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Keeping Howard Healthy

Photograph by Chris Hartlove

Keeping Howard Healthy

Can an experimental program in the richest county in one of the richest states influence the nation’s health care reform agenda?

Eighteen months ago, Elizabeth McCarthy lost her auto sales job and the health insurance that went along with it. She and her husband, Jay, realized that if they got sick they’d have to reach into their own pockets or forgo care altogether. As it turned out, they did a little of both. Jay spent nearly $500 on medications to quell spring allergies that may have been exacerbated by the chemicals he uses in his furniture refinishing business. Elizabeth decided against seeing a doctor for a new prescription of the anti-anxiety drug she’d been taking for several years. And after slipping and cracking her elbow on her icy front stoop, she toughed out months of pain rather than pay for X-rays and treatment.

“I just hoped we wouldn’t get in a wreck or something,” says Jay, 57, who lives with his wife and 9-year-old daughter, Jillian, in a comfortable house in Ellicott City, Md.

The McCarthys are among the estimated 48 million people across the country without medical insurance. The problem was growing at a rapid clip even before the recent meltdown of the national economy, increasing by almost 8 million people between 2000 and 2008. Now, as the unemployment rate rises, health economists worry that the uninsured could swell by millions more.

The repercussions are well-documented: delayed care, large out-of-pocket expenses and over $40 billion nationally in uncompensated care that forces up premiums for those with insurance. An uninsured American receives less preventive care, gets diagnosed later and, once diagnosed, has a greater chance of dying than someone with insurance.

For the McCarthys, this was a reprise. They first lost coverage in the early part of the decade, when Elizabeth, now 50, lost her job selling homes in new developments. Not long after, she spent three days in the hospital where she incurred a $5,000 debt that still dogs the couple today.

Losing health insurance for a second time brought a new round of anxiety. But last fall, they were surprised to learn they were eligible for a new program called the Healthy Howard Access Plan. For a low monthly premium, the plan provides an array of primary care and specialty services along with subsidies for prescription drugs. Among the first residents to enroll in the program, the McCarthys are now part of an experiment to see if—in the absence of comprehensive national reform—a county going its own way can ease the health insurance crisis within its borders.

The richest county in one of the nation’s richest states—with a median household income of $101,000 and a 7 percent uninsured rate that’s less than half the national average—Howard may be more primed for success than most jurisdictions. County Health Officer Peter Beilenson, MD, MPH ’90, who during his 13-year stint as Baltimore health commissioner founded a universal coverage movement called Maryland Health Care for All, went to work on Healthy Howard soon after assuming his new post in February 2007. He says he’s first concerned with the “parochial” goal of bringing relief to thousands of uninsured Howard residents. But he hopes that success will ultimately have the broader effect of prodding state and even national leaders into action.

“Frankly, the reason we did this in Howard is that we’re tired of waiting for things to happen,” says Beilenson, who testified on the issue before a U.S. Senate committee in February. “We didn’t need anyone else’s approval to do this. But on the grander scale, our goal is to influence what comes out of Washington.”

David Holtgrave, chair of the Bloomberg School’s Department of Health, Behavior and Society (HBS), calls Healthy Howard “a proof of concept.” Says Holtgrave, PhD, who will be evaluating the program, “If this works in Howard County, an interesting next study would be to see if there are another five to 10 counties across the country that have wider ranges of income and challenges. They could serve as demonstration projects.”

The McCarthys were the sort of family that county leaders had in mind when they went about crafting their Healthy Howard Access Plan. Started in October 2008, it provides services to uninsured residents who earn too much to qualify for Medicaid but not enough to afford the high cost of individual coverage. To qualify, people must earn somewhere between 116 percent and 300 percent of federal poverty (or $25,000 to $66,000 for a family of four), and pay $50 to $85 a month depending where in the spectrum they fall. Jay and Elizabeth McCarthy pay a combined $115 for dual coverage. (A staff member also helped them enroll their daughter in the state and federally funded Maryland Children’s Health Program, for which they had no idea she was qualified.)

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