Issue Position: Ensuring Full Access to Quality Health Care

Issue Position

San Francisco has long been at the vanguard of smart and innovative public health approaches, and I work to build on that strong foundation. I also fight to ensure that all residents have access to affordable, high-quality healthcare. I stand up for patients to battle rising drug costs, ensure that people living with HIV have access to life-saving treatment, and fund oral health programs for disadvantaged youth. I've also fought against the rise of type 2 diabetes, obesity and other health impacts related to the consumption of sodas, by authoring the proposed soda tax as well as legislation to require health warnings on advertisements so people are better informed about the health impacts of these drinks. I will continue to do everything I can to protect the health of our communities, no matter what it takes.

My work on health issues includes a number of different approaches:

Paid Parental Leave

The United States has fallen behind the rest of the world in requiring paid parental leave. New mothers and fathers often have to choose between spending time with their newborn or putting food on the table. We need to be doing more to support our families, particularly our low-income workers who cannot afford to take this time off. To address this, I authored legislation to require fully paid parental leave for workers, which the Board of Supervisors passed unanimously.

State disability covers up to 70% of an employee's wage for up to six weeks of parental leave. The new law, aimed at putting our workers and families first, makes San Francisco the first city in the country that requires employers to pay the remaining portion of employee income not covered by the state. Employees will now receive his or her full wages for up six weeks of parental leave.

Fighting Drug Cost Hikes

The Affordable Care Act bans exclusion of preexisting conditions from insurance coverage, but we have seen insurance companies classify life-saving drugs as "specialty" drugs and thereby dramatically increase the monthly cost of the drugs for policyholders. Policyholders have been forced to pay as much as $1,000 per month for their needed drugs. When I learned that one provider had placed numerous HIV drugs on this specialty tier list, I met representatives of that organization, and they quickly reversed course. However, non-HIV drugs are also impacted, and various insurance companies are employing this pricing approach. I held an oversight hearing on the subject and am coordinating with members of the California Legislature to support state legislation to address the issue.

Getting to Zero: Ending HIV Infections and Deaths in San Francisco

I'm part of a coalition that is putting together and moving forward a broad strategy to end HIV infections in San Francisco as well as ending HIV-related deaths in our city. Through a combination of innovative prevention efforts, expanded and quick access to effective treatment, and other efforts, we can see the end of new infections. I also held an oversight hearing on the efforts of our coalition.

Protecting HIV Funding

Since I took office in 2011, the federal government has cut over $25 million from San Francisco's allocation of HIV care and prevention funding. These cuts would have devastated our community's ability to cope with the continuing HIV epidemic. Each year, I've helped lead the effort to backfill these cuts in our local budget, and to date, we've backfilled 100% of those cuts.

Tobacco 21

For decades we have seen the catastrophic effects of tobacco use, particularly on those who start using tobacco in their teens. Tobacco use remains the leading cause of preventable death in the United States, killing more than 480,000 people each year and costing the United States as much as $170 billion in health care expenditures.

The Board of Supervisors unanimously passed the legislation I authored to raise the tobacco purchasing age in San Francisco from 18 to 21. San Francisco is now the second largest city in the country, next to New York City, to set the tobacco purchasing age at 21. The new legislation will help reduce adolescent tobacco use, which will combat addiction, help prevent long-term illness, and lower the rate of premature death caused by tobacco use.

Addressing Health Impacts of Sugary Beverages

I authored a measure to create a tax of two pennies per ounce on sugary beverages, with the proceeds dedicated to nutrition, physical activity, and health programs in public schools, parks, and elsewhere. Sugary beverages are contributing significantly to a spike in health problems, including type 2 diabetes in both adults and children. This tax would have reduced consumption of sugary beverages while also funding important programs like physical education, school lunch, after school programs, expanded recreation center hours, organized physical activity in our park system, and food access programs for low income communities. The tax received 56% of the vote, though not the required 2/3.

I also authored groundbreaking legislation to require that ads for sugary beverages contain a health warning, similar to required warnings on tobacco ads. These warnings will give people more information about the health impacts of these drinks, so they can make well-informed decisions about what they choose to consume. This legislation made San Francisco the first in the country to require warnings related to sodas and sugary beverages.

Health Care Access for Transgender People

I strongly advocate for the needs of the transgender community. One major challenge facing transgender people is lack of access to health care, even here in San Francisco. Healthy San Francisco -- our universal healthcare program -- is designed to ensure that all residents of San Francisco have access to care. When Healthy SF was adopted, the Department of Public Health administratively excluded certain medically necessary health procedures for transgender people. For several years, negotiations proceeded to remove that exclusion, but the negotiations stalled. I got involved and helped move the process forward, resulting in a decision to remove the exclusion. I then authored a resolution at the Board urging that result. Transgender people now have full healthcare access under Healthy SF.

Keeping Our Kids Healthy Through Vaccination

Vaccines are a key public health measure to keep our kids healthy and to ensure that all parents can send their kids to school confident that they won't be infected with viruses against which we can vaccinate. More and more parents have chosen not to vaccinate their children, which exposes other children too young to be vaccinated or who cannot be vaccinated for health reasons. I authored a resolution to support SB 277, a state law that eliminates the exemption from vaccination requirements based on a parent's personal beliefs.

Creating a New Gay, Bisexual, and Transgender Men's Health Center

I authored legislation to allow the San Francisco AIDS Foundation to build a comprehensive gay, bisexual, and transgender men's health center in the Castro, and also secured significant funding for the center.

Aging with HIV: Transitioning from Private Disability Insurance to Social Security

San Francisco has a growing population of aging long-term HIV survivors. A number of people who contracted the virus before protease inhibitors were available in the mid-1990s became available were quite sick and went onto private disability policies. Many will be forced to transition to social security when they turn 65, often representing a significant drop in income. This will cause a significant number of people to struggle to afford housing. I requested our Budget & Legislative Analyst to study the issue so that we understand its scope - how many impacted residents over what time period. The study showed what we suspected - that a discrete yet sizable population will experience this challenge over the next 15 years. I'm currently working with advocates and city departments to determine how best to address the problem.

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