Howard County's highly praised attempt to provide low-cost, preventive medical care for uninsured residents is off to a slower than expected start.
Only about 200 people have joined since enrollment in Healthy Howard began last Oct. 1, county health officer Dr. Peter L. Beilenson said, falling short of the admittedly ambitious goal he set of signing up 2,000 members in the program's first year.
"Enrollment is not where I hoped it would be," Beilenson admitted under critical questioning at a recent county council budget hearing. He did note, however, that another 250 applications, many representing entire families, are being processed.
The program is under close scrutiny for how successfully it addresses on a local level one of the most persistent problems facing the nation: how to provide health care for the uninsured, who number 50 million across the country and more than 700,000 in Maryland.
As the Obama administration tackles national health care reform, Howard's effort to provide coverage for every uninsured resident who wants health services will provide a glimpse into what works - or doesn't.
The program is also a signature initiative for County Executive Ken Ulman, a Democrat, and Beilenson, the former Baltimore City health officer who ran unsuccessfully for Congress in 2006, and could figure into any future ambitions of both.
Beilenson said the major roadblock to signing up more clients is lack of awareness. "I think it's very clear people just don't know about it," he said.
Another factor, officials said, is a reluctance of some residents to pay even a small monthly charge for coverage during a time of economic uncertainty.
The sluggish start to enrollment provided an opportunity for the program's chief critic, County Councilman Greg Fox, a Republican, to question whether there is a demand for it and if it merits a second $500,000 infusion of county funding for the coming fiscal year.
"The bottom line is, they're down to enrolling 20 or 25 a month, not 150 a month, and that's going to drop off, not increase," Fox said.
Fox is pushing to cut in half the county's contribution in the fiscal 2010 budget, which the County Council will vote on Wednesday. Supporters of the program say it needs both time and continued funding to succeed.
Patients in the program only began seeing doctors in January, they noted.
Karen Davis, president of the New York-based Commonwealth Fund, a private foundation that supports research on health care issues, said Healthy Howard "seems like it's off to a great start" compared to other locally sponsored programs around the country.
Most require contributions from employers, which Howard doesn't do, but that kind of private funding would have allowed for more advertising, she said.
Davis credited Healthy Howard for directing residents who had called its offices to existing state and federal insurance programs, who contacted Healthy Howard and found they were eligible for existing state and federal insurance programs like the federally funded Children's Health Insurance Program (SCHIP). About 2,500 Howard residents, many of them children, were assisted in this way, partly because of a specialized electronic enrollment system imported from California that identifies the programs for which they are eligible.
"None of those applications would have happened without announcing the [Healthy Howard] program," said Glenn E. Schneider, the Health Department's director of health policy and planning.
Healthy Howard is not insurance, but a network of local providers that charges members $50 to $115 a month for comprehensive medical coverage, including the use of health coaches to improve people's general health and over time lower crisis care expenses. In Maryland, every uninsured person's visit to an emergency room racks up big charges, most of which are paid by insured patients through higher premiums and charges.
Beilenson said his goal of enrolling 2,000 members the first year was overly ambitious and clearly not going to happen. His latest projections are for 908 plan members by July 2010.
"The biggest problem with all this is me," he said. "I made the definition of success this arbitrary 2,000 number."
An initial deluge of 1,100 calls swamped program workers and took several months to work through, he said. The recession has made it harder for some to afford the program's monthly charge.
Beilenson has witnessed the lack of knowledge about the program first-hand. Earlier this month, he screened 14 Howard County women for breast cancer as part of a free health department program, and 12 told him they had no health insurance. Yet not one had heard about Healthy Howard, he said.
Beilenson estimates there are at least 12,000 uninsured legal county residents who need access to health care.
"You have to give us a year or a year and a half to penetrate this market," he said.