Unfunded health care liabilities are mounting in nearly every city in the nation. In some of the larger cities, the difference between funding and liabilities is staggering. For example, take San Francisco where Retiree Care to Cost City $4.4 Billion

After months of delays, the San Francisco controller’s office announced Thursday that it expected the city to pay $4.4 billion to provide municipal retirees and their dependents with lifetime health benefits. The city has set aside $9.7 million to cover the costs.



In an interview, Benjamin Rosenfield, the city’s controller, said that the situation would be worse if the city had not enacted changes that went into effect last year. New city employees must pay 2 percent of their salary into a health care trust fund. Requirements to receive lifetime coverage were also tightened.



But Mr. Rosenfield said tens of thousands of employees are still entitled to lifetime coverage, and they pay nothing into the fund.



To put the $4.4 billion liability in perspective, San Francisco has borrowed $2.6 billion through general obligation bonds in its entire history.



All city employees hired before 2009 were promised lifetime health care after five years of work. The coverage includes all dependents, and it does not matter how long before retirement the employee stopped working for the city.



In November 2009, the United States Government Accountability Office studied retiree health care liabilities of the 39 largest local governments. San Francisco’s then-$4 billion tab ranked No. 6 on the list, behind larger cities like New York and Los Angeles.

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If the city is unable to set aside large sums to address the growing liability, Mr. Rosenfield said, one viable solution would be that “over time and through collective bargaining” current city employees contribute more.