On September 30, 2008, the United States Court of Appeal for the Ninth Circuit Court ruled that the San Francisco Health Care Security Ordinance and the corresponding Health Access Plan were not preempted by the Employee Retirement Income Security Act (ERISA).

San Francisco's Health Care Security Ordinance, enacted by the city in 2006, mandates that all private employers with more than 20 employees pay an assigned amount of money toward employee healthcare or pay the city a fee based on the number of employees and hours worked