Kent Health Plan At Crossroads
Lynda Zeller has been riding a poignant roller coaster as president of Kent Health Plan for the past three years and has managed to survive the jolting ups and downs that naturally come from trying to provide health insurance coverage to the county’s uninsured.
She has reveled in the good this year, but is bracing for the bad that may be just a few days away. And in her reporting of what’s good and what’s bad, Zeller chose to start with the most electrifying positive she could convey.
“I think the community — the business community, in particular — has taken a leadership role in the discussion and in the solution-building toward universal access to care. It’s very exciting.
“Almost every business group has been involved in the discussion and in the solution building,” she said.
Zeller said business has stepped forward on this issue because of the invisible tax, as she put it, that executives and everyone in the community face when the uninsured delay getting care because they can’t afford coverage and then end up having to use more costly emergency services.
Zeller said she also has seen the state take a positive step forward regarding universal access through the Michigan Health Insurance Access Advisory Council, a board that Gov. Jennifer Granholm organized. Granholm secured a federal grant for the group and charged its members with outlining a model for universal access. Chambers of commerce, county health plans, small business associations and others participated in the council.
But when it came time to disband the council, the members decided to continue, and Rob Fowler of the Small Business Association of Michigan agreed to chair the organization.
“They filed papers to incorporate, and they were very clear that they wanted to be a politically independent organization. They exist specifically to increase access to health care; to help with insurance, in particular, is what they’re working toward,” said Zeller.
“There are really a lot of new conversations and a lot of new and very real efforts going on, spearheaded by business throughout Michigan.”
Of course, gaining universal access would put Zeller and the Kent Health Plan out of business — and she said that is fine with her.
“It would be a good thing, but I don’t think this is likely to happen soon,” she said.
Kent Health Plan, which was organized by the late Chuck Zech in 2001, provides services to 6,000 uninsured county residents each year through its four programs. But the enrollment figure represents only 15 percent of the 40,000 residents who earn less than 150 percent of the federal poverty level, which is $15,000 for an individual and $31,000 for a family of four.
“So there are 40,000 people who earn that amount of money who are uninsured in our community, and Kent Health Plan can afford to cover 6,000 of them. So I don’t think we’re going to put ourselves out of business very soon,” said Zeller.
“But I think by raising the awareness and getting the business community involved, we’re going to work really hard at it. I think we really could potentially have a system where at least there is something for everybody.”
Zeller is optimistic that 95 percent of county residents could have some sort of insurance coverage in just three years. She admits to being a “little bit of a Pollyanna” about achieving such a high coverage figure, but she remains confident that many more of the uninsured will be carrying health insurance cards in their wallets by 2010.
But right now, Zeller is dealing with potential funding problems to keep Kent Health Plan afloat. She said the agency has two primary sources, and both are at risk.
The first is the embattled State Children’s Health Insurance Program, or SCHIP, a federally funded program created 10 years ago to provide coverage for kids living in low-income households.
SCHIP, which receives $5 billion a year, was set to expire on Sept. 30 unless renewed by Congress. A bill passed by the House would expand coverage and increase spending to $50 billion over the next five years. A comparable bill in the Senate would raise SCHIP spending to $35 billion over five years. But President Bush said he would veto the bills and a compromise bill that emerged from both chambers for being too expensive.
Because Michigan did a good job of covering children, Zeller said the federal government let the state use its excess SCHIP dollars to cover childless adults. She felt SCHIP would be renewed, but she wasn’t as certain the state would get the waiver to cover childless adults.
“That is who we primarily serve: childless adults. So 3,000 of my people would lose funding that way,” she said.
At HQ’s press time, a final decision on the SCHIP legislation and the state waiver hadn’t been made.
The other funding source at risk for Kent Health Plan is tied to the local hospitals. Zeller said there is a federal rule that questions whether local funding to hospitals can be used to provide care for the indigent. Kent Health Plan uses those dollars to cover people who have income of at least 35 percent of the federal poverty level, a group that roughly makes up the other half of the agency’s enrollment.
“But the good news is, if the Michigan First Plan is approved, it will pick all those people up. So it’s kind of a good-news, bad-news mix,” said Zeller.
That description pretty much paints the picture the agency has had this year. The Adult Benefits Waiver Program, known as Plan A, stopped accepting applications last October as the state closed enrollment to it. That program covers uninsured residents who earn less than $299 per month.
Plan B reopened and began accepting enrollment in July, after being closed for five months. That program covers those whose incomes are 150 percent of poverty.
Plan C provides coverage to small businesses that employ low-wage workers. It has very few enrollees, and Zeller said the lack of response to it has been a disappointment for her. The plan helps subsidize private insurance premiums for employers and employees. The premium is $200 a month, a cost that is equally divided between the business owner, worker, and Kent Health Plan. But enrollment is only averaging about 20 a year.
Despite the roller coaster that Zeller constantly seems to be riding due to the uncertain fate Kent Health Plan faces, she is more than grateful for the financial support her agency has received from many in the community. She said the hospitals, the Cherry Street clinics and The Employers’ Association have especially provided strong support.
“They are all so serious about supporting the efforts of Kent Health Plan. They all feel like they own Kent Health Plan. They give and give and give and give to Kent Health Plan to try to make this system work. You would not know that they are as highly and intensely competitive as they are in the real world in that board room,” she said.
“I can’t say enough about how amazing it is that this community has come together in this way to make this happen. It really is an amazing little community story.” HQX