A rush for health

Howard County's new health access plan for the uninsured gets off to a fast start with 1,100 applicants

November 30, 2008|By Larry Carson | Larry Carson,larry.carson@baltsun.com

With the economy in trouble, 50-year old Elizabeth McCarthy is unemployed, but she and her husband Jay, 57, aren't worried about health care.

The Ellicott City couple were among the first of more than 1,100 Howard County residents who flocked to apply for the county's new health access plan for the uninsured when it launched last month.

"It takes an awful lot of stress off you," said Jay, a self-employed furniture finisher. Elizabeth added, "We've gone without when we should have had care."

Healthy Howard Inc. isn't insurance. But it provides limited-income residents affordable access to primary care doctors and specialists, dental and prescription discounts, and health coaches for preventive care - for a relatively small monthly fee.

And the response has overwhelmed the county. So many people applied after the program's Oct. 1 launch that enrollment sessions at a Columbia library were suspended at month's end to let county workers catch up on processing.

Though participants won't see a doctor under Healthy Howard until January, county health officer Dr. Peter Beilenson is already collecting information that he hopes will allow the program to become a model for use elsewhere. Even as the economic downturn pushes local governments to look for spending cuts, there is interest in Howard's approach, he said.

For County Executive Ken Ulman, now is the time to try new approaches.

As vice chairman of a health steering committee for the Urban County Caucus of the National Association of Counties, Ulman speaks about the program frequently. But he said leaders elsewhere are looking for hard data before making a commitment.

"People are intrigued, but until we can show we could get people access to quality health care, drive down costs and get good health outcomes," few similar programs are likely, he said.

James E. Philipps, a spokesman for NACO in Washington, said the organization has had little feedback from other counties on Howard's plan, though "counties are in the forefront of developing innovative ways to enhance access to health care."

Ulman pushed hard for the program and included $500,000 in county funds to help start it. "Generally, the [health care] debate is: 'How do we expand existing programs,' but very rarely is a new approach unveiled," he said.

"The fiscal crisis makes it more imperative to look at new ways to create a better system."

Even this early, Beilenson said the first enrollments are changing his pre-launch perceptions.

"What we've found in the first 1,100 applicants is really an indictment of the current [health care] system," he said. Hundreds of people who need health care came and stood on line for hours to apply, only to find they were eligible for one of several existing federal or state programs all along.

In addition, Beilenson has been surprised by the large number of young adult applicants. "We thought 20-to-40-year-olds would not come," he said, adding that the demand has made him consider advertising more at Howard Community College.

Shayla-Rene Little, 24, of Columbia, is an example.

A Howard Community College dance student struggling to start her own school for young artists, she's too old for her parents' insurance and can't afford her own. She ignored a recent inner-ear infection until it got worse and she was forced to a hospital emergency room. Now, for $50 a month, she knows care is available.

"I feel more secure," she said.

There have been few desperate cases - people who've put off health care and need immediate treatment - and that lack of so-called "pent-up demand" has also been a surprise, Beilenson said. "Our impression is very few [applicants] have dramatic health problems they haven't taken care of."

There are some, however.

Earlier this month, Beilenson appeared at a Columbia breakfast celebrating the 10th anniversary of the Horizon Foundation, which contributed nearly a quarter of Healthy Howard's first-year budget. He told of being approached at an earlier engagement by a man who had lost one of his two jobs and his health insurance with it. A diabetic, the man had run out of prescribed medications and was unable to get more. His blood sugar level was five times normal.

The diabetic man was sent directly to a hospital emergency room, Beilenson said.

That's exactly the scenario Healthy Howard is designed to prevent. It's open to Howard County residents who earn less than three times the federal poverty level and were without insurance for at least six months.

Under the plan, which this year is intended to reach about 10 percent of the 20,000 uninsured Howard County residents, participants will pay $50 to $115 a month, depending on income and family size. They will get up to six doctor visits per year (seven for women), and access to specialists who are donating services, including mental health care.

Howard County General Hospital, a subsidiary of Johns Hopkins, will not pursue Healthy Howard patients for bills, and emergency room treatment is free for true emergencies.

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