4/23/2010 - Local plan for health care expansion set aside 
By Shaun Bishop 
The Daily News 
 
Following the passage of federal health care reform, a coalition of San Mateo County 
leaders shelved an ambitious plan to expand health care coverage to thousands of 
uninsured Peninsula residents. 
 
The members of the Blue Ribbon Task Force on Adult Healthcare Coverage Expansion 
had aimed to offer coverage to up to 44,000 low-income adults, but the group never 
resolved the crucial question of how to pay for the effort. 
 
After meeting Monday for the first time in over a year, task force members decided to 
halt work on a local plan and focus on helping county health officials implement the 
2,700-page health care legislation signed by President Barack Obama last month. 
 
Supervisor Adrienne Tissier said the federal reform will make affordable coverage 
available to uninsured residents, essentially accomplishing the same mission the task 
force set out to tackle when it formed in September 2006. 
 
"Truthfully, there were definitely some times where we really didn't think health care 
reform was going to happen, so we never stopped," said Tissier, who co-chairs the task 
force with Supervisor Carole Groom. "We never lost sight of the goal and fortunately 
health care reform came, and that really was our goal." 
 
Made up of representatives from labor, hospitals, nonprofits, business and government, 
the 36-member task force originally aimed to expand coverage to low-income adults ages 
19 to 64 who aren't covered by other government programs but can't afford private 
insurance. 
 
Officials believed between 36,000 and 44,000 uninsured people would qualify, allowing 
them to get care at clinics and hospitals in the county by paying a premium of up to $100 
per month. County officials said the program would reduce costs by having fewer 
uninsured people visit the emergency room for primary care. 
 
But the group never devised a way to fund the expanded coverage, which a consultant 
estimated in 2007 would cost about $300 monthly per person or up to $150 million in 
total. 
 
"There was no dedicated funding source, and the challenge is always to try to get those 
who are not paying today to be willing to pay," said Assemblyman Jerry Hill, D-San 
Mateo, who launched the task force with Tissier when he was a county supervisor. 
 
After ruling out a potential countywide tax, a 20-member subcommittee decided in 
January to pursue a minimum spending requirement for employers, similar to the 
employer mandate in San Francisco's health system. But the funding plan didn't make it 
to the full task force before the passage of health care reform in March. 
 
Furthermore, the county would have had to convince each of the 20 cities in the county to 
sign on to the employer mandate idea, no small challenge even in good times. 
 
In the current economy, "I don't think (cities) could say to their businesses, 'Please assess 
a tax,'" Groom said. 
 
Task force members said the research collected in the past few years should be used to 
help county health officials prepare for the rollout of federal reforms in 2014. 
 
"We're already prepared in a lot of ways to think about how we execute the 2014 
obligations to the county," said task force member Luisa Buada, CEO of the Ravenswood 
Family Health Center. 
 
Tissier said she believes local health reform efforts like the task force's and others in Bay 
Area counties helped convince local members of Congress that "they had our full support 
to be engaged in health reform, and they helped fight that battle." 
 
Groom said the group had some important accomplishments since it was formed, 
including helping start a pilot health coverage expansion called Access and Care for 
Everyone, which was funded by a three-year $21 million federal grant. The program has 
about 6,700 people enrolled. 
 
In another example of local health reform, Santa Clara County rolled out last month a 
voluntary, inexpensive insurance program for businesses with less than 50 employees. 
 
Hill said San Mateo County's effort was different because it pursued a broader 
commitment from employers. He said he isn't disappointed that the county's effort didn't 
come to fruition. 
 
"I think it served a great purpose in identifying and focusing on the problem and potential 
solutions," Hill said. "Now we've got one in hand."