Md. County Health Program Highlights Challenges

Howard County, Md., Health Commissioner Dr. Peter Beilenson says more people have enrolled in Healthy Howard, the county's program for the uninsured. But, he says, as many as 10 percent of those enrolled are in danger of being dropped because they cannot afford the program.

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ROBERT SIEGEL, host:

A few weeks ago, we asked people in one Maryland county - Howard County - how the big issues of health care play out in their communities. One of the people we heard from was the county health commissioner, Dr. Peter Beilenson, who runs a program for the uninsured. It's called Healthy Howard. It's small, it's still new, but it's lessons could be applied nationwide. As Dr. Beilenson described it to us, it is a very inexpensive program, heavy on preventive care. For people who make less than three times the poverty level, it's $50 to $85 per person per month. Back in May, the problem was how few people had signed up, and now Dr. Beilenson joins us again for an update. Hi, welcome back.

Dr. PETER BEILENSON (Health Commissioner, Howard County): Thank you.

SIEGEL: Why don't you remind us first of the target group you're trying to get signed up for this Healthy Howard program?

Dr. BEILENSON: The target group is people who have incomes between 117 and 300 percent of poverty. I wish is, to put them in perspective: for a family of four, that's about $25,000 to $66,000 per year. So, it's predominantly the working class folks.

SIEGEL: People who don't have health insurance and don't have such a low incomes that they would qualify for Medicaid, say.

Dr. BEILENSON: That's exactly correct.

SIEGEL: Okay, you had a few hundred people who had signed up. You had a target group of 10,000. What's happened since May?

Dr. BEILENSON: So, what we found the last couple of months are good news and bad news. The good news is we've had our two best months for enrolling people. And we think that's because more of a critical mass of information is getting out to our target population, the working class of Howard County that are uninsured. The disturbing trend has been that in each of the last couple of months, about 10 percent of our people who are enrolled and are actively taking part in our program, have been in danger of automatically being dis-enrolled because the debit cards they have given us had been overdrawn or their credit card had exceeded its credit limit.

SIEGEL: Now, we're talking about people who have - this isn't just a passive sign-up, you know, sign on this piece of paper and you're in the program. They've actually done some pretty heavy documentation to get in. They've expressed some real interest in having access to health care through your plan.

Dr. BEILENSON: Right. These are people who have clearly prioritized their health care. They've had to supply documentation. They've had to come to an orientation. They've signed agreements and they've given us their credit or debit cards for monthly payments. So, these are people who are truly making health care a priority.

SIEGEL: What they get, we should remind folks, was six or seven primary care physician visits a year, hospital fees forgiven, specialist care is given on a pro bono basis. You have a deal on prescriptions as well. This is very cheap. And you - what you're saying is your population is bumping up against dire financial straights, even at the $50 to $85 per person per month cost.

Dr. BEILENSON: That's right. They're bumping up against the financial ceiling with even this very modest amount of outlay required each month. And it's concerning because even the most subsidized of the current health care reform plans that are coming out of Congress for people in our income range, they will be expected to pay at least two times, and upwards of four or five times, more than we are charging with an individual mandate coming down from Washington.

SIEGEL: Are you surprised to learn just how strapped people are in those income levels?

Dr. BEILENSON: We were. We were very surprised. I guess it could - you know, you could criticize us for being in an ivory tower and being public health professionals who, sort of, tried to put together this good, new system of medical-home model and wellness and prevention focus, and thinking that for $50 to $85 per person per month, it would be, you know, pretty easy for folks to do who are making $25,000 to $65,000 a year. But it clearly is an issue, and I think it's something that has to be looked at in Washington, because all the talk of universal health coverage presupposes that there are people who are going to be able to afford the individual mandate.

SIEGEL: Well, Dr. Beilenson, thanks very much for giving us that update on Health Howard.

Dr. BEILENSON: Thank you.

SIEGEL: That's Dr. Peter Beilenson, who is the health commissioner of Howard County, Maryland.

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