Howard Health Initiative Ready to Enroll Uninsured

Howard County Executive Ken Ulman, center, said the county is well suited to attempting such a program. (By Katherine Frey -- The Washington Post)
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The county has put $500,000 toward first-year costs, with additional money coming from foundation grants and other private sources. About 60 to 65 percent of the cost will be funded through the fees participants will pay, Ulman said.

It's unclear how much care the participants will require, but Healthy Howard has budgeted much less per person than the average cost of health care nationally. In 2007, spending on medical care in the United States averaged $6,401 a person, according to an international study. Healthy Howard has budgeted about $1,500 a person for the first year, Beilenson said . The reduction is possible because Howard County General Hospital and many doctors and other health professionals are donating their time or drastically reducing their fees.

Officials at Chase Brexton Health Services in Columbia will provide most of the primary care, and various specialists will step in when needed.

Dave Shippee, chief executive of Chase Brexton, said that the program could be a model for other communities but that there are likely to be some bumps along the way.

"The real proof will be seeing how large this program can get," he said.

Key factors in the program's success will be the types of patients who sign up and how often they use the system, Shippee added. He also said that because the program is open only to legal residents, it does not get at the issue of what to do for those people who need medical care but are in the country illegally.

"It's one of the most innovative program set up to date in the country to pool resources from a variety of different organizations and make health care a reality for people who otherwise wouldn't" have it, said Richard Krieg, president and chief executive of the Horizon Foundation, which has contributed $500,000 to the program.

"This model really is one that says take what you've got in the community and try and weave it together," Krieg said.

The initiative is being closely watched by physicians and advocates for the poor.

"I hope they'll come see the doctor when they have chest pains, versus when they have a heart attack," said cardiologist Michael Silverman, whose doctors group is one of 16 specialty groups providing pro bono care.

Victor J. Broccolino, president of Howard General Hospital, agreed, saying the program could become a "safety valve for our emergency department."

Howard is one of the few jurisdictions nationwide offering a broad solution to the plight of the uninsured. In 2007, San Francisco launched a universal health care program that provides care for about 24,000 residents. Montgomery Cares, a program funded in part by Montgomery County, provides care to uninsured low-income adults through a network of nonprofit clinics.

"The vast majority of our plan will work," Ulman said. "There's no question that people who don't have access will have access. Some of this plan will most likely not work as we want. That's why we wanted to limit [enrollment] this first year. We wanted to have the ability to retool, to make sure we create a system that works."