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Kent Health Plan Offers Coverage For Those Without
GRAND RAPIDS — Coverage for the estimated 55,000 people in Kent County who are without health insurance begins rolling out this fall under an initiative designed to increase public access to health care and cut the amount providers are forced to eat each year for uncompensated care.
The non-profit Kent Health Plan Corp. will initially offer coverage to indigent and low-income persons, then expand next spring to small businesses operators who are unable to afford health insurance for themselves and their employees.
By using existing federal and state Medicaid money that flows into Kent County, and leveraging it with public and private grants and donations to create $9 million in seed money, the Kent Health Plan will seek to provide basic coverage to people who now lack insurance.
Quite often people without health insurance are reluctant to see a doctor when an illness or injury occurs until the condition becomes chronic, which in turn ultimately drives up the cost of care.
“We can help people immediately and help them over the long run by addressing issues early on,” said Chuck Zech, a former vice president for Blue Cross Blue Shield in West Michigan who chaired a committee that has worked for several months to formulate the health plan.
“It’s a matter of cost and the desire to assure maximum prevention and early intervention through primary care,” Zech said.
The Alliance for Health, a regional health-care planning agency in Grand Rapids, launched the initiative a year ago to form a health plan to provide coverage to a growing number of working people who are without insurance. The Alliance for Health brought together key players from the provider and payer sides of the health-care industry, as well as governmental and social service leaders from Kent County, to force the program to address the issue.
The effort comes in an era of double-digit annual increases in health premiums resulting from the escalating cost of health care that forces many small business owners to go without insurance for themselves and their employees.
The Access to Health Care Coalition, a statewide group of health-care and business interests, estimates that more than 1 million Michigan residents are without health coverage. About 75 percent of the individuals are working, typically in low-wage jobs.
The net result for hospitals across the state was $823 million in unpaid medical bills in 2000, most of which was generated by people without health insurance who visited hospital emergency rooms. That’s about $150 million more than what went unpaid in 1999.
From a local perspective, the Kent Health Plan “is a great investment in our community, by our community” that will “succeed for all the right reasons,” Zech said.
“It provides a long-standing vehicle to ensure a greater number of our residents will always have access to health care because they will always have coverage,” Zech said. “This is going to be part of the fabric of health-care financing and delivery in Kent County.
“From every user perspective, there’s a benefit,” he said.
The Kent Health Plan launches Oct. 1 and will initially provide coverage by assuming responsibility for the approximately 2,000 Kent County residents now enrolled in the State Medical Plan that covers people who are unemployed, indigent or chronically ill. The plan will expand in January to low-income persons — those who earn 150 percent of the U.S. poverty rate, which last year stood at $17,029 a year for a family of four — who do not qualify for any government-funded programs.
The last, and by far the largest group, the Kent Health Plan would begin covering is the working uninsured, with enrollment for small businesses beginning in the second quarter of 2002. Employees and employers enrolled in the Kent Health Plan would pay monthly premiums of about $40 each, plus regular co-pays. Existing Medicaid funds will cover the remaining one-third of the plan’s cost.
Benefits for the working uninsured remain undefined for now, although coverage would likely include inpatient and outpatient care and generic prescription medications, Zech said. Organizers of the plan are also still negotiating participating agreements with health-care providers in Kent County, he said.
While the Kent Health Plan is surely not a cure-all to the problem of high health-care costs and the uninsured, as well as the cost-shifting that results from unpaid medical bills, it does represent a start toward addressing the issue locally, Alliance for Health President Lody Zwarensteyn said.
“We’re not unrealistic to say that everyone’s going to come in, but we’re going to start. You have to start somewhere,” Zwarensteyn said.
Zwarensteyn hopes the plan can eventually make a “big dent” in the number of people in Kent County without insurance and serve as a stopgap for small companies to provide employees some form of health coverage until they’re able to afford it in the commercial market.
“This may not be a rich plan, but it is a gap-filler until that company reaches sufficient profitability and can afford a commercial policy,” he said.
The working uninsured portion of the health plan is modeled largely after a similar effort in Muskegon County that now covers about 700 people working at about 300 small businesses.
Launched in late 1999, Access Health provides basic coverage for $38 per month for employers and their employees in Muskegon County and has experienced slow but steady growth. That relatively small pool that Access Health covers is indicative of the population it seeks to reach, said Vondie Woodbury, project director for the Muskegon Community Health Project, a community-based initiative that was behind the drive to form the health plan.
Most of Access Health’s customers are small businesses with a handful of employees. Of those workers, typically half of them are already covered under a spouse’s health insurance, Woodbury said.
“You end up signing up just little groups at a time. There are huge pools of people,” Woodbury said.
Employers participating in Access Health have generally never offered health coverage to their employees. Even when Access Health can identify a potential customer, many small companies and their employees still find it hard to afford the coverage, despite the health plan’s comparatively low cost.
“Many of these companies are hand-to-mouth,” Woodbury said. “They need to feel some comfort that it’s something they want to do and open up that benefit for their employees.”
Given those constraints, those behind Access Health prefer to judge its success based on what it does for clients, rather than how many employers actually enroll.
“It isn’t about the numbers,” Woodbury said. “Your view of success has to be a little different. You have to become a little patient.”