Ineligible? Don't Be So Sure.

By Michael S. Gerber
Special to The Washington Post
Tuesday, August 21, 2007

Uninsured Washington area residents shopping for health coverage -- or convinced they have to go without -- have a new tool to help them assess the options available to them. A Web site first developed for California by the nonprofit Foundation for Health Coverage Education now includes information specific to all 50 states and the District. The same information is available via a toll-free hotline for people using a phone rather than a computer.

While the information on the site isn't new -- several consumer groups have compiled essentially the same facts -- its interactive format lets users shortcut through complexities to personalized options much more quickly and easily. The foundation, funded largely by the insurance industry, argues that the oft-cited figure of 43 million uninsured Americans includes many people who don't know of the choices available to them.

Once a user identifies his state of residence, both the Web site and phone line use five simple questions to gauge a person's eligibility for public and private health plans open to those not covered by employers.

For example, if you report that you and your teenage son live in Washington, have no insurance and have a monthly income of $2,000, one plan you'll hear about will be the DC Healthy Families initiative, which provides health insurance to low-income children and their parents. The Web site also provides links to printable applications for many plans and phone numbers for insurers and government agencies.

Consumer advocates for the uninsured said they welcome any additional tools that could help people find insurance.

"It's a useful Web site, and I think it will help people locate sources of insurance," said Kathleen Stoll, director of health policy for Families USA, a Washington-based health advocacy group. But, she added, many people will still find the search daunting because "the eligibility levels [for public health plans] are very complicated."

Families USA, along with other organizations, offers a link on its Web site to a booklet containing similar information. But users of its site must leaf through many pages to find those that fit their situation.

The foundation's system uses a matrix of answers to its five questions on such matters as household income, employment situation and previous health conditions to personalize its guidance. Advice is also state-specific. So Maryland residents might learn about MCHP, the Maryland Children's Health Program, which uses state and federal funds to insure low-income children, while Virginia residents might be referred to the state's "high risk pool," a privately run plan for individuals not eligible for other insurance.

The matrix is the brainchild of Phil Lebherz, a California insurance executive who says he became frustrated several years ago when he came across people who did not qualify for the plans he was selling. He cited a dishwasher, for example, working at a restaurant that paid for its employees' insurance but not their children's.

"I felt like, to complete the job, I should help that guy get his kids covered," said Lebherz, who decided to create the foundation.

He first prepared pamphlets, then launched the Web site and phone line. After several years of catering solely to California residents, the help line and Web site went national this year. Lebherz said the hotline can assist callers in more than 50 languages.

The group's biggest financial supporter has been the Blue Cross of California Foundation. There's no preference given to insurance companies that donate, Lebherz said. Their motivation, he said, is to ensure that the uninsured population doesn't get so large that the government starts insuring everyone -- and takes away their business.

When a caller or a visitor to the Web site doesn't qualify for a public insurance plan, Lebherz said, the foundation can refer him or her to a network of brokers who sell private plans.

But the main goal is to sign people up for programs for which they didn't know they qualified. Lebherz argues that the number of uninsurable Americans is much lower than 43 million.

"About 14 million are eligible for publicly sponsored programs but not signed up," he said. He also says several million uninsured Americans are eligible for coverage under a federal law known as COBRA, which allows you to stay in an employer's plan after leaving your job. (This option often requires the consumer to pay much higher premiums.)

Although Stoll questions some of Lebherz's figures, she agrees that many children are not receiving coverage for which they are eligible.

"Your kids could be eligible, and you're thinking they're not because you have tried to apply yourself," Stoll said. "We need to do a better job to make it easy and simple." ยท

Michael S. Gerber last wrote for the Health section about comparative cardiac care information posted by the federal government.

© 2007 The Washington Post Company