Health Care Reform Backup Plan

With a far more contentious hearing than expected before the Supreme Court, President Barack Obama's Affordable Care Act (ACA) could be struck down by a sharply divided court when it rules in June. If that happens, insurance will continue to be priced beyond the means of many. It is therefore prudent to look at possible alternatives for these Americans.

Fortunately, a proven model exists today in Howard County: the Healthy Howard Health Plan. With some changes to its financing structure, it could emerge as a viable option for Americans who will not be able to afford to buy insurance should the ACA be struck down.

Initiated in October 2008, Healthy Howard provides comprehensive, affordable health care to working-class families and individuals who have incomes higher than the eligibility level for entitlement programs like Medicaid, but still too low to afford private health insurance. Based on the primary care "medical home" model, with an emphasis on wellness and preventive services, Healthy Howard uses a local, federally qualified health center as our primary care home, paying the health center a monthly capitated rate for each Healthy Howard member, funded by the modest premiums ($50 to $85 per month, depending on income) paid by each member. These premiums also pay for contracts for lab work and most imaging procedures.
At the primary care home, a dedicated care coordinator acts as the point person for managing routine referrals and necessary follow-up for members recently discharged from the hospital. This latter service has been extremely important in Healthy Howard's success at reducing so-called "admission-readmission rates" (where recently hospitalized patients are readmitted, often due to lack of appropriate follow-up care). Additionally, our system of after-hours phone triage, combined with subsidized coverage of urgent care visits, has averted costly emergency room trips. Taken together, these facets of the Healthy Howard plan have resulted in a 50 percent reduction in hospitalization rates and a 35 percent reduction in emergency room visit rates among our members, compared to the same demographic group across the United States.