San Francisco: Decoding the "healthy surcharge"

If you've been to my fair city recently, you might have noticed that some restaurants have an extra line on the end of the check that reads "Healthy San Francisco Surcharge." This fee allows restaurateurs to help pay for the city's health care program. The small charges vary: Some are a percentage of the total (usually around 4 percent), others tack on a dollar or two.

Not all restaurants include the charge, but by city mandate, all businesses with 20-plus employees have to either offer health insurance or help pay for the city's health care access program, Healthy San Francisco. HSF isn't insurance, per se, but it does offer affordable health care for uninsured residents of the city who don't qualify for Medicare or Medi-Cal.

The city charges businesses $1.31 to $1.96 an hour for each employee who needs HSF, depending on company size. Restaurants, just like other employers, are looking for a way to offset that cost, either by adding a surcharge or by simply increasing menu prices.

HSF is wildly successful and popular (94 percent of users surveyed by the Kaiser Family Foundation expressed satisfaction), but the added restaurant surcharges are controversial.

Most restaurant owners want to offer health care, but they argue that having private businesses (instead of the government) pay for the city's health care program is an unfair financial burden.

Starting in 2008, restaurants like Zuni Cafe, Max's Opera Cafe, and Rose Pistola started adding a "Healthy San Francisco" fee to alert customers to the cost of the program, instead of just raising prices. A group of restaurateurs have even filed a suit against the city arguing the employer mandate violates the Employee Retirement Income Security Act. The U.S. Supreme Court has delayed any action, instead seeking advice of President Obama; he has yet to respond.

Some locals are frustrated. "I'm losing my patience with the way restaurants are handling the 'Healthy San Francisco initiative,'" San Francisco Chronicle food critic Michael Bauer has written on his blog. He argues that restaurants should simply raise the menu prices to cover the HSF costs.

So, how does this affect you? Well, you have to pay the surcharge. But you don't have to include the charge when figuring tip. Many locals see it as an annoyance; but on the flip side, unlike many places in the U.S., San Francisco's waitstaff has access to affordable health care.