best intentions, this measure could end up creating huge new costs for City Government.

SPUR's analysis

Under the current Charter, the City cannot offer health plans to residents who are not City employees. This measure would authorize the Health Service Board to consider methods of creating a resident health insurance program and set forth the procedures for adopting such a program. It does not articulate the details of any such plan or how one might be funded; it simply makes it explicit in the City Charter that the City is allowed to provide insurance coverage to non-employee residents and defines the roles of various governmental entities in investigating and drafting such a plan.

The Health Services Board would be authorized to propose a plan, which would require approval by two thirds of the board. It would also require an ordinance approved by three-fourths of the members of the Board of Supervisors detailing how the plan would be implemented. Any plan would also be subject to the regular annual budget process set forth in the Charter.

The measure specifies that the Health Service Trust Fund, which funds coverage for City employees and retirees, could not be used to fund resident coverage.

Furtherance of health coverage is a sound public policy objective and there is no reason the City should not at least explore the options for implementing such coverage for residents.

While the measure causes some concern that a poorly designed health plan for residents could unintentionally lead to large cost increases for City government, the measure contains adequate safeguards to ensure any proposed plan will not be adopted without a high level of public scrutiny. It is not clear at this time whether a viable San Francisco-only health plan could work, but we don't lose anything by exploring the option.

SPUR recommends a "Yes" vote on Proposition G.