Howard County officials plan to announce an ambitious plan next month that would make it one of the first counties in the country to offer health care to all uninsured residents.
Although details are not complete, the move would put prosperous Howard in the forefront of the national debate about the availability of health care - a goal that County Executive Ken Ulman has advocated since his election in November.
"The opportunity to deliver affordable access to those in our community in the wealthiest county in the wealthiest state in the wealthiest country is something we ought to be able to do, and we're pretty close," Ulman said this week.
The plan will be designed so it can be adapted for use in counties elsewhere in the state and nation, said Dr. Peter L. Beilenson, Howard's health officer and the plan's primary architect.
Under the proposal, uninsured residents of any age would pay a small fee for access to primary health care - using a participating doctor or clinic - instead of being forced into crowded hospital emergency rooms. Only Howard County residents would be eligible, Ulman said.
Though the Howard plan is part of a growing trend in which communities try to help people get health care, its intention to cover all uninsured county residents appears to be more comprehensive than the others.
"We thought this was a national issue, but first states, and now local governments, are working on it. If you were to start anywhere, you'd probably start in a wealthy county like Howard," said Gerard F. Anderson, a professor of health policy and management at the Johns Hopkins Bloomberg School of Public Health.
Still, it won't be easy, Anderson said.
"You'd have to have huge border-crossing issues," he said, adding: "I think they would have a great deal of difficulty pulling it off."
By stressing preventive medicine, Howard's plan would be different from other initiatives, including the 10-clinic Montgomery Cares system operated by a nonprofit in Montgomery County, said Richard M. Krieg, president and chief executive officer of the Columbia-based Horizon Foundation.
"This will try to put some high-traction prevention on the ground to really improve health in general. It's a very broad approach," he said.
Beilenson said Howard's plan will combine funds from participants, businesses, foundations and government - mostly money already in the current health care system. Ulman said some county money might be needed. Beilenson said the county plan will not require employer participation.
According to federal studies, 6.9 percent to 9.9 percent of the county's estimated 272,452 residents - 18,800 to 27,000 people - lack health insurance, Beilenson said.
An important element of the Howard plan would be the participation of the Baltimore-based Chase-Brexton Clinic. It treats about 1,000 uninsured patients at its Columbia clinic and can easily expand, said David H. Shippee, the nonprofit's executive director, who has been discussing the proposal with officials for months.
County officials "have to refine the specific population they really want to care for," Shippee said. "The initial idea is to take care of anybody working and uninsured."
Unanswered questions include how to handle family dependents and how to conduct enrollment, he said.
"Eighty-four percent of working people work in small businesses that don't have [health] insurance," Ulman said. "Some of this is just being creative with what is existing - much of it, in fact."
Jonathan Weiner, a health policy professor at Hopkins, agreed that funding should be available. "There is a lot of money already in the system," he said.
Formal announcement of the Howard County health plan is expected Oct. 16, and it would take about a year to implement, Beilenson said.
"We want this to be replicable, Beilenson said. "No matter what comes out of this, we're close enough to a final version that I can say, 'This is not just something a wealthy county can do. This is something that pretty much any county in Maryland can do.'
"This is meant to be a model. It is not a panacea," he said. But without a federal or state comprehensive plan, "we feel the county can do something."
Beilenson, formerly Baltimore's health commissioner, said the plan probably could not be used in the city because of the large number of needy people there, but it would not conflict with any state expansion of Medicaid, the health plan for the poor. If the General Assembly expands coverage for lower-income working families next year, it would complement the Howard County plan, not compete with it, he said.
The Howard plan will not involve seniors or Medicare, Ulman and Beilenson said during an interview Tuesday in Ulman's office.
The 33-year-old county executive feels strongly about the availability of health care partly because of his younger brother Doug's struggle as a cancer survivor.
The announcement of the Howard plan is to come days before an Oct. 27 event at Merriweather Post Pavilion in Columbia featuring cancer survivor and cycling champion Lance Armstrong. The event will benefit the Ulman Cancer Fund, created to help young adult cancer survivors such as Doug Ulman, who works for the Texas-based Lance Armstrong Foundation.
Steven M. Galen, executive director of Montgomery Cares, said more than 600 grass-roots community health programs nationally are trying to provide non-emergency room treatment for the uninsured. Last year, clinics in his seven-year-old program treated nearly 14,000 of the estimated 80,000 uninsured people in the county.
Montgomery County government provides nearly 80 percent of the program's $11.4 million budget. The program does not treat children nor does it receive federal support, Galen said.
A nonprofit in Muskegon County, Mich., a jurisdiction with about 170,000 inhabitants on the eastern shore of Lake Michigan, started a modest system in 1999 aimed primarily at low-wage employees of small businesses. The system, called Access Health, uses federal money that would otherwise go to hospitals for uninsured patients, plus contributions from small-business employers and their workers, to provide basic health care for about 1,200 people.
But the Michigan county still has thousands of uninsured residents, said Paul Fronstin, who studied the program for the Washington, D.C.-based Employee Benefit Research Institute.
San Francisco is also studying ways to expand access to health care, said Sara Collins, assistant vice president of the Commonwealth Fund, a New York-based nonprofit foundation. Several states, including Massachusetts, Illinois, Pennsylvania and California, have adopted plans or are discussing them.
Beilenson said Ulman isn't trying merely to expand coverage. "Ken has set a very audacious goal. Everybody has a right to have access to health care," he said.
Weiner noted that Beilenson helped spearhead a statewide project to extend health care and feels strongly about the issue.
"It's unconscionable in the wealthiest country in the world that we have 47 million uninsured this year, and that number has only gone up year after year," Beilenson said. "In the wealthiest state in the wealthiest country, that number is approaching 800,000, with very little being done. As a county of manageable size, we feel very strongly that health care is a right and also a responsibility."
Beilenson was a founder in 1999 of the Health Care for All Coalition, said Vincent DeMarco, president of the group, which advocates raising the tax on cigarettes by $1 a pack to help fund an expansion of Maryland's health services.