It's been a local political football and a national cause célèbre, criticized for having a high cost-per-beneficiary using county dollars and lauded as saving lives.
Since its inception in 2008, the nonprofit organization Healthy Howard Inc., best known for its subsidized health-care plan for uninsured county residents, has left its mark on county politics and health policy. It has also lifted Howard County out of national health-care mediocrity — as a top-performing county, but in a middle-of-the-pack state, according to one recent study — and placed it at the forefront of the national health-care conversation.
Now, county officials are looking at the organization as the ace up their sleeves in dealing with what will be a massive roll-out of federal health-care reform in coming years.
It is the same reform for which Healthy Howard Inc. — which was "only created to fill a void left by inaction at the federal level," according to County Executive Ken Ulman — was once considered a substitution.
According to Dr. Peter Beilenson, head of the county Health Department, Healthy Howard is the department's most agile resource for interacting with residents looking for health coverage, a role that will become increasingly important as federal officials begin implementing the Patient Protection and Affordable Care Act, passed last year.
The law, if it survives a lawsuit challenging its constitutionality likely to be taken up by the U.S. Supreme Court next year, will require all residents to buy health insurance or face fines in taxes starting in January 2014. That requirement is expected to cause an influx of confused residents at local health offices upon implementation, officials said.
Healthy Howard, which was once assumed to have an expiration date that aligned with the implementation of the federal law, will instead play a continuing and prominent role in dealing with that influx through its Door to Health Care program, they said.
It's an evolution of roles for the organization that has swayed some of its most outspoken critics, including County Council member Greg Fox, a Fulton Republican.
This May marked the first time Fox did not challenge the organization's funding during the county budget process. After years of opposition, Fox noted that his issues with Healthy Howard had diminished.
"I'm better with the new direction," he said at the time.
As it exists today, Healthy Howard is a multifaceted organization handling not only its well known health plan, but also "community wellness" programs and the "Door to Health Care," a program opened in January as a veritable clearinghouse for residents who are unsure of which, if any, existing health programs they are eligible for enrollment in, including Healthy Howard's plan, the Maryland Children's Health Insurance Program (MCHIP), Medical Assistance for Families, Pregnant Women and Children, and the Primary Adult Care Program (PAC).
The "Door," as it is referred to by Healthy Howard staffers, uses software the organization is piloting for the state to help residents complete an electronic application that not only determines potential program eligibility, but also collates needed documentation for enrollment. At times, pieces of that documentation are pulled directly from existing medical databases, including the Medicaid Management Information System, and the Client Automated Resources and Eligibility System.
Before the Door's launch, Beilenson shifted department staffers who work with program applicants into office space adjacent to that of Healthy Howard, furthering direct collaboration between them and streamlining the county's response to residents looking for coverage, he said. The result has been dramatic.
The program has caused a rapid increase in the number of residents whom Healthy Howard serves on a daily basis, partially cutting down criticism that it isn't a cost-effective use of the $500,000-a-year funding it has received from the county since its start.
Between Jan. 18 and Oct. 6, a total of 5,504 residents used the service, an average of 30 per workday, according to Lena Hershkovitz, Healthy Howard's enrollment manager. Many have found some sort of coverage through the process, she said. That, combined with the 750 or so clients enrolled in the organization's health plan, amounts to a large increase in impact, officials said, and that impact has changed minds.
Last year, County Council member Courtney Watson, an Ellicott City Democrat, joined Fox in an unsuccessful attempt to amend the county budget to cut funding to Healthy Howard in half, largely because she felt it wasn't serving enough people, she said.
"I felt that we weren't getting enough bang for our buck," Watson said.
This year, because of the increased service through the Door and increased enrollment in the health plan, Watson voted to approve full funding to the organization.
"Healthy Howard has evolved and taken on a new dimension with Door to Health Care," Watson said. "They're more relevant to a larger number of people than they were before."