"I understand that taxpayers that have nice salaries shouldn't have to cushion the impact for lower-income people," she said. "But if President Obama is going to institute this plan for health care, then it should at least be a plan where you won't forget about the low-income people such as myself."
Healthy Howard offers access to doctors at low cost to county residents in Barnett's predicament. It isn't insurance, but rather a network of services, designed in the absence of federal reform for those who earn too much to qualify for Medicaid but not enough to afford private coverage. For $50 to $85 a month, depending on income, enrollees receive primary care, access to specialty doctors, subsidies for prescription drugs, and a personal health coach.
The architects of the program aimed for monthly costs to be no more than 4 percent to 6 percent of a member's income. In Congress, however, the percentages being tossed around are much higher - between 10 percent and 12 percent.
Federal subsidies would kick in on a sliding scale. One proposal makes subsidies available for people earning up to 300 percent of the poverty level, or $66,150 for a family of four. Meanwhile, two other bills say up to 400 percent of the poverty level, or $88,200 for a family of four. Lawmakers are also negotiating limits on out-of-pocket costs and exemptions for financial hardship.
Even the most heavily subsidized proposals in Congress are twice the cost of Healthy Howard. Some cost six times as much, Beilenson said.
"What you're going to have is people either not complying with individual mandates and getting a penalty, or they will ... end up going bankrupt to pay for their health care," he said. "If they are noncompliant, they still are uninsured and will continue to go to the emergency room and run up costs."
Healthy Howard administrators at times have worked with people in jeopardy of losing benefits to keep them on the plan, with phone call reminders and in some cases, a few extra days to send in payments. The program's small size - just 325 members - made it possible to offer second chances an insurance company with millions of policy holders wouldn't, said Liddy Garcia-Bunuel, Healthy Howard's executive director.
Alan Sager, a professor of health policy at Boston University, said that subsidies - which act as a bridge for families who earn too little to afford the most expensive health care in the world - are at the heart of the effort to provide universal coverage.
