San Francisco can continue to operate its healthcare program after an appeals court ruled that it does not violate federal law. The unanimous ruling overturned a lower court decision that the Healthy San Francisco program had placed an undue financial burden on struggling businesses. Healthy San Francisco is the first plan in the country to offer universal coverage, and requires companies with at least 20 workers to provide healthcare or give part of each employee's hourly salary to the city as a fee to help offset the program's estimated $200 million cost.