Time to close loophole in S.F. health care law
San Francisco Chronicle
Edwin is a young, healthy San Franciscan working at a hotel. While commuting on his bike, he was clipped by a car and taken by ambulance to San Francisco General. Instead of providing Edwin with health insurance, his employer had funded a Health Reimbursement Account. Edwin’s bills totaled $5,500; the amount in his account was $2,500, leaving him $3,000 in debt.
Dave Hayes works at a tech company. On Dec. 27, his employer made a quarterly deposit of $900 into his health reimbursement account, but when Dave went to retrieve his money a few weeks later to pay $900 in medical bills, the account was empty. Under the account’s “use it or lose it” rules, the employer took the money back at the end of the year, just when Dave needed it the most.
These stories demonstrate a few of the failures resulting from a loophole in San Francisco’s groundbreaking health care law. Under this law, businesses with more than 20 employees must make minimum health expenditures on behalf of their workers. Most provide their employees with health insurance or pay into the city’s Healthy San Francisco program. However, a growing number of businesses have found a way to circumvent the spirit of the law by using health reimbursement accounts.
Employers temporarily fund the accounts on a quarterly basis, and employees are supposed to be able to access the funds for their medical needs. However – and here’s the loophole – at the end of the year, businesses get to take back the unspent money. Last year, businesses scooped back a whopping $4 out of every $5 that went into accounts set up to help workers with medical care.
As long as this loophole exists, businesses are motivated to establish barriers that prevent employees from using the funds. Many don’t even tell workers the accounts exist, while others restrict the use of funds so severely that workers can’t pay for health insurance, dental care or prescriptions.
Because businesses get to take back the unspent money each December, it’s best not to get sick early in the year when the accounts are empty. And, because the accounts empty each calendar year, and most employees with health reimbursement accounts work part-time and have little or no savings, it is practically impossible for the Edwins out there to pay for medical emergencies – whether major or minor.
Moreover, this loophole has become a profit center for many restaurants that add “health care” surcharges on their bills while spending little of the money to help workers stay healthy.
San Francisco Supervisor David Campos has a commonsense plan to make sure that HRA funds are available for workers when they need them. Unused funds would be rolled over from year to year, and businesses would have to inform employees about the accounts and how they work.
Campos’ well-crafted amendment will directly address the problem while avoiding legal pitfalls. The alternative proposals not only fail to address the full scope of the problem, they also conflict with federal law, and could place San Francisco’s health care ordinance at legal risk.
The Board of Supervisors should pass the Campos amendment. The loophole is unfair to the majority of businesses that are playing by the rules and to the thousands of workers who so sorely need and deserve health care.