Changes in the works at Healthy Howard

Thousands of Howard residents have stepped from the parking lot of the Health Department offices through the glass door to the county's Door to HealthCare program in the past 18 months, using this portion of the innovative Healthy Howard project to search for a doctor and a way to pay for services.

The door will remain open for the foreseeable future and will admit more people with the advent of the federal Patient Protection and Affordable Care Act in 2014. Changes are in the offing at Healthy Howard.

While the part of the Howard project that provides health services for the uninsured will shut down when the Obama administration's health overhaul law takes effect, the Door program is expected to get many more visitors as uninsured residents seek help figuring out their options.

"We will double or triple in size in terms of the number of people we see," with much of that expansion expected in the first year, said Liddy Garcia-Bunuel, executive director of Healthy Howard, a nonprofit agency that operates through member fees, foundation grants and county money. She said 10,044 people have used the service.

Of the county's population of about 300,000, about 20,000 are believed to be without health insurance. Under the new federal law , if they do not qualify for some other program, they will have to buy private insurance or pay a penalty — the so-called individual mandate that the Supreme Court ruled last month is allowed under Congress' authority to levy taxes.

Garcia-Bunuel said her agency has been spending the past year taking stock of the four-year-old Healthy Howard program by surveying benefactors and clients and looking ahead to what the Supreme Court might do.

If the exact legal grounds underpinning the court's 5-4 ruling were not anticipated, the decision was one of three possibilities considered by Howard's Health Department, said Dr. Peter L. Beilenson, the county's health officer. The department considered the possibility that the justices would strike down the law, uphold part of it or let it stand in its entirety.

While the court struck down the penalty for states that do not expand their Medicaid programs, Maryland is expected to do so anyway.

Former Massachusetts Gov. Mitt Romney, the presumptive Republican presidential nominee, has vowed to repeal the law if elected, but state and Howard officials are proceeding as if the Affordable Care Act will take effect as planned in January 2014. That means the portion of Healthy Howard known simply as the Health Plan and billed as the most progressive aspect of the effort — county officials say it is the only program like it in the country — will fold.

The Health Plan is not insurance, but for a fee much lower than the cost of health insurance on the open market, it provides medical services to people who have no health insurance and do not qualify for another program, such as the MarylandChildren's HealthInsurance Program or Primary Adult Care. As the new law requires that everyone have health insurance, the Health Plan — which has served about 1,700 county residents since it was established in 2008 — will no longer be needed.

What will be necessary will be guides to the new world of health coverage. Garcia-Bunuel calls these people "navigators" who will be certified to work much as the folks who now help the residents who visit the Door to HealthCare.

The Door is "sort of the guts of our program," said Garcia-Bunuel, walking through the tidy gray-carpeted waiting room and past the four cubicles where staff members sit in front of computers, helping applicants figure out their options among an array of government programs using an online application. Without any marketing, she says, there's been a "steady flow" of applicants. "People find us."

Much of the detail of life under the federal health care overhaul is yet to be figured out, Garcia-Bunuel said.

It is unclear how many private insurance companies will take part in the so-called insurance exchange in Maryland and how many navigators the county will need. The computer software to run the program is still being developed by the state of Maryland, which Garcia-Bunuel said is a bit ahead of other states, as Maryland officials have been operating on the assumption that the law would be upheld.

It is also not clear what will happen to the Healthy Howard "health coach" effort, which has been tied to the Health Plan. Those who are using Health Plan services can get a discount on their monthly rate if they also sign up to work with a coach on goals they set for themselves.

Most people pursue a regimen that deals with exercising more and losing weight, said Maureen Pike, director of the Health Plan, who has acted as a health coach. She said the coach tries to know enough about the person's life to know whether financial circumstances and day-to-day schedule are affecting health.

Garcia-Bunuel said she hopes a way can be found to preserve the effort, which includes three health coaches among the 32-member staff at Healthy Howard, which runs on an annual budget of $2.4 million.

"We think it's a really important piece to keep people healthy and well," she said.

It is also in the spirit of other parts of the Healthy Howard program, including health promotion campaigns in local schools, workplaces, restaurants and with families raising children.

Those efforts continue, alongside the work of getting ready for the Affordable Care Act, which Garcia-Bunuel supported while recognizing that it is not the more sweeping transition to a single-payer system that she would have preferred.

"Is this a perfect solution? Absolutely not," she said. "Is this a step in the right direction? Sure."

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