Reinventing Health Care

IN HOWARD: Howard County's challenge is to persuade healthy uninsured residents to sign up for its low-cost plan

March 12, 2009

Officials in Howard County are showing that it is possible to significantly improve the quality of health care available to uninsured residents at a relatively low price - as little as $50 a month for a participant.

The county's new Healthy Howard experiment is not a Cadillac service. Care is available only within the county, and users can't pick who provides it. But the program does coach participants to lead healthier lifestyles and helps diagnose and treat medical issues before they lead to emergency room crises. Despite such obvious benefits, the program's managers have been surprised to discover that persuading relatively healthy residents to sign up for the innovative program is a challenge.

Lessons learned from the Howard program - positive and negative - should provide useful guidance for policymakers in Washington as they respond to the Obama administration's proposal to reform the system and provide health care for more than 45 million people who are uninsured.

One positive discovery by the Healthy Howard administrators was that most of the 3,000 uninsured county residents who first applied to participate in the program were already eligible for health care under a free federal program or relatively low-cost private health insurance. About 1,200 children were enrolled in the state's version of the federally funded Children's Health Insurance Program because of Healthy Howard's efforts. Dr. Peter Beilenson, the county health officer, credits an innovative electronic application process designed by a California nonprofit with helping to identify potentially available health insurance for uninsured residents. This technology could be a useful tool on the national level.

But despite its best efforts, Healthy Howard has yet to attract a significant portion of the estimated 13,000 uninsured county residents. One likely reason: In tough economic times, it is difficult to persuade healthy young people to part with even $50 a month for health insurance they don't think they need. That's something the national debate should take into account.

Healthy Howard is pursuing thousands of community college students and others to convince them that help in shaping a healthy lifestyle is worth the money. More applications from the growing ranks of the unemployed also are anticipated. The county's $500,000 investment in this program should be renewed for next year. It offers significant help for Howard's uninsured, regardless of the outcome of the national debate.

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