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Trapp D – The vast majority of enrollees in San Francisco's health program for the uninsured give it very high marks, but a minority report more difficulty accessing care or higher bills compared with the city's previous safety net system. Healthy San Francisco, launched in July 2007, provides health care and medical homes to uninsured adults through more than two dozen health centers and three hospitals. Participants pay sliding–scale fees and co–pays for certain care, but those earning less than the federal poverty level pay nothing. The program cannot be used to access care outside the city.

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