Uninsured Howard County residents would get up to seven visits to a physician a year and help from health coaches as part of an ambitious low-cost plan that officials hope will enroll 2,000 people the first year and become a national model.
The Healthy Howard Plan, unveiled yesterday by County Executive Ken Ulman, is expected to cost $2.8 million the first year, $1.6 million of which is to come from participants who will pay fees of $50 to $115 a month. The program will launch July 1.
The goal is to gradually provide access to affordable and coordinated health care for about 12,000 uninsured adults and 5,000 children in one of the nation's wealthiest counties by knitting together services from existing programs. To be eligible, participants must have household incomes of less than 300 percent of the federal poverty level, or $61,500 for a family of four.
The Chase-Brexton Clinic in Columbia, which now treats about 1,000 mostly uninsured people, will be the focus of primary care services during the first year.
The program could provide data for state or national policymakers working to widen health care access for working families.
"I think it's quite an innovative model and unique in certain respects," said Karen Davis, president of the New York-based Commonwealth Fund, a private foundation that supports independent research on health-care issues.
"What will be interesting about this is, if we really invest early on with modest-income families, will that lead to better outcomes and offsetting savings?" she said.
Nationally, 47 million Americans are estimated to be without health insurance, with 766,000 in Maryland.
"It's absolutely unacceptable that over 20,000 people [in Howard County] have no health insurance. That is unacceptable, and it ends starting today," Ulman said.
The Healthy Howard Plan seeks to replace a system in which uninsured people seek treatment at crowded, expensive hospital emergency rooms, with the cost paid for in higher premiums for those who are insured.
Instead, the program will provide primary health care at the Chase Brexton Clinic, plus free or heavily discounted medicines and access to participating specialists and mental health services.
The idea, Ulman said, is to guide people through the variety of programs and opportunities while working with them to improve general health.
That would reduce hospital visits by teaching better everyday habits and through improved management of chronic diseases such as cancer, diabetes and heart disease.
Under the county's concept, each person enrolled would be evaluated by a physician and be paired with one of seven health coaches, six of them full-time and one part-time.
The health coaches will work with participants to craft an individual care plan. People who refuse to follow the plan could be put on probation after three months and lose health care after six.
The coaches will act like case managers, keeping track of participants' progress and consulting with the doctors. They will help clients achieve their goals, even if it means helping them get a gym membership or find child care.
Patients needing expensive treatment from specialists would be enrolled in existing insurance programs. For participants diagnosed with cancer, the Healthy Howard program would pay the $2,600 deductible for the Maryland Health Insurance Program and the patient would pay the monthly premiums.
The major difference from other locally sponsored programs, such as one operating in San Francisco, is that no business or individual would be required to enroll.
Only U.S. citizens who have been county residents for one year and uninsured for at least that long would be eligible for the Howard plan.
"It's a response to a real problem. The real serious problem is the failure of both the legislature and the Congress in addressing the insurance markets," said Robert E. Moffit, director for health policy studies at the Heritage Foundation and a member of the Maryland Health Care Commission.
"If it can work to get people better care, it's a good thing to do," he said.
Ulman said he plans to put $500,000 in the county budget next year to help pay for the program, with the final $700,000 in funding coming from donations from individuals and groups. Yesterday, Howard Del. Shane Pendergrass, vice chairman of the House Health and Government Operations Committee, handed over a $1,000 personal check to get the fundraising started.
"We're hopeful we're on the verge of some great things," Ulman said.
Ulman talked about his brother Doug, his father and his mother - all survivors of various kinds of cancers - as a primary motive in pushing him to tackle the issue. Doug Ulman's cancer was discovered by an X-ray in a hospital emergency room after a severe asthma attack at age 19.
"If we had not had health insurance, would we have gone to the hospital? Would we have waited it out?" Ulman asked.
"This is not a perfect plan, but it is a good plan," said Dr. Peter L. Beilenson, the Howard County health officer. "We felt so strongly we have to step out and do something" in the absence of comprehensive action on the state or federal level. "This is explicitly not insurance and not portable."
As part of the program, participants who get emergency treatment at Howard County General Hospital would have any debts they incur there forgiven, which Beilenson said would help reduce reluctance to get treatment and prevent bankruptcies, ruined credit ratings and other stresses that produce health problems.
Victor Boccolino, president of Howard County General, said the hospital now accumulates up to $10 million a year in bad debts but eventually recoups up to 80 percent of that from Maryland's reimbursement system.
Ulman has scheduled three public meetings in November in different areas of the county to explain the program to residents and hear what they think.
Beilenson said substance abuse and mental health services would be another focus of the Health Howard Plan.
"They must have parity with physical problems," Beilenson said.
The Cross Keys-based pro bono Counseling Program of Maryland has agreed to provide psychiatric help for up to 200 participants in Howard's program the first year, said Dr. Marvin Hoss, the president.
Ulman hopes that state plans to increase eligibility for Medicaid and a possible expansion of the federally funded State Children's Health Insurance Program will help the county reach its goals.
As part of the Healthy Howard Plan, county school students are getting letters about the state children's insurance plan and state Comptroller Peter Franchot is reviewing state income tax records to find and notify eligible families about existing health-care programs.
larry.carson@baltsun.com
The Healthy Howard Plan
Participants would pay:
$50 to $85 for one person making up to 300 percent of the federal poverty level. A couple would pay up to $115 a month
$75 fee for emergency room visit (waived if admitted)
$50 fee for urgent care center visit The plan provides:
Free or heavily discounted prescription drugs
Free immunizations, health screenings and inpatient hospital treatment
Up to six doctor visits per year for men, seven for women
No dental or vision coverage For the year starting July 1, the program would cost $2.8 million:
$2.2 million for primary care costs, prescriptions and insurance payments
$448,750 in salaries and wages for 6.5 positions
$88,400 for administration
$41,000 for rent and utilities
$35,000 for insurance and accounting The program would be paid for by:
$1.6 million in participants' fees
$700,000 in donations
$500,000 in county funding
Source: Howard County Health Department