In recent years, a number of state and local health care initiatives have been enacted. Among those garnering the most attention is the Massachusetts Health Care Reform Act, which among other provisions, requires employers not providing sufficient health care benefits to their employees to make “fair share” contributions to the Commonwealth. New proposed regulations, which would make these contribution requirements more onerous, are currently under consideration. Additionally, in Golden Gate Restaurant Association v. City & County of San Francisco, the Ninth Circuit Court of Appeals recently upheld a San Francisco ordinance requiring employers to make certain minimum health care expenditures on the part of their covered employees. Employers with employees in Massachusetts, San Francisco, and other jurisdictions with health care initiatives will need to monitor their health plans to guarantee continued compliance with these changing rules.