San Francisco's universal healthcare program withstood a legal challenge from restaurant owners, setting up the possibility for a showdown before the U.S. Supreme Court. In a split decision, the 9th U.S. Circuit Court of Appeals rejected an appeal from the Golden Gate Restaurant Association, which challenged the program's employer-spending requirement. Under San Francisco's plan, businesses with 20 workers or more must offer health coverage in one of three ways: sign up for private insurance, pay the city for coverage at a network of city and private facilities, or set up healthcare accounts.