Howard Health Initiative Ready to Enroll Uninsured
September 30, 2008
By Lori Aratani
Howard County will launch an ambitious effort this week to offer medical coverage to uninsured residents for as little as $50 a month and already has 1,200 county residents lined up to enroll.
County officials said they developed the Healthy Howard initiative to give legal residents access to a doctor, to reduce crowds in emergency rooms and to lower health-care costs for everyone. The effort comes as jurisdictions across the nation look for ways to address the growing population of people without health insurance.
"Yes, we're stepping out on a limb, but our feeling is we can't continue to wait for our national government to get its act together," said County Executive Ken Ulman (D). "The state is making progress in covering more uninsured, but there still will be a gap. We want to create a model that may help improve the system and the way we approach the uninsured."
For one month, beginning tomorrow, county residents can sign up for the program, which will provide as many as six visits a year to primary-care doctors (women will receive an additional OB/GYN visit under the program), free in-patient hospital care, mental health care, discount prescriptions and other services that would probably cost thousands of dollars if participants had to pay out of pocket. Those enrolled will also be assigned coaches to help them work out personal health plans.
The county and private foundations will pitch in money, and local doctors will provide free or reduced cost services to help keep fees within reach for those currently uninsured.
Officials said they expect most of the participants to be working adults who make too much to qualify for state and federal programs but not enough to afford care. A single person with an income at or below 200 percent of the federal poverty level would pay about $50 a month; a couple with a family income up to 300 percent of the poverty level would pay about $115. For an additional $1.65 a month, they can also buy coverage for basic dental care.
Most children are expected to be covered by state and federal programs, officials said.
The program has been a priority for Ulman, who announced its formation last October. Ulman, elected county executive in 2006, has said Howard is ideally situated to undertake such an effort because of its progressive politics, its relatively small number of uninsured residents and its status as one of the wealthiest jurisdictions in the country.
In its first year, Healthy Howard will be open to 2,200 of the estimated 15,000 Howard adults who lack health coverage, officials said. They said many of the participants are likely to be people who have jobs but lack insurance. They are careful to note that the $2.8 million program does not provide insurance and cannot be used outside county limits.
"This is access, not insurance," said Peter Beilenson, the county's health officer.
The program is open to legal residents of the county who have been uninsured for at least a year, a requirement designed to prevent companies from dumping insured patients into the county's pool.
Doctor visits will not begin until January. Beilenson said if applicants exceed available spots, a lottery will be held. Officials hope to add up to 2,000 enrollees a year thereafter, but they said the number will depend on how the program works in its first year.
The county has put $500,000 toward first-year costs, with additional money coming from foundation grants and other private sources. About 60 to 65 percent of the cost will be funded through the fees participants will pay, Ulman said.
It's unclear how much care the participants will require, but Healthy Howard has budgeted much less per person than the average cost of health care nationally. In 2007, spending on medical care in the United States averaged $6,401 a person, according to an international study. Healthy Howard has budgeted about $1,500 a person for the first year, Beilenson said . The reduction is possible because Howard County General Hospital and many doctors and other health professionals are donating their time or drastically reducing their fees.
Officials at Chase Brexton Health Services in Columbia will provide most of the primary care, and various specialists will step in when needed.
Dave Shippee, chief executive of Chase Brexton, said that the program could be a model for other communities but that there are likely to be some bumps along the way.
"The real proof will be seeing how large this program can get," he said.
Key factors in the program's success will be the types of patients who sign up and how often they use the system, Shippee added. He also said that because the program is open only to legal residents, it does not get at the issue of what to do for those people who need medical care but are in the country illegally.
"It's one of the most innovative program set up to date in the country to pool resources from a variety of different organizations and make health care a reality for people who otherwise wouldn't" have it, said Richard Krieg, president and chief executive of the Horizon Foundation, which has contributed $500,000 to the program.
"This model really is one that says take what you've got in the community and try and weave it together," Krieg said.
The initiative is being closely watched by physicians and advocates for the poor.
"I hope they'll come see the doctor when they have chest pains, versus when they have a heart attack," said cardiologist Michael Silverman, whose doctors group is one of 16 specialty groups providing pro bono care.
Victor J. Broccolino, president of Howard General Hospital, agreed, saying the program could become a "safety valve for our emergency department."
Howard is one of the few jurisdictions nationwide offering a broad solution to the plight of the uninsured. In 2007, San Francisco launched a universal health care program that provides care for about 24,000 residents. Montgomery Cares, a program funded in part by Montgomery County, provides care to uninsured low-income adults through a network of nonprofit clinics.
"The vast majority of our plan will work," Ulman said. "There's no question that people who don't have access will have access. Some of this plan will most likely not work as we want. That's why we wanted to limit [enrollment] this first year. We wanted to have the ability to retool, to make sure we create a system that works."
