Howard County's innovative health access plan for the uninsured who have limited income will likely survive another year, though funding limits could hamper operations.
At least three of the five county council members said they will support the $500,000 requested to get the program through another fiscal year, though program officials said an inability to get more money from private foundations will force a 750-patient limit. The program had 621 people enrolled at the end of April. Final county council budget votes are scheduled for May 19.
According to figures presented to the council, the program has screened 6,089 people and found that 3,789 were eligible for existing insurance plans. Another 789 enrolled in Healthy Howard, but 178 dropped out for a variety of reasons including changes in income and the cost of the program. Participants pay from $50 to $85 a month for comprehensive medical services, though it is not insurance.
"If I'd wanted to apply for what we're doing every month, I'd have asked for $750,000, but we knew the reality of what you are facing," program director Liddy Garcia-Bunuel told the county council at a budget work session Wednesday. "At this point we're at bare bones," deputy director Josh Curtis told the council members. We have managers doing clerical work," he said, and three full-time-equivalent health coaches for all 621 patients.
One big problem is that an anticipated second year of $500,000 of funding from the Horizon Foundation did not materialize, Garcia-Bunuel said. The foundation provided $150,000 instead. Other area foundations have refused grants to Healthy Howard, officials said, either due to the recession or because they see Howard County as the wealthiest county in the wealthiest state in the nation and feel county government should pay for it. And because enrollment is lower than expected, there's less income from monthly premiums to pay for basic administrative costs. The program also needs a cash reserve in case of serious, costly cases.
Later, however, Richard M. Krieg, President and CEO of Horizon, produced a March 2008 letter signed by county health officer Dr. Peter Beilenson in which the first year's funding is described as a "one-time" matching grant with "no expectation and no committment" of additional money. Beilenson said program officials had applied for more, however, and had hoped to receive it.
Council Republican Greg Fox said he will offer an amendment to cut at least some of the county funding to the program, and council chairwoman Courtney Watson, an Ellicott City Democrat, said she may go along with Fox, but the other three Democrats on the council said they will support the program.
"I still have to do what I have to do," Fox? said. The general population doesn't have health coaches who promote healthier lifestyles and thus lower health care costs, he said. "Why should the (county) residents be paying for that?"
But the majority of council members strongly disagreed.
"This has kept a lot of people from needing other services," said Jen Terrasa, a southeastern county Democrat. "People go into bankruptcy, lose their houses" over health bills if they are not insured.
"I see this program as the way we should be doing things as a compassionate community," west Columbia Democrat Mary Kay Sigaty said. Calvin Ball, an east Columbia Democrat, agreed.
"I haven't heard a good rationale on why we should decimate funding for a service so badly needed," Ball said after the session. The program is a signature initiative of county executive Ken Ulman, who has enjoyed national notice for creating it.
Watson praised Healthy Howard, but later said she "may have to part ways with my Democratic colleagues on voting to fund the program.
"I think you're doing very good work," she told Beilenson, Healthy Howard's architect and the county health officer, and other Healthy Howard officials. "This program is incredibly innovative, but that is not the only consideration," she said.
She, like Fox, questioned the need for $500,000 since the enrollment is much lower than the 2,200 originally predicted for the program's first year. Enrollment began in October 2008 and treatment began in January2009. Watson also said she thought foundations, especially the Horizon Foundation, should "think differently" about the program and contribute more.
Healthy Howard will cease to exist in 2014 Garcia-Bunuel said, when the new national health care changes take effect. Since that law requires everyone to buy insurance and Healthy Howard is not insurance, it will go out of business or morph into a regional insurance co-op that won't require public money. As currently constituted, the program will need money for only three more years. If the county cuts funding in half, the program will go out of business, Garcia-Bunuel said.
"We are as slim as we absolutely can be," she said.
She added that now, as word spreads among uninsured working people, more are starting to apply.
"Now more than anything it's word of mouth," she said.
Fox seized on early studies of the program's patients that showed they had no more serious health problems than the general insured public to mean the program hasn't added anything special. He contends the thousands who learned they qualify for existing insurance by applying to Healthy Howard could be served in other, cheaper ways.
But Terrasa and program officials rebuffed that idea, saying that the program is serving as a vital "portal" for those without insurance and who have limited incomes. Getting nearly 3,800 people insurance is exactly what the program should be doing and is a major success, they argued, not a liability.