How Howard County Is Helping the Uninsured

In mid-October, we announced the Healthy Howard Plan. Built on strong community partnerships, the plan will give uninsured Howard County residents access to an affordable and comprehensive list of health-care services designed to keep them healthy and out of emergency rooms. The plan is not insurance, nor is it portable, but it will help bridge the care gap until the state and federal governments act to solve the problem.

Howard is the third-richest county in the United States, but that affluence does not insulate our residents from social ills. About 20,000 of our residents are uninsured despite the fact that 85 percent are part of working families. When you are uninsured, lack of health-care access means not getting care when you are sick, not getting the preventive screenings that could save your life and high medical debt that could ruin your family's financial future.

What few know about our health-care system is that about $1,000 of the premiums paid by the typical Maryland family with health insurance goes directly to covering the cost of hospital and emergency room care of the uninsured. That's right -- those with insurance are paying a "hidden health tax" to provide late and expensive care to others. Clearly, lack of health-care access affects us all whether we have insurance or not. Doesn't it make more sense, from both a moral and financial standpoint, to make certain the uninsured have access to the health-care services they need?

Patients in our new Healthy Howard Plan must be legal residents of Howard County and must have been uninsured for at least a year (the latter to avoid the problem of companies "dumping" their insured employees into this plan). Those who pay the monthly fee of $50 to $85 will gain access to comprehensive health services, including primary care, preventive screenings, steeply discounted prescription drugs, mental health and substance-abuse services, inpatient hospital care, and specialty care for the conditions that kill or sicken county residents most frequently. By leveraging existing programs and relying on new partnerships with health-care providers of all kinds, we will be able to give participants access to far more than the traditional primary-care-only plans that exist around the country.

Access to health care is a right and a responsibility. To that end, every participant will be teamed with a health coach to help him or her overcome barriers to healthful living. By working with their coaches and primary care providers, patients will develop a health action plan with measurable goals. While the "health coach" idea is not novel, our plan is innovative in that all of our patients will work with coaches and their action plans will be community-focused.

Take a typical patient with one chronic condition -- a 60-year-old diabetic who doesn't exercise and who is overweight. His health action plan might include nutrition classes, quarterly blood- sugar tests, diabetic foot checks and exercise three times a week. Working with our health coach team and community partnership coordinator, this patient would confront the barriers that stop him from eating well and exercising. Maybe that means having access to a low-cost gym class with babysitting for his grandchildren or a group nutrition class on Saturday mornings. Keeping with our philosophy of rights and responsibility, if our patient does not substantively comply with the action plan, he would eventually lose most program services except the primary care services for which he paid.

All of this is geared toward one overarching goal: improving the health of our participants and, by extension, of the community as a whole. To that end, we will be working with faculty members from our flagship academic institutions to evaluate the impact of our program on two major questions. Does providing access to this array of services, combined with health action plans, make a difference in the health status of our participants? And, cumulatively, do inappropriate use of emergency room services and potentially preventable hospital stays decrease? If the answer to both those questions is yes, as we believe they will be, our program will not only improve the health of Howard residents but could influence state and national health policy as well.

-- Peter L. Beilenson -- Ken Ulman

Peter L. Beilenson is the Howard County health officer. He formerly served as Baltimore health commissioner and founded the Maryland Health Care for All Coalition in 1999. Ken Ulman is Howard County executive.