Uninsured

Howard County officials plan to announce an ambitious plan next month that would make it one of the first counties in the country to offer health care to all uninsured residents. Although details are not complete, the move would put prosperous Howard in the forefront of the national debate about the availability of health care - a goal that County Executive Ken Ulman has advocated since his election in November. "The opportunity to deliver affordable access to those in our community in the wealthiest county in the wealthiest state in the wealthiest country is something we ought to be able to do, and we're pretty close," Ulman said this week.

Diane MacPherson, of Lowell, Mass., lost her job at a relocation management company a year ago, and with it the health insurance for herself, her husband and their 4-year-old daughter. Her husband works in construction and does not have access to health care coverage at work. Continuing her family health insurance under the federal Cobra program would have cost $931 a month, so the MacPhersons decided to insure only their daughter, at a cost of $270 a month. Two months ago, when MacPherson's unemployment compensation payments ran out, they dropped their health insurance altogether.

Maryland House leaders unveiled a plan yesterday that would extend medical coverage to nearly 250,000 uninsured residents, a proposal that immediately ignited a debate over the key funding mechanism - a doubling of the state's cigarette tax to $2 a pack. The $600 million health care proposal aims to provide coverage for every child in Maryland by expanding Medicaid, while requiring that higher-income individuals and families buy insurance or pay a fee. It also would give subsidies to small businesses to provide insurance to workers and require that private insurers allow adults up to age 25 to stay on their parents' plan.

WASHINGTON -- The proportion of American children without health insurance is growing, and current trends in health care and welfare reform threaten to accelerate that dangerous trend, researchers and child-care advocates say.About 10 million American children under 18 were uninsured in 1994 - the latest year for which numbers are available, according to a recently released General Accounting Office report. That was 14.2 percent of all kids, up from 12.4 percent in 1992."It is a large and growing problem, and it appears that prospects for the future are even bleaker," Edward Howard, executive vice president of the nonpartisan Alliance for Health Reform, at a seminar on children's health coverage, said.

DALLAS - The last time Kevin Thornton had health insurance was three years ago. The lack of it was not much of a problem until he began having trouble swallowing. "I broke down earlier this year and went in and talked to a doctor about it," said Thornton, who lives in Sherman, north of Dallas. A barium X-ray cost him $130, and the radiologist charged $70, expenses he charged to his credit cards. The doctor ordered other tests that Thornton could not afford. "I was supposed to go back after the X-ray results came, but I decided just to live with it for a while," he said.

An Ellicott City pediatrician convicted of Medicaid fraud was sentenced yesterday to 18 months of home detention and ordered to provide free medical care for uninsured children. Howard County Circuit Court Judge Diane O. Leasure imposed the sentence, which spared Dr. Alfredo J. Herrera from jail, after a hearing that featured testimony from a series of community workers and volunteers - including a state senator and the chairman of Maryland's Transplant Resource Center. Despite requests for jail time from Assistant Attorney General Catherine Schuster Pascale, who said Herrera's decision to perform unneeded tests on young children created a large number of victims, Leasure said she wasn't sure that jail would serve the interests of the state's residents.

Some may gravitate toward the lucrative side of medicine, but not Dr. Daniel Aukerman or Dr. Sharon Y. Alongi. These two Carroll County physicians each, in their own ways, live out a common mission: treating indigent people who would otherwise lack access to medical care. For their work with uninsured and mentally ill patients, Aukerman and Alongi were recently honored by the nonprofit Partnership for a Healthier Carroll County. Aukerman learned at an early age to help make the world a better place.

WASHINGTON - Maryland was one of only three states that showed a big decline over the last six months of 2003 in enrollment in a national program to cover uninsured children, according to a report released yesterday by the Kaiser Commission on Medicaid and the Uninsured. The state health department said what has happened is mostly a bookkeeping change, not a cutback in coverage; most of the children kept the same insurance, but had it financed by a different program. Advocates, however, said even if the numbers are small, changes in state policies had denied coverage to some children, causing problems for those families.

Since the day the clinic quietly opened a month ago, men have been coming, nursing aching teeth and bad shoulders, worrying about HIV and high blood pressure. Some haven't seen a doctor in years. Others are so sick they have to be taken away in an ambulance. When the Baltimore City Health Department renovated part of its Druid Health Center on North Avenue, doctors expected it would take a while for patients to hear about the new Men's Health Center. Instead, dozens and dozens of men have been showing up. The only one of its kind in the nation, the free clinic serves uninsured men ages 19 to 64, providing primary and dental care, substance abuse counseling, and even links to jobs.

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.