San Francisco moved closer Tuesday to becoming the nation's first city to provide health care coverage for all its residents.

The city's Board of Supervisors unanimously approved a plan that would give adults access to medical services regardless of immigration or employment status. The plan's estimated cost is $200 million a year.

Financed by local government, mandatory contributions from employers and income-adjusted premiums, the universal care plan would cover the cost of everything from checkups, prescription drugs and X-rays to ambulance rides, blood tests and operations.

Unlike health insurance, it would not pay for services obtained outside San Francisco. Participants would have to receive care at existing clinics and public hospitals and from doctors who already participate in an HMO for low- and middle-income clients.

The Board of Supervisors must vote on the plan, which has been strongly opposed by the business community, once more for it to become final.

Businesses with more than 50 employees would have to start participating next July, while smaller enterprises would begin in April 2008.