Howard's Health Plan Would Require Legislation
Requirements Likely to Delay Implementation

By Susan DeFord
Washington Post Staff Writer
Thursday, February 7, 2008

Howard County's innovative plan to provide access to health care for an estimated 20,000 uninsured residents requires state legislation because of its unusual structure.

But even if the legislation is approved by the Maryland General Assembly this session, the program will be delayed until Oct. 1, said Howard health officer Peter Beilenson, who helped develop the initiative. That would give state officials time to write regulations governing the program, known as Healthy Howard.

Beilenson said the program cannot be defined as health insurance because that would produce major financial burdens, such as a requirement for reserve capital.

"That would kill this," Beilenson told Howard lawmakers in Annapolis recently. "That would require millions we can't possibly raise."

A representative of the Maryland Insurance Administration said the agency is reviewing the plan to determine whether it constitutes an insurance program.

"I believe this is different from anything we've seen," spokeswoman Karen L. Barrow said. "Perhaps that's why we're needing to set up special rules for it."

"We're certainly interested in working with Healthy Howard and the General Assembly to develop the appropriate regulatory scheme," she said.

A draft of the legislation outlines a "public-private partnership" to provide health care. Del. Shane Pendergrass (D-Howard) and Sen. Edward Kasemeyer (D-Howard) are introducing identical versions of the bill.

There are few comparable initiatives in the country, Beilenson told the legislators, noting that only San Francisco is pursuing such a comprehensive measure for its uninsured residents.

Of the 20,000 people in Howard without insurance, 5,000 are children and may be eligible for federal assistance, Beilenson said. State and local officials are working to notify families that they could apply for subsidized children's health benefits.

Among Howard's uninsured adults 19 to 65, an estimated 85 percent work or have family members who work. Small businesses, however, often don't offer their employees health insurance.

In its first year, the program would have a $2.8 million budget and serve 2,000 people who are legal county residents, Beilenson told lawmakers. The plan would use existing federal programs, local government money, private donations and user fees to provide primary and specialty care, medications and lifestyle management. The program eventually may offer dental and vision care as well, Beilenson said. Sixty percent of the initial budget would come from monthly fees ranging from $50 to $85 that would be charged to people enrolled in the program.

The program, run by the newly created nonprofit Healthy Howard, also seeks $500,000 from the county in its 2008-09 budget and $700,000 in private funds.

An important feature of the plan is the decision by Howard County General Hospital to forgive existing medical debts of Healthy Howard participants, Beilenson said.

The hospital is hoping that regular access to primary and specialty care would keep participants from seeking expensive emergency room care. Health-care insurance rates in Maryland are adjusted to help hospitals cover the cost of uncompensated care.

Howard's plan could "slow down the increase in [health insurance] rates, which affect everybody's premiums," Beilenson said.