Low-Cost Health Care in Howard Not an Easy Sell

What if you build it and they don't come?

Officials in Howard County thought their low-cost health-care program would be an easy sell in a community where an estimated 15,000 adults are without coverage. But nearly four months later, they are struggling to get people to enroll.

Turns out, Howard is not unique. In Arkansas, a statewide program offering coverage through small businesses has enrolled 5,000 people, even though it can accommodate 10 times as many. And in Massachusetts, where health coverage is required by law, more than 167,000 individuals are losing tax benefits because they haven't signed up for insurance.

As the Obama administration and the Democratic-led Congress work to fulfill President Obama's campaign pledge to extend health coverage to more Americans, the experiences of those jurisdictions demonstrate a frustrating paradox: Even when low-cost health coverage is offered, many people fail to take advantage of it. People don't think they need coverage, don't know programs exist or don't have the money to afford even comparatively inexpensive, subsidized programs.

As a result, the programs have stepped up their marketing efforts. Howard officials plan to increase outreach efforts to local college students and small businesses. They are even resorting to cold cash -- offering some nonprofit community groups $20 for each person they help recruit for the program.

But the numbers alone show how daunting the job is.

In 2006, about 12 million non-elderly uninsured Americans -- about one in four -- were eligible for existing state or federal health programs but weren't enrolled, according to a recent study by the National Institute for Health Care Management, a D.C.-based nonprofit group underwritten partly by insurers. In all, 45 million people are without health coverage, a number expected to grow as the economy sheds jobs.

Still, even if more programs are offered, experts said, there is no guarantee that uninsured individuals will take advantage of them.

John Gruber, a Massachusetts Institute of Technology economics professor who studies health-care issues, said there is a long history of voluntary coverage programs that have failed because too few people enroll. The reasons run the gamut: People don't think they need coverage, don't know programs exist or don't have the money.

Julia Flynn, who lives in Howard and runs a marketing business with her sister, fits two of those three categories. She does everything she can to stay healthy -- everything, that is, but buy health insurance. She said she can't afford the premiums.

"It's always on my mind,'' said Flynn, who uses holistic treatments to keep healthy. She hasn't had any serious medical problems, but "when something does come up and I have to see the doctor, it's very upsetting."

There's a chance she could be eligible for coverage under Healthy Howard, which offers care for as little as $50 a month, but she wasn't aware of the program, the first of its kind in the Washington region and one of two of its type in the country.