Howard seeking care for all

Program would provide affordable health care for uninsured residents

Sun exclusive

September 13, 2007|By Larry Carson | Larry Carson,Sun reporter

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.

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