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.