While the employers are still fighting to invalidate San Francisco's 2006 universal health care ordinance, most of the program's participants say it's been a success.

A survey by the Kaiser Family Foundation found that 63% of 1,100 program users were "very satisfied" with the program, known as Healthy San Francisco, while an additional 31% said they were "somewhat satisfied."

The landmark law requires all employers in San Francisco with 20 or more employees to provide insurance to their workers or pay a payroll tax to the city to help fund health care for the uninsured via a network of community clinics and hospitals.

The Golden Gate Restaurant Assn. has petitioned the U.S. Supreme Court to hear its argument that the law violates the Employee Retirement Income Security Act, which precludes states and local governments from dictating the content of employee benefit plans.

Although the survey's results come at a time when Congress is debating over health reform, the report's authors warned against drawing any comparisons between the proposed “public plan option” and San Francisco's program, much less trying to replicate it elsewhere.

Enrollees are only covered within the city and can only receive care from the participating providers, many of which already were extending health care services to the poor and uninsured, they point out.

"One potentially important factor in the success of Healthy San Francisco is the fact that San Francisco had a strong ‘safety net' system of care in place before the creation of the program," the study notes. "Many of the clinics that became designated medical homes under Healthy San Francisco were already providing services to the city's uninsured through a system of sliding scale payments based on patients' incomes. In fact, more than three-quarters of participants enrolled in the program as of October 31, 2008, had at least one previous visit to their Healthy San Francisco medical home in the prior two years."

Currently more than 45,000 city residents are enrolled in Healthy San Francisco, 92% of whom said they signed up for the program because they could not afford medical care or health insurance and were ineligible for other public programs. Seventy-three percent of participants have income levels below the federal poverty line. Under the program rules, residents cannot be denied coverage regardless of employment, immigration status or pre-existing conditions.