Like the thousands of Howard County residents who are without health insurance, Carol Ray cannot afford preventive health care or visits to the dentist.
A mother of two teenage boys, Ray, 45, said her $25,000-a-year secretarial job at a small extermination company can cover her apartment's rent and utilities and other necessities, but not private health insurance.
"I'm not looking for handouts. I'm just looking for something I can afford," Ray said about finding insurance.
The Ellicott City resident said she believes she has found affordable coverage as part of the Howard County government's initiative to provide health insurance for every low-wage resident in the county.
The first step of the program, announced last month by County Executive Ken Ulman, will give 175 county residents the opportunity to buy a discounted two-year insurance plan through Kaiser Permanente. A lottery will be held Tuesday to determine the recipients.
Ulman will announce full details of his plan Oct. 16.
Kaiser's plan charges participants a portion of the cost -- ranging from $19.35 a month for individuals who are below 175 percent of the federal poverty level and $112.40 a month for families with more than three members and who fall between 175 and 250 percent of the poverty standard, the nonprofit HMO said.
"Whatever your state of health, if you're chosen through the lottery, we'll cover you," said Kaiser Mid-Atlantic President Marilyn Kawamura.
While Ray can afford the program, many of the county's 18,000 to 27,000 uninsured residents cannot, said Barbara Hope, director of social services for St. John the Evangelist Catholic Church in Columbia.
"Families are going to have trouble paying that," said Hope, who helps uninsured community members find affordable health care. "I'm glad somebody is doing something, coming up with something creative, but I know they're having trouble paying their gas and electric bills. If they're weighing that everyone's healthy, they would probably pay for gas and electric instead."
Uninsured residents have limited options.
The county Health Department offers family planning clinics and Howard County General Hospital runs at least three annual health fairs that target minority populations.
Health Alliance, a clinic for the uninsured in Howard County, closed its year-round services in June 2006. The clinic was replaced when Chase Brexton Health Services opened its Columbia branch in September 2006.
However, since May Chase Brexton has not been accepting new referrals for uninsured patients because about 80 percent of the new patients did not have health insurance, said David Shippee, Chase Brexton's chief executive officer.
"We had to take that step, unfortunately, because we could not handle [the uninsured] ourselves," Shippee said. "It's been amazing, the increased demand in Howard County specifically."
To remain operational, the Baltimore-based health center wants one-third of all patients to have commercial insurance coverage, one-third government-funded coverage and the remaining third uninsured.
When Ray fell ill with stomach pains this year, like the majority of the county's uninsured, she went to Howard County General Hospital's emergency room. She could not afford her treatment, and now she said she ignores calls made to her home from a bill collector.
As more residents turn to the emergency room, the hospital pays more for patients who are ineligible for assistance. The hospital spent $987,000 from July 2006 to June 2007 to cover their treatment -- about $180,000 more than in the previous year, said Sharon Sopp, the hospital's spokeswoman.
Social service providers are attempting to find doctors who will accept patients at lower costs, but demand has become overwhelming, several groups said.
"I've done pretty well to get people connected with resources, but that gets more challenging," said Kris Holmes, the nurse coordinator for Parish Nurse Health Ministries of Howard County. "There's fewer and fewer services for folks whose incomes are lower or don't have health care insurance."
Applications for the Kaiser plan are accepted online and in the county's public libraries. More than 200 people have signed up, said Lisa De Hernandez, the public information director for the Howard County Health Department.
Ray, whose sons are covered through the State Children's Health Insurance Program, will not have to wait for the lottery. The county gave her an additional slot for the Kaiser plan last week in gratitude for her de facto role as a spokeswoman for the uninsured. Lately, she has appeared on several television programs to discuss living without health insurance.
Those who are not selected should be pulled into the larger county plan when it is announced. But aside from those who submit applications, the county can make only rough estimates of how many residents need insurance.
"Counties across the country have been clamoring for the census bureau to give us a better idea [of how many are uninsured]. ... No one has had enough cash to measure it on a continued basis, which is what we need to do," said Glenn Schneider, the county's director of health services. "The most important thing we as a county can do is find the people who are uninsured and connect them, if they wish, with something we can offer."
After details of the plan are revealed, the Health Department will organize three town hall meetings for feedback on the plan and ways to improve it, said Dr. Peter L. Beilenson, director of the county Health Department.
Information: www.hchealth.org, or 410-313-4267.